VR-219_Visit_Request_Form.xlsx
XLSX spreadsheet 50 KB Posted
- Attached to
- Firing Range Lead Extraction Federal contract opportunity
- Solicitation number
- DJF-19-2100-PR-0007091
About this file
Visit Request Form 219 - (Maximum 4 People per company) Must submit via email to ecaldwell2@fbi.gov no later than 08/26/2019 @ 3:00 PM (eastern time).
View the file
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| Range_Lead_Extraction_Site_Visit_-_RFIs.pdf | ||
| SF30_-_Amendment_0002.pdf | ||
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| SF_1449_-_Solicitation_-_Firing_Range_Lead_Extraction.pdf | ||
| Solicitation_Questions.pdf | ||
| Combined_Synopsis_Solicitation_Firing_Range_Lead_Extraction.pdf | ||
| FBO_-_7091_-_Lead_Extraction_SOW.pdf |
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Text version
Visit Information
| SEC-219 | Visit Request Form |
| v2.4 112015 | One-Day Escorted Visits: 1-10 Visitors |
Save a copy of this form to your local computer before completing sections I-IV. Once the udpated form has been saved email the completed form directly to your CSO for processing at least 24-48 hours in advance of the visit. Personnel with FBI-issued SACS badges or agency-issued IC Badges need not be listed. Repeat visitors may be required to pass a clearance or undergo a Limited Background Investigation for continued access. Escorts must be listed in Section IV, one escort for every five visitors. Visits must be approved by a Unit Chief or higher. The sponsor must: 1) have a SACS badge, 2) complete all lines on this page on the secret network only, 3) conduct indices checks on foreign nationals, 4) NOT forward the form to any of the visitors. FBI personnel requesting information from individuals in order to complete this form should provide those individuals with a copy of the Privacy Act Notice available at the link on the bottom of this form. Red triangles provide additional guidance. For more than 10 guests, use the Group Visit Request form.
* Notice to Sponsor: Visitors should be reminded of the PED policy, including no wireless, Bluetooth, cameras, or laptops (unless approved by security).
| I. Sponsor's Information | ||||
| Sponsor's Name: | ||||
| Kyle Malo: This is the lead person responsible for advising all sponsored visitors of FBI policy, restrictions. Must complete all sections of this form prior to submitting to their CSO. | Edd | Caldwell | Sponsor's Phone Number: 0 | |
| First | Last | |||
| Sponsor's Division: | FFD | Approving Unit Chief (or higher): |
cmcoffey: Visitors will be approved by the Unit Chief (or equivalent) that supervises the sponsor, unless the sponsor is a GS-15/SES themselves.
| II. Visit Details | |||
| Visit Date: | 29-Aug-19 | Level of classified info being shared: |
kmalo: For classified meetings, the visitors must also have a valid VAR on record with SecD, verifying their clearance. This must be submitted at least three (3) days prior to the visit. See your CSO for details on passing clearances.
| Unclassified | Locations/Rooms to be Visited: | Range 1 | Unclassified | 21-Aug-19 | 6:00 AM | 6:00 AM | |
| Arrival Time: | 12:30 PM | Meeting Description: |
kmalo: Please briefly describe the purpose of the meeting.
| Firing Range Lead Extraction Site Visit | Secret | 22-Aug-19 | 6:15 AM | 6:15 AM | |||||||
| Departure Time: | 2:30 PM | Top Secret | 23-Aug-19 | 6:30 AM | 6:30 AM | ||||||
| SCI (any level) | 24-Aug-19 | 6:45 AM | 6:45 AM | ||||||||
| III. Visitor Information | 25-Aug-19 | 7:00 AM | 7:00 AM | ||||||||
| Last Name | First Name | Middle Name | Professional Affiliation |
Kyle Malo: Personal guests are restricted to certain event such as Family Day, retirements, special events. Use this field to note the visitor's professional affiliation (agency, company, organization, etc.)
| SSN | ||||
| (Passport # for foreigners) | DOB | Citizenship | Country of Birth | Foreign Nat'l Indices Checks |
Kyle Malo: The sponsor is responsible for conducting Indices checks on all foreign national guests. Mark N/A for US Citizens.
