Sample RMS Template.xlsx

XLSX spreadsheet 231 KB Posted Jun 26, 2024

Attached to: Risk Management Surveys (RMS) for Safety & Health - 99 Leased Locations
Solicitation number: 47PF0024Q0122
Issued by: General Services Administration Public Buildings Service Region 5

About this file

Written by GovTribe AI · Jun 26, 2024

This document is a Risk Management Survey (RMS) template for safety and health assessments at 99 leased federal government locations. The template covers various safety and health risk areas such as asbestos, drinking water, electrical, emergency planning, hazardous materials, indoor air quality, and more. Each risk area has a series of assessment questions, a risk assessment code (RAC) rating, and recommended corrective actions. The template appears to be associated with a federal contract opportunity, Solicitation Number 47PF0024Q0122, issued by the General Services Administration (GSA) Public Buildings Service Region 5, for conducting these risk management surveys at the 99 leased locations. The contract likely requires the selected contractor to complete the RMS assessments and provide detailed documentation for each facility.

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Other files

File	Type	Posted
47PF0024Q0122 SF18.pdf	PDF	Jun 26, 2024
RFQ Safety and Health RMS Surveys 99 Locations.pdf	PDF	Jun 26, 2024
47PF0024Q0122 Quote Breakdown Sheet.xlsx	XLSX spreadsheet	Jun 26, 2024

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RAC Summary

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GSA	Risk Management Survey

Safety Health Survey

RAC Summary
12445	EDITABLE	N
Asbestos	6
Drinking Water	6
Electrical	6
Emergency Planning	6
Equipment Machine Guard	6
HazMat HazCom	6
Hazardous Energy Control	6
Indoor Air Quality	6
Lead	6
Non-ionizing Radiation	6
Confined Spaces	6
Powered Industrial Vehicles	6
Radon	6
Walking-Work Surfaces	6
High Risk Operations	6
	6
Overall RAC	6

IRIS Building Profile

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GSA	Risk Management Survey

Questions Response Findings/Observations

IRIS Building Profile
Region	5			1708	8327	3756882	1
GSA Building Number	IL2465ZZ			1708	8328	3756883	1
GSA Building Name	RICKARD CENTER			1708	8329	3756884	1
Building Street Address	1124 RICKARD RD			1708	8330	3756885	1
Building City	SPRINGFIELD			1708	8331	3756886	1
Date of Building Construction	2000			1708	8334	3756888	1
Building State	IL			1708	8332	3756887	1
Building Size (RSF)				1708	8333		1
Building Size (GSF)	3253			1708	8335	3756889	1
Total Number of Floors Above Grade	1			1708	8337	3756890	1
Total Number of Floors Below Grade	0			1708	8338	3756891	1
12445		N	1708

Building Information

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GSA	Risk Management Survey

Questions Response Findings/Observations

Building Profile
Date(s) of Onsite Survey				1710	8339	1
Surveyor				1710	8340	1
Type of Occupancies				1710	8341	3
Building Point(s) of Contact for Survey				1710	8342	1
Lease Number				1710	8370	1
Lease Expiration Date				1710	8371	1
Property Type				1710	8345	3
What is the tenant breakdown?				1710	8346	3
Primary Tenants				1710	8347	1
Identify any Unique Space Type(s). If "other" is chosen, please describe the "other" unique space in the comments section.				1710	8351	3
Identify any Unique Space Type #2.				1710	8372	3
Identify any Unique Space Type #3.				1710	8373	3
Identify any Unique Space Type #4.				1710	8374	3
12445	EDITABLE	N	1710

Asbestos

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GSA	Risk Management Survey

Asbestos

				Risk Assessment Code (RAC)			Recommended Corrective Actions
Questions	Response	Findings/Observations	Regulatory Citation	Probability	Severity	RAC	Repeat Findings	Repeat Condition ID	Localized or Building Wide	Recommendation

