D-4 Media Sanitation TSA Form.doc
DOC document 75 KB Posted
- Attached to
- Transportation Security Administration Checkpoint Integrated Logistics Support (ILS) Services
- Solicitation number
- 70T04024R7672N001
About this file
This document is a Media Sanitization Certificate from the Transportation Security Administration (TSA). It is used to certify that media containing sensitive or classified information has been properly sanitized for reuse or disposal. The form captures information about the physical asset or virtual server, the classification level, and the sanitization process performed. It includes certification by the individual conducting the sanitization and an independent validating official. This form is required to be completed and retained per TSA policy on IT media sanitization.
The related federal contract opportunity is a request for proposals (RFP) for Checkpoint Maintenance Services for the Transportation Security Administration (TSA). The solicitation number is 70T04024R7672N001. The RFP is for commercial items and interested parties must monitor the SAM.gov website for updates. Questions are due by April 24, 2024 and proposals are due by June 4, 2024. Historical data is available upon request to the Contracting Officer.
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Text version
DEPARTMENT OF HOMELAND SECURITY
Transportation Security Administration
MEDIA SANITIZATION CERTIFICATE
INSTRUCTIONS: The individual performing media sanitization must complete and sign this form and store it in a defined location available for future audit.
SECTION I. Contact Information of Individual Conducting Media Sanitization
| Name/Badge: |
| Office/Location/Airport Code: |
| Phone: |
SECTION II. Hardware/Media Information
| Physical Asset No. : |
| Serial No.: |
| FORMCHECKBOX |
Virtual Server
Server Name:
| Type: |
| Make: |
| Model: |
SECTION III. Classification Level (check one)
FORMCHECKBOX
Unclassified FORMCHECKBOX Sensitive But Unclassified (SBU) FORMCHECKBOX Classified (SECRET or Above)
NOTE: Media containing classified information may only be reused to process classified information at or above the level previously contained/processed on the media.
SECTION IV. Certification by Individuals Conducting and Validating Media Sanitization
I certify that I have: (check all that apply)
FORMCHECKBOX
Performed sanitization of media or virtual server indicated above to meet the requirements of the: TSA MD 1400.3, Information Technology (IT) Security, the TSA Information Assurance (IA) Handbook, OIT SOP on IT Media Sanitization, and TS-046 IT Media Sanitization and Disposition.
FORMCHECKBOX
Performed the sanitization of all areas that could be successfully overwritten on the media indicated above.
FORMCHECKBOX
Removed (or destroyed) the label formerly in use. (N/A if virtual server).
FORMCHECKBOX
Affixed the completed TSA Form 1411 Media Disposition Label to the media indicating that the media was (N/A if virtual server): FORMCHECKBOX Degaussed FORMCHECKBOX Destroyed FORMCHECKBOX Overwritten FORMCHECKBOX Re-imaged
NOTE: The representative signing at the bottom of TSA Form 1412 (Media Sanitization Certificate) who actually verifies or validates the sanitization process cannot be from the same organization and must be an independent entity or party from the person or technician conducting the actual sanitization of media or data.
Print Name of Person Conducting Media Sanitization
Signature of Person Conducting Media Sanitization / Date
Contract Name and Number
Print Name of Validating Official
Signature of Validating Official / Date
FORMCHECKBOX
Federal Employee
FORMCHECKBOX
Contractor
TSA Form 1412 (12/14) rev [File: 1400.5.1 ] Page 1 of 1
File details come from the government source that posted it. Updated .