Security requirements check list #6

Security requirements check list #6 form English: (PDF, 877KB)

Contract number:

Security classification:

Part A: Contract information

1. Originating government department or organization:

2. Branch or directorate:

3a. Subcontract number:

3b. Name and address of subcontractor:

4. Brief description of work:

5a. Will the supplier require access to Controlled Goods?

Yes

5b. Will the supplier require access to unclassified military technical data subject to the provisions of the Technical Data Control Regulations?

Yes

6. Indicate the type of access required:

6a. Will the supplier and its employees require access to Protected and/or Classified information or assets?
(Specify the level of access using the chart in Question 7. c)

Yes

6b. Will the supplier and its employees (for example cleaners, maintenance personnel) require access to restricted access areas? No access to Protected and/or Classified information or assets is permitted.

Yes

6c. Is this a commercial courier or delivery requirement with no overnight storage?

Yes

7a. Indicate the type of information that the supplier will be required to access:

Canada

NATO

Foreign

7b. Release restrictions:

Canada for Release restrictions

No release restrictions for Canada Not Selected

Not releasable for Canada Not Selected

Restricted to for Canada

Specify country(ies) for Canada:

NATO for Release restrictions

All NATO countries for NATO Not Selected

Restricted to for NATO

Specify country(ies) for NATO:

Foreign for Release restrictions

No release restrictions for Foreign Not Selected

Restricted to for Foreign

Specify country(ies) for Foreign:

7c. Level of information:

Canada for Level of information

Protected A for Canada Selected

Protected B for Canada Not Selected

Protected C for Canada Not Selected

Confidential for Canada Not Selected

Secret for Canada Not Selected

Top Secret for Canada Not Selected

Top Secret (SIGINT) for Canada

NATO for Level of information Not Selected

NATO Unclassified Not Selected

NATO Restricted Not Selected

NATO Confidential Not Selected

NATO Secret Not Selected

COSMIC Top Secret for NATO

Foreign for Level of information Not Selected

Protected A for Foreign Not Selected

Protected B for Foreign Not Selected

Protected C for Foreign Not Selected

Confidential for Foreign Not Selected

Secret for Foreign Not Selected

Top Secret for Foreign Not Selected

Top Secret (SIGINT) for Foreign

8. Will the supplier require access to Protected and/or Classified COMSEC information or assets?

Yes

If yes, indicate the level of sensitivity:

9. Will the supplier require access to extremely sensitive INFOSEC information or assets?

Yes

Short title(s) of material:

Document number:

Part B: Personnel (supplier)

10. Personnel security screening level required :

Note

If multiple levels of screening are identified, a security classification guide must be provided.

Reliability status Not Selected

Confidential Not Selected

Secret

Top Secret Not Selected

Top Secret – SIGINT Not Selected

NATO Confidential Not Selected

NATO Secret Not Selected

COSMIC Top Secret Not Selected

Site access

Special comments:

10b. May unscreened personnel be used for portions of the work?

Yes

If yes, will unscreened personnel be escorted?

Yes

Part C: Safeguards (supplier)

Information / assets

11a. Will the supplier be required to receive and store Protected and/or Classified information or assets on its site or premises?

Yes

11b. Will the supplier be required to safeguard COMSEC information or assets?

Yes

Production

11c. Will the production (manufacture, and/or repair and/or modification) of Protected and/or Classified material or equipment occur at the supplier’s site or premises?

Yes

Information technology media

11d. Will the supplier be required to use its IT systems to electronically process, produce or store Protected and/or Classified information or data?

Yes

11e. Will there be an electronic link between the supplier’s IT systems and the government department or agency?

Yes

Note

For users completing the form manually use the summary chart below to indicate the category(ies) and level(s) of safeguarding required at the supplier’s site(s) or premises.

For users completing the form online (via the Internet), the summary chart is automatically populated by your responses to previous questions.

Summary chart: Protected

Summary chart: Protected
Category	A	B	C
Information / assets
Production
IT media
IT link

Summary chart: Classified
Category	Confidential	Secret	Top Secret
Information / assets
Production
IT media
IT link

Summary chart: NATO
Category	NATO Restricted	NATO Confidential	NATO Secret	COSMIC Top Secret
Information / assets
Production
IT media
IT link

Summary chart: COSMEC
Category	Protected A	Protected B	Protected C	Confidential	Secret	Top Secret
Information / assets
Production
IT media
IT link

12a. Is the description of the work contained within this SRCL Protected and/or Classified?

Note

If yes, classify this form by annotating the top and bottom in the area entitled “Security classification”.

Yes

12b. Will the documentation attached to this SRCL be Protected and/or Classified?

Note

If yes, classify this form by annotating the top and bottom in the area entitled “Security classification” and indicate with attachments (for example Secret with Attachments).

Yes

Part D: Authorization

13. Organization project authority:

Organization project authority Name (print):

Organization project authority Title:

Signature:

Organization project authority Telephone number:

Organization project authority Facsimile number:

Organization project authority Email address (yourname@domain.com):

Organization project authority Date (YYYY-MM-DD):

14. Organization security authority:

Name Organization security authority (print):

Organization security authority Title:

Signature:

Organization security authority Telephone number:

Organization security authority Facsimile number:

Organization security authority Email address (yourname@domain.com):

Organization security authority Date (YYYY-MM-DD):

15. Are there additional instructions (for example Security Guide, Security classification Guide) attached?

No Yes

16. Procurement officer:

Name Procurement officer (print):

Procurement officer Title:

Signature:

Procurement officer Telephone number:

Procurement officer Facsimile number:

Procurement officer Email address (yourname@domain.com):

Procurement officer Date (YYYY-MM-DD):

17. Contracting security authority:

Contracting security authority Name (print):

Contracting security authority Title :

Signature:

Digitally signed by Saumur, Jacques 0 Date: 2019.09.17 13:08:24 -04'0'0

Contracting security authority Telephone number:

Contracting security authority Facsimile number:

Contracting security authority Email address (yourname@domain.com):

Contracting security authority Date (YYYY-MM-DD):

Security classification:

Date modified:: 2020-07-28

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Security requirements check list #6

Part A: Contract information

Part B: Personnel (supplier)

Note

Part C: Safeguards (supplier)

Information / assets

Production

Information technology media

Note

Summary chart: Protected

Note

Note

Part D: Authorization