Exhibit C3 - Surveilence Form 1181-A.xlsx

XLSX spreadsheet 22 KB Posted

Attached to
Full Maintenance Services at Lawton, OK Federal Building, O&M Services at Oklahoma City Federal Building
Solicitation number
47PH0220R0011
Issued by

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CONTRACT CLEANING INSPECTION REPORTPage 1 of 1
Building Name:Building NumberBuilding Address

Name of Contractor and Contract number Name of Contractors Representative Signature of Contractors Representative

Name of Inspector Is Inspector a Contractor or GSA associate? Signature of Inspector

Name of Contracting Officer Name of COR Date and time of Inspection

INSTRUCTIONS: This form will be used for the 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 findings and recommendations section and complete quantity column. After rated
deficiencies have been corrected the inspector shall initial and date in the date corrected column.
WORK DESCRIPTION - LOCATIONQUANTITYREMARKSINITIAL AND
(Room No. Corridor, Lobby(By measure( X )DATE
or either)or count)SAT.UNSAT.CORRECTED

GENERAL SERVICES ADMINISTRATION GSA FOR 1181-A

WORK DESCRIPTION - LOCATION

(Floor, Room No., Corridor, Lobby , or either)

QUANTITY

(By measure or count)

TYPE

OF

EQUIPMENT

CONDITION (X)

SAT.

UN-SAT.

OUT

OF

SERV.

INSERT PHOTOS HERE

INITIAL AND

DATE

CORRECTED

WORK DESCRIPTION - LOCATION

(Floor, Room No., Corridor, Lobby , or either)

QUANTITY

(By measure or count)

TYPE

OF

EQUIPMENT

CONDITION (X)

SAT.

UN-SAT.

OUT

OF

SERV.

INSERT PHOTOS HERE

INITIAL AND

DATE

CORRECTED

WORK DESCRIPTION - LOCATION

(Floor, Room No., Corridor, Lobby , or either)

QUANTITY

(By measure or count)

TYPE

OF

EQUIPMENT

CONDITION (X)

SAT.

UN-SAT.

OUT

OF

SERV.

INSERT PHOTOS HERE

INITIAL AND

DATE

CORRECTED

WORK DESCRIPTION - LOCATION

(Floor, Room No., Corridor, Lobby , or either)

QUANTITY

(By measure or count)

TYPE

OF

EQUIPMENT

CONDITION (X)

SAT.

UN-SAT.

OUT

OF

SERV.

INSERT PHOTOS HERE

INITIAL AND

DATE

CORRECTED

WORK DESCRIPTION - LOCATION

(Floor, Room No., Corridor, Lobby , or either)

QUANTITY

(By measure or count)

TYPE

OF

EQUIPMENT

CONDITION (X)

SAT.

UN-SAT.

OUT

OF

SERV.

INSERT PHOTOS HERE

INITIAL AND

DATE

CORRECTED

WORK DESCRIPTION - LOCATION

(Floor, Room No., Corridor, Lobby , or either)

QUANTITY

(By measure or count)

TYPE

OF

EQUIPMENT

CONDITION (X)

SAT.

UN-SAT.

OUT

OF

SERV.

INSERT PHOTOS HERE

INITIAL AND

DATE

CORRECTED

WORK DESCRIPTION - LOCATION

(Floor, Room No., Corridor, Lobby , or either)

QUANTITY

(By measure or count)

TYPE

OF

EQUIPMENT

CONDITION (X)

SAT.

UN-SAT.

OUT

OF

SERV.

INSERT PHOTOS HERE

INITIAL AND

DATE

CORRECTED

WORK DESCRIPTION - LOCATION

(Floor, Room No., Corridor, Lobby , or either)

QUANTITY

(By measure or count)

TYPE

OF

EQUIPMENT

CONDITION (X)

SAT.

UN-SAT.

OUT

OF

SERV.

INSERT PHOTOS HERE

INITIAL AND

DATE

CORRECTED

WORK DESCRIPTION - LOCATION

(Floor, Room No., Corridor, Lobby , or either)

QUANTITY

(By measure or count)

TYPE

OF

EQUIPMENT

CONDITION (X)

SAT.

UN-SAT.

OUT

OF

SERV.

INSERT PHOTOS HERE

INITIAL AND

DATE

CORRECTED

WORK DESCRIPTION - LOCATION

(Floor, Room No., Corridor, Lobby , or either)

QUANTITY

(By measure or count)

TYPE

OF

EQUIPMENT

CONDITION (X)

SAT.

UN-SAT.

OUT

OF

SERV.

INSERT PHOTOS HERE

INITIAL AND

DATE

CORRECTED

WORK DESCRIPTION - LOCATION

(Floor, Room No., Corridor, Lobby , or either)

QUANTITY

(By measure or count)

TYPE

OF

EQUIPMENT

CONDITION (X)

SAT.

