TSA-1603-1 Corporate Security Review Interview Form - Hazmat

Corporate Security Reveiw Form Interview - Hazmat Addendum
1. Interviewee USDOT#

Corporate Security Review Interview
Form- Hazmat Addendum

General
Information

3. Organization Name

Address

Version #

Mailing
12. Address 1

8. Address 2

13. Address 2
10. State 11. Zip Code

Site

Corporate

4. Transportation Mode
5. Type of Organization
Motor Carrier
Private
Motorcoach
Public
School Bus
HAZMAT Carrier
6. Number Of Employees (Including Drivers)

Physical
7. Address 1

9. City

2. CSR Date Performed

14. City

Same as Physical

15. State 16. Zip Code

Interview Team

Interview Participants

Security Coordinator
Contact Information

17. Primary Security Coordinator Name
18. Office

19. Cell

20. Fax

21. Email

25. Fax

26. Email

22. Alternate Security Coordinator Name
23. Office

24. Cell

27. 24/7 Emergency Operations Number

28. Name

29. Title

30. Phone

31. Email

32. Name

33. Title

34. Phone

35. Email

36. Name

37. Title

38. Phone

39. Email

40. Name

41. Role

42. Organization

43. E-mail

44. Name

45. Role

46. Organization

47. E-mail

48. Name

49. Role

50. Organization

51. E-mail

Report Author

Report Author

Report Author

WARNING: This record contains Sensitive Security Information that is controlled under 49 CFR parts 15 and 1520. No part of this record may be
disclosed to persons without a "need to know", as defined in 49 CFR parts 15 and 1520, except with the written permission of the Administrator of the
Transportation Security Administration or the Secretary of Transportation. Unauthorized release may result in civil penalty or other action. For U.S.
Government agencies, public disclosure is governed by 5 U.S.C. 552 and 49 CFR parts 15 and 1520.

TSA Form 1603-1, March 2010

OMB Control Number 1652-0036, Expiration Date mm/dd/yyyy

Corporate Security Reveiw Form Interview - Hazmat Addendum
CSR Version #

Page 2 of 12

Organization Name

Date of CSR

0

1/0/1900

HAZMAT ADDENDUM
SECURITY ASSESSMENT AND SECURITY PLAN
Yes/No
1 Does the carrier have a security plan prepared in accordance with 49CFR 172.800?
(request a copy of the security plan)
A) Does the security plan include a security assessment?
(request a copy of the security assessment)
B) Is the carrier familiar with the PHMSA Risk Management Self-Evaluation Framework (RMSEF)?
C) Is the carrier familiar with the FMCSA Guidance on Developing an Effective Security Plan?
D) What areas did the Security Plan/Security Assessment identify as gaps in security?
Briefly record or describe those areas below:
Comments:

E) Were specific actions identified and undertaken to improve security?

AWARENESS OF SECURITY PRACTICES
Yes/No
2 Is the carrier a member of an industry or private sector association?
If so, which ones?
American Chemistry Council Responsible Care Program
Chlorine Institute
International Cargo Security Council
Compressed Gas Association
Others: __________________________________
Comments:

WARNING: This record contains Sensitive Security Information that is controlled under 49 CFR parts 15 and 1520. No part of this record may be
disclosed to persons without a "need to know", as defined in 49 CFR parts 15 and 1520, except with the written permission of the Administrator of the
Transportation Security Administration or the Secretary of Transportation. Unauthorized release may result in civil penalty or other action. For U.S.
Government agencies, public disclosure is governed by 5 U.S.C. 552 and 49 CFR parts 15 and 1520.

