Attachment_J5_-_Sample_Authorized_Service_Interruption_Request_Form.pdf
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- Attached to
- Global Network Services (GNS) Federal contract opportunity
- Solicitation number
- HC1013-15-R-0003
- Issued by
- Defense Information Systems Agency
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Attachment J5 - Sample Authorized Service Interruption Request Form
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Text version
08 Jan 2015
REQUIRED INFORMATION
**WHEN FILLED OUT, THIS FORM SHALL BE TREATED AS PROPRIETARY INFORMATION AND SHALL BE
SHARED ONLY WITH AUTHORIZED PERSONNEL**
1. REQUESTOR’S NAME:
2. COMMERCIAL PHONE #:
3. REQUESTORS EMAIL ADDRESS (UNCLAS):
4. PRIMARY DATE:
5. PRIMARY START TIME: (ZULU/GMT):
6. PRIMARY END TIME: (ZULU/GMT):
7. ALTERNATE DATE: (If Applicable)
8. ALTERNATE START TIME: (ZULU/GMT):
9. PRIMARY END TIMEEND: (ZULU/GMT):
10. MULTI-PHASED MAINTENANCE: DATES AND TIMES FOR EACH PHASE (ZULU/GMT) - (If Applicable)
11. PHYSICAL ADDRESS OF MAINTENANCE:
12. LOGICAL LOCATION OF MAINTENANCE: - (If Applicable)
13. DETAILED DESCRIPTION OF MAINTENANCE THAT WILL BE ACCOMPLISHED:
14. IMPACT OF MAINTENANCE (HAZCON/ OUTAGE):
15. ORGANIZATION PERFORMING MAINTENANCE: (ex: site personnel/ public works
/vendor):
16. ACCESS REQUIRED TO GOVERNMENT SITE? (YES / NO / NA):
17. VISITOR ACCESS REQUEST REQUIRED? (YES / NO / NA):
18. ARE ALL RESOURCES AVAILABLE (Techs, software, equip, patches etc.)? (YES / NO /
NA):
08 Jan 2015
19. ESTIMATED RECOVERY TIME (IF MAINTENANCE HAS TO BE STOPPED):
20. LIST OF AFFECTED CCSDS/SERVICES/SYSTEMS/APPLICATIONS/EQUIPMENT:
21. COMMERCIAL VENDOR TICKET #: (If Applicable):
22. COMMERCIAL VENDOR NOC 24X7 CONTACTS PHONE #:
23. SITE PRIMARY POC CONTACT INFO: (If Applicable): CMCL /DSN & CELL FOR 24X7
CONTACT / UNCLASS EMAIL: / CLASS EMAIL:
24. SITE ALTERNATE POC CONTACT INFO: (If Applicable): CMCL /DSN & CELL FOR
24X7 CONTACT / UNCLASS EMAIL: / CLASS EMAIL:
File details come from the government source that posted it. Updated .