UN-SAT.

OUT

OF

SERV.

INSERT PHOTOS HERE

INITIAL AND

DATE

CORRECTED

WORK DESCRIPTION - LOCATION

(Floor, Room No., Corridor, Lobby , or either)

QUANTITY

(By measure or count)

TYPE

OF

EQUIPMENT

CONDITION (X)

SAT.

UN-SAT.

OUT

OF

SERV.

INSERT PHOTOS HERE

INITIAL AND

DATE

CORRECTED

WORK DESCRIPTION - LOCATION

(Floor, Room No., Corridor, Lobby , or either)

QUANTITY

(By measure or count)

TYPE

OF

EQUIPMENT

CONDITION (X)

SAT.

UN-SAT.

OUT

OF

SERV.

INSERT PHOTOS HERE

INITIAL AND

DATE

CORRECTED

WORK DESCRIPTION - LOCATION

(Floor, Room No., Corridor, Lobby , or either)

QUANTITY

(By measure or count)

TYPE

OF

EQUIPMENT

CONDITION (X)

SAT.

UN-SAT.

OUT

OF

SERV.

INSERT PHOTOS HERE

INITIAL AND

DATE

CORRECTED

WORK DESCRIPTION - LOCATION

(Floor, Room No., Corridor, Lobby , or either)

QUANTITY

(By measure or count)

TYPE

OF

EQUIPMENT

CONDITION (X)

SAT.

UN-SAT.

OUT

OF

SERV.

INSERT PHOTOS HERE

INITIAL AND

DATE

CORRECTED

WORK DESCRIPTION - LOCATION

(Floor, Room No., Corridor, Lobby , or either)

QUANTITY

(By measure or count)

TYPE

OF

EQUIPMENT

CONDITION (X)

SAT.

UN-SAT.

OUT

OF

SERV.

INSERT PHOTOS HERE

INITIAL AND

DATE

CORRECTED

WORK DESCRIPTION - LOCATION

(Floor, Room No., Corridor, Lobby , or either)

QUANTITY

(By measure or count)

TYPE

OF

EQUIPMENT

CONDITION (X)

SAT.

UN-SAT.

OUT

OF

SERV.

INSERT PHOTOS HERE

INITIAL AND

DATE

CORRECTED

WORK DESCRIPTION - LOCATION

(Floor, Room No., Corridor, Lobby , or either)

QUANTITY

(By measure or count)

TYPE

OF

EQUIPMENT

CONDITION (X)

SAT.

UN-SAT.

OUT

OF

SERV.

INSERT PHOTOS HERE

INITIAL AND

DATE

CORRECTED

WORK DESCRIPTION - LOCATION

(Floor, Room No., Corridor, Lobby , or either)

QUANTITY

(By measure or count)

TYPE

OF

EQUIPMENT

CONDITION (X)

SAT.

UN-SAT.

OUT

OF

SERV.

INSERT PHOTOS HERE

INITIAL AND

DATE

CORRECTED

WORK DESCRIPTION - LOCATION

(Floor, Room No., Corridor, Lobby , or either)

QUANTITY

(By measure or count)

TYPE

OF

EQUIPMENT

CONDITION (X)

SAT.

UN-SAT.

OUT

OF

SERV.

INSERT PHOTOS HERE

INITIAL AND

DATE

CORRECTED

WORK DESCRIPTION - LOCATION

(Floor, Room No., Corridor, Lobby , or either)

QUANTITY

(By measure or count)

TYPE

OF

EQUIPMENT

CONDITION (X)

SAT.

UN-SAT.

OUT

OF

SERV.

INSERT PHOTOS HERE

INITIAL AND

DATE

CORRECTED

WORK DESCRIPTION - LOCATION

(Floor, Room No., Corridor, Lobby , or either)

QUANTITY

(By measure or count)

TYPE

OF

EQUIPMENT

CONDITION (X)

SAT.

UN-SAT.

OUT

OF

SERV.

INSERT PHOTOS HERE

INITIAL AND

DATE

CORRECTED

WORK DESCRIPTION - LOCATION

(Floor, Room No., Corridor, Lobby , or either)

QUANTITY

(By measure or count)

TYPE

OF

EQUIPMENT

CONDITION (X)

SAT.

UN-SAT.

OUT

OF

SERV.

INSERT PHOTOS HERE

INITIAL AND

DATE

CORRECTED

WORK DESCRIPTION - LOCATION

(Floor, Room No., Corridor, Lobby , or either)

QUANTITY

(By measure or count)

TYPE

OF

EQUIPMENT

CONDITION (X)

SAT.

UN-SAT.

OUT

OF

SERV.

INSERT PHOTOS HERE

INITIAL AND

DATE

CORRECTED

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