Exhibit C3 Surveillance Forms Waco Buy.pdf
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- 47PH0219R0028
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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
INSPECTOR (Print name)
TIME STARTED
INTERVIEWED BY
WORK DESCRIPTION - LOCATION
(Room No., Corridor, Lobby or either)
QUANTITY
(By measure or count)
CHECK ONE
REMARKS
SAT. UNSAT.
TIME COMPLETED
DATE
REPORT NO. CONTRACT NO.
INSPECTOR'S SIGNATURE
DATE OF INSPECTION
CONTRACTOR'S RECEIPT TIME DATE
GSA FORM 1181A (REV. 12-97)
Prescribed by Custodial Management Desk Guide
GENERAL SERVICES ADMINISTRATION
GSA FORM 1181A (REV. 12-97)
Prescribed by Custodial Management Desk Guide
GENERAL SERVICES ADMINISTRATION
REMARKS
UNSAT.SAT.
CHECK ONEQUANTITY
(By measure or count)
WORK DESCRIPTION - LOCATION
(Room No., Corridor, Lobby or either)
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
INSPECTOR (Print name)
TIME STARTED
INTERVIEWED BY
WORK DESCRIPTION - LOCATION
(Room No., Corridor, Lobby or either)
QUANTITY
(By measure or count)
CHECK ONE
REMARKS
SAT.
UNSAT.
TIME COMPLETED
DATE
REPORT NO.
CONTRACT NO.
INSPECTOR'S SIGNATURE
DATE OF INSPECTION
CONTRACTOR'S RECEIPT
TIME
DATE
GSA FORM 1181A (REV. 12-97)
Prescribed by Custodial Management Desk Guide
GENERAL SERVICES ADMINISTRATION
GSA FORM 1181A (REV. 12-97)
Prescribed by Custodial Management Desk Guide
GENERAL SERVICES ADMINISTRATION
REMARKS
UNSAT.
SAT.
CHECK ONE
QUANTITY
(By measure or count)
WORK DESCRIPTION - LOCATION
(Room No., Corridor, Lobby or either)
| BUILDING: |
| REPORT NUMBER: |
| CONTRACT NUMBER: |
| CONTRACTOR'S RECEIPT: |
| INSPECTOR (Print name): |
| TIME STARTED: |
| INTERVIEWED BY: |
| WORK DESCRIPTION - LOCATION (Room Number, Corridor, Lobby or either). Line 28 of 28: |
| QUANTITY (By measure or count): |
| REMARKS: |
| TIME COMPLETED: |
| TIME : |
| Date. Enter 2 digit month, 2 digit day and 4 digit year.: |
| Date. Enter 2 digit month, 2 digit day and 4 digit year.: |
| Date of Inspection. Enter 2 digit month, 2 digit day and 4 digit year.: |
| INSPECTOR'S SIGNATURE. This is a protected field.: |
| INSPECTOR'S SIGNATURE. DIGITAL SIGNATURE.: |
| CHECK ONE. SATISFACTORY: 0 |
| CHECK ONE. SATISFACTORY: 0 |
| CHECK ONE. UNSATISFACTORY: 0 |
| CHECK ONE. UNSATISFACTORY: 0 |
| CHECK ONE. SATISFACTORY: 0 |
| CHECK ONE. SATISFACTORY: 0 |
| CHECK ONE. UNSATISFACTORY: 0 |
| CHECK ONE. UNSATISFACTORY: 0 |
| CHECK ONE. SATISFACTORY: 0 |
| CHECK ONE. SATISFACTORY: 0 |
| CHECK ONE. UNSATISFACTORY: 0 |
| CHECK ONE. UNSATISFACTORY: 0 |
| CHECK ONE. SATISFACTORY: 0 |
| CHECK ONE. SATISFACTORY: 0 |
| CHECK ONE. UNSATISFACTORY: 0 |
| CHECK ONE. UNSATISFACTORY: 0 |
| CHECK ONE. SATISFACTORY: 0 |