TSA Form 1603-1, March 2010

OMB Control Number 1652-0036, Expiration Date mm/dd/yyyy

Corporate Security Reveiw Form Interview - Hazmat Addendum
CSR Version #

Page 3 of 12

Organization Name

Date of CSR

0

1/0/1900

AWARENESS OF SECURITY PRACTICES CONT'D
Yes/No
3 Is the carrier enrolled in a Federal security program?
If so, which ones?
TSA Air Carrier Security Programs
Cargo Security Program (49 CFR Part 1544)
Indirect Air Carrier Security Program (49 CFR Part 1548)
Customs-Trade Partnership Against Terrorism (CTPAT) (Customs and
Border Protection)
(DHS)
(ref)
Tier One
Certified
Tier Two Validated
Chemical Facility Anti-Terrorism Standards (DHS) (6 CFR Part 27)
Department of Defense Transportation Regulations, DoD 5100.76-M, Physical
Security of Sensitive Conventional Arms, Ammunition, and Explosives
Comments:

INVENTORY CONTROL PROCESS
Yes/No
4 Does the carrier have a written inventory control process?
If so, how is it implemented?
Manual Paper Records
Computerized Data System with Entries
Fully Automated, Computerized System (barcode or other inventory
control
system)
Other______________________________

Comments:

BUSINESS AND SECURITY CRITICAL INFORMATION
Yes/No
5 Does the carrier have a written control process for business and security critical information?
If so, which of the following does it control?
Telecommunications Systems (fax machines, dispatch)
Printed Records (Bills of Lading, Invoices)
Locking Storage Capability (cabinets, offices)
Comments:

WARNING: This record contains Sensitive Security Information that is controlled under 49 CFR parts 15 and 1520. No part of this record may be
disclosed to persons without a "need to know", as defined in 49 CFR parts 15 and 1520, except with the written permission of the Administrator of the
Transportation Security Administration or the Secretary of Transportation. Unauthorized release may result in civil penalty or other action. For U.S.
Government agencies, public disclosure is governed by 5 U.S.C. 552 and 49 CFR parts 15 and 1520.

TSA Form 1603-1, March 2010

OMB Control Number 1652-0036, Expiration Date mm/dd/yyyy

Corporate Security Reveiw Form Interview - Hazmat Addendum
CSR Version #

Page 4 of 12

Organization Name

Date of CSR

0

1/0/1900

VALID CDL
Yes/No
6 Does the motor carrier have a process in place to confirm that all drivers employed to drive a vehicle transporting
hazardous materials possess a valid CDL with hazmat endorsement including a security threat assessment under
49 CFR Part 1572?
Comments:

COMMUNICATION PLAN
Yes/No
7 Does the motor carrier have a written communication plan that includes an SOP for communication between
company employees in the event of a security event?
Comments:

8 Does the SOP provide methods of two-way communications between company personnel?
Comments:

WARNING: This record contains Sensitive Security Information that is controlled under 49 CFR parts 15 and 1520. No part of this record may be
disclosed to persons without a "need to know", as defined in 49 CFR parts 15 and 1520, except with the written permission of the Administrator of the
Transportation Security Administration or the Secretary of Transportation. Unauthorized release may result in civil penalty or other action. For U.S.
Government agencies, public disclosure is governed by 5 U.S.C. 552 and 49 CFR parts 15 and 1520.

TSA Form 1603-1, March 2010

OMB Control Number 1652-0036, Expiration Date mm/dd/yyyy

Corporate Security Reveiw Form Interview - Hazmat Addendum
CSR Version #

Page 5 of 12

Organization Name

Date of CSR

0

1/0/1900

VEHICLE SECURITY PLAN
Yes/No
9 Does the motor carrier have a written plan identifying methods of ensuring that all company vehicles are secured
when unattended?
If so, which system(s) are used to secure vehicles?
Shut Down of Vehicle Engine
Removal of Ignition Keys
Closing Windows
Locking Vehicle Doors
Key Control Policy with Secured Control of Keys
Steering Wheel Locking System
Air Brake Locking System
Wheel Locks
Comments:

CARGO SECURITY PROGRAM
Yes/No
10 Does the motor carrier have a written plan identifying methods of ensuring that all cargo containers
are secured when not in use during loading, unloading, or maintenance procedures?
If so, which security action(s) are included in the plan?
Glad Hand Locks
King Pin Locks
Wheel Locks
Lockout Control Process
Other ____________________________________
Comments:

WARNING: This record contains Sensitive Security Information that is controlled under 49 CFR parts 15 and 1520. No part of this record may be
disclosed to persons without a "need to know", as defined in 49 CFR parts 15 and 1520, except with the written permission of the Administrator of the
Transportation Security Administration or the Secretary of Transportation. Unauthorized release may result in civil penalty or other action. For U.S.
Government agencies, public disclosure is governed by 5 U.S.C. 552 and 49 CFR parts 15 and 1520.

