A8 - DL0584 Visitor Register Form.pdf

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PDF (DLA)

DLA FORM 584, SEP 2016

VISITOR REGISTER

Prescribed by: DOD Manual 4160.21-M & DLAM 5200.08 Sponsor: DS Certification: All the fields (including Time-Out field) for each visitor are COMPLETED Print Name (CAPITAL LETTERS), Signature and Date by DLA Site Lead/Area Manager (Applies to DLA Disposition Only):

PREVIOUS VERSIONS ARE OBSOLETE

VISITOR REGISTER INSTRUCTIONS

PDF (DLA)

DLA FORM 584, SEP 2016 PREVIOUS VERSIONS ARE OBSOLETE

DATE

TIME

MONTH

DAY

OUT

IN

PRINTED NAME

SIGNATURE

BADGE OR

PASS

NUMBER

ORGANIZATION OFFICE,

COMPANY, OR DoDAAC

DESTINATION

OR PURPOSE

OF VISIT

PRINTED NAME OF

GOVERNMENT POC OR

ENTRY CONTROL OFFICER

VEHICLE REGISTRATION NUMBER

POST/BUILDING: This is the building, warehouse, scale house, scrap yard, or other location. This must be filled out on each page.YEAR:This is the calendar year.DATE: Use numeric identification of MM and DD format. (i.e. 03 08)TIME: Use appropriate military time (24 Hours format) for arrival (in) and departure (out).PRINTED NAME: Printed name of individual visiting.SIGNATURE: Signature of visitor.ORGANIZATION OFFICE, COMPANY, DODAAC: Enter Department of Defense Activity Address Code (DoDAAC) represented. If no DoDAAC, enter Organization Officer or Company address of visitor.VEHICLE REGISTRATION NUMBER: Vehicle License Plate Number to include State of Issue.DESTINATION OR PURPOSE OF VISIT: This may determine the type of color coded badge that is issued as appropriate:ORANGE = Sales Partner/CustomerGREEN = RTD CustomerSKY BLUE = Turn-In CustomerPURPLE = Other/Special VisitorBADGE OR PASS NUMBER: Serialized number from the appropriate visitor badge issued at time of sign in once Visitor's Identification and authorization has been validated.PRINTED NAME OF GOVERNMENT POC OR ENTRY CONTROL OFFICER: Name of DLA employee who verified and validated the visitor's identification and supporting documentation authorizing the visit.SIGNATURE OF DLA SITE LEAD: Signature of the site lead or area manager validating the visitor log.

dlaforms@dla.mil

DES

DLA Forms DLA Form 584, Visitor Register May 1996 DOD Manual 4160.21-M