	Asbestos
	If required in the lease contract, has the lessor provided a written statement that no asbestos is present?				Not Possible	No Impact	6	No		1755	8566		4
	If asbestos is present, is there a current asbestos management plan or O&M plan?				Not Possible	No Impact	6	No		1755	8567		4
	Are visual inspections of the asbestos inventory conducted annually?	N/A	Not applicable for Leased building		Not Possible	No Impact	6	No		1755	8568	3728668	4
	Are asbestos notifications documented (e.g., annual, the start of a contract, and before an abatement project)?	N/A	Not applicable for Leased building		Not Possible	No Impact	6	No		1755	8569	3728669	4
	Is asbestos maintenance or renovation done in accordance with Federal, state and local regulations?				Not Possible	No Impact	6	No		1755	8570		4
	Are pre-alteration assessments done before work that could disturb asbestos, as verified through the asbestos program manager? If in leased space, this would only apply to GSA-managed projects.				Not Possible	No Impact	6	No		1755	8571		4
	Other Findings
	Other Findings 1				Not Possible	No Impact	6	No		1754	8556		1
	Other Findings 2				Not Possible	No Impact	6	No		1754	8557		1
	Other Findings 3				Not Possible	No Impact	6	No		1754	8558		1
	Other Findings 4				Not Possible	No Impact	6	No		1754	8559		1
	Other Findings 5				Not Possible	No Impact	6	No		1754	8560		1
	Other Findings 6				Not Possible	No Impact	6	No		1754	8561		1
	Other Findings 7				Not Possible	No Impact	6	No		1754	8562		1
	Other Findings 8				Not Possible	No Impact	6	No		1754	8563		1
	Other Findings 9				Not Possible	No Impact	6	No		1754	8564		1
	Other Findings 10				Not Possible	No Impact	6	No		1754	8565		1
	Overall RAC
	Overall RAC	6						No		1753	8553		5
	User Adjusted RAC
: Once the surveyor has reviewed the findings and Overall RAC provided above, if the RAC does not represent the risk associated with the findings as a whole, please provide an adjusted RAC and explanation below.							No		1753	8554		6
	Explanation of User Adjusted RAC							No		1753	8555		1
	12445	EDITABLE	N	1753
	6	6	N

Drinking Water

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GSA	Risk Management Survey

Drinking Water

				Risk Assessment Code (RAC)			Recommended Corrective Actions
Questions	Response	Findings/Observations	Regulatory Citation	Probability	Severity	RAC	Repeat Findings	Repeat Condition ID	Localized or Building Wide	Recommendation

	Drinking Water
	Is the water from a public or municipal provider?				Not Possible	No Impact	6	No		1767	8620		4
	If the water is from a well source, is it tested regularly in accordance with State or local requirements?				Not Possible	No Impact	6	No		1767	8621		4
	Have there been any unresolved drinking water complaints from GSA tenants since the last survey?				Not Possible	No Impact	6	No		1767	8622		4
	Is chlorine testing and flushing conducted per PBS Guidance to Avoid Water Stagnation?	N/A	Not applicable for Leased building		Not Possible	No Impact	6	No		1767	8623	3728670	4
	If a GSA-managed child care center is present, has testing been performed for lead and copper per PBS Drinking Water Policy requirements?				Not Possible	No Impact	6	No		1767	8624		4
	If a GSA-managed child care center is present, are all outlets flushed weekly?	N/A	Not applicable for Leased building		Not Possible	No Impact	6	No		1767	8625	3728671	4
	Are backflow prevention devices certified as prescribed by applicable Federal, state, and local laws, ordinances, and regulations? If no regulations exist, at least annually per the O&M contract requirements.	N/A	Not applicable for Leased building		Not Possible	No Impact	6	No		1767	8692	3728672	4
	Other Findings
	Other Findings 1				Not Possible	No Impact	6	No		1766	8610		1
	Other Findings 2				Not Possible	No Impact	6	No		1766	8611		1
	Other Findings 3				Not Possible	No Impact	6	No		1766	8612		1
	Other Findings 4				Not Possible	No Impact	6	No		1766	8613		1
	Other Findings 5				Not Possible	No Impact	6	No		1766	8614		1
	Other Findings 6				Not Possible	No Impact	6	No		1766	8615		1
	Other Findings 7				Not Possible	No Impact	6	No		1766	8616		1
	Other Findings 8				Not Possible	No Impact	6	No		1766	8617		1
	Other Findings 9				Not Possible	No Impact	6	No		1766	8618		1
	Other Findings 10				Not Possible	No Impact	6	No		1766	8619		1
	Overall RAC
	Overall RAC	6						No		1765	8607		5
	User Adjusted RAC
: Once the surveyor has reviewed the findings and Overall RAC provided above, if the RAC does not represent the risk associated with the findings as a whole, please provide an adjusted RAC and explanation below.							No		1765	8608		6
	Explanation of User Adjusted RAC							No		1765	8609		1
	12445	EDITABLE	N	1765
	6	6	N

