UNITED STATES MARINE CORPS MARINE CORPS INSTALLATIONS EAST-MARINE CORPS BASE CAl-IP LEJEUNE

pSC BOX 20005 CAMP LEJEUNE Ne 28542-0005

Canc: Dec 2014

MCIEAST-MCB CAMLEJBul 5213 G;-~JADJ

1 7 DEC 'l~\~ MARINE CORPS INSTALLATIONS EAST-MARINE CORPS BASE CAMP LEJEUNE BULLETIN 5213

From: To:

Subj:

Commanding General Distribution List

FORMS MANAGEMENT PROGRAM ANNUAL CHECKLIST

Ref: (a) SECNAV M-5213.1 (b) MCO 5600.31A (c) MCIEAST-MCB CAMLEJO 5213.1

Enel: (1) Checklist of Current MCIEAST-MCB CAMLEJ (2) Checklist of Cancelled MCIEAST-MCB CAMLEJ Forms

1. Purpose. To publish a listing of current and cancelled local command forms, per references (a) through (c).

2. Background. Each command shall provide for continuing analysis, review and control of all forms originated or sponsored by this command to ensure that forms are effective efficient and economical in serving their intended purpose.

3. Action

a. Commander's Intent and Concept of Operations

(1) Commanding General's Intent. Establish the guidelines for update and submission of all Marine Corps Installations East-Marine Corps Base Camp Lejeune (MCIEAST-MCB CAMLEJ) forms.

(2) Concept of Operations. Sections will regularly review the MCIEAST-MCB CAMLEJ forms they sponsor for currency and relevance. Obsolete forms will be cancelled or revised.

b. Subordinate Element Missions. Follow and comply with this Bulletin.

c. Coordinating Instructions. All new MCIEAST-MCB CAMLEJ forms and requests for changes to current forms listed in enclosure (1) must be routed through the MCIEAST-MCB CAMLEJ Adjutant.

(1) MCIEAST-MCB CAMLEJ forms are located on Naval Forms Online at https:!!navalforms.documentservices.dla.mil!web!public!home.

(2) This Bulletin is canceled upon receipt of the next consolidated annual checklist. Enclosure (2) provides a list of cancelled forms.

(3) Point of contact is MCIEAST-MCB CAMLEJ Forms Management Coordinator at (910) 451-4452 or DSN 751-4452.

DISTRIBUTION STATEMENT A: Approved for public release; distribution is unlimited.

MCIEAST-MCB CAMLEJBul 5213

1 7 DEC 2013

4. Reserve Applicability. This Bulletin is applicable to all personnel assigned to Headquarters MCIEAST-MCB CAMLEJ.

DISTRIBUTION: AlB

T. L. FROEMMING By direction

2

MCIEAST-MCB CAMLEJBUL 5213

~ 7 DEC 20.

CHECKLIST OF CURRENT MCIEAST-MCB CAMLEJ FORMS

IDENTIFIER TITLE SPONSOR DATE

MCIEAST-MCB CAMLEJ/BPO/8 Notification of CPI Event BPO l2-0ct-12

MCIEAST-MCB CAMLEJ/BPO/9 project Charter BPO 12-0ct-12

MCIEAST-MCC CAMLEJ/BPO/lO EEO Climate Survey BPO lO-Dec-13

MCIEAST-MCB CAMLEJ/CHAP/l Disbursement Request/Religious

CHAP l3-Nov-13 Offering Fund

Marine Corps Base Camp Lejeune MCIEAST-MCB CAMLEJ/CHAP/1730.9/3 Application For Use of Chapel eHAP 13-Nov-13

Facilities

MCIEAST-MCB CAMLEJ/CHAP/4 Clergy and Religious Support eHAP l3-Nov-13 providers Application for Base

MCIEAST-MCB CAMLEJ/CIG/HQ/1 Commanding General's Evaluation

erG l-Jan-13 Report

MCIEAST-MCB CAMLEJ/CIG/UQ/2 Action Request erG 12-Jul-12

MCIEAST-HCB CAMLEJ/CIG/HQ/3 Fax Cover Sheet eIG 24-Jan-13

MCIEAST-MCB CAMLEJ/CIG/HQ/5 Community Service Agreement erG l2-Aug-12

MCIEAST MCB CAMLEJ/CIG/HQ/6 Appeal To The Command Inspector eIG 3-Dec 13

MCIEAST-MCB CAMLEJ/CIG/1640.10/7 Notice to Accused Upon Pretrial

erG IO-Dec-13 Confinement

MCIEAST-MCB CAMLEJ/CIG/1640.l0/8 Commander's 72 Hour Notice erG 20-Nov-13

Notice of Hissing 12-Uour MCIEAST-MCB CAMLEJ/CIG/1640.l0/9 Memorandum for Continued Pretrial erG IO-Dec-13

Confinement

MCIEAST-MCB CAMLEJ/CIG/!640.10/10 pretrial Confinement Hearing

erG IO-Dec-13 Record

MCIEAST-MCB CAMLEJ/CONT/4200.1/1 purchase Card Purchase Request CaNT 12-Nov-13

MClEAST-MCB CAMLEJ/CONT/2 Justification for Urgency eONT l-Nov-13

MCIEAST-MCB CAMLEJ/CONT/3 Justification for SAP Sole Source CaNT I-Nov-13

MCIEAST-MCB CAMLEJ/CONT/4 OCONOS GCPC Acquisition CONT I-Nov-13 Documentation Record

MCIEAST-MCB CAMLEJ/CONT/4200.1/5 purchase Card Setup Form CaNT I-Jul-13

MCIEAST-MCB CAMLEJ/CONT/4200.l/6 Cardholder Purchase Log eONT lO-Dec-13

MCIEAST/EEO/ORDER NUMBER/! Discrimination and Sexual EEO IQ-Dec-13 Harrassment (DASH) Report

MCIEAST-MCB CAM LEJ/G-l/AAU/S040.S/1 MCIEAST-MCB CAMLEJ AAU Discrepancy

G-1 2l-Feb-13 Notice

MCIEAST-MCB CAMLEJ/G-l/ADJ/5720.I/l MCIEAST MeB CAMLEJ FOIA Request

G-l l6-0ct-13 Form

MCIEAST-MCB CAMLEJ/G-I/ADJ/16S0.2/2 Service Member of the Month G-1 2l-May-12

MCIEAST-MCB CAMLEJ/G-l/ADJ/5720.l/3 MCIEAST MCB CAMLEJ Privacy Act G-1 23-0ct-13 Request

MClEAST-MCB CAMLEJ/G-I/ADJ/4 Reports Evaluation Checklist G-1 IS-0ct-I3

MCIEAST-MCB CAMLEJ/G-I/ADJ/S Directive Managers Control G-l 5-Har-13 Checklist

MCIEAST-MCB CAMLEJ/G-l/ADJ/5730.1/7 MClEAST-MCB CAMLEJ CONGRWT G-1 lS-Oct-13 Privacy Act Statement

MCIEAST-MCB CAMLEJ/G-l/ADJ/5730.1/8 MCIEAST MCB C~~EJ Telephonic G-1 15-0ct-13 CONGRINT/SPLINT

Enclosure (1)

MCIEAST-MCB CAMLEJBUL 5213

r, 7 DEC

MCIEAST-MCB CAMLEJ/G-l/ADJ/5400.1/9 MCIEAST-MCB CAMLEJ Route Sheet G-l I5-0ct-13

MClEAST-MCB CAMLEJ/G-l/ADJ/IO Record of Disclosure-Consent

G-l 15-0ct-13 Authorization Form

MCIEAST-MCB CAMLEJ/G-l/ADJ/ll ECP Application Checklist G-l l-Apr-13

MCIEAST-MCB CAMLEJ/G-l/ADJ/12 MECEP Application Checklist G-l l-Apr-13

MCIEAST-MCB CAMLEJ/G-l/ADJ/13 Regular Warrant Officer

G-l I-Apr-13 Application Checklist

MCIEAST-MCB CAMLEJ/G-l/ADJ/14 Limited Duty Officer Application

G-l I-Apr-13 Checklist

MCIEAST-MCB CAMLEJ/G-l/ADJ/5360.3/15 Hold Harmless Agreement G-l I-Apr-13

MCIEAST-MCB CAMLEJ/G-l/ADJ/16 Annual Form Review Letter G-l I5-0ct-13

MCIEAST-MCB CAMLEJ/G-I/ADJ/17 Training Roster G-l 15-0ct-13

MCIEAST-MCB CAMLEJ/G-l/ADJ/PLOO7-12/I9 MCIEAST MCB CAMLEJ Conference G-l 15-0ct-13

