Appendix A Of Wvot-Pr1001 Form - West Virginia Department Of Transportation
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1Appendix A of WVOT-PR1001
Requesting a Technical Investigation of an Employee
**Sections 1 through 3 must be filled out by Supervisors or Managers Only**
Section 1
1. Supervisor or Manager Requesting Investigation ________________________________________
2. Title ______________________ 3. Agency_____________________ 4. Phone # _______________
Section 2
1. Name of Individual to be Investigated __________________________________________________
2. Email ____________________________________ 3. Userid _______________________________
Section 3
1. Purpose of Investigation or Suspected Violation (see 4.1.3 of WVOT-PR1001, attach additional
pages if necessary to explain)
2. Interval of Investigation From ___________________________ To: __________________________
3. Report Due Date ____________________________________________________________________
Section 4
This section must ONLY be filled out by a Cabinet Secretary, a Commissioner, an Office Director,
the Office of Special Investigations, or an Equivalent Authority:
1. Has the Technical Investigations procedure been read and understood? ___ Yes ___ No
2. Has the requestor provided sufficient information to initiate this investigation? ___Yes __ No
3. Does your Agency require Legal and/or Personnel approval for investigation actions? __Yes __No
4. If so, has this request been approved by your Agency Legal and/or Personnel Dept.? __Yes __No
5. (Print) Name_____________________________________ 6. Agency__________________________
7. Email _______________________________________ 8. Phone _____________________________
9. Signature ___________________________________________ 10. Date ______________________
This form must be forwarded to the Chief Information Security Officer (CISO) along with ALL supporting
documentation. Send by Fax: (304) 558-1351 OR Mail: Office of Technology, One Davis Square, 321 Capitol
Street, Charleston, WV 25301, Attn: CISO
Section 5 – ***Internal Use Only ***
1.Has the investigator verified the authorizing signature? ____ Yes ____ No
2. Signature of Investigator ______________________________________ 3. Date _______________
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