Electrical

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GSA	Risk Management Survey

Electrical

				Risk Assessment Code (RAC)			Recommended Corrective Actions
Questions	Response	Findings/Observations	Regulatory Citation	Probability	Severity	RAC	Repeat Findings	Repeat Condition ID	Localized or Building Wide	Recommendation

	Electrical
	Are there any visible electrical safety hazards in the GSA controlled space?				Not Possible	No Impact	6	No		1759	8586		4
	Has an Arc Flash analysis for the building been conducted?	N/A	Not applicable for Leased building		Not Possible	No Impact	6	No		1759	8585	3728673	4
	Are proper Arc Flash warning labels posted on the appropriate electrical equipment?	N/A	Not applicable for Leased building		Not Possible	No Impact	6	No		1759	8587	3728674	4
	Have electrical spaces been limited to qualified personnel only per OSHA requirements?	N/A	Not applicable for Leased building		Not Possible	No Impact	6	No		1759	8588	3728675	4
	Is there a plan to replace electrical equipment that has reached the end of its life?	N/A	Not applicable for Leased building		Not Possible	No Impact	6	No		1759	8589	3728676	4
	Other Findings
	Other Findings 1				Not Possible	No Impact	6	No		1758	8575		1
	Other Findings 2				Not Possible	No Impact	6	No		1758	8576		1
	Other Findings 3				Not Possible	No Impact	6	No		1758	8577		1
	Other Findings 4				Not Possible	No Impact	6	No		1758	8578		1
	Other Findings 5				Not Possible	No Impact	6	No		1758	8579		1
	Other Findings 6				Not Possible	No Impact	6	No		1758	8580		1
	Other Findings 7				Not Possible	No Impact	6	No		1758	8581		1
	Other Findings 8				Not Possible	No Impact	6	No		1758	8582		1
	Other Findings 9				Not Possible	No Impact	6	No		1758	8583		1
	Other Findings 10				Not Possible	No Impact	6	No		1758	8584		1
	Overall RAC
	Overall RAC	6						No		1757	8572		5
	User Adjusted RAC
: Once the surveyor has reviewed the findings and Overall RAC provided above, if the RAC does not represent the risk associated with the findings as a whole, please provide an adjusted RAC and explanation below.							No		1757	8573		6
	Explanation of User Adjusted RAC							No		1757	8574		1
	12445	EDITABLE	N	1757
	6	6	N

Emergency Planning

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GSA	Risk Management Survey

Emergency Planning

				Risk Assessment Code (RAC)			Recommended Corrective Actions
Questions	Response	Findings/Observations	Regulatory Citation	Probability	Severity	RAC	Repeat Findings	Repeat Condition ID	Localized or Building Wide	Recommendation

