7-GSA_Form_3559.doc

GSA Form DOC document 33 KB Posted

Attached to
Fire Safety Surveys
Solicitation number
EQ10PME-15-5002-5009
Issued by

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Form 3559

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Text version

FACILITY NAME

FACILITY ADDRESS

BUILDING NUMBER

● Scheduled

○ Follow-up

○ Unscheduled

CONDUCTED BY

DATE OF SURVEY

DATE OF REPORT

REPORT CONTROL NUMBER

○ S&EM – Safety and Environmental Survey

● F - Firesafety

○ FS&H – Facility Safety and Health

○ OSH – Occupational Safety and Health

○ M - Miscellaneous

Findings and Recommendations:

001
Finding:

Recommendation:

Ref:

Estimated Cost:

Hazard Severity: (Assigned by GSA)

Mishap Probability: (Assigned by GSA)

Risk Assessment Code: (Assigned by GSA)

Responsible Official: (Assigned by GSA)

R-10 GSA Form 3559 (revised 2014)

File details come from the government source that posted it. Updated .