Ombudsman Reference Verification Sheet

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Enclosure (3) to COMDINST 1750.4D

Ombudsman Reference Verification Sheet

Use this form to verify reference checks for the ombudsman. It shall be maintained in the

Administrative file.

Reference Check # 1

Reference Name: _______________________________Date: ____________

Comments: _____________________________________________________

_______________________________________________________________

Verified by: _______________________

Reference Check # 2

Reference Name: _______________________________Date: ____________

Comments: _____________________________________________________

_______________________________________________________________

Verified by: _______________________

Reference Check # 3

Name: _________________________________________Date: ___________

Comments: _____________________________________________________

_______________________________________________________________

Verified by: _______________________

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