erssiteinspection

ERS Data Remote Workplace
Security Inspection Checklist
USDA ERS
OMB No. 0536-XXXX
Exp. Date:

SITE INSPECTION CHECKLIST
Request No

ERS Representative:
Researcher Name:
Researcher Org:
Address:
Phone Number:
An ERS authorized representative must perform a virtual site inspection of the remote data access point workplace to complete
form. Forward completed form to the [email protected] for review and approval.
WORKPLACE DESCRIPTION/ PHYSICAL SECURITY/CONFIDENTIALITY

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2
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5
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8

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Home or Office?
a. Floor and room number
Free from high traffic?
Isolated from public areas within the building?
Accessible by authorized individuals only?
Located inside a lockable room?
Monitor is not visible from windows or doors?
Researcher has signed ERS Confidentiality Agreement.
Researcher is aware that screen sharing, screen
capture, printing, photography, or any other form of
data replication is prohibited.

Home

Office

YES
YES
YES
YES
YES
YES

NO
NO
NO
NO
NO
NO

YES

NO

MACHINE INFORMATION

Manufacturer
Model Number
Serial Number
IP Address (IPv4)

ERS Representative Signature and Date
FOR ERS SECURITY STAFF USE ONLY

Approved:

Yes

No

ERS Security Staff Signature and Date:

Sensitive But Unclassified (SBU) Information Disseminate only on a Need to Know Basis
The information you provide will be used for statistical purposes only. Your responses will be kept confidential and any person who willfully discloses ANY
identifiable information about you or your operation is subject to a jail term, a fine, or both. This survey is conducted in accordance with the Confidential
Information Protectionprovisions of Title V, Subtitle A, Public Law 107-347 and other applicable Federal laws. Response is voluntary.
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information
unless it displays a valid OMB control number. The valid OMB number is 0536-xxxx. The time required to complete this information collection is estimated
to average 30 minutes per project, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed,
and completing and reviewing the collection of information.