TAGSIA.COM
OT Access Request Form
In accordance with IACS UR E27 Section 4.1 (IAM)
Doc ID: TAG-OT-SEP-01
Issue Date: Feb 2026
Rev: 1.0
Issue Date: Feb 2026
Rev: 1.0
1. APPLICANT DETAILS
| Full Name / Rank: | Company: | ||
| System to Access: | |||
2. JUSTIFICATION & SCOPE
| Purpose: Maintenance, Troubleshooting, Update, or Configuration Change? | |
| Access Level: Operator, Engineer (ETO), or Admin (OEM)? | |
| Duration: Estimated time required for the task? |
3. SECURITY ACKNOWLEDGMENT
I hereby acknowledge that I will follow the vessel’s Cyber Security Policy. I will not use unauthorized USB devices, will not connect the system to external networks unless authorized, and will report any security anomalies observed during my session.
Applicant Signature:
Date:
Authorized (ETO/Ch. Eng):
Stamp & Signature
