# Sample permission worksheet

Blank discussion aid. It is not an executed agreement or a grant of rights. Complete it with the authorized parties before the specified operation.

| Decision                                                       | Agreed value or unresolved question |
| -------------------------------------------------------------- | ----------------------------------- |
| Owner and authority to approve                                 |                                     |
| Named recipient or expressly approved confidential designation |                                     |
| Source and sample version                                      |                                     |
| Included systems, periods and fields                           |                                     |
| Exclusions                                                     |                                     |
| Specific inspection or model operation permitted               |                                     |
| Operations outside that permission                             |                                     |
| Processing environment and access controls                     |                                     |
| Transfer path                                                  |                                     |
| Outputs that may leave                                         |                                     |
| Retention and deletion conditions                              |                                     |
| Who approves a different use                                   |                                     |
| Preparation deliverable and effort limit                       |                                     |
| Performer, verifier, payer and change approver                 |                                     |
| Applicable document and approval evidence                      |                                     |

Do not insert live credentials, personal records or private identity maps. A completed worksheet belongs in the parties' controlled process; this blank worksheet does not submit anything to Rightmark.