READINESS AND DEPLOYMENT CHECKLIST (OMB 0412-0580; Expiration Date: XX/XX/XXX) | ||||||||||||
1. DATE (YYYYMMDD) | 2. NAME (Last, First, Middle) | 3. ORGANIZATIONLA ID NUMBER | ||||||||||
4. SERVICE AFFILIATION | 5. COMPONENT | 6. STATUS | 7. E-MAIL ADDRESS | |||||||||
USAID Commerce | ACTIVE | PSC | ||||||||||
DOS Treasury | STAND-BY | DH | 8. CITIZENSHIP COUNTRY | |||||||||
DOJ DHS | RESERVE | |||||||||||
USDA | 9. DEPLOYMENT COUNTRY | |||||||||||
10. JOB TITLE | ||||||||||||
11.OVERALL STATUS OF EACH SECTION | ||||||||||||
a. Readiness Certification | b. Personnel | c. Finance | d. Training | d. Medical | ||||||||
YES NO ![]() |
YES NO ![]() |
YES NO![]() |
YES NO![]() |
YES NO![]() |
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f. Training | g. Security | h. Medical | i. Dental | j. Vision | ||||||||
YES NO![]() |
YES NO![]() |
YES NO![]() |
YES NO![]() |
YES NO![]() |
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SECTION I - DEPLOYMENT VALIDATION | ||||||||||||
Part B. Team Leader Acknowledgement: (Commanders may approve a non-deployable individual for deployment based on the certifying official's recommendation, criticality, and mission needs, unless otherwise indicated.) I Acknowledge the SRP Sites findings. | ||||||||||||
1. PRINTED NAME (TEAM LEADER) | 2. GRADE | 3. ADDRESS | ||||||||||
4. SIGNATURE | 5. TITLE | |||||||||||
6. PHONE NUMBER | 7. E-MAIL ADDRESS | 8. Date | ||||||||||
READINESS AND DEPLOYMENT CHECKLIST | ||||||||||||
NAME (Last, First Middle) | SSN | |||||||||||
READINESS CERTIFICATION | DEPLOYMENT VALIDATION | |||||||||||
SECTION II - PERSONNEL | GO | NO GO | NA | DATE (YYYYMMDD) | GO | NO GO | NA | DATE (YYYYMMDD) | ||||
1. Emergency Data Information/Locator Card | ||||||||||||
2. Insurance Verification/MEDEVAC Insurance Policy Curent (Verification) | ||||||||||||
3. DoS/USAID Badge | ||||||||||||
4. Passport requested or in possession, if required (carried by person) | ||||||||||||
5. Visa requested or in possession, if required (carried by person) | ||||||||||||
6. Citizenship/Natrualization Verification | ||||||||||||
7. Travel Authorization Orders | ||||||||||||
8. Airline Tickets | ||||||||||||
9. SF 50 (Stand-by personnel only) | ||||||||||||
10. Passport Photo in database | ||||||||||||
11. Service Agreement (Stand-by personnel only) | ||||||||||||
12a. Signature of Certifying Official | 12b. Grade/Title | 12c. Date (YYYYMMDD) | ||||||||||
SECTION III - SUPPLY AND LOGISTICS | ||||||||||||
1. Personal clothing, basic issue or like quantities | ||||||||||||
2. Organizational clothing and equipment issued | ||||||||||||
3. Theater specific clothing issued | ||||||||||||
4. Theater specific equipment issued | ||||||||||||
5a. Signature of Certifying Official | 5b. Grade/Title | 5c. Date (YYYYMMDD) |
READINESS AND DEPLOYMENT CHECKLIST | |||||||||||
NAME (Last, First Middle) | SSN | ||||||||||
SECTION IV -TRAINING | READINESS CERTIFICATION | DEPLOYMENT VALIDATION | |||||||||
GO | NO GO | NA | DATE (YYYYMMDD) | GO | NO GO | NA | DATE (YYYYMMDD) | ||||
1. Force Protection Training administered | |||||||||||
2. OPSEC/SAEDA Briefing | |||||||||||
3. Deployment Briefing to Family Members | |||||||||||
4. Safety and Local laws for deployment area briefing | |||||||||||
5. Media Awareness Training | |||||||||||
6. Sector specific training requirements completed | |||||||||||
7. Military Common Task Training | |||||||||||
