Annual Security Appraisal Form
FOR MANAGERS OF NATIONAL SECURITY CLEARANCE HOLDERS
Completing this form is a mandatory part of the management process for all national security clearance holders. If a clearance
holder’s line manager is not available or unable to comment, another manager with adequate knowledge of the clearance holder
should complete this form.
If your organisation shares a clearance, the sharing agreement between organisations determines who completes the assessment.
This form must be completed every year, either on the anniversary date of the security clearance or at a date your organisation chooses.
This section to be completed by security team or chief security officer prior to sending out.
Reference number
Date:
Reporting Period
Manager details
Line managers name (may or may not work for
the sponsoring organisation)
Job title
Organisation
Clearance holders name
Holder’s clearance level
Details about the clearance holder
Please answer the following questions about the clearance holder to the best of your ability. If any of your responses are adverse,
expand on your response as necessary in the space provided.
1. Are you aware of the clearance holder having access to classified information?
(CONFIDENTIAL, SECRET, or TOP SECRET)
Yes Give details below
No Go to question 2.
a. What was the highest classification of information they accessed?
b. How often did they access classified information?
2. Are you satisfied with the clearance holder’s attitude to security?
Yes Go to question 3.
No Give details below.
[ Insert classification here ]
[ Insert classification here ]
Managers full name
Managers full name
Organisation
Clearance holder
Confidential
Confidential
Frequency
Reference number
dd/mm/yyyy
dd/mm/yyyy
dd/mm/yyyy
3. Does the clearance holder abide by your organisation’s security policies?
For example, policies for IT systems and access controls.
Yes Go to question 4.
No Give details below.
4. Are you aware of any grounds for doubting the clearance holder’s suitability for
continued access to classified information, assets, or work locations?
Yes Give details below.
No Go to question 5.
5. In the past year, has the clearance holder informed you of any significant changes in
their personal circumstances?
Yes Give details below.
No Go to question 6.
6. How often do you have contact with the clearance holder outside work hours?
Often
Occassionally
Not at all
7. Do you have any security concerns about the clearance holder which should be
discussed with the chief security officer?
Yes
No
Do you have any further comments?
Once you have completed this form, email a copy of this form to [enter details of form here].
[ Insert classification here ]
[ Insert classification here ]
Provide details here
Provide details here
Provide details here
Managers comments
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