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OSD/WHS SECURITY MANAGEMENT OUT-PROCESSING CHECKLIST
1. NAME OF EMPLOYEE: a. LAST b. FIRST

2. ORGANIZATION/OFFICE

3. (X one)
CIVILIAN CONTRACTOR MILITARY OTHER

4. DEPARTURE DATE (YYYYMMDD)

5. ORGANIZATIONAL SECURITY MANAGER COMPLETING THIS CHECKLIST a. NAME (Last, First, Middle Initial) b. TELEPHONE NUMBER

CHECKLIST (Do not list classified information on this checklist.)
(1) Requirement 1. PERSONNEL SECURITY a. Employee debriefed - SF 312. b. Employee debriefed - SD 416 (forward to WHS Security Operations Division). c. Employee debriefed - SSO DIA d. Employee debriefed: NATO ATOMAL CNWDI SIOP (2) Initials/Date Completed

e. Clearance (access) removed from appropriate database (e.g., JPAS). f. Visit Requests cancelled (collateral, SCI).

2. CLASSIFIED MATERIAL a. Classified documents (material): b. COMSEC equipment (material): Inventory conducted Inventory conducted 100% of material accounted for 100% of material accounted for

3. BADGING (Notify appropriate badge office if badge is not recovered.) a. Pentagon badge. b. Common Access Card (CAC). c. Other (describe):

4. FACILITY ACCESS a. SCIF access removed. b. SAP facility access removed. c. Open Storage facility access removed. d. Combinations and/or access codes changed.

SD FORM 820, FEB 2009

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CHECKLIST (Continued)
(1) Requirement 5. PROPERTY RETURNED a. Controlled Unclassified Information (material). b. DD Form 2501 (Courier Card). c. SCI Courier Authorization Card. d. Kastle Security cards/fob/other. (2) Initials/Date Completed

USE THIS SPACE FOR ADDITIONAL REMARKS, IF NEEDED.

SD FORM 820 (BACK), FEB 2009

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