TSA Form 1603-1, March 2010

OMB Control Number 1652-0036, Expiration Date mm/dd/yyyy

Corporate Security Reveiw Form Interview - Hazmat Addendum
CSR Version #

Page 6 of 12

Organization Name

Date of CSR

0

1/0/1900

SEAL/LOCK CONTROL PROGRAM
Yes/No
11 Does the motor carrier have a written policy implementing a seal/lock control program?
If so, which does the program include?
Procurement
Storage
Accountability
Installation
Response to Seal Anomalies
Removal and Inspection
Comments:

12 Does the motor carrier have a copy of the User's Guide on Security Seals for Domestic Cargo (January 2007)
available?
Comments:

HIGH ALERT LEVEL PROTOCOLS
Yes/No
13 Does the motor carrier have a written policy implementing specific actions during periods of an elevated threat
condition?
Comments:

14 Does the written policy provide specific actions to be implemented by the carrier and the driver during periods of
an elevated threat condition?
If so, which of the following does it include?
Identification of local and state law enforcement officials with their phone numbers
along the intended route of shipment
Identify secure locations to seek refuge along the intended route shipment
Identify private sector escorts to provide increased vehicle security and
surveillance for shipments exceeding 200 miles
Other appropriate security measures during periods of an elevated threat condition
Comments:

WARNING: This record contains Sensitive Security Information that is controlled under 49 CFR parts 15 and 1520. No part of this record may be
disclosed to persons without a "need to know", as defined in 49 CFR parts 15 and 1520, except with the written permission of the Administrator of the
Transportation Security Administration or the Secretary of Transportation. Unauthorized release may result in civil penalty or other action. For U.S.
Government agencies, public disclosure is governed by 5 U.S.C. 552 and 49 CFR parts 15 and 1520.

TSA Form 1603-1, March 2010

OMB Control Number 1652-0036, Expiration Date mm/dd/yyyy

Corporate Security Reveiw Form Interview - Hazmat Addendum
CSR Version #

Page 7 of 12

Organization Name

Date of CSR

0

1/0/1900

SECURITY INSPECTION POLICY
Yes/No
15 Does the motor carrier have a written plan implementing security inspection policies?

Comments:

16 Does the written policy provide specific actions to be implemented by the carrier and driver during periods of an
elevated threat condition?
If so, which of the following does it include?
Frequency of inspections
Identify specific areas of the vehicle to be inspected
Reporting and response procedures to follow if a suspicious package is found
Training program to recognize suspicious packages and to implement the motor
carrier's policies
Frequency of training
Comments:

REPORTING POLICY AND PROCEDURES
Yes/No
17 Does the motor carrier have a written plan establishing reporting policies and procedures to follow when
describing suspicious incidents, threats, or concerns?
If so, which of the following does the plan include?
Motor carrier points of contact
Points of contact and phone numbers for local and State law enforcement
agencies
Telephone number required in 49 CFR 172.604 and 172.606
Comments:

WARNING: This record contains Sensitive Security Information that is controlled under 49 CFR parts 15 and 1520. No part of this record may be
disclosed to persons without a "need to know", as defined in 49 CFR parts 15 and 1520, except with the written permission of the Administrator of the
Transportation Security Administration or the Secretary of Transportation. Unauthorized release may result in civil penalty or other action. For U.S.
Government agencies, public disclosure is governed by 5 U.S.C. 552 and 49 CFR parts 15 and 1520.