	Emergency Planning
	Is there a current occupant emergency plan (OEP) in place?				Not Possible	No Impact	6	No		1719	8412		4
	Are emergency drills performed (e.g., fire, tornado, etc)?				Not Possible	No Impact	6	No		1719	8413		4
	Other Findings
	Other Findings 1				Not Possible	No Impact	6	No		1718	8402		1
	Other Findings 2				Not Possible	No Impact	6	No		1718	8403		1
	Other Findings 3				Not Possible	No Impact	6	No		1718	8404		1
	Other Findings 4				Not Possible	No Impact	6	No		1718	8405		1
	Other Findings 5				Not Possible	No Impact	6	No		1718	8406		1
	Other Findings 6				Not Possible	No Impact	6	No		1718	8407		1
	Other Findings 7				Not Possible	No Impact	6	No		1718	8408		1
	Other Findings 8				Not Possible	No Impact	6	No		1718	8409		1
	Other Findings 9				Not Possible	No Impact	6	No		1718	8410		1
	Other Findings 10				Not Possible	No Impact	6	No		1718	8411		1
	Overall RAC
	Overall RAC	6						No		1717	8399		5
	User Adjusted RAC
: Once the surveyor has reviewed the findings and Overall RAC provided above, if the RAC does not represent the risk associated with the findings as a whole, please provide an adjusted RAC and explanation below.							No		1717	8400		6
	Explanation of User Adjusted RAC							No		1717	8401		1
	12445	EDITABLE	N	1717
	6	6	N

Equipment Machine Guard

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GSA	Risk Management Survey

Equipment Machine Guard

				Risk Assessment Code (RAC)			Recommended Corrective Actions
Questions	Response	Findings/Observations	Regulatory Citation	Probability	Severity	RAC	Repeat Findings	Repeat Condition ID	Localized or Building Wide	Recommendation

	Equipment Machine Guard
	Is the facility machinery properly guarded and/or interlocked?	N/A	Not applicable for Leased building		Not Possible	No Impact	6	No		1775	8658	3728677	4
	Other Findings
	Other Findings 1				Not Possible	No Impact	6	No		1774	8648		1
	Other Findings 2				Not Possible	No Impact	6	No		1774	8649		1
	Other Findings 3				Not Possible	No Impact	6	No		1774	8650		1
	Other Findings 4				Not Possible	No Impact	6	No		1774	8651		1
	Other Findings 5				Not Possible	No Impact	6	No		1774	8652		1
	Other Findings 6				Not Possible	No Impact	6	No		1774	8653		1
	Other Findings 7				Not Possible	No Impact	6	No		1774	8654		1
	Other Findings 8				Not Possible	No Impact	6	No		1774	8655		1
	Other Findings 9				Not Possible	No Impact	6	No		1774	8656		1
	Other Findings 10				Not Possible	No Impact	6	No		1774	8657		1
	Overall RAC
	Overall RAC	6						No		1773	8645		5
	User Adjusted RAC
: Once the surveyor has reviewed the findings and Overall RAC provided above, if the RAC does not represent the risk associated with the findings as a whole, please provide an adjusted RAC and explanation below.							No		1773	8646		6
	Explanation of User Adjusted RAC							No		1773	8647		1
	12445	EDITABLE	N	1773
	6	6	N

HazMat HazCom

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GSA	Risk Management Survey

HazMat HazCom

				Risk Assessment Code (RAC)			Recommended Corrective Actions
Questions	Response	Findings/Observations	Regulatory Citation	Probability	Severity	RAC	Repeat Findings	Repeat Condition ID	Localized or Building Wide	Recommendation

