BPA F 5632_11 BPA Visitor(s) Access Request

BPA F 5632.11e
(05-18)

OMB

U.S. DEPARTMENT OF ENERGY
BONNEVILLE POWER ADMINISTRATION

BPA VISITOR(S) ACCESS REQUEST
INSTRUCTIONS: All requests should be submitted at least 24 hours in advance.
Control Center Access: ALL visitor(s) without unescorted physical access please fill out Section A and refer to Section C. Send the completed
form as an attachment via e-mail to the appropriate mailbox: Ross Access Request or Munro Access Request.
For all visitors (non-BPA personnel) attending a meeting or visiting BPA Headquarters, Ross Complex, Munro Complex or Celilo Complex
please fill out Section A and refer to Section C. Send the completed form as an attachment via e-mail to the appropriate mailbox: HQ Access
Request, Ross Access Request, Munro Access Request or [email protected].
Foreign Visitors (non-US citizens) should fill out form BPA F 5632.08e, Unclassified Visits and Assignments - Foreign Nationals Registration
(Short Form). Do not submit visitor access requests for Foreign Nationals to HQ Access Request, Ross Access Request, Munro Access
Request or Celilo Access Request, until the Foreign National Visits and Assignments (FV&A) request has been approved by the FV&A Office.

A. Visitor Information (If the visitor is not a U.S. citizen review the Foreign Visitors paragraph above.)
1. Name:

6. Visit Date(s):

2. Check if
US Citizen:

4. Wi-Fi
Access
Needed?

3. Company Name/Relationship to BPA Host:

7. Visit Time(s):

5. Check for Escorted Control Center:
Control Center(s)
Dittmer

Munro

Dittmer

Munro

Dittmer

Munro

Dittmer

Munro

Dittmer

Munro

Dittmer

Munro

Dittmer

Munro

Dittmer

Munro

Dittmer

Munro

Dittmer

Munro

8. Meeting/Event Location(s) (Include room numbers):

9. Reason for the visit or meeting:

B. BPA Host/Point of Contact/Escort
10. Name of BPA Host (POC):

11. Work Phone:

12. Name of Escort (if different than POC):

13. Work Phone:

14. Submitted by (Name):

15. Work Phone:

16. Routing:

17. Date:

C. Non-BPA Personal Computing Device Policy
The BPA Host (POC) is responsible for ensuring that their visitors have read and comply with the Non-BPA Personal Computing Device Policy indicated below.
All BPA and non-BPA IT-related equipment is subject to seizure and search.
Policy Statement: A non-BPA personal computing device is any electronic device not owned by or licensed to BPA which is capable of storing, manipulating,
sending and/or receiving data or images such as, but not limited to: a laptop computer, a smart phone, a personal digital assistant (PDA) or removable media.
BPA authorizes you to bring in your Non-BPA Personal Computing Device into the BPA facilities under the following restrictions and conditions:
• You are not permitted to connect any personal computing devices to BPA networks. Exceptions would be 1) if your sponsor above requests wireless guest
access and it is approved (preferred) or 2) Written approval from the Office of Cyber Security for a DSL line.
• Non-BPA personal computing devices may be connected to audio/visual output devices such as monitors and projectors.
• Any personal electronic storage devices being used, such as a flash/jump/thumb drive, CD, DVD, or external hard drive must first be scanned for viruses
at the BPA Help Desk (x4357) prior to being used on BPA equipment.
• You are subject to all Federal laws, regulations and policies, and specifically all BPA Cyber Security policies. Please consult your sponsor should you have
any questions.
• BPA assumes no risk or liability for loss, damage, or theft of your Non-BPA Personal Computing Device while in a BPA facility. There is no expectation of
Privacy when you bring your personal computing device onto BPA property. You assume all risk and responsibility.

D. Access Authorization
18. General Access (Physical Security):
Approved
Disapproved

19. Signature:

20. Date Processed:

For Control Center approvals, forward Dittmer requests via email to Control Cntr Privileges and Munro requests to Munro Control Cntr Privileges.
21. Control Center Access (Security Privilege Coordinator):
22. Signature:
23. Date Processed:
Approved
Disapproved

E. Daily Access Book (for Physical Security Office use only)
24. Section Number:

25. Sub Section:

26. Pull Date (Day, Month, Year):

27. Request processed for filing by (Initials):

File Code: SS-18-11(d) Retention: see BPA Record Manual

OMB

BPA F 5632.11e
(05-18)

Paperwork Reduction Act Burden Disclosure Statement
This data is being collected to ensure the security and safety of BPA employees, contractors, and facilities. The data you supply will be used by security
personnel for all visitors attending or visiting BPA facilities. Public reporting burden for this collection of information is estimated to average .16
hours per response, including the time for reviewing instructions, searching exiting data sources, gathering and maintaining that data needed,
and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of
information, including suggestions for reducing this burden, to Office of the Chief Information Officer, Enterprise Policy Development &
Implementation Office, IM-22, Paperwork Reduction Project (enter OMB control number), U.S. Department of Energy, 1000 Independence Ave SW,
Washington, DC, 20585-1290; and to the Office of Management and Budget (OMB), OIRA, Paperwork Reduction Project (enter OMB control number),
Washington, DC 20503.
Notwithstanding any other provision of the law, no person is required to respond to, nor shall any person be subject to a penalty for failure to
comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a
currently valid OMB control number.
The Paperwork Reduction Act (PRA) of 1995 requires each Federal agency to seek and obtain approval from the Office of Management and Budget (OMB)
before undertaking a collection of information directed to 10 or more persons of the general public, including persons involved in or supporting the
operations of Government-owned, contractor-operated facilities.