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D11N Phase 2 Assignment to Duty Request Form
**Only the below listed Auxiliary Activities and activities that can be completed virtually are authorized in D11. For all other Auxiliary Activities a waiver must be routed to the D11 Prevention Division Chief for final approval determination.**
In accordance with Update 1 - D11 Novel Coronavirus (COVID-19) - D11 Auxiliary Awareness and Guidance (Phase 2) approved by District 11 Prevention Division Chief and Auxiliary COVID-19 Reconstitution Guidance put out by CG-BSX-1.
Tthe Following activities may be approved by the appropriate order issuing authority (OIA): Private Aids to Navigation Verifications, Marine Dealer/ RBS Program Visits, Telecommunications (site visits), Vessel Safety Checks, OPFAC Inspections and Proctoring.
The following activities may be completed under Phase 2 if requested and approved by the appropriate Order Issuing Authority (OIA): Operational missions, AUXCLERGY, Office work and other activities as specifically requested by an Active Duty unit.
In order to be assigned to duty for these activities you shall follow all personnel protective equipment and training requirements outlined in the two above mentioned documents. In addition every Auxiliarist participating in one of the approved activities must complete and submit (one time only) the Aux-COVID-19 High Risk Certification Form (BEFORE requesting assignment to duty) and submit it to the DIRAUX office mailto: D11AUXNorthern@uscg.mil in order to be considered for assignment to duty. A new Aux-COVID-19 High Risk Certification Form does not need to be submitted with each request for assignment to duty as long as the member states that the form has been submitted and there are no changes to the member’s status.
Flotilla Officers cannot authorize assignment to duty during Phase 2.
Due to current District Eleven policy prohibiting Active Duty members from commuting in uniform, Auxiliary members will only be authorized to wear an Aux polo and khakis or clean pants/shorts for approved activities unless specifically authorized in an approved Assignment to duty Request.
All approved activities are to be conducted individually unless otherwise noted specifically below or being conducted with a member of the same household or a member within their established COVID bubble.
All Assignment to Duty Request forms, Aux-COVID-19 High Risk Certification Forms and COVID bubble lists, if completing the assignment within the bubble, must be submitted to the appropriate DIRAUX office via the shared email inbox D11AUXNorthern@uscg.mil at least one week prior to the requested assignment to duty date. The DIRAUX Office will forward the request to the appropriate OIA.
A member may request assignments to duty for one activity for a week at a time. For example if an examiner would like to complete VSCs on Thursday, Friday and Saturday they may submit one request for all days one week in advance.
Member Name
*
First
Last
Member ID#
*
Email
*
Division and Flotilla
*
Example 06-05
Date Submitted: (at least 7 days prior to requested activity date :
*
MM
/
DD
/
YYYY
Event Date
*
MM
/
DD
/
YYYY
Days of event
*
Please select
1
2
3
4
5
6
Nature of request:
Please select
Land Based PATON Verification
No Contact Marine Dealer Visitation
Telecommunications site visits
Vessel Safety Checks
Test Proctoring
OPFAC Inspections
Additional Activity Options:
Operational mission requested by Active Duty
Please select
Watchstanding
AUXCHEF
Marine Inspections
AUXCLERGY
Other (list below)
List Other
Are you currently certified in Core Training and any competency required for requested mission?
*
Please select
Yes
No
Do you have a COVID 19 High Risk Assessment form on file (submitted to D11AUXNorthern@uscg.mil
*
Please select
Yes
No
Any changes to the Risk Assesment Form since filing?
*
Please select
Yes
No
Have you completed Blood Borne Pathogens Training (Course #100293) and provided a copy of course completion to the DIRAUX shared email?
Please select
Yes
No
N/A
Will this activity be completed with a COVID Bubble?
*
Please select
Yes
No
Has a Covid-19 Bubble Request Form been submitted to the DIRAUX Office?
(submitted to D11AUXNorthern@uscg.mil)
*
Please select
Yes
No
N/A
Covid-19 Bubble Nickname
Have there been any changes to members in the COVID Bubble since it was submitted?
*
Please select
Yes
No
N/A
Was this activity requested by an Active Duty Unit?
*
Please select
Yes
No
If Yes, which unit?
Have orders been submitted in AUXDATA II
Please select
Yes
No
N/A
Where will you be performing activity
*
Details of requested event, including expected duration, number of VSCs or PVs to be performed, and any other amplifying information to explain activity
*
By submitting this form you agree that you have reviewed the pertinent documents and certify that you understand the guidelines set forth for required PPE and will provide same at your expense.
*
Please select
Yes
No