	HazMat HazCom
	Does the O&M contractor have a written hazard communication program per 1910.1200(e)?	N/A	Not applicable for Leased building		Not Possible	No Impact	6	No		1739	8498	3728678	4
	Does the O&M contractor maintain a chemical inventory, and SDSs for each chemical per 1910.1200(e)(1)(i)?	N/A	Not applicable for Leased building		Not Possible	No Impact	6	No		1739	8499	3728679	4
	Does the O&M contractor properly label and store their chemicals?	N/A	Not applicable for Leased building		Not Possible	No Impact	6	No		1739	8500	3728680	4
	Does the Custodial contractor have a written hazard communication program per 1910.1200(e)	N/A	Not applicable for Leased building		Not Possible	No Impact	6	No		1739	8501	3728681	4
	Does the Custodial contractor maintain a chemical inventory and SDSs for each chemical per 1910.1200(e)(1)(i)?	N/A	Not applicable for Leased building		Not Possible	No Impact	6	No		1739	8502	3728682	4
	Does the Custodial contractor properly label and store their chemicals?	N/A	Not applicable for Leased building		Not Possible	No Impact	6	No		1739	8693	3728683	4
	If emergency eyewash and shower equipment are used to treat chemical splashes or eye injuries in the workplace, is the equipment activated weekly and inspected per the ANSI/ISEA Z358.1 standard?	N/A	Not applicable for Leased building		Not Possible	No Impact	6	No		1739	8694	3728684	4
	If applicable, do the GSA tenants have a written hazard communication program per 1910.1200(e)?				Not Possible	No Impact	6	No		1739	8695		4
	If applicable, do the GSA tenants maintain a chemical inventory, and SDSs for each chemical per 1910.1200(e)(1)(i)?				Not Possible	No Impact	6	No		1739	8696		4
	If applicable, do the GSA tenants properly label and store their chemicals?				Not Possible	No Impact	6	No		1739	8697		4
	Other Findings
	Other Findings 1				Not Possible	No Impact	6	No		1738	8488		1
	Other Findings 2				Not Possible	No Impact	6	No		1738	8489		1
	Other Findings 3				Not Possible	No Impact	6	No		1738	8490		1
	Other Findings 4				Not Possible	No Impact	6	No		1738	8491		1
	Other Findings 5				Not Possible	No Impact	6	No		1738	8492		1
	Other Findings 6				Not Possible	No Impact	6	No		1738	8493		1
	Other Findings 7				Not Possible	No Impact	6	No		1738	8494		1
	Other Findings 8				Not Possible	No Impact	6	No		1738	8495		1
	Other Findings 9				Not Possible	No Impact	6	No		1738	8496		1
	Other Findings 10				Not Possible	No Impact	6	No		1738	8497		1
	Overall RAC
	Overall RAC	6						No		1737	8485		5
	User Adjusted RAC
: Once the surveyor has reviewed the findings and Overall RAC provided above, if the RAC does not represent the risk associated with the findings as a whole, please provide an adjusted RAC and explanation below.							No		1737	8486		6
	Explanation of User Adjusted RAC							No		1737	8487		1
	12445	EDITABLE	N	1737
	6	6	N

Hazardous Energy Control

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GSA	Risk Management Survey

Hazardous Energy Control

				Risk Assessment Code (RAC)			Recommended Corrective Actions
Questions	Response	Findings/Observations	Regulatory Citation	Probability	Severity	RAC	Repeat Findings	Repeat Condition ID	Localized or Building Wide	Recommendation

	Hazardous Energy Control
	Does the O&M Contractor have a written hazardous energy control program?	N/A	Not applicable for Leased building		Not Possible	No Impact	6	No		1743	8516	3728685	4
	If observed, are proper lockout/tagout practices and procedures followed?	N/A	Not applicable for Leased building		Not Possible	No Impact	6	No		1743	8517	3728686	4
	Other Findings
	Other Findings 1				Not Possible	No Impact	6	No		1742	8506		1
	Other Findings 2				Not Possible	No Impact	6	No		1742	8507		1
	Other Findings 3				Not Possible	No Impact	6	No		1742	8508		1
	Other Findings 4				Not Possible	No Impact	6	No		1742	8509		1
	Other Findings 5				Not Possible	No Impact	6	No		1742	8510		1
	Other Findings 6				Not Possible	No Impact	6	No		1742	8511		1
	Other Findings 7				Not Possible	No Impact	6	No		1742	8512		1
	Other Findings 8				Not Possible	No Impact	6	No		1742	8513		1
	Other Findings 9				Not Possible	No Impact	6	No		1742	8514		1
	Other Findings 10				Not Possible	No Impact	6	No		1742	8515		1
	Overall RAC
	Overall RAC	6						No		1741	8503		5
	User Adjusted RAC
: Once the surveyor has reviewed the findings and Overall RAC provided above, if the RAC does not represent the risk associated with the findings as a whole, please provide an adjusted RAC and explanation below.							No		1741	8504		6
	Explanation of User Adjusted RAC							No		1741	8505		1
	12445	EDITABLE	N	1741
	6	6	N

