Request Form for Access to CommUNITY Survey Portal

This form is designed to facilitate the process of requesting access to our survey portal. Please take a few moments to provide the necessary information so that survey sponsors can review your request and grant you the appropriate access. This template (download) has examples and serves as a reference for the verbiage used in this form.

Requests are submitted weekly to Press Ganey and may take an additional week to process.
Survey sponsors will review your request and may follow up with additional questions.

Name of Requester

Individual requesting new/additional access for the Accessor.

Requester's Employee ID

8-digit employee ID can be found in UC Path

Requester's Email

Name of Accessor

Full name of person requesting new/additional access to the Press Ganey survey results portal

Accessor's Employee ID

8-digit ID can be found in UC Path

Accessor's Email

Adding or Removing Access?

If adding, are they a new accessor?

Permission Type (Role)

Indicate which type of permissions access they should be receiving; see the list of available permissions to choose from above.

Hierarchy for accessing

Work unit ID for accessing

Work unit name for accessing

Business Justification

Additional Notes