| CHECK ONE. SATISFACTORY: 0 |
| CHECK ONE. UNSATISFACTORY: 0 |
| CHECK ONE. UNSATISFACTORY: 0 |
| CHECK ONE. SATISFACTORY: 0 |
| CHECK ONE. SATISFACTORY: 0 |
| CHECK ONE. UNSATISFACTORY: 0 |
| CHECK ONE. UNSATISFACTORY: 0 |
| CHECK ONE. SATISFACTORY: 0 |
| CHECK ONE. SATISFACTORY: 0 |
| CHECK ONE. UNSATISFACTORY: 0 |
| CHECK ONE. UNSATISFACTORY: 0 |
| CHECK ONE. SATISFACTORY: 0 |
| CHECK ONE. SATISFACTORY: 0 |
| CHECK ONE. UNSATISFACTORY: 0 |
| CHECK ONE. UNSATISFACTORY: 0 |
| CHECK ONE. SATISFACTORY: 0 |
| CHECK ONE. SATISFACTORY: 0 |
| CHECK ONE. UNSATISFACTORY: 0 |
| CHECK ONE. UNSATISFACTORY: 0 |
| CHECK ONE. SATISFACTORY: 0 |
| CHECK ONE. SATISFACTORY: 0 |
| CHECK ONE. UNSATISFACTORY: 0 |
| CHECK ONE. UNSATISFACTORY: 0 |
| CHECK ONE. SATISFACTORY: 0 |
| CHECK ONE. SATISFACTORY: 0 |
| CHECK ONE. UNSATISFACTORY: 0 |
| CHECK ONE. UNSATISFACTORY: 0 |
| CHECK ONE. SATISFACTORY: 0 |
| CHECK ONE. SATISFACTORY: 0 |
| CHECK ONE. UNSATISFACTORY: 0 |
| CHECK ONE. UNSATISFACTORY: 0 |
| CHECK ONE. SATISFACTORY: 0 |
| CHECK ONE. SATISFACTORY: 0 |
| CHECK ONE. UNSATISFACTORY: 0 |
| CHECK ONE. UNSATISFACTORY: 0 |
| CHECK ONE. SATISFACTORY: 0 |
| CHECK ONE. SATISFACTORY: 0 |
| CHECK ONE. UNSATISFACTORY: 0 |
| CHECK ONE. UNSATISFACTORY: 0 |
| CHECK ONE. SATISFACTORY: 0 |
| CHECK ONE. SATISFACTORY: 0 |
| CHECK ONE. UNSATISFACTORY: 0 |
| CHECK ONE. UNSATISFACTORY: 0 |
| CHECK ONE. SATISFACTORY: 0 |
| CHECK ONE. SATISFACTORY: 0 |
| CHECK ONE. UNSATISFACTORY: 0 |
| CHECK ONE. UNSATISFACTORY: 0 |
| CHECK ONE. SATISFACTORY: 0 |
| CHECK ONE. SATISFACTORY: 0 |
| CHECK ONE. UNSATISFACTORY: 0 |
| CHECK ONE. UNSATISFACTORY: 0 |
| CHECK ONE. SATISFACTORY: 0 |
| CHECK ONE. SATISFACTORY: 0 |
| CHECK ONE. UNSATISFACTORY: 0 |
| CHECK ONE. UNSATISFACTORY: 0 |
| CHECK ONE. SATISFACTORY: 0 |
| CHECK ONE. SATISFACTORY: 0 |
| CHECK ONE. UNSATISFACTORY: 0 |
| CHECK ONE. UNSATISFACTORY: 0 |
| CHECK ONE. SATISFACTORY: 0 |
| CHECK ONE. SATISFACTORY: 0 |
| CHECK ONE. UNSATISFACTORY: 0 |
| CHECK ONE. UNSATISFACTORY: 0 |
| CHECK ONE. SATISFACTORY: 0 |
| CHECK ONE. SATISFACTORY: 0 |
| CHECK ONE. UNSATISFACTORY: 0 |
| CHECK ONE. UNSATISFACTORY: 0 |
| CHECK ONE. SATISFACTORY: 0 |
| CHECK ONE. SATISFACTORY: 0 |
| CHECK ONE. UNSATISFACTORY: 0 |
| CHECK ONE. UNSATISFACTORY: 0 |
| CHECK ONE. SATISFACTORY: 0 |
| CHECK ONE. UNSATISFACTORY: 0 |
| CHECK ONE. SATISFACTORY: 0 |
| CHECK ONE. UNSATISFACTORY: 0 |
| CHECK ONE. SATISFACTORY: 0 |
| CHECK ONE. UNSATISFACTORY: 0 |
| CHECK ONE. SATISFACTORY: 0 |
| CHECK ONE. UNSATISFACTORY: 0 |
| CHECK ONE. SATISFACTORY: 0 |
| CHECK ONE. UNSATISFACTORY: 0 |
| CHECK ONE. SATISFACTORY: 0 |
| CHECK ONE. UNSATISFACTORY: 0 |
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