Indoor Air Quality

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GSA	Risk Management Survey

Indoor Air Quality

				Risk Assessment Code (RAC)			Recommended Corrective Actions
Questions	Response	Findings/Observations	Regulatory Citation	Probability	Severity	RAC	Repeat Findings	Repeat Condition ID	Localized or Building Wide	Recommendation

	Indoor Air Quality
	Have there been any unresolved IAQ complaints from GSA tenants since the last survey?				Not Possible	No Impact	6	No		1747	8531		4
	Does the building management office maintain a log of IAQ issues or complaints in NCMMS?	N/A	Not applicable for Leased building		Not Possible	No Impact	6	No		1747	8533	3728687	4
	Is the GSA Lease Administration Manager familiar with the IAQ portion of the contract?				Not Possible	No Impact	6	No		1747	8534		4
	Are there visible signs of water damage or mold?				Not Possible	No Impact	6	No		1747	8535		4
	If present, is the building dealing with water intrusion or visible mold growth per industry standards (e.g., ANSI / IICRC S500 & S520)?				Not Possible	No Impact	6	No		1747	8536		4
	Other Findings
	Other Findings 1				Not Possible	No Impact	6	No		1746	8521		1
	Other Findings 2				Not Possible	No Impact	6	No		1746	8522		1
	Other Findings 3				Not Possible	No Impact	6	No		1746	8523		1
	Other Findings 4				Not Possible	No Impact	6	No		1746	8524		1
	Other Findings 5				Not Possible	No Impact	6	No		1746	8525		1
	Other Findings 6				Not Possible	No Impact	6	No		1746	8526		1
	Other Findings 7				Not Possible	No Impact	6	No		1746	8527		1
	Other Findings 8				Not Possible	No Impact	6	No		1746	8528		1
	Other Findings 9				Not Possible	No Impact	6	No		1746	8529		1
	Other Findings 10				Not Possible	No Impact	6	No		1746	8530		1
	Overall RAC
	Overall RAC	6						No		1745	8518		5
	User Adjusted RAC
: Once the surveyor has reviewed the findings and Overall RAC provided above, if the RAC does not represent the risk associated with the findings as a whole, please provide an adjusted RAC and explanation below.							No		1745	8519		6
	Explanation of User Adjusted RAC							No		1745	8520		1
	12445	EDITABLE	N	1745
	6	6	N

Lead

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GSA	Risk Management Survey

Lead

				Risk Assessment Code (RAC)			Recommended Corrective Actions
Questions	Response	Findings/Observations	Regulatory Citation	Probability	Severity	RAC	Repeat Findings	Repeat Condition ID	Localized or Building Wide	Recommendation

