DA Form 4664-1-r Tempest Inspection Report Supplement - Facility Profile

DA Form 4664-1-r or the "Tempest Inspection Report Supplement - Facility Profile" is a Department of the Army-issued form used by and within the United States Military.

The form - often incorrectly referred to as the DD form 4664-1-r - was last revised on June 1, 1983. Download an up-to-date fillable DA Form 4664-1-r down below in PDF-format or look it up on the Army Publishing Directorate website.

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TEMPEST INSPECTION REPORT SUPPLEMENT - FACILITY PROFILE
For use of this form, see TB 380-7; the proponent agency is INSCOM.
SERVICE TIMES
FACILITY NAME
FIN
DATE OF INSPECTION
TVL:
P & RW:
ONSITE:
SECTION I - PTSI DATA
VI - VALUE OF INTELLIGENCE
PA - PROBABILITY OF ACCESS
IE - INSPECTOR'S ESTIMATE
100
SCI =
POST:
OPEN
CLOSED
CIV
TS =
CEM YES OR PROBABLE
%
S =
%
COUNTRY:
US
ALLIED
%
C =
CEM NO OR NOT PROBABLE
VI TOTAL
COMMUNIST
NEUTRAL
PTSI =
SECTION II - PHYSICAL DATA
FACILITY CONTROLLED SPACE PERIPHERY IS:
WALLS, FLOOR, CEILING OF FACILITY
SECURITY FENCE OF CLOSED POST
WALLS, ROOF OF BUILDING HOUSING FACILITY
UNLIMITED DUE TO UNDERGROUND LOCATION
SECURITY FENCE AROUND BUILDING OR FACILITY
OTHER (Specify)
ACCESS TO CONTROLLED SPACE IS:
SECURITY GUARD CONTROLLED
EMPLOYEE CONTROLLED
LOCK CONTROLLED
OTHER (Specify):
FACILITY IS ENCLOSED BY:
SHIELD OF:
IRON/STEEL
FOIL
LAMINATED/ARMORED PANELS
CONDUCTIVE PAINT
BASIC CONSTRUCTION OF:
MASONRY
WOOD
METAL
OTHER (Specify)
SECTION III - EXCEPTION OPERATION DATA
N/A
REQUEST PENDING
APPROVED, DATE:
BY (MACOM):
SECTION IV - EQUIPMENT RADIATION DATA
KEYING-SIGNALING
TEMPEST APPROVED
CEM PROBABILITY
RED PROCESSORS NAME/NOMENCLATURE
HIGH
LOW
YES
NO
ERTZ
CS
YES
NO
DA FORM 4664-1-R, JUN 1983
APD LC v1.00
TEMPEST INSPECTION REPORT SUPPLEMENT - FACILITY PROFILE
For use of this form, see TB 380-7; the proponent agency is INSCOM.
SERVICE TIMES
FACILITY NAME
FIN
DATE OF INSPECTION
TVL:
P & RW:
ONSITE:
SECTION I - PTSI DATA
VI - VALUE OF INTELLIGENCE
PA - PROBABILITY OF ACCESS
IE - INSPECTOR'S ESTIMATE
100
SCI =
POST:
OPEN
CLOSED
CIV
TS =
CEM YES OR PROBABLE
%
S =
%
COUNTRY:
US
ALLIED
%
C =
CEM NO OR NOT PROBABLE
VI TOTAL
COMMUNIST
NEUTRAL
PTSI =
SECTION II - PHYSICAL DATA
FACILITY CONTROLLED SPACE PERIPHERY IS:
WALLS, FLOOR, CEILING OF FACILITY
SECURITY FENCE OF CLOSED POST
WALLS, ROOF OF BUILDING HOUSING FACILITY
UNLIMITED DUE TO UNDERGROUND LOCATION
SECURITY FENCE AROUND BUILDING OR FACILITY
OTHER (Specify)
ACCESS TO CONTROLLED SPACE IS:
SECURITY GUARD CONTROLLED
EMPLOYEE CONTROLLED
LOCK CONTROLLED
OTHER (Specify):
FACILITY IS ENCLOSED BY:
SHIELD OF:
IRON/STEEL
FOIL
LAMINATED/ARMORED PANELS
CONDUCTIVE PAINT
BASIC CONSTRUCTION OF:
MASONRY
WOOD
METAL
OTHER (Specify)
SECTION III - EXCEPTION OPERATION DATA
N/A
REQUEST PENDING
APPROVED, DATE:
BY (MACOM):
SECTION IV - EQUIPMENT RADIATION DATA
KEYING-SIGNALING
TEMPEST APPROVED
CEM PROBABILITY
RED PROCESSORS NAME/NOMENCLATURE
HIGH
LOW
YES
NO
ERTZ
CS
YES
NO
DA FORM 4664-1-R, JUN 1983
APD LC v1.00
SECTION V - SEPARATION DATA
Is minimum required separation maintained between RED equipment, RED power lines, RED signal lines, and the
following as prescribed by the separation table (Figure C-2 or C-3, TB 380-7, as applicable)?
MINIMUM SEPARATION
CEM PROBABILITY
POTENTIAL CONDUCTORS/RADIATORS
YES
NO
N/A
YES
NO
BLACK CRYPTO AND ANCILLARY UNITS
BLACK EQUIPMENT
BLACK POWER LINES
BLACK SIGNAL LINES
FORTUITOUS CONDUCTORS
BLACK TELEPHONE SYSTEMS
CONTROLLED SPACE PERIPHERY
RF TRANSMITTERS
PART VI - INSTALLATION DATA
CONDUCTOR
CABLE
GROUNDS:
ISOLATION,
CEM
SHIELDING
SIGNAL,
DECOUPLING
PROBA-
OR
POWER,
POTENTIAL CONDUCTORS/RADIATORS
REMARKS
OR
BILITY
CONDUIT
SHIELDING
FILTERS
YES
NO
YES
NO
YES
NO
YES
NO
RED EQUIPMENT
BLACK EQUIPMENT
RED SIGNAL LINES
BLACK SIGNAL LINES
RED POWER
BLACK POWER
BLACK TELEPHONE SYSTEM
FORTUITOUS CONDUCTORS
SHIELDED ENCLOSURES
GENERAL REMARKS/FACILITY DIAGRAM
APD LC v1.00
Reverse of DA Form 4664-1-R, Jun 1983

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