USMEPCOM Forms |
Description |
Date |
Type |
Size |
20-1-3-R-E |
Post IG Inspection Survey |
10/01/2013
|
PDF |
16 kb
|
20-1-4 |
USMEPCOM Inspector General Action Request |
04/01/2019
|
PDF |
15 kb
|
25-1-4 |
USMEPCOM Acceptable Use Policy |
11/01/2023 |
PDF |
192 kb |
25-1-7-E |
USMEPCOM Sanitization Validation Form |
06/01/2017 |
PDF |
957 kb |
25-50-4-E |
Record of Accountable Mail |
05/01/2016
|
PDF |
14 kb
|
25-50-6-E |
Mail Manager's Inspection Guide |
11/01/2007
|
PDF |
22 kb
|
25-50-9-E |
Justification for Next-Day Mail Service |
08/15/2023
|
PDF |
1.24 mb
|
25-50-10-E |
Quarterly Positive Accountability Postage Administration System (PAPAS) Report |
11/01/2007
|
PDF |
22 kb
|
25-50-11-E |
Official Mail Manager Weekly Inspection Log |
06/17/2013
|
PDF |
61 kb
|
25-51-2 |
Records Management Program Evaluation Checklist |
09/01/2017 |
PDF |
1454 kb |
25-52-1-R-E |
Privacy Act Information for Desk Top |
04/01/2005
|
PDF |
13 kb
|
37-1-E |
Daily Record of Civilian Medical Services |
05/01/1997
|
PDF |
24 kb
|
37-1-1-E |
Monthly Record of Civilian Medical Services |
05/01/1997
|
PDF |
456 kb
|
37-1-2-R-E |
Itemized Listing of Medical Services for Medical Examinations Public Vouchers |
10/01/2004
|
PDF |
46 kb
|
40-1-2-R-E |
Report of Medical Examination/Treatment |
07/01/2023
|
PDF |
208 kb
|
40-1-3 |
Report of Vision Information Changes |
02/01/2023 |
PDF |
297 kb |
40-1-4 |
MEPS Refractive Eye Surgery Work Sheet |
02/01/2023 |
PDF |
161 kb |
40-1-5 |
Consultation Contact Performance Report |
06/01/2016 |
PDF |
512 kb |
40-1-6 |
HCG Control Log |
06/01/2016
|
PDF |
1453 kb
|
40-1-8 |
Uri-Stix Control Log |
06/01/2016
|
PDF |
960 kb
|
40-1-11 |
Blood Pressure Measurement Worksheet |
04/01/2020 |
PDF |
224 kb |
40-1-12-E |
MEPS Fee Basis Provider Work Record |
03/01/2009
|
PDF |
14 kb
|
40-1-14-E |
CME Conference/Training After Action Report |
03/01/2009
|
PDF |
15 kb
|
40-1-15-E |
Supplemental Health Screening Questionnaire |
10/01/2019
|
PDF |
12 kb
|
40-1-18 |
Tattoos/Brands/Piercing/Ear Gauging/Scars/Birthmarks |
06/01/2016 |
PDF |
975 kb |
40-1-19 |
Operator Preventive Maintenance Medical and Nonmedical Equipment Checklist |
06/01/2021 |
PDF |
282 kb |
40-2-1-E |
Medical Provider Initial Application |
09/01/2014
|
PDF |
1626 kb
|
40-2-2-E |
Malpractice History and Status Questionnaire |
09/01/2014
|
PDF |
2033 kb
|
40-2-3-E |
Provider Clinical Assessment and Qualification |
10/01/2015
|
PDF |
1715 kb
|
40-2-4-E |
Contract Provider Quality Management Form |
10/01/2015
|
PDF |
838 kb
|
40-2-5-E |
CME Conference/Training After-Action Report |
09/01/2014
|
PDF |
900 kb
|
40-8-1-E |
Drug, Alcohol, and HIV Testing Acknowledgment form |
04/01/2017
|
PDF |
75 kb
|
40-8-2-E |
