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TAGSIA.COM
Media & Device Authorization
Third-Party Connectivity & Liability Waiver (IACS UR E26)
Doc ID: TAG-OT-SEP-03
Issue Date: Feb 2026
Rev: 1.1
Issue Date: Feb 2026
Rev: 1.1
1. TECHNICIAN / SERVICE PROVIDER DETAILS
| Full Name: | Date: | ||
| Company: | Work Order #: |
2. REGISTERED DEVICES & MEDIA
List all laptops, USB drives, or field communicators intended for connection to Vessel OT.
| Device Type | S/N or Asset Tag | Target System (AMS/NAV/etc) | “Sheep Dip” Scan? |
|---|---|---|---|
| YES | |||
| YES | |||
| YES |
3. DECLARATION OF COMPLIANCE
By signing below, the Service Provider/Technician confirms:
- All listed devices have been scanned for malware within the last 24 hours.
- No unauthorized “hotspots” or wireless bridges will be connected to OT networks.
- The Service Provider assumes full liability for any operational downtime or damage resulting from the introduction of malicious code.
- Temporary file transfers will be deleted from the host machine upon task completion.
Service Technician:
Signature & Date
Authorized Vessel Officer:
Stamp, Signature & Date
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