Request

MCIEAST-MCB CAMLEJ/G-l/ADJ/5210.5/20 Records Management Report G-l IO-Dec-13

MCIEAST-MCB CAMLEJ/G-l/ADJ/5211.6/25 privacy Act Self Assessment Form G-l 18-Jul-13

MClEAST-MCB CAMLEJ/G-l/ADJ/26 Classified Material Receipt G-l lS-Jul-13

MCIEAST-MCB CAMLEJ/G-l/ADJ/27 Civil Service Employee of the

G-l 21-0ct-13 Quarter Voting Form

MClEAST-MCB CAMLEJ/G-l/ADJ/28 Civil Service Employee of the Year

G-l 2I-0ct-l3 Voting Form

MCIEAST-MCB CAMLEJ/G-l/ADJ/29 Meritorious Promotion Data Sheet

G-l lO-Dec-13 GYSGT

MCIEAST-MCB Cru-ILEJ/G-l/ADJ/30 Meritorious Promotion Data Sheet G-l lO-Dec-13

SSGT

MClEAST-MCB CAMLEJ/G-l/ADJ/31 Tatoo Screening Form G-l IO-Dec-13

MClEAST-MCB CAMLEJ/G-I/CHRO-E/12000.1/l Record of Official Time G-l 12-Jul-l2

MCIEAST-MCB CAMLEJ/G-l/CHRO-E/12?OO.1/3 Confirmation of Reasonable G-l I2-Jul-12 Accommodation Request Form

MCIEAST-MCB CAMLEJ/G-l/CHRO-E/12000.1/4 Reasonable Accommodation Request

G-l 12-May-l2 Checklist

MCIEAST-MCB CAMLEJ/G-I/CHRO-E/5 Recorrunendation For Award G-l 12-Jul-12

MCIEAST-MCB CAMLEJ/G-l/CHRO-E/12000 .1/6 Reasonable Accorrunodation Annual G-l 12-Jul-12 Report Tracking Information

MCIEAST-MCB CAMLEJ/G-l/CHRO-E/7 Change in Official Personnel G-l l2-May-12 Record

MCIEAST-MCB CAMLEJ/G-I/CHRO-E/8 Justification for Pay Setting of a G-l I2-Jul-12

Reinstatement Eligible

MCIEAST-MCB CAMLEJ/G-l/CHRO-E/9 personal History Card G-l 12-Jul~12

MCIEAST-MCB CAMLEJ/G-I/CIIRO-E/IO Orientation Checklist for New

G-l 12-Jul-12 Employees

MCIEAST-MCB CAMLEJ/G-I/CHRO-E/ll Civilian Personnel Worksheet G-l l2-Jul-12

MCIEAST-MCB CAMLEJ/G-l/CHRO-E/12000.1/I2 Civilian Employee Clearance

G-l 12-Jul-12 Checklist (RESTRICTED)

MCIEAST-MCB CAMLEJ/G-l/CHRO-E/l3 Occupational Health Permit G-l l2-Jul-12

MCIEAST~MCB CAMLEJ/G-l/CHRO-E/lS Civil Service Employee of the G-l 12-Jun-12 Quarter/Year Nomination

MClEAST-MCB CAMLEJ/G-l/CHRO-E/16 Prior Civilian Work Experience G-l 12-May-12

2 Enclosure (I)

MCIEAST-MCB CAMLEJBUL 5213

1 7 DEC 2013

MClEAST-MCB CAMLEJ/G-l/CHRO-E/17 Request for Crediting G-l 12-May-12

MCIEAST-MCB CAMLEJ/G-l/CHRO-E/12000.1/21 Environmental Differential Pay

G-l 12-May-12 (EDP) Request

Employment Statement Regarding

MClEAST-MCB CAMLEJ/G-I/CHRO-E/23 Retirement, Severance Pay, G-l 12-May-12 Repayment of Voluntary Sep

Incentive

MCIEAST-MCB C~~EJ/G-l/CHRO-E/24 statement of Understanding for G-l 12-May-12 Former Military Members

MCIEAST-MCB CAM:LEJ/G-l/CHRQ-Ej27 Personal Information Data G-1 12-May-12

MCIEAST-MCB CAMLEJ/G-l/CHRO-E/28 Requirement to Participate in the G-l 12-May-12

Mandatory EFT

l-lCIEAST-MCB CAMLEJ/G-l/CRRO-E/29 Selective Service Male Applicants G-l 12-May-12 Only

MCIEAST-MCB CAMLEJ/G-1/CIiRO-E/30 standards of Conduct G-l 12-May-12

MCIEAST-MCB CAMLEJ/G-I/CHRO-E/31 Disclosure of SSN G-l 12-May-12

statement of Understanding MCIEAST-MCB CAMLEJ/G-I/CHRO-E/32 Regarding Conditions of Term G-l 12-May-12

Appointment

MCIEAST-MCB CAMLEJ/G-l/CHRO-E/33 Civilian Identification Card G-1 12-May-12

Notice of Random Drug Testing MClEAST-MCB CAMLEJ/G-l/CHRO-E/34 Under the DON Drug-Free Workplace G-1 19-Mar-13

prgram

MCIEAST-MCB CAMLEJ/G-l/CHRO-E/35 Statement of Understanding

G-l 12-May-12 Temporary Employment

MCIEA5T-MCB CAMLEJ/G-I/CHRO-E/12000.1/36 Recruitment/Relocation Incentive G-1 IO-Dec-13 Justification Form

MCIEAST-MCB CAM LEJ/G-l/CHRO-E/37 Justification for paysetting of G-l 12-Apr-12 Reinstatement Eligible

MCIEAST-MCB CAMLEJ/G-I/CHRO-E/12000.1/38 Recruitment/Relocation Incentive G-l lO-Dec-13 Service Agreement

HCIEAST-MCB CAMLEJ/G-l/CHRO-E/12000.1/39 Retention Incentive Justification G-I lO-Dec-13 Form

MCIEAST-MCB CAMLEJ/G-l/CHRO-E/12000.1/40 Accretion of Duties or Planned G-1 IO-Dec-13 Management Action Decision

MCIEAST-MCB CAMLEJ/G-l/CHRO-E/12000.1/41 Accretion or Planned Management G-l lO-Dec-13 Action (PHA) Justification

MCIEAST-MCB CAMLEJ/G-1/CHRO-E/12550.S/42 Hazardous Duty Pay Form

(HOP) Request G-l IO-Dec-13

MCIEAST-MCB CAMLEJ/G-I/CHRO-E/12000.1/43 Highest Previous Rate (IlRP) G-l IO-Dec-13 Justification Form

Superior Qualifications HCIEAST-MCB CAMLEJ/G-I/CHRO-E/l2000.1/44 Appointment (Advance In-Hire Rate) G-l IO-Oec-13

Justification Form

Request for Creditor Annual Leave MClEA5T-MCB CAMLEJ/G-I/CHRO-E/l2000.1/45 Purposes for Non-Federal G-1 IO-Dec-13

Experience (2 pages)

HCIEAST-MCB CAMLEJ/G-l/CHRO-E/12000.1/46 DON Recruit Fill Request Form G-1 IO-Dec-13

MCIEAST-MCB CAMLEJ/G-l/CHRO-E/l2000.1/47 Official Time for Representatives G-l IO-Dec-13 on 100% Official Time Form

MCIEAST-MCB CAMLEJ/G-1/CHRO-E/12000.1/48 wellness Program Waiver and G-1 10-Dec-13 Release of Liability