	Lead
	Does the building contain damaged paint, similar surface coatings, or accumulated dust that contains lead?				Not Possible	No Impact	6	No		1723	8427		4
	Are pre-alteration assessments done before work that disturb paint, similar surface coatings, or accumulated dust that could contain lead? If in leased space, this would only apply to GSA-managed projects.				Not Possible	No Impact	6	No		1723	8428		4
	Other Findings
	Other Findings 1				Not Possible	No Impact	6	No		1722	8417		1
	Other Findings 2				Not Possible	No Impact	6	No		1722	8418		1
	Other Findings 3				Not Possible	No Impact	6	No		1722	8419		1
	Other Findings 4				Not Possible	No Impact	6	No		1722	8420		1
	Other Findings 5				Not Possible	No Impact	6	No		1722	8421		1
	Other Findings 6				Not Possible	No Impact	6	No		1722	8422		1
	Other Findings 7				Not Possible	No Impact	6	No		1722	8423		1
	Other Findings 8				Not Possible	No Impact	6	No		1722	8424		1
	Other Findings 9				Not Possible	No Impact	6	No		1722	8425		1
	Other Findings 10				Not Possible	No Impact	6	No		1722	8426		1
	Overall RAC
	Overall RAC	6						No		1721	8414		5
	User Adjusted RAC
: Once the surveyor has reviewed the findings and Overall RAC provided above, if the RAC does not represent the risk associated with the findings as a whole, please provide an adjusted RAC and explanation below.							No		1721	8415		6
	Explanation of User Adjusted RAC							No		1721	8416		1
	12445	EDITABLE	N	1721
	6	6	N

Non-ionizing Radiation

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GSA	Risk Management Survey

Non-ionizing Radiation

				Risk Assessment Code (RAC)			Recommended Corrective Actions
Questions	Response	Findings/Observations	Regulatory Citation	Probability	Severity	RAC	Repeat Findings	Repeat Condition ID	Localized or Building Wide	Recommendation

	Non-ionizing Radiation
	Are radio frequency (RF) transmitting devices on the facility's roof?	N/A	Not applicable for Leased building		Not Possible	No Impact	6	No		1731	8460	3728688	4
	Are safety zones established and proper danger signage posted?	N/A	Not applicable for Leased building		Not Possible	No Impact	6	No		1731	8461	3728689	4
	If applicable, is the FCC license and RF emissions analysis report from the device owner documented?	N/A	Not applicable for Leased building		Not Possible	No Impact	6	No		1731	8462	3728690	4
	Other Findings
	Other Findings 1				Not Possible	No Impact	6	No		1730	8450		1
	Other Findings 2				Not Possible	No Impact	6	No		1730	8451		1
	Other Findings 3				Not Possible	No Impact	6	No		1730	8452		1
	Other Findings 4				Not Possible	No Impact	6	No		1730	8453		1
	Other Findings 5				Not Possible	No Impact	6	No		1730	8454		1
	Other Findings 6				Not Possible	No Impact	6	No		1730	8455		1
	Other Findings 7				Not Possible	No Impact	6	No		1730	8456		1
	Other Findings 8				Not Possible	No Impact	6	No		1730	8457		1
	Other Findings 9				Not Possible	No Impact	6	No		1730	8458		1
	Other Findings 10				Not Possible	No Impact	6	No		1730	8459		1
	Overall RAC
	Overall RAC	6						No		1729	8447		5
	User Adjusted RAC
: Once the surveyor has reviewed the findings and Overall RAC provided above, if the RAC does not represent the risk associated with the findings as a whole, please provide an adjusted RAC and explanation below.							No		1729	8448		6
	Explanation of User Adjusted RAC							No		1729	8449		1
	12445	EDITABLE	N	1729
	6	6	N

Confined Spaces

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GSA	Risk Management Survey

Confined Spaces

				Risk Assessment Code (RAC)			Recommended Corrective Actions
Questions	Response	Findings/Observations	Regulatory Citation	Probability	Severity	RAC	Repeat Findings	Repeat Condition ID	Localized or Building Wide	Recommendation

