Attachment_F_DLA_SP_Camera_Pass_Request_Form.pdf

PDF 74 KB Posted

Attached to
Repairs and Upgrades to Substation Federal contract opportunity
Solicitation number
SP330016B0017
Issued by
Defense Logistics Agency Distribution

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Attachment F

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SP330016B0017_and_continuation_pages.pdf PDF
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Camera Pass Request Form

Security & Emergency Services

User Name:

Company/Unit:

Phone Number:

Location(s) Required:

Dates/Length of Time (up to 1 year):

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

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:DSSUSQSECURITY@dla.mil

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.

USER NAMES SIGNATURE

User Name:
CompanyUnit:
Phone Number:
Locations Required:
up to 1 year:
Justification:
Name:
Phone:
Approved:
Disapproved:
Pass:
Security Assistant:
Date Issued:
USER NAMESRow1:
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Dropdown1: [Request Type]
Dropdown2: [Equipment Type]
Check Box4: Off
Check Box5: Off

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