Documentation Checklist Crediting

MCIEAST-MCB CAMLEJ/G-l/CHRO-E/12000.1/49 Non-Federal and Active Duty G-1 lO-Oec-13 Service for Annual Leave Accrual

Rate

MCIEAST-MCB CAMLEJ/G-I/CHRO-E/WFLC/2 Individual Leadership Development G-1 l8-Nov-13 plan (ILOP)

3 Enclosure (1)

MCIEAST~MCB CAMLEJBUL 5213

1 7 DEC 2013

MCIEAST MCB CAMLEJ/G l/CHRO E/WFLC/5 Mentor and participant Agreement G 1 IB-Nov-13

MCIEAST-MCB CAMLEJ/G-l/CHRO~E/WFLC/6 Mentor Action Plan G-1 18-Nov-13

MCIEAST-MCB CAMLEJ/G-I/CHRO-E/WFLC/7 Individual Development Plan (IDP)

G-1 5-Feb-13 for Uon-Supervisory Personnel

MCIEAST-MCB CAMLEJ/G-l/CHRO-E/WFLC/9 CCLD Registration Form G-1 I-Jan-13

MCIEAST-MCB CAMLEJ/G-l/CHRO-E/WFLC/IO Individual Development Plan (lOP) G-1 5-Feh-13 for Supervisory Personnel

MCIEAST-MCB CAMLEJ/G-l/CHRO-E/WFLC/ll Reimbursement Agreement G-1 IB-Nov-13

MClEAST-MCB CAM LEJ/G-l/IA/lOOl.2/1 Individual Augmentation After G-1 I2-Jul-12 Action Questionaire

MCIEAST-MCB CAM LEJ/G-1/IA/IOO1.2/2 Individual Augmentation

G-1 12-Jul-12 Eligibility Checklist

HCIEAST-MCB CAM LEJ/G-l/IDCC/5512.1/1 Report of Lost or Stolen G-1 18-Jun-13 Identification Card

MCIEAST-MCB CAM LEJ/G-l/IDCC/5SI2.1/2 Signature Card G-1 lO-Dec-13

MCIEAST-MCB CAM LEJ/G-l/IDCC/7 Construction/Contractor Pass

G-1 23-Jan-13 Request

MClEAST-MCB CAMLEJ/G-1/IPAC/SOOI.l/4 MCIEAST-MCB CAMLEJ Check In/Out

G-1 9-May-ll Sheet

MClEAST-MCB CAMLEJ/G-I/IPAC/S Kickback Log Sheet G-1 lO-Dec-13

MCIEAST-MCB CAMLEJ/G-l/IPAC/l1 IPAC Terminal Leave Request G-1 9-May-ll

MCIEAST-MCB CAMLEJ/G-l/IPAC/DTS/l Data Systems Request form G-1 5-Apr-ll

MCIEAST-MCB CAMLEJ/G-l/IPAC/DTS/2 Statement in-Lieu of Receipts G-1 9-May-ll

MClEAST-MCB CAMLEJ/G-l/IPAC/PTS/3 DTS Read Only Access (ROA) Request G-1 9-May-ll

MCIEAST-MCB CAMLEJ/G-l/IPAC/DTS/4 DTS Electronic Funds Transfer G-1 IS-Oct-13 (EFT) Form

MCIEAST MCB CAMLEJ/G l/IPAC/Command Support MClEAST MCB CAMLEJ Leave G-1 19-Mar-12 Branch/SOOl,l/1 Correction

MCIEAST-MCB CAMLEJ/G l/IPAC/Corrunand Support Composite Score Worksheet (Current G-1 9-May-ll Branch/SOOl.I/2 After 1 Oct 09)

MCIEAST-MCB CAMLEJ/G-I/IPAC/outbound/l Advance Pay: Statement of

G-1 9-May-ll Understanding

MCIEAST-MCB CAMLEJ/G-I/IPAC/outbound/3 Permanent Change of Station (PCS)

G-1 9-May-ll Data Sheet

Authorization for Advance MCIEAST-MCB CAMLEJIG-I/IPAC/OUTBOUND/5 Dependents Travel and/or G-1 l4-Feb-12

Dislocation Allowance

MCIEAST-MCB CAMLEJ/G-l/IPAC/OUTBOUND/6 Overseas Accompanied Routing Sheet G-1 S-Apr-ll

Financial Statement for Corporals MCIEAST-MCB CAHLEJ/G~I/IPAC/OUTBOOND/8 and below Ordered to an G-1 5-Apr-ll

Accompanied Overseas Tour

MCIEAST-MCB CAMLEJ/G-l/IPAC/OUTBQUND/9 Documents Required for Preliminary

G-1 5-Apr-ll Overseas Screening

MCIEAST-MCB C~ffiEJ/G-I/IPAC/OUTBOUND/ll Statement of Understandlng for G-1 5-Apr-ll Circuitous Travel

MCIEAST-MCB CAMLEJ/G-l/IPAC/OUTBOUND/12 separations Cover Sheet G-1 lO-Dec-13

MCIEAST-MCB CAMLEJ/G-I/IPAC/UDB/9 pre Deployment Audit After Action G-1 5-Apr-ll Report

MCIEAST-MCB CAMLEJ/G-I/IPAC/CSB/I Member Married to Member Data G-1 I4-Mar-ll Sheet

MCIEAST-HCB CAMLEJ/G-l/IPAC/CSB/2 Request for Waiver of Indebtedness G-1 5-Apr-ll Package

MCIEAST-MCB CAHLEJ/G-I/IPAC/CSB/3 Letter to Loan Holder G-1 19-Mar-12

4 Enclosure (I)

MCIEAST-MCB CAMLEJBUL 5213

1 7 DfC ?Ol~

MCIEAST-MCB CAMLEJ/G-l/IPAC/CSB/4 Certification of Lost or Stolen

G-1 19-Mar-12 Meal Card

MClEAST-MCB CAMLEJ/G-l/IPAC/CSB/S Indebtedness Case G-l 25-Jan-12

MCIEAST-MCB CAMLEJ/G-l/IPAC/CSB/6 Substantiate Entitlement to BAQ G-1 lO-Dec-13

MCIEAST-MCB CAMLEJ/G-1/IPAC/INBOUND/2 TLE Worksheet G-1 19-Har-12

HCIEAST-MCB CAMLEJ/G-l/IPAC/INBOUND/3 Request for Dislocation Allowance G-1 19-Mar-12

MCIEAST-MCB CAMLEJ/G-I/IPAC/INBOUNDi6 Inbound First Stage Audit G-1 5-Apr-ll

MCIEAST-MCB CAMLEJ/G-1/IPAC/INBOUND/8 Quality Control Sheet G-1 16-Nov-ll

MCIEAST-MCB CAMLEJ/G-l/IPAC/INBOUND/IO Travel Claim Correction Form G-l I-Jan-12

MCIEAST-MCB CAMLEJ/G-I/IPAC/INBOUND/ll Navy, Other Service Personnel, And G-l 28-Mar-13 Civilian Personnel Join Checklist

MCIEAST-MCB CAM LEJ/G-l/JRC/5000.5/13 Red Cross Message Worksheet G-1 lO-Dec-13

MCIEAST-MCB CAM LEJ/G-l/PERS/1320.9/1 Non-Funded Temporary Additional G-1 lO-Dec-13 Duty Request

HCIEAST-MCB CAM LEJ/G-l/PERS/5005.5/5 Leave Extension Authorization Form G-1 18-Jun-13

MCIEAST-MCB CAM LEJ/G-l/PERS/5005.5/6 Desertion Form G-l 18-Jun-13

MCIEAST-MCB CAMLEJ/G-l/POSTAL/5112.1/1 Deployed Mail Cover Sheet G-l 25-Jul-12

HClEAST-MCB CAMLEJ/G-l/POSTAL/Sl12.1/2 Mail Orderly Statement of G-1 25-Jul-12 Understanding

MClEAST-MCB CAMLEJ/G-l/POSTAL/5112.1/3 MPO-MAO-UMR Incident/Threat Report G-1 3-Nov-13

HCIEAST-MCB CAM LEJ/G-I/RAO/l Retiree Appreciation Day/Luncheon G-l 12-Aug-12 After Action Report

