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Retirement Planner Clear, Purge, Destroy Blank certificate Disposal Ledger Pricing About
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Blank Certificate of Sanitization

Every field of the sample certificate in NIST SP 800-88r2, Appendix C, on one printable page. Fill it in by hand, or keep records in the Disposal Ledger and print them already filled in.

Certificate of Sanitization

Fields follow the sample form in NIST SP 800-88r2, Appendix C

Ref. ________

Person performing sanitization

Name
Title
Organization
Location
Phone
Email

Media information

Vendor / make
Media type
Model number
Serial number
Property number
Source
Classification
Operational / damaged

Sanitization details

Sanitization method Clear Purge Destroy

Sanitization technique
Tools used (include version)
Verification / status
Validation
Notes
Date sanitized

Media destination / disposition

Internal reuse External reuse Recycling facility Manufacturer Other

Details

Signature

I attest that the information provided on this statement is accurate to the best of my knowledge.

SignatureDate

Concurrence

Name
Title
Organization
Location
Phone
Email
SignatureDate