COMMONWEALTH OF PENNSYLVANIA

DEPARTMENT OF HUMAN SERVICES, INSURANCE AND AGING

INFORMATION TECHNOLOGY PROCEDURE

Name Of Procedure:
Investigation Request Form Instructions / Number:
PRO-ENSS004
Domain: / Category:
Network & Privacy / Administrative Procedures
Date Issued: / Issued By:
05/28/2004 /

Sandra K. Patterson, CIO Bureau of Information Systems

Date Reviewed:
05/05/2017

General:

This document provides information to aid in the completion of the Investigation Request Form. The Investigation Request Form is intended for use when a supervisor or management suspects an employee of offensive E-Mail, unacceptable usage of the employee’s PC hard drive and/or possible internet abuse from a Commonwealth PC.

Investigation requests can only be submitted by management personnel. Requests are to the submitted to the Bureau of Information Systems, IT Security Policy Unit.

Procedure:

Investigation Request Form Instructions:

Requester / Supervisor Name
Requester E-Mail / Supervisor E-Mail Address
Requestor Phone / Supervisor Phone Number
Program Office / Program Office Name
Submission Date / Today’s Date
Employee Name / Last, First, Middle name of Employee to be investigated
Employee Type / Commonwealth Employee or Contractor?
Employee Network User ID / CWOPA User ID
Probation / Employee on Probationary Status? Yes or No
Counseled / Has Employee been counseled? Yes or No
Reprimanded / Has Employee been reprimanded? Yes or No
Type of Investigation / (Select one) E-Mail, Internet or PC Hard drive
Start Date / Date to start Internet investigation
End Date / Date to end Internet investigation
Justification / Be specific, describe the suspected abuse.
Send Completed Form to / PW,

Refresh Schedule:

All procedures and referenced documentation identified in this document will be subject to review and possible revision annually or upon request by the DHS Information Technology Standards Team.

Procedure Revision Log:

Change Date / Version / Change Description / Author and Organization
05/28/2004 / 1.0 / Initial Creation / Amy Way Worley
12/17/2004 / 1.0 / Reviewed / Doug Rutter
11/21/2007 / 1.1 / Reviewed, Reformatted / Doug Rutter
12/10/2008 / 2.0 / Reviewed, Reformatted / DTE, Policy Unit Staff
05/17/2010 / 2.1 / Updated contact information / Cliff VanScyoc
02/23/2011 / 2.2 / Reviewed content – No changes / Doug Rutter
05/05/2017 / 2.3 / Annual Update / John Miknich

Investigation Request Form Instructions Page 1 of 2