MCIEAST-MCB CAM LEJ/G-I/RLO/l MCIEAST-MCB CAMLEJ Reserve Order

G-1 9-Jan-13 Request

MCIEAST-MCB CAM LEJ/G-1/RLO/2 MCIEAST-MCB CAMLEJ lMA Unit Muster G-1 9-Jan-13 Sheet

MClEAST-MCB CAMLEJ/G-3~5/HQ/l G-3/5 Route Sheet G-3/5 14-Uov-13

MCIEABT-MCB CAMLEJ/G-3~5/HIST/S060.30 1 Lejeune Memorial Gardens Request Form

Park G-3/5 a-Oct-13

MCIEAST-MCB CAMLEJ/G-3~5/CBC/5750.1/1 Oral History Release Form G-3/5 14-Nov-13

MClEAST-MCB Cru4LEJ/G-3~5/0-P/3440.S/1 aSI Installation Worksheet G-3/5 14-Nov-13

MCIEAST-MCB CAMLEJ/G-3_5/RCD/l Range Control Safety Card ( 2 G-3/S 14-Nov-13 sided) (RESTRICTED)

MCIEAST-HCB CAMLEJ/G-3 5/RCD/3570.1/2 Waiver of Liability and Assumption G-3/5 14-Nov-13 - Risk Management

MCIEAST-MCB CAMLEJ/G-3 5/APP-ATC/3722.3/S Standardized Monthly Training G-3/S I-May-13 - Report/Quarterly Situation Report

MCIEAST-MCB CAMLEJ/G-3_5/APP-ATC/3722.3/6 Standardized Monthly Training G-3/5 I-May-12 Situation Report

MClEAST-MCB CAMLEJ/G-3_S/APP-ATC/3722.3/7 Quarterly MCIEAST Situation Report G-3/5 I-May-13 for Quarter

MCIEAST-MCB CAMLEJ/G-3_5/APP-ATC/3722.3/8 Training Evaluation Report-5 day G-3/5 I-May-12 Evaluation

MCIEAST-MCB CAMLEJ/G-3 5/APP-ATC/3722.3/9 Training Evaluation Report-l day G-3/5 I-May-12 - Evaluation

MCIEAST-MCB CAMLEJ/G-3_5/APP-ATC/3722.3/10 Record Of Audit G-3/5 I-May-12

MCIEAST-MCB CAMLEJ/G-3 5/APP-ATC/3722.3/11 Formal - Training History G-3/5 l-l-ray-12

5 Enclosure (ll

MCIEAST-MCB CAMLEJBUL 5213

1 7 DEC 21m

MCIEAST-MCB CAMLEJ/G-3 5/APP-ATC/3722.3/12 - Facility Position Qualification G-3/5 14-Nov-13

MCIEAST-MCB CAMLEJ/G-3 5/APP-ATC/3122.3/13 - Equipment Certification G-3/5 14-Nov-13

MCIEAST-MCB CAMLEJ/G-3 5/APP-ATC/3122.3/14 -

History of Designations G-3/5 14-Nov-13

MCIEAST-MCB CAMLEJ/G-3 5/APP-ATC/3722.3/15 Annual position Evaluation G-3/5 14-Nov-13 -

MCIEAST-MCB CAMLEJ/G-3 5/APP-ATC/3722.3/16 - Deferred T&R Syllabus G-3/5 14-Nov-13

MCIEAST-MCB CAMLEJ/G-3~ 5/APP-ATC/3122.3/17 Annual proficiency Training G-3/5 14-Nov-13

MClEAST-MCB CAMLEJ/G-3 5/APP-ATC/3722.3/l8 - Record of Deployment G-3/S l-May-13

MCIEAST-MCB CAMl.EJ/G-3 5/APP-ATC/3122.3/19 NATOPS Evaluation Checklist G-3/5 lO-Dec-13 -

MCIEAST-MCB CAMLEJ/G-3 5/APP-ATC/3722.3/20 ATC Order Procedure Tracking G-3/5 l8-Apr-12 - Record

MCIEAST-MCB CAMLEJ/G-3 5/APP-ATC/3722.3/22 Precision Approach Radar (GCA) G-3/5 I-May-13 - Data

MCIEAST-MCB CAMLEJ/G-3 ~5/APP-ATC/3122.3/23 ATC Hazard/Mishap Report G-3/5 I-May-I2

MClEAST-MCB CAMLEJ/G-3 5/APP-ATC/3710.l/24 Flight Demo/Static After Action G-3/5 I-May-I2 - Report Encl (I)

MCIEAST-MCB CAMLEJ/G-3 ~5/APP-ATC/31IO.l/25 Quarterly Expenditure Report G-3/5 1-Har-13

MCIEAST-HCB CAHLEJ/G-3 5/APP-ATC/37IO.l/26 - Aviation Flash Report G-3/5 18-Apr-12

MCIEAST-MCB CAHLEJ/G-3 5/APP-ATC/3710.1/27 A&E - Certification Format G-3/5 l-May-12

MCIEAST-MCB CAMLEJ/G-4/HQ/l G-' Internal Route Sheet G-' 27-Jun-I2

MClEAST-MCB CAMLEJ/G-4/HQ/2 G-' Awards Information Sheet G-4 9-Aug-13

MCIEAST-MCB CAMLEJ/G-4/HQ/3 G-' Plans and Accomplishments G-' 9-Aug-13

MCIEAST-MCB CAMLEJ/G-4/BMT/l Hotor Transport Vehicle Request G-' 27-Jun-12

MClEAST-MCB CAMLEJ/G-4/BMT/2 Motor Transport Vehicle Safety G-' 8-Sep-I3

Inspection Checklist

MCIEAST-MCB CAMLEJ/G-4/BHT/4 Condition Inspection Checklist G-4 8-Sep-13

MCIEAST-MCB CANLEJ/G-4/BHT/7 Fork Maintenance Inspection Form G-4 27-Jun-12

MCIEAST-HCB CAMLEJ/G-4/BMT/9 Vehicle Assignment and Tennination G-4 27-Jun-12

MClEAST-MCB CAMLEJ/G-4/SAFETY/2 Notice of Ammunition/Explosives G-4 27-Jun-12

Safety Violation Discrepancy

MCIEAST-MCB CAMLEJ/G-4/SUPPLY/4400.22/1 Non Availibility Statement (NAS) G-4 lO-Dec-13 and Property Waiver Request

MCIRAST-MCB CAMLEJ/G-4/SUPPLY/4400.22/2 Lejeune Servemart Credit Card G-4 IO-Dec-13

Request

MCIEAST-HCB CAMLEJ/G-4/SUPPLY/4 Fuel Farm Vehicle Operator G-' 27-Jun-12 Checklist

MCIEAST-MCB CAMLEJ/G-6/HQ/I G-6 Internal Route Sheet G-6 26-Jul-13

MCIEAST-MCB CAMLEJ/G-6/HQI2 G-6 Plans and Accomplishments G-6 26-Jul-13

MCIEAST-MCB CAMLEJ/G-6/MSD/OPS/3 IT Waiver Request G-6 6-Nov-13

MCIEAST-MCB CAMLEJ/G-6/CS/l Service Request User Account Form G-6 IO-Dec-13 (SR-UAF)

MCIEAST-MCB CAMLEJ/G-6/COM/l Communications Electronics Support G-6 26-Jul-13

6 Enclosure (1)

MCIEAST-MCB CAMLEJBUL 5213

1 7 DfC 2013

MCIEAST-MCB CAMLEJ/G-6/TELECOH/l Telecommunication Service Request G-6 26-Jul-13

MCIEAST-MCB CAMLEJ/G-S/2 Time Keepers for SLDCADA G-B 5-Nov-13

MCIEAST-MCB CAMLEJ/G-S/LHD/7 Work Schedule Change G-B 5-Nov-13

MCIEAST-MCB CAMLEJ/G-S/ B Risk Assessment Test script G-B 20-Feh-13

MCIEAST-MCB CAMLEJ/G-8/9 Reimbursable Account Check-In G-B 5-Nov-13

MCIEAST-MCB CAMLEJ/G-S/ 10 Control Assessment Test Script G-B 20-Feb-13

MCIEAST-MCB CAMLEJ/G-S/ 11 Internal Control Accomplishment G-B 20-Feb-13

MCIEAST-MCB CAMLEJ/G-S/ 12 Corrective Action Plan G-B 20-Feb-13

MCIEAST-MCB CAMLEJ/G-S/13 Assessable Unit Listing G-S 20-Feb-13

MCIEAST-MCB CAMLEJ/G-F/GEO/1 GIS Authorization Access Request G-F 1S-Nov-13

(GAM)

