26-SIMACQ-E30-0034-FORM_2210.2.pdf

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PED form.xlsx christine.r.hansen 11.0.1.20130826.2.901444 Manufacturer Model From:

To:

Is the requester a contractor?

Contract #________________________________________ (if applicable) MY SIGNATURE AFFIXED TO THIS STATEMENT IS CERTIFICATION THAT I HAVE READ AND THOROUGHLY UNDERSTAND THE ABOVE CONTENTS If yes, does the requester have access to similar government furnished equipment with protection equal to or better than

NMCI?

Countermeasures applied to the above devices(s) to ensure protection against unauthorized recording or exporting photographic images or audible information:

1. Requester is responsible for preventing unauthorized recording, transmitting, or exporting photographic images or audible information. Violations of this policy can cause the removal of camera pass privileges and removal from NSWC PHD.

2. Possession of a Photographic and Recording Device Permit does not constitute authority to take photographs in other command jurisdictions.

3. Photographers must comply with the NSWCPHD Code 105 SOP #105-040

4. The NSWC PHD Public Affairs Officer and Security Manager must review all photographs taken in NSWC PHD areas/facilities per the NSWCPHD Code 105 SOP #105-040

ACKNOWLEDGEMENT OF NSWC PHD PHOTOGRAPHIC AND RECORDING DEVICE PERMIT POLICY

As required by NAVSEA 5510.2 (series) NSWC PHD 2210/2 (Rev. 9/18)

PHOTOGRAPHIC AND RECORDING DATA

Description Serial no.

Building Manager Signature:

THIS FORM MUST BE CARRIED ON PERSON AT ALL TIMES.

Command Communications Officer Signature:

APPROVING OFFICIALS

Department Manager Signature:

Applicant Signature:

Specific Area(s)/Facilities Where the Above Devices Will Be Used:

PHOTOGRAPHIC AND RECORDING DEVICE PERMIT

Name: ______________________________________ Phone #: ____________________________________ Email Address: ________________________________ Command/Company: __________________________ Dept/Code:___________________________________ Dates Requested: ______________________________ Security Manager Signature:

Copy of signed document must be retained for two years from the date of signature.