Breath Alcohol Analyzer Calibration Record |
11/21/2013
|
PDF |
1822 kb
|
40-8-3 |
Urine Sample Custody Document |
04/01/2023
|
PDF |
2.46 MB
|
40-8-7-R-E |
Facts About HIV **
|
06/01/2018
|
PDF |
|
40-8-12-E |
HIV Screening Record |
04/01/2023
|
PDF |
2.54 MB
|
40-8-13-E |
HIV Indeterminate or Positive Processing Checklist |
11/21/2013
|
PDF |
1967 kb
|
40-8-14-E |
Release of Medical Information |
11/01/2009
|
PDF |
1085 kb
|
40-8-15-E |
HIV POSITIVE Initial Notification Counseling Checklist |
12/02/2013
|
PDF |
1085 kb
|
40-8-16-E |
HIV Notification Counseling Checklist |
11/21/2013
|
PDF |
11 kb
|
40-8-18-E |
Facts About HIV Indeterminate |
11/21/2013
|
PDF |
20 kb
|
40-8-19-E |
HIV Indeterminate Initial Notification Counseling Checklist |
11/21/2013
|
PDF |
594 kb
|
40-8-20-E |
HIV/DAT Testing Control Log |
11/21/2013
|
PDF |
890 kb
|
40-8-22-E |
Label Disposal Log |
10/01/2013
|
PDF |
887 kb
|
40-9-1-R-E |
Hepatitis B Vaccination Declination |
03/01/2004
|
PDF |
888 kb
|
40-9-2-R-E |
Viral Testing Consent |
03/01/2004
|
PDF |
1381 kb
|
40-9-3-R-E |
Sharp Injury Record |
03/01/2004
|
PDF |
8 kb
|
40-9-5-E |
Refrigerator Temperature Log |
12/17/2012
|
PDF |
1072 kb
|
350-1-1 |
Unit Training Schedule |
03/01/2016
|
PDF |
1.14 mb
|
350-1-2 |
Training Development Division Request for Support |
04/01/2014
|
PDF |
8 kb
|
350-1-3-R |
Run/Walk for Your Life Program - Entry Request |
12/01/1998
|
PDF |
11 kb
|
350-1-4 |
Record of Individual Training |
08/01/2007
|
PDF |
87 kb
|
350-1-5 |
Annual Training Plan |
08/01/2000
|
PDF |
19 kb
|
350-1-15 |
Training Attendance Roster |
04/16/2012
|
PDF |
126 kb
|
360-1-2-R-E |
Name, Photograph and Recording (Video/Audio) Release |
02/01/1999
|
PDF |
11 kb
|
380-1-1-E |
MEPS Annual Physical Security Questionnaire |
04/01/2013
|
PDF |
597 kb
|
380-1-2-E |
Blue Dart Report |
04/01/2013
|
PDF |
662 kb
|
385-1-1-E |
Deficiency Log |
04/01/2013
|
PDF |
39 kb
|
385-1-2-E |
USMEPCOM Deficiency Notice |
04/01/2013
|
PDF |
590 kb
|
420-3-1-R-E |
Facility Work Request, |
01/01/2006
|
PDF |
23 kb
|
420-3-2-R-E |
Above Standard Service Requirements |
01/01/2006
|
PDF |
19 kb
|
570-3-1 |
Headquarters/Sector Personnel Strength Feeder Report |
05/01/2018
|
PDF |
2380 kb
|
570-3-2 |
MEPS Personnel Strength Feeder Report** |
05/01/2018
|
PDF |
|
570-3-3 |
USMEPCOM Management Review Board Request Form |
08/01/2023
|
PDF |
2.58 mb
|
600-25-1-E |
USMEPCOM Award Nomination |
02/01/2016
|
PDF |
1.96 mb
|
600-25-2-E |
Spirit Certificate of Volunteer Recognition |
07/01/2014
|
PDF |
1875 kb
|
600-25-3-E |
Liberty Certificate of Volunteer Recognition |
07/01/2014
|
PDF |
1875 kb
|
600-25-4-E |
Freedom Certificate of Volunteer Recognition |
07/01/2014
|
PDF |
1875 kb
|
600-25-5-E |
