Whs Form 2 - Staff Summary Sheet
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3STAFF SUMMARY SHEET
TO
ACTION
SIGNATURE AND DATE
TO
ACTION
SIGNATURE AND DATE
Coord
Chief, DD
7
1
DD, ESD
Coord
8
2
Dir, ESD
Coord
9
3
DA ODCMO Signature
10
4
11
5
12
6
13. ACTION OFFICER
14.OFFICE SYMBOL
15. TELEPHONE
16. CONTROL NUMBER
[leave blank]
17. SUBJECT
18. DATE
Request for DD Form 106 Signature for DoD [Type] #, "Title"
19. SUMMARY
1. The attached issuance (TAB A) [insert purpose of issuance].
2. This issuance was internally coordinated, comments from the [insert offices] were adjudicated, and changes were made to the
issuance as appropriate. The [insert offices] concur without comment. The consolidated comments matrix is at TAB B.
3. Copies of the issuance were provided to [insert offices], but they did not respond.
4. [Only necessary if you got a legally objectionable review] The Office of the General Counsel of the Department of Defense
declared this issuance "not legally objectionable." Any required legal changes were made to the issuance.
5. The list of coordinating officials is at TAB C.
RECOMMENDATION: Sign the attached DD Form 106 to initiate external coordination and return to ESD/DD for placement on
the Directives Portal.
[Name of your director or his or her deputy]
[Official's title]
Attachments:
As stated
WHS FORM 2, FEB 2017
Adobe Professional 11
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