TSC YEAR-FILE NO./REPEAT EXAM # STATE
EXAMPLE

TSC 03-001/1 GA
TECHNICAL SURVEILLANCE COUNTERMEASURES
SURVEY

1. On (Date), representatives of Technical Security Consultants Inc. conducted a comprehensive Technical Surveillance Countermeasures (TSCM) Survey of (Name and address of organization, title or name , building number, room number of each area checked). This service was accomplished by (Names of persons performing the TSCM service).
   (Fill in underlined areas with appropriate information.)
2. The survey consisted of a Radio Frequency (RF) spectrum evaluation covering the frequency range from 2 KHz to 1.6 GHz. All signals encountered were evaluated for their AM, FM, Video and sub-carrier composition. An electronic examination was performed on the telephone lines and all telephones were physically examined for the presence of unauthorized devices. A physical examination was performed.
3. Within the limits of the equipment and the capabilities of the specialist performing the survey, no indications of transmitting or surreptitious listening devices were noted or located.
4. Several items of a security hazard nature were noted and are described in attachment 2.
5. Mr. (or Mrs.) was briefed on the results of this survey.

Attachment 1
Scope and Limitations

1. During the performance of this Technical Surveillance Countermeasures survey, the following evaluations were performed:
   1. A radio frequency (RF) examination of the frequency spectrum from 2 KHz to 1.6 GHz. These RF signals were examined to insure that any AM, FM, SSB, video or sub carrier signals detected were valid commercial or private signals and that they did not originate from within the area serviced.
   2. An electronic examination of the telephone(s) and lines to detect any audio which would indicate an unauthorized listening device or modification to the telephone instrument.
   3. A thorough electronically enhanced physical examination in and about the area to detect any non operational or operational devices, as well as to detect any physical security weaknesses which could provide an avenue of access to the serviced area from an area of lesser security.
   4. A check for structure borne audio and excess wiring which might provide a fortuitous avenue of attack.
2. The technical surveillance countermeasures survey performed was intended to draw conclusions only pertaining to the service(s) performed and cannot be relied upon to disclose procedural irregularities or illegal acts committed by persons authorized or having access to the serviced area(s). The overall effectiveness of the examination(s) performed may be impacted by the existing technical limitations imposed by the equipment, time constraints and the degree of confidentiality afforded by you.

TSC 90-043/2 AZ
Attachment 2
Findings and Recommendations
FINDING:
RECOMMENDATION 1: