Attachment 5 Visitor Request Worksheet.pdf

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Construct 145th Security Forces Building
Solicitation number
W50S87-26-B-A002
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This is a form template used by the 145th Security Forces Squadron (SFS) at a U.S. Air Force installation to process visitor access requests for non-Department of Defense affiliated civilian visitors. The form authorizes the conduct of National Crime Information Center (NCIC) checks on visitors and establishes procedures for granting or denying installation access based on fitness criteria.

The form requires sponsors to complete Section I with visitor information including full name (no initials), Social Security number, driver's license number and state, date of birth, requested visit dates and times, visitor affiliation, and specific destination and purpose for the visit. The form notes that contractors requiring access for more than 10 cumulative days must complete a separate 145 AW Form 28. Security Forces personnel complete Section II by conducting NCIC and CJLEADS vetting, annotating results as "APPROVED" or "DENIED," loading all information into the Main Gate Database, and distributing the completed worksheet to the originator, sponsor, and the designated email address (145MSG.S5Pass.ID@us.af.mil). If a visitor is denied access, SFS personnel must document the reason for denial and any relevant restrictions. The form is classified as Controlled Unclassified Information (CUI) and is governed by 10 U.S.C. 8013, DODI 1000.30, AFMAN 31-101 V3, and AFI 33-332.

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Page 1 of 2 Current as of 19 November 2021

CUI

145 SFS VISITOR'S REQUEST WORKSHEET

AUTHORITY: 10 U.S.C. 8013, DODI 1000.30, AFMAN 31-101 V3, and AFI 33-332 PRINCIPLE PURPOSE(S): To conduct National Crime Information Center (NCIC) check, on non-DoD affiliated civilian visitors. DISCLOSURE:

Disclosure of requested information is voluntary. However, failure to provide information may result in access privileges being refused or withdrawn.

The Controlled Unclassified Information Statement will apply throughout the duration of the visitor's visit to the 145 AW Installation.

1. INSTRUCTIONS

All information must be completed; First, Middle, and Last Names (no initials). Email worksheet to 145MSG.S5Pass.ID@us.af.mil

SECTION I: Ensure all blocks are complete.

1.1. SPONSOR'S RANK/ NAME 1.2. SPONSOR'S PHONE NUMBER & UNIT

1.3. VISITORS AFFILIATION 1.4 VISITOR'S DESTINATION & PURPOSE FOR VISIT

Visitor's Information

1.5. NAME (LAST, FIRST, MIDDLE) 1.6. SOCIAL SECURITY # 1.7. DL# & STATE 1.8. DOB 1.9. DATES & TIMES 1.10. VETTING RESULTS 1.11. VETTED BY

SECTION II: To be completed, signed, and dated by Security Forces.

2.1. DISTRIBUTION INSTRUCTIONS APPROVED and DENIED ON FITNESS CRITERIA.

Ensure all information is loaded into the Main Gate Database and completed worksheet is sent to the originator, sponsor (if different than the originator), and 145MSG.S5Pass.ID@us.af.mil

2.2. INFORMATION NEEDED FOR DENIAL ON FITNESS CRITERIA AND/OR MISCELLANEOUS COMMENTS, I.E. MAY NOT DRIVE.

Ensure full name, company, and reason for denial is placed below and/or comments if needed: Date:

CUI

Controlled by: 145 AW Controlled by: 145 SFS CUI Category: PRVCY Distribution/Dissemination Controls: FEDCON POC: TSgt Mark P. Dow, (704) 398-4833 mailto:usaf.nc.145-aw.list.bdoc@mail.mil mailto:usaf.nc.145-aw.list.bdoc@mail.mil

Page 2 of 2 Current as of 19 November 2021

INSTRUCTIONS FOR COMPLETING VISITOR REQUEST WORKSHEET

SECTION I TO BE COMPLETED BY SPONSOR:

Block 1.1. Enter the sponsor's Rank/Name and DOD or Social Security Number.

Block 1.2. Enter sponsor's contact number and unit.

Block 1.3. Enter company's name or visitors purpose of visiting 145th AW Installation.

Block 1.4. Enter the visitors allowed destination or destinations by sponsor and a brief description of the visitor's purpose for visit.

Block 1.5. Enter Full Last Name, Full First Name, and Full Middle Name (No Initials).

Block 1.6. Visitor's Social Security Number.

Block 1.7. Enter visitor's issued driver's license or state issued ID number and state of issue.

Block 1.8. Enter visitor’s Date of Birth.

Block 1.9. Ensure to enter the requested dates and times of the visitor.

(Note: Contractors that will need access for more than 10 cumulative days will need to complete an 145 AW Form 28.)

SECTION 1.10. & 1.11.: TO BE COMPLETED BY SFS:

Block 1.10. Ensure personnel are vetted via NCIC and CJLEADS. Vetting results will be annotated by APPROVED or DENIED.

Block 1.11. SFS personnel conducting the vetting will place their initials in this block.

SECTION II: TO BE COMPLETED, SIGNED, AND DATED BY SFS:

Block 2.1. Ensure all information is loaded into the Main Gate Database and completed worksheet is sent to the originator, sponsor (if different than the originator), and 145MSG.S5Pass.ID@us.af.mil

Block 2.2. This section will be used to annotate the reason for the denial, if visitor is denied, and/or any other pass-on information on the visitor, i.e. may not drive due to invalid driver’s license etc.