8a. SIGNATURE OF CERTIFYING OFFICIAL | 8b. Grade/Title | 8c.DATE (YYYYMMDD) | |||||||||
SECTION V- SECURITY | |||||||||||
1. Security clearance meets requirement for duty position | |||||||||||
2. Security clearance meets requirement for deployment mission | |||||||||||
3. Security Clearance Provided to Gaining EMB. | |||||||||||
4a. SIGNATURE OF CERTIFYING OFFICIAL | 4b. Grade/Title | 4c. DATE (YYYYMMDD) | |||||||||
SECTION VI- MEDICAL | |||||||||||
1. Shot/Innoculations Current | |||||||||||
2. Immunizations current | |||||||||||
3. Current physical exam on hand (Class I) | |||||||||||
4. Country specific immunizations required for deployment area. | |||||||||||
5. Prescriptions, sufficient supply; minimum 90 day if Overseas) | |||||||||||
6. Medical Tags/Bracelets | |||||||||||
7a. SIGNATURE OF CERTIFYING OFFICIAL | 7b. Grade/Title | 7c. DATE (YYYYMMDD) |
Civilian Response Corps (CRC) Inprocessing Checklist | |||||||||||||
Privacy Act Statement | |||||||||||||
Adminstrative Information | |||||||||||||
Name (Last, First M.I.) | Organization ID Number | Grade | Hiring Mechanism | ||||||||||
Date of Birth | Age | Height | Weight | Hair Color | Eye Color | Blood Type | Religion | ||||||
Home Address | Phone Number (Work) | Duty Title | |||||||||||
Phone Number (Home) | |||||||||||||
Primary E-Mail Address | |||||||||||||
Phone Numner (Cell) | |||||||||||||
Section/Organization Address | Alternate E-Mail Address | ||||||||||||
Emergency Information | |||||||||||||
Address | A/ Phone Number | ||||||||||||
E-Mail Address | Alternate E-Mail Address | ||||||||||||
Security Information | |||||||||||||
Security Clearence | Date Initiated | Expiration Date | |||||||||||
Languages (Reading/Writing/Verbal) | Equipment Sizes | ||||||||||||
a. | c. | Hat Size | Boot Size | Coat Size | |||||||||
b. | d. | Trouser Size | Glove Size | NBC Suit Size | |||||||||
NBC Glove Size | NBC Boot Size | Protective Mask Size | |||||||||||
Sector Expertise | Foreign Country Experience | ||||||||||||
Sector | Experience | Country | Duration (Mos.) | Desciption | |||||||||
Training | |||||||||||||
Orientation Training | Date | Annual Training | |||||||||||
Military Training | Date | Civilian Training | Date | Language Training | Date | Skill Level (i.e. 1/1/1) | |||||||
USAID 101 | Weapons Familiarization | R & S Training | Arabic | ||||||||||
Military 101 | Convoy Live Fire | DG Training | |||||||||||
CMM 102 | NBC Training | Conflict Management Tng | |||||||||||
State 101 | First Aid | HAZMAT Training | |||||||||||
Equal Opportuniy | Communication | EPA Training | |||||||||||
IT Training | Land Navigation | Cultural Awareness | Sapnish | ||||||||||
Drivers Training | Rule of Law | Japanese | |||||||||||
WST Training | Chinese | ||||||||||||
H.E.A.T. Training | |||||||||||||
EST 2000 | |||||||||||||
MOUT Training | |||||||||||||
Counter IED Training | |||||||||||||
Medical | |||||||||||||
Physical | Required Medical Items | Allergies | |||||||||||
Type | Date | Type | Yes/No | 1 | |||||||||
Spectacles (2 Pair) | |||||||||||||
Shots/Immunization/Vaccinations | Preotective Mask Inserts (2 Pair) | 2 | |||||||||||
Type | Yes/No | Type | Yes/No | Ear Plugs (Fitted) | |||||||||
Yellow Fever | Hepatitis B | Hear Aids | 3 | ||||||||||
Influenza | Anthrax | Medical Warning Tags | |||||||||||
Hepatitis A | Smallpox | ||||||||||||
File Type | application/vnd.ms-excel |
Author | Administrator |
Last Modified By | USAID |
File Modified | 2010-01-07 |
File Created | 2002-06-26 |