Attachment_1_-_Contractor_Site_Access_Form.pdf

FOUO

In compliance with the Privacy Act of 1974, this information is Personal Data and must be protected from disclosure.

NSSC Contractor Access Request Form

Company Name:__________________________ Bldg/Area working:_____________ NSSC POC: ______________________ POC Phone #:__________________

Last Name First Name DOB DL# DL State

Current Address States Resided In During Past 5 Years

Per U.S. Army Directive-Type Memorandum (DTM) 09-012, all of the above information is required for unescorted access. If the POC or visitor elects not to provide all the information requested, then the visitor must be signed in at the gate by the POC and escorted the entire time they are on the installation. The POC will only be notified if the visitor is not authorized entry onto the installation.

All U.S. visitors 18 years of age and older must be vetted prior to entry to NSSC. Foreign visitors (both official and unofficial) must be vetted through the appropriate Foreign Disclosure Officer based on the organization he/she is coming to see. Please contact the appropriate office for instructions. For NSRDEC/TACOM contact 508-233-5497 and for all others contact DPTMS at 508-233-6972.

In compliance with the Privacy Act of 1974, this information is Personal Data and must be protected from disclosure.

To protect PII, there are two methods of submitting this form. This form can be emailed encrypted to “USARMY Natick SSC IMCOM

Atlantic List NATI-PoliceVisitorAccess” at email address usarmy.natick.imcom-atlantic.list.nati-policevisitoraccess@mail.mil.

Alternatively, this form can be faxed to (508) 233-6293.

Requests must be received by USAG Natick Police at least 24 hours prior to the visitor’s arrival. Upon successful vetting, the visitor will be added to the Daily Access Roster for the date of the visit. The Daily Access Roster is maintained at the Main Gate.

If a visitor has already been vetted within the last 90 days, then send an email request to the above address at least 24 hours prior to the visitor’s arrival. Include the visitor’s full name, date of visit, time of visit and POC. If the visitor was vetted within the last 90 days, they will be added to the Daily Access Roster. Visitors not vetted within the last 90 days will have to resubmit this form to the USAG Natick Police.

Contact the USAG Natick Police Desk at 508-233-4201, to verify whether or not a visitor has been vetted within the last 90 days.

Please direct any questions regarding this process to the USAG Natick Police Desk at 508-233-4201 or Rick Dutkiewicz at 508-233-4099.