| How: Access Sentinel (icon located on your desktop). In the top left area, under the search field, select the "UNI" box and enter the subject's name in the search field. If you discover any FBI investigations regarding the subject, discuss those finding with the CSO. If nothing negative is discovered, simply enter "Negative Results" in the field. | 26-Aug-19 | 7:15 AM | 7:15 AM | ||||||||||
| Ex | Example | John | Quill | French Embassy | 123-45-6789 | 7-Jan-70 | France | France | Negative Results | 27-Aug-19 | 7:30 AM | 7:30 AM | |
| Click to Sort by Name | First | Middle | Click to Sort by Affiliation | SSN | DOB | Citizenship | Country | Results | 28-Aug-19 | 7:45 AM | 7:45 AM | ||
| 1 | 29-Aug-19 | 8:00 AM | 8:00 AM | ||||||||||
| 2 | 30-Aug-19 | 8:15 AM | 8:15 AM | ||||||||||
| 3 | 31-Aug-19 | 8:30 AM | 8:30 AM | ||||||||||
| 4 | 1-Sep-19 | 8:45 AM | 8:45 AM | ||||||||||
| 5 | 2-Sep-19 | 9:00 AM | 9:00 AM | ||||||||||
| 6 | 3-Sep-19 | 9:15 AM | 9:15 AM | ||||||||||
| 7 | 4-Sep-19 | 9:30 AM | 9:30 AM | ||||||||||
| 8 | 5-Sep-19 | 9:45 AM | 9:45 AM | ||||||||||
| 9 | 6-Sep-19 | 10:00 AM | 10:00 AM | ||||||||||
| 10 | 7-Sep-19 | 10:15 AM | 10:15 AM |
| IV. Escorts (1 to 5 ratio) | V. Foreign National Policy Acknowledgement | 8-Sep-19 | 10:30 AM | 10:30 AM | ||||
| Last Name | First Name | Phone Ext. | Sponsor MUST adhere to the following: | Sponsor's Initials: |
kmalo: Only applicable if the sponsor is hosting any foreign nationals.
Kyle Malo: This is the lead person responsible for advising all sponsored visitors of FBI policy, restrictions. Must complete all sections of this form prior to submitting to their CSO.
Kyle Malo: The sponsor is responsible for conducting Indices checks on all foreign national guests. Mark N/A for US Citizens.
How: Access Sentinel (icon located on your desktop). In the top left area, under the search field, select the "UNI" box and enter the subject's name in the search field. If you discover any FBI investigations regarding the subject, discuss those finding with the CSO. If nothing negative is discovered, simply enter "Negative Results" in the field.
cmcoffey: Visitors will be approved by the Unit Chief (or equivalent) that supervises the sponsor, unless the sponsor is a GS-15/SES themselves.
kmalo: For classified meetings, the visitors must also have a valid VAR on record with SecD, verifying their clearance. This must be submitted at least three (3) days prior to the visit. See your CSO for details on passing clearances.
kmalo: Please briefly describe the purpose of the meeting.
| 9-Sep-19 | 10:45 AM | 10:45 AM | ||||||||||