MCIEAST-MCB CAMLEJ/G-F/GEO/3 MCIEAST-MCB CAMLEJ IG&S Map G-F 1S-Nov-13 Request

MCIEAST-MCB CAMLEJ/G-F/BHD/PllOO12.3/1 AFFADAVIT In Support of Request

G-F 1-Oct-12 for BAH

MCIEAST-MCB CAMLEJ/G-F/BHD/2 Bachelor Housing Voucher G-F 1-Oct-12

MCIEAST-MCB CAMLEJ/G-F/BHD/3 ALSCO Linen Order Form G-F IO-Dec-13

MCIRAST-MCB CAMLEJ/G-F/BHD/4 Cleaning and Office Supply Request G-F lO-Dec-13

MCIEAST-MCB CAMLEJ/G-F/BHD/5 Daily ALSCO Laundry Count G-F lO-Dec-13

MClEAST-MCB CAMLEJ/G-F/BHD/6 Linen Count G-F IO-Dee-13

MCIEAST-MCB CAMLEJ/G-F/EMD/l MSDS Add Form G-F 13-Nov-13

MCIEAST-MCB CAMLEJ/G-F/EMD/5090.12/3 Request for Environmental Impact G-F 13-Nov-13

Data Review

MCIEAST-MCB CAMLEJ/G-F/EMD/5090.12/4 Field Exercise Request for G-F 21-Feb-13 Environmental Impact Review

MCIEAST-MCB CAMLEJ/G-F/EMD/5090.115/7 Hunting Pass (RESTRICTED) G-F 13-Nov-13

MCIEAST-MCB CAMLEJ/G-F/EMD/5090.1IS/8 GSRA & OLF, Oak Grove Security and

G-F I3-Nov-13 Key Agreement (SAMPLE)

MCIRAST-MCB CAMLEJ/G-F/EMD/5090.1I5/9 Waiver of Liability and Assumption G-F 12-Nov-13

of Risk Assessment (SAMPLE)

MCIEAST-MCB CAMLEJ/G-F/EMD/5090.115/10 Certificate of Understanding G-F 12-11ov-13

(Sample)

MCIEAST-MCB CAMLEJ/G-F/EMD/S090.115/11 Certificate of Release of the G-F 12-11ov-13 Government (SAMPLE)

MCIEAST-MCB CAMLEJ/G-F/EMD/13 EMD-Label Request/Shelf Life G-F l2-Nov-13

MClEAST-MCB CAMLEJ/G-F/EMD/14 EMD - Work Request G-F 12-Nov-13

MCIEAST-MCB CAMLEJ/G-F/EMD/15 EMD-Incidental Fuel Request G-F l2-11ov-13

MClEAST~MCB CAMLEJ/G-F/EMD/16 EMIl Hazardous Material/Waste Turn-

G-F 13-Nov-13 In Request

MCIEAST-MCB CAMLEJ/G-F/EMD/17 EMD-AHML Approval Request G-F 13-11ov-13

MCIEAST-MCB CAMLEJ/G-F/EMD/5090.9/18 END-Unit Level Spill Form G-F 13-Nov-13

MCIEAST-MCB CAMLEJ/G-F/EMD/24 Earth Day Registration Form G-F 8-Mar-13

7 Enclosure (1)

MCIEAST-MCB CAMLEJBUL 5213

a 7 DEC i'013

MCIEAST-MCB CANLEJ/G-F/EMD/2S Daily Above Ground Storage Tank G-F 7-Feb-13 Inspection Log

MCIEAST-MCB CAMLEJ/G-F/EMD/26 Monthly ECO Checklist G-F 13-Feb-13

MCIEAST-MCB CAMLEJ/G-F/EMD/S090.9/27 Environmental Personnel Training

G-F 13-Nov-13 Record

MClEAST-MCB CAMLEJ/G-F/EMD/S090.9/28 Medical Waste Storage Tank Turn In G-F 17-Dec-12 Log

MCIEAST-MCB CANLEJ/G-F/EMD/29 Quarterly ECC Checklist G-F I6-Jan-13

MCIEAST-MCB CAMLEJ/G-F/EMD/S090.9/3Q Weekly Hazardous Waste Site

G-F I3-Nov-13 Inspection

Monitoring Log for Oil pollution MCIEAST-MCB CANLEJ/G-F/EMD/S090.91/3I Abatement FacilitieDWS Daily G-F I5-Jul-13

Inspection

MCIEAST-MCB CAMLEJ/G-F/FHD/3 Housing Referal Service G-F 1-0ct-lZ

MCIEAST-MCB CAMLEJ/G-F/FHD/6 Sales/Rental Listings G-F 1-0ct-IZ

MCIEAST-MCB CAMLEJ/G-F/FHD/7 Active Waiting List Letter G-F 1-0ct-12

MCIEAST-MCB CAMLEJ/G-F/FHD/ll Letter of Intent G-F 1-0ct-12

MCIEAST-MCB CANLEJ/G-F/FHD/17 Family Housing Customer Service G-F IB-Apr-13

Document

MCIEAST-MCB CAMLEJ/G-F/FHD/26 Statement of Understanding for the G-F I-Dct-12 Rental partnership Program

MCIEAST-MCB CAMLEJ/G-F/FHD/28 Verification of Eligibility G-F 13-Nov-13

MClEAST-MCB CAMLEJ/G-F/FHD/33 Rental partnership Program

G-F 1-0ct-12 Application

MCIEAST-MCB CAHLEJ/G-F/FHD/35 Statement of Understanding for On-

G-F 1-0ct-12 Base Housing

MCIEAST-MCB CAMLEJ/G-F/FHD/11101.31/36 privacy Act Release Form G-F 2-Nov-12

MCIEAST-MCB CANLEJ/G-F/IDD/II013.4/1 Minor Construction project G-F 13-Nov-13

Validation Form

MCIEAST-MCB CAMLEJ/G-F/PWD/l13BO.4/1 Work Request (Maintenance G-F lO-Dec-13

Management)

MCIEAST-MCB CAMLEJ/HQ/1400.2/I Special Recognition Board Privacy CG HQ 23-Apr-13

Act Release Statement

MClEAST-MCB CAMLEJ/RQ/2 Conference Facility Request CG HQ 23-Apr-13

Marine of the Year/Non~ MCIEAST-MCB CAMLEJ/HQ/3 Commissioned Officer of the CG HQ 10-Dec-13

Quarter/Year Checklist

MClEAST-MCB CAMLEJ/HQ/1400.2/5 Board Data Sheet (SNCO) CG HQ 23-Apr-13

MCIEAST-MCB CAMLEJ/HQ/6 Distinguished Guest Quarters CG HQ 25-Apr-13

Request

MCIEAST-MCB CAMLEJ/HQSPTBN/HQ/l HQSPTBN Check-In/Check-Out Sheet HQSPTBU 6-Feb-13

(RESTRICTED)

Headquarters & Support Battalion MCIEAST-MCB CAMLEJ/HQSPTBN/HQ/3 Leave and Liberty Personnal Travel HQSPTBN 22-Apr-13

Form

MCIEAST-MCB CAMLEJ/UQSPTBN/ADJ/l Voting Sign-In Roster HQSPTBU l-Mar-13

MClEAST-MCB CAMLEJ/HQSPTBN/ADJ/Z Mail Pickup Sign in Sheet JIQSPTBN 6-Feb-13

MCBCL/HQSPTBU/ADJ/4 Fax Cover Sheet HQSPTBN 6-Feb-13

MClEAST-MCB CAMLEJ/HQSPTBN/ADJ/5 HQSPTBN Route Sheet HQSPTBU 6-Feb-13

MCIEAST-MCB CAMLEJ/HQSPTBU/ADJ/ll BEQ Check-In FORM HQSPTBN 1 Ma 13

Enclosure (1)

