Mechanical Contract Inspection Report sample.pdf

PDF 784 KB Posted

Attached to
Student Support/Facilities Operation Maintenance Services Federal contract opportunity
Solicitation number
70LCHS25RPFB00001
Issued by
Department of Homeland Security Federal Law Enforcement Training Center

About this file

Written by GovTribe AI ·

This is GSA Form 3423 (Rev. 5/2010), a Mechanical Contract Inspection Report template used to document inspections of areas and equipment under mechanical contracts. The form allows inspectors to record inspection results by rating the condition of areas and equipment as either Satisfactory, Unsatisfactory, or Out of Service.

The form includes fields for building information, contract number, report number, inspector details, start/completion times, and contractor signatures. The main body contains columns for recording the location (mechanical area), equipment number, type of equipment, condition ratings, remarks, and initial/date. The form requires explanations in the remarks section for any unsatisfactory or out of service ratings. This is a blank template form that would be used during actual mechanical equipment inspections and does not contain any specific inspection data.

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CONDITION ( ✓ )

SATIS

FACTO

RY

OUT OF

SERVICE

MECHANICAL CONTRACT INSPECTION REPORT

CONTRACT NUMBERBUILDING

LOCATION

(Mechanical area)

EQUIPMENT

NUMBER

TYPE OF

EQUIPMENT

INITIAL

AND

DATE

REMARKS

STARTED

REPORT NUMBER

REVIEWED BY

COMPLETED

DATE

INSPECTION

INSPECTOR'S SIGNATURE

CONTRACTOR'S

RECEIPT

CONTRACTOR'S SIGNATURE

TIME DATE

UNSAT

ISFACT

ORY

GENERAL SERVICES ADMINISTRATION GSA 3423 (REV. 5/2010)

INSTRUCTIONS: This form will be used for the Inspection of areas and equipment under mechanical contracts by inspectors to record results. The condition of the area(s) and equipment will be rated SATISFACTORY, UNSATISFACTORY, or OUT OF SERVICE. Explain unsatisfactory or out of service rating in remarks.

INSPECTORS NAME (Print)

TIME

REMARKSUNSAT

ISFACT

ORY

TYPE OF

EQUIPMENT

EQUIPMENT

NUMBER

LOCATION

(Mechanical area)

INITIAL

AND

DATE

SATIS

FACTO

RY

OUT OF

SERVICE

GSA 3423 (REV. 5/2010) BACK

GSA 3423 - Mechanical Contract Inspection Report

\\iaimain\apps1\Pam_Ward\Logos\Pointer.jpg Image of a right arrow pointing to the Time Started field.

\\iaimain\apps1\Pam_Ward\Logos\Pointer.jpg Image of a right arrow pointing to the Contractor's Signature, Time, and Date fields for the Contractor's Receipt.

SATIS

FACTORY

OUT OF

SERVICE

MECHANICAL CONTRACT INSPECTION REPORT

CONTRACT NUMBER

BUILDING

LOCATION (Mechanical area)

EQUIPMENT NUMBER

TYPE OF EQUIPMENT

INITIAL

AND

DATE

REMARKS

STARTED

REPORT NUMBER

REVIEWED BY

COMPLETED

DATE

INSPECTION

INSPECTOR'S SIGNATURE

CONTRACTOR'S RECEIPT

CONTRACTOR'S SIGNATURE

TIME

DATE

UNSAT

ISFACTORY

GENERAL SERVICES ADMINISTRATION

GSA 3423 (REV. 5/2010)

INSTRUCTIONS: This form will be used for the Inspection of areas and equipment under mechanical contracts by inspectors to record results. The condition of the area(s) and equipment will be rated SATISFACTORY, UNSATISFACTORY, or OUT OF SERVICE. Explain unsatisfactory or out of service rating in remarks.