| 1 | Foreign nationals, regardless of title or position, must be escorted at all times. SCIF access is prohibited unless coordinated with the CSO and with Division Head approval. Escorts must ensure all space is sanitized in advance of the visit and that all employees in the area are aware of the visitor’s presence. Access to any FBI system/ computer is prohibited. Access via this form is only valid for one-day visits. See IOD and your CSO for multi-day visit protocol. All visitors to FBI buildings and facilities must provide identification in compliance with the standards outlined in the REAL ID Act, which establishes minimum requirements when using state-issued identification for accessing federal facilities. | 10-Sep-19 | 11:00 AM | 11:00 AM | ||||||||
| 2 | 11-Sep-19 | 11:15 AM | 11:15 AM | |||||||||
| Privacy Act Notice | ||||||||||||
| This form is for official use only. Personal information about individuals contained on this form is subject to the Privacy Act of 1974, as amended, and should be viewed only by FBI personnel with a valid need-to-know. | 12-Sep-19 | 11:30 AM | 11:30 AM | |||||||||
| Detailed Guidance: | Access and Visitor Control Policy (4.2.8 covers Escort Requirements) | |||||||||||
| Foreign National Access Policy | 13-Sep-19 | 11:45 AM | 11:45 AM | |||||||||
| 14-Sep-19 | 12:00 PM | 12:00 PM | ||||||||||
| 15-Sep-19 | 12:15 PM | 12:15 PM | ||||||||||
| 16-Sep-19 | 12:30 PM | 12:30 PM | ||||||||||
| 17-Sep-19 | 12:45 PM | 12:45 PM | ||||||||||
| 18-Sep-19 | 1:00 PM | 1:00 PM | ||||||||||
| 19-Sep-19 | 1:15 PM | 1:15 PM | ||||||||||
| 20-Sep-19 | 1:30 PM | 1:30 PM | ||||||||||
| 21-Sep-19 | 1:45 PM | 1:45 PM | ||||||||||
| 22-Sep-19 | 2:00 PM | 2:00 PM | ||||||||||
| 23-Sep-19 | 2:15 PM | 2:15 PM | ||||||||||
| 24-Sep-19 | 2:30 PM | 2:30 PM | ||||||||||
| 25-Sep-19 | 2:45 PM | 2:45 PM | ||||||||||
| 26-Sep-19 | 3:00 PM | 3:00 PM | ||||||||||
| 27-Sep-19 | 3:15 PM | 3:15 PM | ||||||||||
| 28-Sep-19 | 3:30 PM | 3:30 PM | ||||||||||
| 29-Sep-19 | 3:45 PM | 3:45 PM | ||||||||||
| 30-Sep-19 | 4:00 PM | 4:00 PM | ||||||||||
| 1-Oct-19 | 4:15 PM | 4:15 PM | ||||||||||
| 2-Oct-19 | 4:30 PM | 4:30 PM | ||||||||||
| 3-Oct-19 | 4:45 PM | 4:45 PM | ||||||||||
| 4-Oct-19 | 5:00 PM | 5:00 PM | ||||||||||
| 5-Oct-19 | 5:15 PM | 5:15 PM | ||||||||||
| 6-Oct-19 | 5:30 PM | 5:30 PM | ||||||||||
| 7-Oct-19 | 5:45 PM | 5:45 PM | ||||||||||
| 8-Oct-19 | 6:00 PM | 6:00 PM | ||||||||||
| 9-Oct-19 | No visits past 6pm | After 6pm, see CSO | ||||||||||
| 10-Oct-19 | ||||||||||||
| 11-Oct-19 | ||||||||||||
| 12-Oct-19 | ||||||||||||
| 13-Oct-19 | ||||||||||||
| 14-Oct-19 | ||||||||||||
| 15-Oct-19 | ||||||||||||
| 16-Oct-19 | ||||||||||||
| 17-Oct-19 | ||||||||||||
| 18-Oct-19 | ||||||||||||
| 19-Oct-19 | ||||||||||||
| 20-Oct-19 | ||||||||||||
| 21-Oct-19 |
&"Calibri,Bold"&KFF0000PII: DO NOT PRINT or RETAIN COPY