HCIEAST-HCB CAHLEJBUL 5213

HCBCL/HQSPTBN/LEGAL/1 Restraint Huster Record HQSPTBN 6-Feb-13

HCIEAST-HCB CAHLEJ/HQSPTBN/S-3/10 NECD Checklist HQSPTBN 10-Apr-12

MClEAST-MCB CAMLEJ/LSST-E/LEGASST/I Legal Assistance Client Intake

LSSS-E I4-Jun-13 Questionnaire

MCIEAST-MCB CANLEJ/LSST-E/LEGASST/3 Will and Beneficiary Worksheet LSSS-E 14-Jun-13

MCIEAST-MCB CAMLEJ/LSST-E/LEGASST/5 Step-Parent Adoption worksheet LSSS-E 25-Har-13

MCIEAST-MCB CAMLEJ/LSST-E/LEGASST/6 Child Name Change Worksheet LSSS-E 2S-Mar-13

Worksheet for preparing MCIEAST-MCB CAMLEJ/LSST-E/LEGASST/8 Separation and Parenting LSSS-E IO-Dec-13

Agreement

MClEAST MCB CAMLEJ/LSST E/LEGASST/9 Adult Name Change Worksheet LSSS E 14 Jun 13 MCIEAST MeB CAHLEJ/LSST E/LEGASST/IO Uncontested Divorce Worksheet LSSS-E 25 Mar 13

MCIEAST-MCB CAMLEJ/MCCS/HQ/1700.3/1 Request for Nonappropriated Funds MCCS 22-Feb-13

Waiver of Liability and Assumption MCIEAST-MCB CAMLEJ/MCCS/HQ/5760.5/2 of Risk Agreement with the United MCCS IO-Dec-I3

States Marine Corps

MCIEAST-MCB CANLEJ/MCCS/HQ/3 Cash Controls for Petty Cash Fund MCCS 15-Feb-13

MCIEAST-MCB CAMLEJ/MCCS/HQ/4 Cash Controls for Change Fund MCCS 15-Feb-13

MClEA5T-MCB CAMLEJ/MCCS/UQ/5 Cash Verification Form MCCS IS-Feb-13

HCIEAST-MCB CAMLEJ/MCCS/HQ/7 Inventory Cover Sheet MCCS 15-Feb-13

MCIEAST-MCB CAHLEJ/MCCS/HQ/8 Marine Corps Exchange Inventory NCCS 15-Feb-13

MClEAST-MCB CAMLEJ/MCCS/HQ/IO Maintenance Work Request MCCS 22-Feb-13

MCIEAST-HCB CAMLEJ/MCCS/HQ/II Orders and Bulletins Signature

MCCS 22-Feb-13 Receipt

MCIEAST-MCB CAMLEJ/MCCS/UQ/13 Cash Shortage/Overage Discrepancy MCCS 19-Mar-13

Report

MCIEAST-MCB CAMLEJ/MCCS/HQ/23 Request for MCCS TAD Orders MCCS 13-Jun-13

MClEAST-MCB CAMLEJ/MCCS/HQ/27 NAF Application for Employment MCCS 13-Jun-I3

MCIEAST-MCB CAMLEJ/MCCS/HQ/31 Special Request for Checks MCCS 22-Feb-13

MClEAST-MCB CAMLEJ/MCCS/HQ/33 Facsimile Transmittal MCCS 22-Feb-13

MCIEAST-MCB CAMLEJ/MCCS/HQ/35 Shoplifting Stat Sheet MCCS 21-Har-13

MCIEAST-MCB CAMLEJ/MCCS/HQ/7010.1/36 Voluntary Statement Regarding MCCS 6-Jun-Il

Larceny of Government Property

Use of Camp Lejeune Swimming Pools MCIEAST-MCB CAMLEJ/MCCS/HQ/5760.2/37 and Training Tanks Participant MCCS 14-Feb-13

Information

MCIEAST-MCB CAMLEJ/MCCS/HQ/5760.2/38 Waiver of Liability and Assumption

MCCS 13-Jun-12 of Risk Agreement (Swimming Pools)

Parental Permission Form of Marine MCIEAST-MCB CAMLEJ/MCCS/HQ/5760.2/39 Corps Base, Camp Lejeune MCCS I-Feb-13

Activities

MClEAST-MCB CAMLEJ/MCCS/HQ/5830.7/40 Report of Lost or Damaged MCCS MCCS IO-Dec-13

Property

MCIEAST-MCB CAMLEJ/MCCS/HQ/5830.7/41 Certificate of Counsel MCCS IO-Dec-13

9 Enclosure (1)

MCIEAST-MCB CAMLEJBUL 5213

f 1 DfC iun

MClEAST-MCB CAMLEJ/MCCS/EDU/P1560.11/1 Tuition Assistance Application Hecs 22-Feb-13 Form

MCIEAST-MCB CAMLEJ/MCCS/HR/12432.3/3 HeCS Employee Check Out Form NeCS 30-Jan-13

MCIEAST-MCB CAMLEJ/MCCS/HR/12432.3/4 MeCS Separation Form HeCS 30-Jan-13

MCIEAST-MCB CAMLEJ/MCCS/CDS/S Notification of Child's Illness Mecs 22-Feb-13

MCIEAST-HCB CAMLEJiMCCS/CDS/7 Infant Daily Activity Schedule HeCS 22-Feb-13

MCIEAST-MCB CAMLBJ/MCCS/CDS/9 Family Day Care Home (FDCH)

HeCS I-Mar-13 provider Application

MCIEAST-MCB CAMLEJ/MCCS/COMMUNITYREC/17 Resale Lot Authorization HeCS 2D-Dec-12

MClEAST-MCB CAMLEJ/MCCS/FDHP/l Data Call for Food & Hospitality HeCS 22-Feb-13

Division

MCIEAS'I:-MCB CAMLEJ/MCCS/FDHP/9 Special Events Vendor

MCCS 22-Feb-13 Certification of Gross Sales

MCIEAST-MCB CAMLEJ/MCCS/FDHP/IO Request For Sanitation Inspection MCCS 22-Feb-13

MCIEAST-MCB CAML8J/MCCS/MMCX/2 Recommendation for Time Off

MCCS 22-Feb-13 Incentive Award

MCIEAST-MCB CAMLEJ/MCCS/MMCX/9 MCCS Goals and Objectives MCCS 22-Feb-13

MCIRAST-MCB CAMLEJ/MCCS/SPORT!l Camp Lejeune Youth Sports

MCCS 22-Feb-13 Registration Form

MCIEAST-MCB CAMLEJ/MCCS/SPQRT/3 Youth Sports Uniform & Equipment

MCCS 22-Feb-13 Issue Record

MCIEAST-MCB CAMLEJ/MCCS/SPQRT/4 Special Request Form MCCS 2l-Mar-13

CAMLEJ/MCCS/SPORT/6 Youth Sports Application for 22-Feb-13 MCIEAST-MCB

Volunteers MCCS

MCIEAST-MCB CAMLEJ/MCCS/SPORT/7 Sports Branch-Camp Johnson Gym

MCCS lO-Dec-13 Request

Sports Branch-Outdoor Space MCIEAST-MCB CAMLEJ/MCCS/SPQRT!8 Request Forms-Gottage Memorial MCCS lO-Dec-13

Field House

MCIEAST MCB CAMLEJ/MCCS/SPORT/l6 youth Sports Participant Survey MCCS 22 Feb 13

MCIEAST-MCB CAMLEJ/MCCS/SPORT/18 Women's Intramural Softball Letter

MCCS 25-Jul-13 of Participation

MCIEAST-MCB CAMLEJ/MCCS/SPQRT/l9 Waiver of Liability and Assumption MCCS 25-Jul-13

of Risk Agreement for MCCS

MCIEAST-MCB CAMLEJ/MCCS/SPORT/20 Wage Garnishment Agreement MCCS 24-Jun-13

MCIEAST-MCB CAMLEJ/MCCS/OUTDOOR REC/l outdoor Adventures Picnic Areas MCCS lO-Dec-13