Teamwork Certificate |
10/01/2010
|
PDF |
86 kb
|
600-25-6-E |
Certificate of Appreciation |
10/01/2010
|
PDF |
1996 kb
|
600-25-7-E |
Certificate of Achievement |
10/01/2010
|
PDF |
86 kb
|
601-4-R-E |
Student Test Answer Sheet Discrepancy List |
04/01/2024
|
PDF |
104 kb
|
601-4-2-R-E |
Processing and Distribution Control Record |
02/01/2024
|
PDF |
1.29 mb
|
601-4-3-E |
Student ASVAB Test Record |
01/01/2024
|
PDF |
1071 kb
|
601-4-4-R-E |
Receipt of Armed Services Vocational Aptitude Battery (ASVAB) Booklets |
07/01/2005
|
PDF |
10 kb
|
601-4-5-R-E |
Student Testing Database Maintenance Form |
02/01/2024
|
PDF |
668 kb
|
601-4-6-R-E |
Centers of Influence (COI) Event Fund Cite Request |
07/01/2005
|
PDF |
11 kb
|
601-4-7-R-E |
Centers of Influence (COI) Event After-Action Report |
07/01/2005
|
PDF |
10 kb
|
601-4-11-R-E |
Educational Staff Agreement |
02/01/2020
|
PDF |
1164 kb
|
601-4-12-R-E |
Educational Staff Agreement for Voluntary Services |
07/01/2005
|
PDF |
10 kb
|
601-4-13-R-E |
State/Local Marketing Event - Funding Request |
02/01/2024
|
PDF |
1.28 mb
|
601-4-14-R-E |
Professional Organizational Membership Reimbursement Request |
07/01/2005
|
PDF |
10 kb
|
601-4-15-E |
Proctor Support Form |
07/01/2005
|
PDF |
13 kb
|
611-1-R-E |
ASVAB Test Loss Compromise Telephone Report |
12/04/2013
|
PDF |
10 kb
|
611-1-2-R-E |
Unverified Test Scores (Single Applicant) |
12/04/2013
|
PDF |
10 kb
|
611-1-1-R-E |
Inventory of Accountable Test Material |
05/31/2022
|
PDF |
2024 kb
|
611-1-1-i |
Inventory of Accountable Test Material Instructions |
05/31/2022 |
PDF |
54.7 kb |
611-1-6-R-E |
MET Site Cost Analysis |
12/01/2016
|
PDF |
72 kb
|
611-1-7-R-E |
Aptitude Testing Processing List |
06/01/2006
|
PDF |
13 kb
|
611-1-8-R-E |
Inventory of MEPS Accountable Test Material |
05/01/2003
|
PDF |
9 kb
|
611-1-9-R-E |
Daily Inventory Log |
12/04/2013
|
PDF |
11 kb
|
611-1-11-R-E |
Statement of Disposition of Test Materials ** |
05/31/2022
|
PDF |
2416 kb
|
611-1-14-I-R-E |
MET Site TA Review (ICAT) |
08/01/2017
|
PDF |
1900 kb
|
611-1-14-P-R-E |
MET Site TA Review (Paper and Pencil) |
08/01/2017 |
PDF |
1899 kb |
611-1-18-E |
Military Entrance Test Site Update |
12/04/2013
|
PDF |
13 kb
|
611-1-19-R-E |
MET Site Accountable Material Checklist for Test Administrators |
12/01/2005
|
PDF |
22 kb
|
611-1-21 |
Applicant High School Pull Request |
10/01/2020 |
PDF |
2929 kb |
690-13-1-R-E |
Overtime Request and Authorization |
05/01/2000
|
PDF |
1394 kb
|
690-13-2-E |
Request for Alternative Work Schedule (AWS)** |
12/01/2011
|
PDF |
825 kb
|
690-13-4-E |
Personnel Processing Checklists |
03/01/2015
|
PDF |
1481 kb
|
690-13-5-E |
USMEPCOM Time and Attendance Record Sheet |
12/12/2012
|
PDF |
19 kb
|