(6)_DLA_SP_Camera_Pass_Request_Form.pdf

Camera Pass Request Form

Security & Emergency Services

Name:

Company/Unit:

Phone Number:

Location(s) Required:

Dates/Length of Time:

Justification:

Signature:

If Contractor, COR or sponsor information and approval/disapproval required

Name:

Phone Number:

Once complete, attach form and send to the Security Management Branch for approval.

Security Management Branch Use:

Approved Disapproved Approved Disapproved

David Koons Dominick Versace

Approved Disapproved Amy Snyder

Geraldine Fadden

Approved Disapproved

Pass & ID Use:

Pass #:

Security Assistant:

Date Issued:

I have read and understand the image capturing device policy. All photos will be vetted by the Security Management Branch in accordance with the installation policy.

Printed Name:

Date:

mailto:david.koons@dla.mil;%20geraldine.fadden@dla.mil;%20amy.snyder@dla.mil;%20dominick.versace@dla.mil?subject=Camera%20Pass%20Request

ADDITIONAL PERSONNEL: The following personnel have reviewed and understand the image capturing device policy. All photos will be vetted by the Security Management Branch in accordance with the installation policy.

NAME SIGNATURE