(Note: SFS member conducting the vetting will need to sign and date the completed form, Section II, Block 2.2.)

mailto:usaf.nc.145-aw.list.bdoc@mail.mil

SECTION I TO BE COMPLETED BY SPONSOR:
Block 1.1. Enter the sponsor's Rank/Name and DOD or Social Security Number.
Block 1.3. Enter company's name of visitor being sponsored, if applicable, and/or any additional comments.
Block 1.7. Enter visitor's issued driver's license or state issued ID number and state of issue.
APPROVED or DENIED.
18 DOBRow6:
Row5:
110 VETTING RESULTSRow6:
1101 VETTED BYRow6:
15 NAME LAST FIRST MIDDLERow7:
16 SOCIAL SECURITY Row7:
17 DL STATERow7:
18 DOBRow7:
Row6:
110 VETTING RESULTSRow7:
1101 VETTED BYRow7:
15 NAME LAST FIRST MIDDLERow8:
16 SOCIAL SECURITY Row8:
17 DL STATERow8:
18 DOBRow8:
Row7:
110 VETTING RESULTSRow8:
1101 VETTED BYRow8:
15 NAME LAST FIRST MIDDLERow9:
16 SOCIAL SECURITY Row9:
17 DL STATERow9:
18 DOBRow9:
Row8:
110 VETTING RESULTSRow9:
1101 VETTED BYRow9:
15 NAME LAST FIRST MIDDLERow10:
16 SOCIAL SECURITY Row10:
17 DL STATERow10:
18 DOBRow10:
Row9:
110 VETTING RESULTSRow10:
1101 VETTED BYRow10:
15 NAME LAST FIRST MIDDLERow11:
16 SOCIAL SECURITY Row11:
17 DL STATERow11:
18 DOBRow11:
Row10:
110 VETTING RESULTSRow11:
1101 VETTED BYRow11:
15 NAME LAST FIRST MIDDLERow12:
16 SOCIAL SECURITY Row12:
17 DL STATERow12:
18 DOBRow12:
Row11:
110 VETTING RESULTSRow12:
1101 VETTED BYRow12:
15 NAME LAST FIRST MIDDLERow13:
16 SOCIAL SECURITY Row13:
17 DL STATERow13:
18 DOBRow13:
Row12:
110 VETTING RESULTSRow13:
1101 VETTED BYRow13:
15 NAME LAST FIRST MIDDLERow14:
16 SOCIAL SECURITY Row14:
17 DL STATERow14:
18 DOBRow14:
Row13:
110 VETTING RESULTSRow14:
1101 VETTED BYRow14:
15 NAME LAST FIRST MIDDLERow15:
16 SOCIAL SECURITY Row15:
17 DL STATERow15:
18 DOBRow15:
Row14:
110 VETTING RESULTSRow15:
1101 VETTED BYRow15:
15 NAME LAST FIRST MIDDLERow16:
16 SOCIAL SECURITY Row16:
17 DL STATERow16:
18 DOBRow16:
Row15:
110 VETTING RESULTSRow16:
1101 VETTED BYRow16:
15 NAME LAST FIRST MIDDLERow17:
16 SOCIAL SECURITY Row17:
17 DL STATERow17:
18 DOBRow17:
Row16:
110 VETTING RESULTSRow17:
1101 VETTED BYRow17:
15 NAME LAST FIRST MIDDLERow18:
16 SOCIAL SECURITY Row18:
17 DL STATERow18:
18 DOBRow18:
Row17:
110 VETTING RESULTSRow18:
1101 VETTED BYRow18:
15 NAME LAST FIRST MIDDLERow19:
16 SOCIAL SECURITY Row19:
17 DL STATERow19:
18 DOBRow19:
Row18:
110 VETTING RESULTSRow19:
1101 VETTED BYRow19:
15 NAME LAST FIRST MIDDLERow20:
16 SOCIAL SECURITY Row20:
17 DL STATERow20:
18 DOBRow20:
Row19:
110 VETTING RESULTSRow20:
1101 VETTED BYRow20:
15 NAME LAST FIRST MIDDLERow21:
16 SOCIAL SECURITY Row21:
17 DL STATERow21:
18 DOBRow21:
Row20:
110 VETTING RESULTSRow21:
1101 VETTED BYRow21:
15 NAME LAST FIRST MIDDLERow22:
16 SOCIAL SECURITY Row22:
17 DL STATERow22:
18 DOBRow22:
Row21:
110 VETTING RESULTSRow22:
1101 VETTED BYRow22:
15 NAME LAST FIRST MIDDLERow23:
16 SOCIAL SECURITY Row23:
17 DL STATERow23:
18 DOBRow23:
Row22:
110 VETTING RESULTSRow23:
1101 VETTED BYRow23:
15 NAME LAST FIRST MIDDLERow24:
16 SOCIAL SECURITY Row24:
17 DL STATERow24:
18 DOBRow24:
Row23:
110 VETTING RESULTSRow24:
1101 VETTED BYRow24:
15 NAME LAST FIRST MIDDLERow25:
16 SOCIAL SECURITY Row25:
17 DL STATERow25:
18 DOBRow25:
Row24:
110 VETTING RESULTSRow25:
1101 VETTED BYRow25:
15 NAME LAST FIRST MIDDLERow26:
16 SOCIAL SECURITY Row26:
17 DL STATERow26:
18 DOBRow26:
Row25:
110 VETTING RESULTSRow26:
1101 VETTED BYRow26:
Text 2: 704-391-4109
Text 1: MSgt Sarah Marshall
Text 3: Construct Security Forces Building/FJRP229030
Text 4: 4930 Minuteman Way/Civil Engineering Bldg #43 (Classroom)

Charlotte,NC 28208

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