Public Works and Government Services Canada
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Effective measures to protect national security are only possible with knowledge of contacts or incidents involving representatives of other countries, both in and outside of Canada.
This report assists in the gathering of this essential information while relieving individuals of much of the responsibility and burden of reporting all such contacts or incidents in full. The completed forms are retained for assessments by the Industrial Security Program who may forward them to CSIS, DND, RCMP, and/or any other entity with a need-to-know, if this action is considered warranted in the interest of national security.
Entries should be made in the following circumstances:
Contact with Foreign National, Defense Attachés or Defense Advisers, other officials, or trade or business representatives from any country other than those that are part of NATO;
When contact with anyone seems persistent or unusual in any respect.
Entries should be made in respect of incidents or sightings which seem unusual in any respect or suggest that you have become the subject of harassment, surveillance, eavesdropping, unauthorized entry to your residence or office, or unusual interest by anyone, particularly officials or representatives of countries other than a NATO country.
Time, date – indicate if details are approximate
Location – please include address where contact or incident occurred if known
Details of the reporting individuals must be included along with those of all other persons present during the contact or incident; the names of any foreign nationals present should be spelled as accurately as possible to assist in identification but even phonetic approximations can be quite useful if shown as such. Nationalities, stated or apparent, should also be recorded.
Many occasions when contacts or incidents occur will include a combination of social, informal, official business or other encounters, but all elements should be indicated. Any additional relevant information can be attached to the form.
Similarly, virtually any conversation or discussion will range over a number of subjects but the general topic area should be recorded as possible including personal details disclosed by either party. Other details such as the circumstances that led to the contact or incident and the factors that made it noteworthy or unusual should be recorded.
Include as much information as possible. However, if any contact or incident is recognized as warranting a full report, please ensure you address all points and attach any relevant documentation.
Send to the Attention: Resolution of Doubt, Personnel Security Screening
Protected When Completed
Details of person filing the report
Contact initiated by (if known)
Details of contacts or security incident
Means of Contact:
Reason or occasion leading to this report:
Person filing the report
Please forward completed forms to the Industrial Security Program Attn: Chief, Resolution of Doubt, Personnel Security Screening
