Atch 33- AIS Form 2015.pdf
PDF 2 MB Posted
- Attached to
- Nellis/Creech AFB Multiple Award Construction Contract (MACC) Solicitation Federal contract opportunity
- Solicitation number
- FA486119RA001
About this file
This document is an Automated Information Systems equipment briefing and acknowledgement form used at the Nevada Test and Training Range. It requires individuals to acknowledge briefing requirements for bringing AIS equipment, cameras, or other devices onto the Range. Permitees must have a security clearance, and all equipment must be mission related and pre-approved. Photographers need a camera permit and must brief daily operations for approval. Pictures are limited to approved subjects and facilities, and custodial approval is required for classified materials. All photos require NTTR review before release. Temporary permits must be returned upon completion, and permits can be revoked at any time. The accompanying federal contract opportunity is a multiple award construction contract for projects at Nellis and Creech Air Force Bases, solicited by the Department of the Air Force Air Combat Command. No further details are provided on requirements, response dates, or incumbent contractors.
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Text version
NEVADA TEST AND TRAINING RANGE (NTTR)
File 22d
AUTOMATED INFORMATION SYSTEMS (AIS) EQUIPMENT BRIEFING AND ACKNOWLEDGEMENT
I. Name: __________________________________________ SSN (LAST 4) _________ Start Date:
(Last) (First) (Middle Initial) Unit/Sq/Company: _____________________ End Date:
Location of Work: ______________________________________
Duties Requiring Permit: _________________________________________________________________________________________
Lisa.Coker Typewritten Text
Lisa.Coker Text Box "L"
Lisa.Coker Typewritten Text IE: Southern Range (14) / Tolicha Peak (15) / TTR (17)
Lisa.Coker Typewritten Text COMPLETED FORMS MUST BE FORWARDED TO THE NTTR SECURITY OFFICE, A MINIMUM OF 5 WORKING DAYS PRIOR TO THE START OF VISIT
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Lisa.Coker Text Box Clearance Level:
Lisa.Coker Typewritten Text Not to exceed one year
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Lisa.Coker Rectangle
Lisa.Coker Text Box "Q"
Lisa.Coker Text Box Top Secret
Lisa.Coker Text Box Secret
Lisa.Coker Rectangle
Lisa.Coker Line
Lisa.Coker Typewritten Text (Pass holder must hold a current security clearance)
Lisa.Coker Line
Lisa.Coker Text Box Camera Permit
Lisa.Coker Line
Lisa.Coker Text Box
III
Lisa.Coker Text Box
Lisa.Coker Text Box AIS Equipment / All Other Equipment / Additional Item Equipment
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Lisa.Coker Line
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Lisa.Coker Text Box All equipment brought on the Range will be mission related and will require justification prior to approval. All persons using a camera, video or still on the Ranges of the Nevada Test and Training Range, must possess a NTTR Camera Permit authorized and issued by the NTTR Security Office (Nellis AFB, Bldg 200, DSN 348-4606, Comm 702-653-4606). The camera holder must brief Black Jack (DSN 348-4705/4707, Comm 702-653-4705/4707) daily. This brief will include the WHO, WHERE, WHEN, AND WHY specific photographs are being taken. NO photographs will be taken without the daily approval from Black Jack. This includes personnel flying into Range air space.
1. The photographer will take pictures of only material specifically approved by the NTTR and will avoid taking pictures that include any other range facilities or equipment.
2. Photographers taking pictures of any classified or sensitive material must have the approval of the custodian and/or the approval of the head of the organization responsible for the material. When the classification or sensitivity of material being photographed is in doubt, it is the responsibility of the photographer to obtain approval from the custodian/owner of the material.
3. The photographer and all personnel, who will have access to the photographs, film, negatives, etc., must be cleared to at least the level of photographed material.
4. All photographs taken will be reviewed and approved by the NTTR Program Security Office and/or other designated NTTR staff prior to being released.
5. Temporary Camera permits will be returned to Security personnel at the Entry Control point upon completion of photographing activities.
6. Only the individual who has been issued a camera permit and have signed this briefing and acknowledgement, are authorized to use approved photographic/video equipment.
7. The equipment pass can be revoked at any time by authorized NTTR personnel.
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Lisa.Coker Text Box IV Permit User's Signature: Date:
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Lisa.Coker Text Box
OFFICE USE ONLY
Lisa.Coker Text Box Authorizing Official:
Lisa.Coker Text Box Officials Signature:
Lisa.Coker Text Box Date:
Lisa.Coker Text Box Permit Number:
Lisa.Coker Text Box
Lisa.Coker Text Box I Name: ____________________________________ SSN (LAST 4): _________ Start Date: ____________ End Date: ____________ (Last) (First) (Middle Initial) (not to exceed one year)
Location of Work: _____________________________________ Duties Requiring Permit: ______________________________________________ IE: Southern Range (14) / Tolicha Peak (15) / TTR (17)
Lisa.Coker Text Box Camera /Video
Lisa.Coker Text Box Computer W/O Built in Camera
Lisa.Coker Text Box Model and Serial Number
Lisa.Coker Text Box Type of Equipment, Model and Serial Number (Attach Additional Pages as Needed)
Lisa.Coker Text Box
II
Lisa.Coker Text Box Optic # Provided By Authorizing Office:
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Lisa.Coker Typewritten Text
Lisa.Coker Typewritten Text Org/Company:
Lisa.Coker Typewritten Text Duty or Contact Phone #:
| OPTICS NUMBER: |
| Last Name: |
| First Name: |
| Middle Initial: |
| SSAN (Last 4): |
| Start Date: |
| End Date: |
| Location of Work: |
| Duties Requiring Permit: |
| Org/Company: |
| Phone: |
| Q: Off |
| L: Off |
| TS: Yes |
| S: Off |
| Camera/Video: |
| Computer W/O Built in Camera: |
| AIS Equipment/All Other/Additional: |
| Date Signed: |
| Auth Official: |
| Date Approved: |
| Permit Number: |
File details come from the government source that posted it. Updated .