SF 2730-LSB (6-2006) Replaces (4-2005) Issue

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  Badge Office Fax #:     Date                                       
  844-4263                                                      

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# OUO

# SANDIA NATIONAL LABORATORIES (SNL) LOST/STOLEN BADGE REPORT

Badge Issued To: Report Completed By:

  -------------------------------- ----- --------------------------------
                                              /     

  Print Full Name                        Print Full Name/Title

                                         

  Social Security Number                 Signature

       ,                                      /     

  Badge Number and Contract Number       Employer/Dept. Number
  (if applicable)                        

                                              

                                         Phone Number (include area code)
  -------------------------------- ----- --------------------------------

This is notification that a Sandia National Laboratories badge has been:

  ----------- ------------- --------------- ---------------- ----------------
  Lost        Stolen        Confiscated     Unrecoverable    Forgotten

  ----------- ------------- --------------- ---------------- ----------------

+------------------------------+---+-----------------+-----------------+
| 1)  When was the last time   |   |                 |                 |
|     and date that you had    |   |                 |                 |
|     your SNL badge?          |   |                 |                 |
|                              |   |                 |                 |
| >                            |   |                 |                 |
|                              |   |                 |                 |
| 2)  Where was the last       |   |                 |                 |
|     physical location where  |   |                 |                 |
|     you had your SNL badge?  |   |                 |                 |
|                              |   |                 |                 |
| >                            |   |                 |                 |
|                              |   |                 |                 |
| 3)  How many times have you  |   |                 |                 |
|     lost your badge          |   |                 |                 |
|     (including this time)?   |   |                 |                 |
|     NOTE: This will be       |   |                 |                 |
|     verified through the SNL |   |                 |                 |
|     Badge Office System.     |   |                 |                 |
|                              |   |                 |                 |
| >                            |   |                 |                 |
|                              |   |                 |                 |
| 4)  What attempts have you   |   |                 |                 |
|     made to recover or       |   |                 |                 |
|     locate the badge?        |   |                 |                 |
|     (Please provide proof of |   |                 |                 |
|     these attempts such as   |   |                 |                 |
|     phone numbers of         |   |                 |                 |
|     contacts where you tried |   |                 |                 |
|     to locate badge or       |   |                 |                 |
|     registered letter        |   |                 |                 |
|     receipt so that theses   |   |                 |                 |
|     attempts can be          |   |                 |                 |
|     verified.)               |   |                 |                 |
|                              |   |                 |                 |
| >                            |   |                 |                 |
|                              |   |                 |                 |
| 5)  If your badge was        |   |                 |                 |
|     confiscated, what date   |   |                 |                 |
|     and time did this occur? |   |                 |                 |
|     Which Kirtland Air Force |   |                 |                 |
|     Base (KAFB) gate did     |   |                 |                 |
|     this occur? What was the |   |                 |                 |
|     name of the Security     |   |                 |                 |
|     Officer?                 |   |                 |                 |
|                              |   |                 |                 |
| >                            |   |                 |                 |
|                              |   |                 |                 |
| 6)  If you returned your     |   |                 |                 |
|     badge to your employer   |   |                 |                 |
|     or to a Sandia employee, |   |                 |                 |
|     what date/time was it    |   |                 |                 |
|     and who (specific        |   |                 |                 |
|     person) accepted your    |   |                 |                 |
|     badge?                   |   |                 |                 |
|                              |   |                 |                 |
| >                            |   |                 |                 |
|                              |   |                 |                 |
| 7)  If your badge was stolen |   |                 |                 |
|     please indicate where    |   |                 |                 |
|     the badge was stored     |   |                 |                 |
|     i.e., vehicle,           |   |                 |                 |
|     residence, purse,        |   |                 |                 |
|     briefcase, etc.          |   |                 |                 |
|                              |   |                 |                 |
| >                            |   |                 |                 |
|                              |   |                 |                 |
| 8)  Please describe in       |   |                 |                 |
|     detail the circumstances |   |                 |                 |
|     that led to the theft of |   |                 |                 |
|     the badge i.e., badge    |   |                 |                 |
|     stored in vehicle and    |   |                 |                 |
|     vehicle stolen from      |   |                 |                 |
|     driveway, residence      |   |                 |                 |
|     burglarized and badge    |   |                 |                 |
|     taken, badge stored in a |   |                 |                 |
|     briefcase and was taken  |   |                 |                 |
|     during a vehicle         |   |                 |                 |
|     burglary, etc.           |   |                 |                 |
|                              |   |                 |                 |
| >                            |   |                 |                 |
|                              |   |                 |                 |
| 9)  In addition to the       |   |                 |                 |
|     badge, list other items  |   |                 |                 |
|     that were taken.         |   |                 |                 |
|                              |   |                 |                 |
| >                            |   |                 |                 |
|                              |   |                 |                 |
| 10) Was a police report      |   |                 |                 |
|     filed? If so, please     |   |                 |                 |
|     provide the report       |   |                 |                 |
|     number and reporting     |   |                 |                 |
|     agency.                  |   |                 |                 |
|                              |   |                 |                 |
| >                            |   |                 |                 |
+------------------------------+---+-----------------+-----------------+
|                              |   |                 |                 |
+------------------------------+---+-----------------+-----------------+
| I understand that the        |   |                 |                 |
| credential is property of    |   |                 |                 |
| the U.S. Government, and     |   |                 |                 |
| that it is ***my             |   |                 |                 |
| responsibility*** to do      |   |                 |                 |
| everything possible to       |   |                 |                 |
| recover it as soon as        |   |                 |                 |
| possible. In the event the   |   |                 |                 |
| credential is recovered, I   |   |                 |                 |
| will return it to the Badge  |   |                 |                 |
| Office immediately.          |   |                 |                 |
+------------------------------+---+-----------------+-----------------+
|                              |   |                 |                 |
+------------------------------+---+-----------------+-----------------+
| Signature                    |   | Date            |                 |
+------------------------------+---+-----------------+-----------------+