TSA Form 1603-1, March 2010

OMB Control Number 1652-0036, Expiration Date mm/dd/yyyy

Corporate Security Reveiw Form Interview - Hazmat Addendum
CSR Version #

Page 8 of 12

Organization Name

Date of CSR

0

1/0/1900

SHIPMENT PRE-PLANNING, ADVANCE NOTICE OF ARRIVAL AND RECEIPT
Yes/No
18 Does the carrier have a written policy to address shipment pre-planning, advance notice of arrival and receipt
confirmationIfprocedures
with the
shippers
consignees?
so, which does
policyand
include?
Route with the least public exposure
Route with minimal delay
Estimated time of arrival (ETA)
Load specifics (shipping paper information)
Driver Identification
Receipt confirmation with shippers and consignee
Methods of communication
Comments:

PREPLANNING ROUTES
Yes/No
19 Does the carrier have a written policy to ensure pre-planning of primary and alternate routes?
If so, which does the policy include?
Avoiding or minimizing proximity to highly populated urban areas or critical
infrastructure (bridges, dams, and tunnels)
Protocols for operations during periods of elevated threat conditions (Orange or
Red) under the Homeland Security Advisory System
Comments:

SECURITY FOR TRIPS EXCEEDING HOURS OF SERVICE

Yes/No

20 Does the carrier have a written policy to address security for trips that exceed the drivers' hours of service in Title
49 Code of Federal
Regulations
395?
If so, which
does thePart
policy
include?
Vehicle Attendance
Visual Observation
Driver Teams
Vetted Companions
Secure Locations (mutual agreement with industry partners, State weigh stations
and inspection facilities that provide law enforcement protection)
Comments:

WARNING: This record contains Sensitive Security Information that is controlled under 49 CFR parts 15 and 1520. No part of this record may be
disclosed to persons without a "need to know", as defined in 49 CFR parts 15 and 1520, except with the written permission of the Administrator of the
Transportation Security Administration or the Secretary of Transportation. Unauthorized release may result in civil penalty or other action. For U.S.
Government agencies, public disclosure is governed by 5 U.S.C. 552 and 49 CFR parts 15 and 1520.

TSA Form 1603-1, March 2010

OMB Control Number 1652-0036, Expiration Date mm/dd/yyyy

Corporate Security Reveiw Form Interview - Hazmat Addendum
CSR Version #

Page 9 of 12

Organization Name

Date of CSR

0

1/0/1900

DEDICATED TRUCK
Yes/No
21 Does the carrier have a written policy to ensure that, except under emergency situations, contracted shipments
remain with the primary carrier?

Comments:

22 Are there situations that are covered in the policy that allow for subcontracting, driver/team substitutions, or
transloading of shipments?
Briefly describe those situations in the comment box.
Comments:

TRACTOR ACTIVATION CAPABILITY
Yes/No
23 Does the carrier utilize driver identification by login and password or biometric data to drive the tractor?
If so, which does it include?
Written Policy and Instructions
Login
Password
Biometric Data
Other __________________________
Comments:

WARNING: This record contains Sensitive Security Information that is controlled under 49 CFR parts 15 and 1520. No part of this record may be
disclosed to persons without a "need to know", as defined in 49 CFR parts 15 and 1520, except with the written permission of the Administrator of the
Transportation Security Administration or the Secretary of Transportation. Unauthorized release may result in civil penalty or other action. For U.S.
Government agencies, public disclosure is governed by 5 U.S.C. 552 and 49 CFR parts 15 and 1520.

