Attachment 5 - DL0584 Visitor Register Form.pdf
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- VLM Maintenance Services
- Solicitation number
- SP3300-26-Q-0186
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Defense Logistics Agency Distribution
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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
| TextBox: |
| month: |
| day: |
| timeIn: |
| timeOut: |
| printedName: |
| visitorSign: |
| badgePassNumber: |
| orgOfficeCo: |
| vehiclereg: |
| destinationPurpose: |
| approvalName: |
File details come from the government source that posted it. Updated .