GSA Form 1181A EXAMPLE.docx
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GSA Form 1181A – Contract Cleaning Inspection Report
This form shall be filled out and submitted to the Contractor when deficiencies are found during the COR's inspections.
This form can be found at: GSA Insite/Financial Transactions/GSA Forms Library
CONTRACT CLEANING INSPECTION REPORT
INSTRUCTIONS: Form is used for inspection of contract cleaning by inspectors to record results. The condition of area(s) inspected will be rated SATISFACTORY or UNSATISFACTORY. Explain unsatisfactory rating in remarks column and complete quantity column.
| BUILDING | Report NO. | CONTRACT NO. | |
| 450 Golden Gate | GS-09-06-KSD-0000 |
INSPECTOR (Print Name) INSPECTOR'S SIGNATURE
JOHN DOE
| TIMED STARTED | TIME COMPLETED | DATE OF INSPECTION | ||||
| 9:00 A.M. | 10:50 A.M. | 10/31/06 | ||||
| INTERVIEWED BY | DATE CONTRACTOR'S RECEIPT TIME | DATE | ||||
| MS. DEE | 11/01/06 | sup. signature | 1:00 p.m. 11/01/06 | |||
| WORK DESCRIPTION – LOCATION QUANTITY CHECK ONE | REMARKS |
(Room No., Corridor, lobby, or either) SAT. UNSAT.
By Measure or count .
3rd Floor East
| M3-5171 | X | Rust on toilet base under bolt | of toilet | |
| 3-5178 | X |
Women's Public Restroom X Men's Public Restroom
| -M-7665 | X | Slight build up in corners of | urinal | ||
| Drinking Fountains | X | Mineral Build up |
-1st near room 1-5566
GENERAL SERVICES ADMINISTRATION GSA FORM 1181A
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