**OUO**

  ------------- -------------- ------- -- ------------ ----------- -- ----------------------- ------------ ----------- -- -------------
  **BADGE                                                                                                                 
  OFFICE USE                                                                                                              
  ONLY**                                                                                                                  

                                                                                                                          

                Unclassified              Classified                  Contractor/Consultant                               Employee
                Visitor                   Visitor                                                                         

                                                                                                                          

  Lost/Stolen                  Q L S                   (**CIRCLE                              New Badge    Q L S TS FN    
  Badge Type:                  TS FN                   ONE**)                                 Type:        UC             
                               UC                                                                          (**CIRCLE      
                                                                                                           ONE)**         

                                                                                                                          

  Lost/Stolen                                                                                 New Badge                   
  Badge No.:                                                                                  No.:                        

  ***IT IS A                                                                                                              
  REQUIREMENT                                                                                                             
  THAT SIMP BE                                                                                                            
  NOTIFIED                                                                                                                
  IMMEDIATELY                                                                                                             
  UPON REPORTED                                                                                                           
  THEFT OF A                                                                                                              
  SECURITY                                                                                                                
  BADGE!***                                                                                                               
  ------------- -------------- ------- -- ------------ ----------- -- ----------------------- ------------ ----------- -- -------------

**NOTE:** Do not issue a replacement Security Badge until

all of the proceeding steps have been

accomplished:

-   Lost badge -- report must be completed in its entirety; notification
    to SIMP is not required.

-   Stolen badge -- report must be completed in its entirety.

-   If badge was stolen request a Police report and attach, if report is
    not readily available then request that the report is sent to SIMP
    ASAP.

-   Verbal contact with SIMP must be accomplished and **form must be
    faxed (845-0476)**. If a SIMP representative is not available, then
    a voice message must be left at which point a badge can be issued.

-   This form is not to be filed until an "Event number" is obtained
    from SIMP, which is specifically for tracking stolen badges.

  ---------------- ---------- ------- -------------- -- -- ------- -------- --------- ------- ------- ------- ---------- ------ ----------- ------ -- -- ------- ----------
                   SIMP                                            Badge                                                        FOR STOLEN                       
                   Notified                                        Office                                                       SECURITY                         
                                                                   Staff                                                        BADGES,                          

                                                                                                              Initials          PLEASE                           
                                                                                                                                ATTACH                           
                                                                                                                                POLICE                           
                                                                                                                                REPORTS                          

  Date:                                                                               Time:                                                                      

  Investigator's                                                                                                                POLICE                           
  Name:                                                                                                                         REPORT                           
                                                                                                                                OBTAINED:                        

                                                                                                                                                                 

  Pager:                              505-540-2382                                                                                          YES          NO      

  Fax:                                505-845-0476                          **EVENT                                                                              
                                                                            #:**                                                                                 

                                                                                                                                                                 
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