&"Calibri,Bold"&KFF0000PII: DO NOT PRINT or RETAIN COPY https://formsportal.fbinet.fbi/forms/fd1028/Policy%20and%20Guidance%20Library/0750DPG.pdfhttps://formsportal.fbinet.fbi/forms/FD1028/Policy%20and%20Guidance%20Library/0172D.htmlhttps://intranet.fbinet.fbi/DO/FD/SO/Pages/Real%20ID.aspxhttps://go.fbinet.fbi/DO/FD/OSO/Documents/Personnel%20and%20Industrial%20Security/Visitor%20Privacy%20Act%20Notice.pdfhttps://intranet.fbinet.fbi/DO/FD/SO/Pages/Real%20ID.aspxhttps://intranet.fbinet.fbi/DO/FD/OSO/Pages/Real%20ID.aspx Security Use Only
VISITOR SIGN-IN REGISTER
| Sponsor: | Edd | Caldwell | Visit Date: | 29-Aug-19 |
| Sponsor Ext: | 0 | Anticipated Arrival Time: | 12:30 PM | |
| Sponsor Division: | FFD |
| Visitor Information | CSO | ACU Security Specialist: | Visitor Signature | |||
| Last | First | Professional Affiliation | Status | ACU | ||
| Emp. | FSS | |||||
| Check | NCIC Check | Badge |
Number
| 0 | 0 | 0 | |
| 0 | 0 | 0 | D |
| 0 | 0 | 0 | |
| 0 | 0 | 0 | |
| 0 | 0 | 0 | |
| 0 | 0 | 0 | |
| 0 | 0 | 0 | |
| 0 | 0 | 0 | |
| 0 | 0 | 0 | |
| 0 | 0 | 0 |
CSO Notes: ACU Notes lists
| Unclassified |
| Secret |
| Top Secret |
| SCI (any level) |
| 21-Aug-19 | 6:00 AM | 6:00 AM |
| 22-Aug-19 | 6:15 AM | 6:15 AM |
| 23-Aug-19 | 6:30 AM | 6:30 AM |
| 24-Aug-19 | 6:45 AM | 6:45 AM |
| 25-Aug-19 | 7:00 AM | 7:00 AM |
| 26-Aug-19 | 7:15 AM | 7:15 AM |
| 27-Aug-19 | 7:30 AM | 7:30 AM |
| 28-Aug-19 | 7:45 AM | 7:45 AM |
| 29-Aug-19 | 8:00 AM | 8:00 AM |
| 30-Aug-19 | 8:15 AM | 8:15 AM |
| 31-Aug-19 | 8:30 AM | 8:30 AM |
| 1-Sep-19 | 8:45 AM | 8:45 AM |
| 2-Sep-19 | 9:00 AM | 9:00 AM |
| 3-Sep-19 | 9:15 AM | 9:15 AM |
| 4-Sep-19 | 9:30 AM | 9:30 AM |
| 5-Sep-19 | 9:45 AM | 9:45 AM |
| 6-Sep-19 | 10:00 AM | 10:00 AM |
| 7-Sep-19 | 10:15 AM | 10:15 AM |
| 8-Sep-19 | 10:30 AM | 10:30 AM |
| 9-Sep-19 | 10:45 AM | 10:45 AM |
| 10-Sep-19 | 11:00 AM | 11:00 AM |
| 11-Sep-19 | 11:15 AM | 11:15 AM |
| 12-Sep-19 | 11:30 AM | 11:30 AM |
| 13-Sep-19 | 11:45 AM | 11:45 AM |
| 14-Sep-19 | 12:00 PM | 12:00 PM |
| 15-Sep-19 | 12:15 PM | 12:15 PM |
| 16-Sep-19 | 12:30 PM | 12:30 PM |
| 17-Sep-19 | 12:45 PM | 12:45 PM |
| 18-Sep-19 | 1:00 PM | 1:00 PM |
| 19-Sep-19 | 1:15 PM | 1:15 PM |
| 20-Sep-19 | 1:30 PM | 1:30 PM |
| 21-Sep-19 | 1:45 PM | 1:45 PM |
| 22-Sep-19 | 2:00 PM | 2:00 PM |
| 23-Sep-19 | 2:15 PM | 2:15 PM |
| 24-Sep-19 | 2:30 PM | 2:30 PM |
| 25-Sep-19 | 2:45 PM | 2:45 PM |
| 26-Sep-19 | 3:00 PM | 3:00 PM |
| 27-Sep-19 | 3:15 PM | 3:15 PM |
| 28-Sep-19 | 3:30 PM | 3:30 PM |
| 29-Sep-19 | 3:45 PM | 3:45 PM |
| 30-Sep-19 | 4:00 PM | 4:00 PM |
| 1-Oct-19 | 4:15 PM | 4:15 PM |
| 2-Oct-19 | 4:30 PM | 4:30 PM |
| 3-Oct-19 | 4:45 PM | 4:45 PM |
| 4-Oct-19 | 5:00 PM | 5:00 PM |
| 5-Oct-19 | 5:15 PM | 5:15 PM |
| 6-Oct-19 | 5:30 PM | 5:30 PM |
| 7-Oct-19 | 5:45 PM | 5:45 PM |
| 8-Oct-19 | 6:00 PM | 6:00 PM |
| 9-Oct-19 | No visits past 6pm | After 6pm, see CSO |
| 10-Oct-19 | ||
| 11-Oct-19 | ||
| 12-Oct-19 | ||
| 13-Oct-19 | ||
| 14-Oct-19 | ||
| 15-Oct-19 | ||
| 16-Oct-19 | ||
| 17-Oct-19 | ||
| 18-Oct-19 | ||
| 19-Oct-19 |
File details come from the government source that posted it.