INSPECTORS NAME (Print)

TIME

CONDITION ( ✓ )

REMARKS

UNSAT

ISFACTORY

TYPE OF EQUIPMENT

EQUIPMENT NUMBER

LOCATION

(Mechanical area)

INITIAL

AND

DATE

SATIS

FACTORY

OUT OF

SERVICE

GSA 3423 (REV. 5/2010) BACK

BUILDING.:
REVIEWED BY.:
LOCATION (Mechanical area). LINE 3 OF 18. CONTINUED FROM PAGE 1.:
Enter the type of equipment for the second location, continued from page 1. :
Enter any remarks you may have especially if unsatisfactory or out of service was checked for the second location, continued from page 1. :
Enter the equipment number for the second location, continued from page 1. :
Enter your initials if you're the inspector for the second location, continued from page 1. :
REPORT NUMBER.:
CONTRACT NUMBER.:
INSPECTION.:
INSPECTORS NAME (Print).:
Enter the date the report was reviewed. Enter 2 digit month, 2 digit day and 4 digit year. :
CONTRACTOR'S RECEIPT. DATE OF SIGNATURE. Enter 2 digit month, 2 digit day and 4 digit year.:
If you're the inspector, enter the date you initialed for the second location, continued from page 1. Enter 2 digit month, 2 digit day and 4 digit year.:
Click here to mark the condition as satisfactory for the fourteenth location, continued from page 1. : 0
Click here to mark the condition as satisfactory for the fourteenth location, continued from page 1. : 0
Click here to mark the condition as unsatisfactory for the fourteenth location, continued from page 1. : 0
Click here to mark the condition as unsatisfactory for the fourteenth location, continued from page 1. : 0
Click here to mark the condition as out of service for the fourteenth location, continued from page 1. : 0
Click here to mark the condition as out of service for the fourteenth location, continued from page 1. : 0
Click here to mark the condition as out of service for the thirteenth location, continued from page 1. : 0
Click here to mark the condition as out of service for the thirteenth location, continued from page 1. : 0
Click here to mark the condition as unsatisfactory for the thirteenth location, continued from page 1. : 0
Click here to mark the condition as unsatisfactory for the thirteenth location, continued from page 1. : 0
Click here to mark the condition as satisfactory for the thirteenth location, continued from page 1. : 0
Click here to mark the condition as satisfactory for the thirteenth location, continued from page 1. : 0
Click here to mark the condition as satisfactory for the twelfth location, continued from page 1. : 0
Click here to mark the condition as satisfactory for the twelfth location, continued from page 1. : 0
Click here to mark the condition as unsatisfactory for the twelfth location, continued from page 1. : 0
Click here to mark the condition as unsatisfactory for the twelfth location, continued from page 1. : 0
Click here to mark the condition as out of service for the twelfth location, continued from page 1. : 0
Click here to mark the condition as out of service for the twelfth location, continued from page 1. : 0
Click here to mark the condition as out of service for the eleventh location, continued from page 1. : 0
Click here to mark the condition as out of service for the eleventh location, continued from page 1. : 0
Click here to mark the condition as unsatisfactory for the eleventh location, continued from page 1. : 0
Click here to mark the condition as unsatisfactory for the eleventh location, continued from page 1. : 0
Click here to mark the condition as satisfactory for the eleventh location, continued from page 1. : 0
Click here to mark the condition as satisfactory for the eleventh location, continued from page 1. : 0
Click here to mark the condition as satisfactory for the tenth location, continued from page 1. : 0
Click here to mark the condition as satisfactory for the tenth location, continued from page 1. : 0
Click here to mark the condition as unsatisfactory for the tenth location, continued from page 1. : 0
Click here to mark the condition as unsatisfactory for the tenth location, continued from page 1. : 0
Click here to mark the condition as out of service for the tenth location, continued from page 1. : 0
Click here to mark the condition as out of service for the tenth location, continued from page 1. : 0
Click here to mark the condition as out of service for the ninth location, continued from page 1. : 0
Click here to mark the condition as out of service for the ninth location, continued from page 1. : 0
Click here to mark the condition as unsatisfactory for the ninth location, continued from page 1. : 0
Click here to mark the condition as unsatisfactory for the ninth location, continued from page 1. : 0
Click here to mark the condition as satisfactory for the ninth location, continued from page 1. : 0
Click here to mark the condition as satisfactory for the ninth location, continued from page 1. : 0
Click here to mark the condition as satisfactory for the eighth location, continued from page 1. : 0
Click here to mark the condition as satisfactory for the eighth location, continued from page 1. : 0
Click here to mark the condition as unsatisfactory for the eighth location, continued from page 1. : 0
Click here to mark the condition as unsatisfactory for the eighth location, continued from page 1. : 0
Click here to mark the condition as out of service for the eighth location, continued from page 1. : 0
Click here to mark the condition as out of service for the eighth location, continued from page 1. : 0
Click here to mark the condition as out of service for the seventh location, continued from page 1. : 0