TSA Form 1603-1, March 2010

OMB Control Number 1652-0036, Expiration Date mm/dd/yyyy

Corporate Security Reveiw Form Interview - Hazmat Addendum
CSR Version #

Page 10 of 12

Organization Name

Date of CSR

0

1/0/1900

PANIC BUTTON CAPABILITY
Yes/No
24 Does the carrier utilize "Panic Button" technology for the driver to transmit emergency alert notifications or to
disable the vehicle?
If so, which?
Emergency Alert Notifications
Vehicle Disable Capability
Other __________________________
Comments:

TRACTOR AND TRAILER TRACKING SYSTEM
Yes/No
25 If the carrier has a tracking system, which does it include? (Refer to Section 8: En-Route Security #2)
Current position by latitude and longitude
Geofencing and route monitoring
Alert notifications of route deviations
Remote monitoring of trailer "connect" and "disconnect" events
Polling capability to request current location and status report for the
tractor and trailer
Periodic position reports (how long are the intervals between reports)
Periodic testing and recording of results
Comments:

WARNING: This record contains Sensitive Security Information that is controlled under 49 CFR parts 15 and 1520. No part of this record may be
disclosed to persons without a "need to know", as defined in 49 CFR parts 15 and 1520, except with the written permission of the Administrator of the
Transportation Security Administration or the Secretary of Transportation. Unauthorized release may result in civil penalty or other action. For U.S.
Government agencies, public disclosure is governed by 5 U.S.C. 552 and 49 CFR parts 15 and 1520.

TSA Form 1603-1, March 2010

OMB Control Number 1652-0036, Expiration Date mm/dd/yyyy

Corporate Security
Reveiw
Form Interview - Hazmat
CSR Version
#
Page 11Addendum
of 12
Organization Name
Date of CSR

0

1/0/1900

CONTINUATION SHEET
COMMENTS: (To begin a new line of text press ALT & Enter keys at the same time.)

What type of Hazardous Materials do you carry?

What are your chemicals of concern?

Where do you, as an industry feel vulnerable?

What concerns do you have?

WARNING: This record contains Sensitive Security Information that is controlled under 49 CFR parts 15 and 1520. No part of this record may be
disclosed to persons without a "need to know", as defined in 49 CFR parts 15 and 1520, except with the written permission of the Administrator of the
Transportation Security Administration or the Secretary of Transportation. Unauthorized release may result in civil penalty or other action. For U.S.
Government agencies, public disclosure is governed by 5 U.S.C. 552 and 49 CFR parts 15 and 1520.

TSA Form 1603-1, March 2010

OMB Control Number 1652-0036, Expiration Date mm/dd/yyyy

Corporate Security Reveiw Form Interview - Hazmat Addendum
CSR Version #

Page 12 of 12

Organization Name

Date of CSR

0

1/0/1900

DOCUMENTS SECURED
(Security Sensitive Materials) * Should be marked as such
COMMENTS: (To begin a new line of text press ALT & Enter keys at the same time.)

Date

Initials

Security Plan
Vulnerability Assessments
Critical Asset List
Emergency Operations Plan
Disaster Recovery Plan
System Maps
Organizational Chart
Training Curriculum
Track Charts

Paperwork Reduction Act Statement: This form is designed to gather information to establish the current
state of security practices for highway modes of transportation. The results will be used to assist the
Transportation Security Administration in making policy and programmatic decisions to improve overall security
within the surface transportation community. It is estimated that the total average burden per response
associated with this questionnaire is approximately 2 to 3 hours. Please send comments to: TSA-11, Attention:
PRA 1652-0036, 601 South 12th Street, Arlington, VA 20598. An angency may not conduct or sponsor, and
persons are not required to respond to a collection of information unless it displays a current valid OMB control
number. The OMB control number assigned to this collection is 1652-0036 which expires dd/mm/yyyy.
WARNING: This record contains Sensitive Security Information that is controlled under 49 CFR parts 15 and 1520. No part of this record may be
disclosed to persons without a "need to know", as defined in 49 CFR parts 15 and 1520, except with the written permission of the Administrator of the
Transportation Security Administration or the Secretary of Transportation. Unauthorized release may result in civil penalty or other action. For U.S.
Government agencies, public disclosure is governed by 5 U.S.C. 552 and 49 CFR parts 15 and 1520.

TSA Form 1603-1, March 2010

OMB Control Number 1652-0036, Expiration Date mm/dd/yyyy