MCIEAST-MCB CAMLEJ/MCCS/OUTDOOR REC/2 outdoor Adventures Code Of MCCS lO-Dec-13

Conduct/Hold Harmless

MCIEAST-MCB CAMLEJ/MCCS/OUTDQOR REC/3 Outdoor Adventures Medical History

MCCS lO-Dec-13 Release Form

MCIEAST-MCB CAMLEJ/MCCS/FACM/l Building Inspection Checklist MCCS 22-Feb-13

MCIEAST-MCBCAMLEJ/MCCS/FACM/2 Vehicle Maintenance Inspection

MCCS 22-Feb-13 Form

MClEAST-MCB CAMLEJ/MCCS/ SFFB/l Semper Fit Personal Training

MCCS 22-Feb-13 Medical Release Form

MCIEAST-MCB CAMLEJ/MCCS/SFFB/2 CourtHouse Bay Climbing Wall MCCS 22-Feb-13 Acknowledgement ltr

MCIEAST-MCB CAMI.EJiMCCS/SFFB/3 safety, Policy, and Procedures for

MCCS 22-Feb-13 the Climbing Wall

MCIEAST-MCB CAMLEJ/MCCs/sFFB/4 Utilization of APF Command Support MCCS lO-Dec-13

Funds

MCIEAST-MCB CAMLEJ/MCCS/SFFB/18 Semper Fit Personal Training

MCCS 22-Feb-13 Health Questionnaire

10 Enclosure (1)

MCIEAST-MCB CAMLEJBUL 5213

3 7 DEC 2013:

MCIEA$T-MCB CAMLEJ/MCCS/SFFB/20 SACO Sample Needs Assessment MCCS 22-Feb-13

MCIEAST-MCB CAMLEJ/MCCS/SFFB/21 Semper Teen Program Application MCCS 22-Feb-13

MCIEAST-MCB CAMLEJ/MCCS/SFFB/6000.1/23 Risk Factor Assessment MCCS 22-Feb-13

MCIEAST-MCB CAMLEJ/NAVHOSP/OHPMU/6260.4/1 Hearing Conservation Application

NAVHOSP l-Aug-12 (SAMPLE)

MCIEAST-MCB CAMLEJ/NAVHOSP/OHPMU/6260.4/3 occupational Exposure Registry NAVHOSP l-Aug-12 (OER) Requirements (SAMPLE)

MCIEAST-MCB CAMLEJ/NAVHOSP/OHPMU/6260.4/4 Request for On site Audio Testing NAVHOSP 1-Aug-12 (SAMPLE)

MCIEAST-MCB CAMLEJ/SAFETY/l prescription Protective Eyewear SAFETY IS-Nov 13

MCIEAST-MCB CAMLEJ/SAFETY/5104.1/2 Authorization to Ship Radioactive SAFETY 15-Nov-13 Material

MCIEAST-MCB CAMLEJ/SAFETY/5104.1/3 Radioactive Material (RAMI SAFETY I5-Nov-13 Movement Form

MCIEAST-MCB CAMLEJ/SAFETY/5100.8/4 Confined Space Entry Permit SAFETY 15-Nov-13

MCIEAST-MCB CAMLEJ/SAFETY/5 Flammable/ Explosive Vapor Test

SAFETY 15-Nov-13 (SAMPLE)

MCIEAST-MCB CAMLEJ/SAFETY /9 User Incident Reporting Worksheet SAFETY 15-Nov-13

MCIEAST-MCB CAMLEJ/SAFETY/5104.1/10 RSO Incident Report Checklist SAFETY lS-Nov-13

MCIEAST-MCB CAMLEJ/SAFETY/5104.1/11 Radiation Safety Training Record SAFETY 15-Nov-13 for Females

MCIEAST-MCB CAMLEJ/SAFETY/5104.1/12 Letter Declaring Pregnancy SAFETY IS-Nov-13

MCIEAST-MCB CAMLEJ/SAFETY/SlO4.1/13 Radiological Controls Program SAFETY I5-Nov-13 Review Checklist

MCIEAST-MCB CAMLEJ/SAFETY/5100.2/14 Risk Assessment Worksheet SAFETY 15-Nov-13

MCIEAST-MCB CAMLEJ/SAFETY/5100.2/15 Seatbelt Use Acknowledgement SAFETY 1S-Nov-13 Statement

MCIEAST-MCB CAMLEJ/SAFETY/SI00.8/16 RPP Qualification and SAFETY 10-Dec-13 Certification Card

Request for Medical Clearance for MCIEAST-MCB CAMLEJ/SAFETY/5l00.8/17 Medical Respirator Use Medical SAFETY ll-Jun-13

Written Evaluation

Personal Record of Respirator MCIEAST-MCB CAMLEJ/SAFETY/5100.8/l8 Medical Clearance, Fit~Testing, SAFETY 17-Sep-13

and Training

MCIEAST-MCB CAHLEJ/SAFETY/5100.8/19 Fit Test Operator Evaluation Form SAFETY 17-Sep-13

MCIEAST-MCB CAHLEJ/SAFETY/SlOO.8/20 RPPM's Annual Respiratory SAFETY lO-Dec-13 Protection Program Audit

MCIEAST-MCB CAMLEJ/SAFETY/SI00.8/21 Weekly Respirator Inspection SAFETY 10-Dec-13

MCIEAST-MCB CAMLEJ/SAFETY/SlOO.8/22 voluntary Use Filtering Face Piece SAFETY 10-Dec-13 Respirator Card (RESTRICTED)

MClEAST-MCB CAMLEJ/SAFETY/5100.8/23 Cartridge Change out Schedule SAFETY 17-Sep-13 Worksheet

Permit Required Confined Space MClEAST-MCB CAMLEJ/SAFETY/5100.8/24 Entry Program Detector SAFETY l7-Sep-13

Calibration/Bump Test Log

MCIEAST-MCB CAMLJE/SAFETY/SlOO.8/2S Mandatory Hepatitis B Vaccination SAFETY lO-Dec-13 Declination Form

l-fCIEAST-HCB Cru{1EJ/SAFETY/5100.8/26 PRCS Program Review Checklist SAFETY lO-Dec-13

MCIEAST-MCB CAl-ffiEJ/SAFETY/5100.8/27 Job Hazard Analysis Worksheet SAFETY 17-Jun-l3

MCIEAST-HCB CAMLEJ/SAFETY/SlOO.8/28 Bloodborne pathogen Incident

SAFETY 10-Dec-13 Report

11 Enclosure (1)

MCIEAST-MCB CAMLEJBUL 5213

11 DEC 2013

MClEAST-MCB CAMLEJ/SAFETY/5100.8/29 Written Hazard Communication

SAFETY 17-Jun-13 Program Template

MCIEAST-MCB CAMLEJ/SES/HQ/2 SES Route Sheet SES 30-Apr-13

CAM LEJ/SES/FlRE/l EMSS Patient Discharge Information

SES 30-Apr-13 MCIEAST-HCB (RESTRICTED)

