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
|
|
|
|
|
|
|
f. Training |
g. Security |
h. Medical |
i. Dental |
j. Vision |
|
|
|
|
|
|
YES NO
|
YES NO
|
YES NO
|
YES NO
|
YES NO
|
|
|
|
|
|
|
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) |