Click here to mark the condition as out of service for the seventh location, continued from page 1. : 0
Click here to mark the condition as unsatisfactory for the seventh location, continued from page 1. : 0
Click here to mark the condition as unsatisfactory for the seventh location, continued from page 1. : 0
Click here to mark the condition as satisfactory for the seventh location, continued from page 1. : 0
Click here to mark the condition as satisfactory for the seventh location, continued from page 1. : 0
Click here to mark the condition as satisfactory for the sixth location, continued from page 1. : 0
Click here to mark the condition as satisfactory for the sixth location, continued from page 1. : 0
Click here to mark the condition as unsatisfactory for the sixth location, continued from page 1. : 0
Click here to mark the condition as unsatisfactory for the sixth location, continued from page 1. : 0
Click here to mark the condition as out of service for the sixth location, continued from page 1. : 0
Click here to mark the condition as out of service for the sixth location, continued from page 1. : 0
Click here to mark the condition as out of service for the fifth location, continued from page 1. : 0
Click here to mark the condition as out of service for the fifth location, continued from page 1. : 0
Click here to mark the condition as unsatisfactory for the fifth location, continued from page 1. : 0
Click here to mark the condition as unsatisfactory for the fifth location, continued from page 1. : 0
Click here to mark the condition as satisfactory for the fifth location, continued from page 1. : 0
Click here to mark the condition as satisfactory for the fifth location, continued from page 1. : 0
Click here to mark the condition as satisfactory for the fourth location, continued from page 1. : 0
Click here to mark the condition as satisfactory for the fourth location, continued from page 1. : 0
Click here to mark the condition as unsatisfactory for the fourth location, continued from page 1. : 0
Click here to mark the condition as unsatisfactory for the fourth location, continued from page 1. : 0
Click here to mark the condition as out of service for the fourth location, continued from page 1. : 0
Click here to mark the condition as out of service for the fourth location, continued from page 1. : 0
Click here to mark the condition as out of service for the third location, continued from page 1. : 0
Click here to mark the condition as out of service for the third location, continued from page 1. : 0
Click here to mark the condition as unsatisfactory for the third location, continued from page 1. : 0
Click here to mark the condition as unsatisfactory for the third location, continued from page 1. : 0
Click here to mark the condition as satisfactory for the third location, continued from page 1. : 0
Click here to mark the condition as satisfactory for the third location, continued from page 1. : 0
Click here to mark the condition as satisfactory for the second location, continued from page 1. : 0
Click here to mark the condition as satisfactory for the second location, continued from page 1. : 0
Click here to mark the condition as unsatisfactory for the second location, continued from page 1. : 0
Click here to mark the condition as unsatisfactory for the second location, continued from page 1. : 0
Click here to mark the condition as out of service for the second location, continued from page 1. : 0
Click here to mark the condition as out of service for the second location, continued from page 1. : 0
Click here to mark the condition as satisfactory for the first location, continued from page 1. : 0
Click here to mark the condition as satisfactory for the first location, continued from page 1. : 0
Click here to mark the condition as unsatisfactory for the first location, continued from page 1. : 0
Click here to mark the condition as unsatisfactory for the first location, continued from page 1. : 0
Click here to mark the condition as out of service for the first location, continued from page 1. : 0
Click here to mark the condition as out of service for the first location, continued from page 1. : 0
Sign here if you're the contractor. :
If you're the contractor, enter the time you received and signed this inspection report. :
Click here to mark the condition as satisfactory for the eighteenth location, continued from page 1. : 0
Click here to mark the condition as unsatisfactory for the eighteenth location, continued from page 1. : 0
Click here to mark the condition as out of service for the eighteenth location, continued from page 1. : 0
Click here to mark the condition as out of service for the seventeenth location, continued from page 1. : 0
Click here to mark the condition as unsatisfactory for the seventeenth location, continued from page 1. : 0
Click here to mark the condition as satisfactory for the seventeenth location, continued from page 1. : 0
Click here to mark the condition as satisfactory for the sixteenth location, continued from page 1. : 0
Click here to mark the condition as unsatisfactory for the sixteenth location, continued from page 1. : 0
Click here to mark the condition as out of service for the sixteenth location, continued from page 1. : 0
Click here to mark the condition as out of service for the fifteenth location, continued from page 1. : 0
Click here to mark the condition as unsatisfactory for the fifteenth location, continued from page 1. : 0
Click here to mark the condition as satisfactory for the fifteenth location, continued from page 1. : 0

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