MCIEAST-MCB CAM LEJ/SES/FIRE/5 Apparatus Check sheet SES 30-Apr-13

MCIEAST-MCB CAM LEJ/SES/FIRE/6 Fire Extinguisher Service SES 30-Apr-13

MCIEAST-MCB CAMLEJ/SES/OPS/2 Request for Funeral Pass SES 25-Mar-13

MCIEAST-MCB CAMLEJ/SES/OPS/3 Request for VIP/Special Event Pass SES 25-Mar-13

MCIEAST-MCB CAMLEJ/SES/OPS/5 Request for Wedding Pass SES 25-Har-13

MCIEAST-MCB CAMLEJ/SES/PMO/l Notification Form/Checklist SES 25-Mar-13

MCIEAST-MCB CAMLEJ/SES/PMO/5500.1/2 Firearms Regulations

SES 10-Dec-13 Acknowledgement Letter

MCIEAST-MCB CAMLEJ/SES/PMO/3 Animal Redemption SES 25-Mar-13

MCIEAST-MCB CAMLEJ/SES/PMO/4 Request For Animal Trap SES 25-Mar-13

MCIEAST-MCB CAMLEJ/SES/PMO/6 Juvenile Miranda Rights SES I-May-13

MCIEAST-MCB CAMLEJ/SES/PMO/B PMO Vehicle Information Sheet SES 25-Mar-13

MCIEAST-MCB CAMLEJ/SES/PMO/9 Suspension of Base Privileges SES 25-Mar-13

MCIEAST-MCB CAMLEJ/SES/PMO/ll Serious Incident Report SES 25-Mar-13

MCIEAST MCB CAMLEJ/SES/PMO/12 Decal Action Sheet (RESTRICTED) SES 25 Mar 13

MCIEAST-MCB CAMLEJ/SES/PMO/15 Field Interview Card SES 25-Mar-13

MCIEAST-MCB CAMLEJ/SES/PMO/l7 Curfew Violation Notice SES 18-Sep-13

MCIEAST-MCB CAMLEJ/SES/PMO/lS Minor Offense Report (RESTRICTED) SES lS-Sep-13

MCIEAST-HCB CAMLEJ/SES/PMO/20 Lost/Stolen Cellular phone Report SES 18-Sep-13

MCIEAST-MCB CAMLEJ/SES/PMO/2l Field Sobriety Test Worksheet SES 18-Sep-13

MCIEAST-MCB CAHLEJ/SES/PMO/22 Vehicle Impound Slip SES 30-Apr-13

MCIEAST-MCB CAHLEJ/SES/PMO/23 Vehicle Impound Warning Slip SES IS-Sep-13

MCIEAST-MCB CAMLEJ/SES/PMO/24 Domestic Animal Control Citation

SES 30-Apr-13 (RESTRICTED)

MCIEAST-MCB CAMLEJ/SES/PMO/26 Temporary Vehicle Pass (RESTRICTED) SES 30-Apr-13

MCIEAST-MCB CAMLEJ/SES/PMO/27 suspected Banned Breed Form SES lO-Oct-13

HClEAST-MCB CAMLEJ/SES/PMO/28 Aggressive Dog/Animal Form SES lO-Oct-13

12 Enclosure (1)

HCIEAST-MCB CAMLEJBUL 5213

11 O£C 2013

MCIEAST-MCB CAMLEJ/SES/PMO/29 Service Dog Evaluation Sheet SES lO-Dec-13

MCIEAST-MCB CAMLEJ/SES/PMO/34 Non-Criminal Damage Report SES 30-Apr-13

MCIEAST-MCB CAMLEJ/SES/PMO/4450.4/36 Vehicle Storage Record SES 30-Apr-13

MCIEAST-MCB CAMLEJ/SES/PMO/37 Stray/Nuisance/Bite Report SES 30-Apr-13

MCIEAST-MCB CAMLEJ/SES/PMO/39 Vehicle Safety Inspection

SES 30-Apr-13 Checklist

MCIEAST-MCB CAM LEJ/SES/PMO/40 Third Party Traffic Violation SES 30-Apr-13 Reporting Form

MClEAST-MCB CAMLEJ/SES/PMO/I0570.1/41 Animal Pickup Authorization

SES 18-Sep-13 Certification Form

MCIEA$T-MCB CAMLEJ/SES/PHO/I0570.1/42 Letter for Seizure Destruction of SES l8-Sep-13 a Domesticated Animal

MCIEAST MCB CAMLEJ/SES/PMO/43 Information Exchange Slip SES 30-Apr 13

MCIEAST-MCB CAHLEJ/SES/PMO/5822.4/44 Physical Security Survey (SAMPLE) SES 30-Apr-13

MCIEAST-MCB CAMLEJ/SES/PMO/5822.4/45 Crime Prevention Survey SES 30 Apr 13 MCIEAST MCB CAMLEJ/SES/PMO/5500.3/46 Telephone Bomb Threat Checklist SES 30 Apr 13 MClEAST-MCB CAMLEJ/SES/PMO/55 Taxi Service Agreement SES 30 Apr 13

MCIEAST-MCB CAMLEJ/SES/PMO/5822.4/56 Crime Prevention Survey for SES 30-Apr-13 Businesses, Cash and Merchandise

MCIEAST-MCB CAMLEJ/SES/PMO/5822.4/57 Crime Prevention Survey Checklist SES 30-Apr-13 for Bachelor Enlisted Quarters

MCIEAST-MCB CAMLEJ/SES/PMO/58 Sponsorship Verification SES 30-Apr-13 Information

MCIEAST-MCB CAHLEJ/SES/9ll/1 Request and Security Agreement for SES 21-Feb-13 CrimQnal History Information

MCIEAST-MCB CAMLEJ/SJA/5760.l/2 Checklist for Non-Federal Entities SJA 23-Apr-13 and Informal Fund Activities

MCIEAST-MCB CAMLEJ/SJA/5760.1/3 Interview of Private Organizations SJA 23-Apr-13

Worksheet for Positions Required MCIEAST-MCB CAMLEJ/SJA/5370.11/30 to Provide a Financial Disclosure SJA 3-Jan-12

Worksheet

MCIEAST-MCB CAMLEJ/WTBN/l Training Area Request Form ""BN IO-Dec-13

MClEA$T-MCB CAMLEJ/WTBN/2 Fax Cover Sheet ""BN IO-Dec-13

HCIEAST-MCB CAMLEJ/WTBN/3 ""BN Route Sheet wrBN IO-Dec-i3

MCIEAST-MCB CAMLEJ/WTBN/4 WTBN Check In/out sheet ""BN IO-Dec-13 (RESTRICTED)

MCIEAST-MCB CAMLEJ/WTBN/5 ""BN Line Card (RESTRICTED) wrBN lO-Dec-13

MCIEAST-MCB CAMLEJ/WTBN/6 ""BN Pit Card (RESTRICTED) WTBN IO-Dec-13

MCIEAST-MCB CAMLEJ/WTBN/7 WTBN Score Card, Table Two wrBN IO-Dec-13 (RESTRICTED)

MCIEAST-MCB CAMLEJ/WTBN/9 Score Card, Table Three wrBN IO-Dec-13 (RESTRICTED)

MClEA$T-MCB CAMLEJ/WTBN/I0 Combat pistol Program Score Card wrBN lO-Dec-13

MCIEAST-MCB CAMLEJ/WTBN/11 COInbat Markmanship Coach Course

WTBU IO-Dec-13 Screening Checklist

MClRAST-HCB CAMLEJ/WTBN/12 Combat Markmanship Trainer Course WTBN lO-Dec-13

13 Enclosure (I)

MCIEAST-MCB CAMLEJBUL 5213

1 7 DEC 2013 CHECKLIST OF CANCELLED MCIEAST-MCB CAMLEJ FOru~S

IDENTIFIER TITLE SPONSOR

MClEAST-MCB CAMLEJ/CONT/4200.1/7 AO/CR Certification Statement CONT

Gen Notice of Drug Testing under DON Orug-MCIEAST-MCB CAMLEJ/G-1/CHRO-E/25 Free Workplace Program G-1

MCIEAST-MCB CAM LEJ/G-1/PERS/1320.12/7 Youth sponsorship ReqUest Form G-1

MCIEAST-MCB CAM LEJ/G-1/PERS/1320.12/8 Sponsorship Request Form G-1

MClEAST-MCB CAMLEJ/G-F/GEO/2 Web-Enabled Map Services Access Request Form G-F

MCIEAST-MCB CAMLEJ/G-F/EMO/12 RCRS pollution Abatement Service Ticket G-f

MCBCL/HQSPTBN/S-3/S Rif Qual MCCS

MCBCL/MCCS/SFFB/19 Beirut Memorial 10K Run/Walk MCCS

MCBCL/MCCS/MMCX/5 Uniform Alteration Authorization MCCS

MCBCL/MCCS/HR/2 Trip Report Format MCCS

MCIEAST-MCB CAMLEJ/MCCS/HQ/5760.2/29 Hold Harmless Agreement MCCS

Enclosure (2)