	Confined Spaces
	Are confined spaces in the building documented, including permit-required confined spaces (PRCS)?	N/A	Not applicable for Leased building		Not Possible	No Impact	6	No		1763	8603	3728691	4
	Are PRCS in the building properly labeled?	N/A	Not applicable for Leased building		Not Possible	No Impact	6	No		1763	8604	3728692	4
	Are GSA employees prohibited from entering PRCS?	N/A	Not applicable for Leased building		Not Possible	No Impact	6	No		1763	8605	3728693	4
	Does the O&M contractor have a written confined space entry program?	N/A	Not applicable for Leased building		Not Possible	No Impact	6	No		1763	8606	3728694	4
	Other Findings
	Other Findings 1				Not Possible	No Impact	6	No		1762	8593		1
	Other Findings 2				Not Possible	No Impact	6	No		1762	8594		1
	Other Findings 3				Not Possible	No Impact	6	No		1762	8595		1
	Other Findings 4				Not Possible	No Impact	6	No		1762	8596		1
	Other Findings 5				Not Possible	No Impact	6	No		1762	8597		1
	Other Findings 6				Not Possible	No Impact	6	No		1762	8598		1
	Other Findings 7				Not Possible	No Impact	6	No		1762	8599		1
	Other Findings 8				Not Possible	No Impact	6	No		1762	8600		1
	Other Findings 9				Not Possible	No Impact	6	No		1762	8601		1
	Other Findings 10				Not Possible	No Impact	6	No		1762	8602		1
	Overall RAC
	Overall RAC	6						No		1761	8590		5
	User Adjusted RAC
: Once the surveyor has reviewed the findings and Overall RAC provided above, if the RAC does not represent the risk associated with the findings as a whole, please provide an adjusted RAC and explanation below.							No		1761	8591		6
	Explanation of User Adjusted RAC							No		1761	8592		1
	12445	EDITABLE	N	1761
	6	6	N

Powered Industrial Vehicles

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GSA	Risk Management Survey

Powered Industrial Vehicles

				Risk Assessment Code (RAC)			Recommended Corrective Actions
Questions	Response	Findings/Observations	Regulatory Citation	Probability	Severity	RAC	Repeat Findings	Repeat Condition ID	Localized or Building Wide	Recommendation

	Powered Industrial Vehicles
	Do any occupants of the GSA controlled space use powered industrial vehicles (e.g., fork truck, tractor, platform lift truck, motorized hand truck, and other specialized industrial truck)?				Not Possible	No Impact	6	No		1751	8550		4
	If yes, does that organization have a specific written powered industrial vehicle program applicable to the vehicles used?				Not Possible	No Impact	6	No		1751	8551		4
	Is an evaluation of each powered industrial truck operator's performance within the last three years documented?				Not Possible	No Impact	6	No		1751	8552		4
	Other Findings
	Other Findings 1				Not Possible	No Impact	6	No		1750	8540		1
	Other Findings 2				Not Possible	No Impact	6	No		1750	8541		1
	Other Findings 3				Not Possible	No Impact	6	No		1750	8542		1
	Other Findings 4				Not Possible	No Impact	6	No		1750	8543		1
	Other Findings 5				Not Possible	No Impact	6	No		1750	8544		1
	Other Findings 6				Not Possible	No Impact	6	No		1750	8545		1
	Other Findings 7				Not Possible	No Impact	6	No		1750	8546		1
	Other Findings 8				Not Possible	No Impact	6	No		1750	8547		1
	Other Findings 9				Not Possible	No Impact	6	No		1750	8548		1
	Other Findings 10				Not Possible	No Impact	6	No		1750	8549		1
	Overall RAC
	Overall RAC	6						No		1749	8537		5
	User Adjusted RAC
: Once the surveyor has reviewed the findings and Overall RAC provided above, if the RAC does not represent the risk associated with the findings as a whole, please provide an adjusted RAC and explanation below.							No		1749	8538		6
	Explanation of User Adjusted RAC							No		1749	8539		1
	12445	EDITABLE	N	1749
	6	6	N

Radon

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GSA	Risk Management Survey

Radon

				Risk Assessment Code (RAC)			Recommended Corrective Actions
Questions	Response	Findings/Observations	Regulatory Citation	Probability	Severity	RAC	Repeat Findings	Repeat Condition ID	Localized or Building Wide	Recommendation

	Radon
	If required in the lease contract, is there a record of radon testing?				Not Possible	No Impact	6	No		1727	8442		4
	If yes, are the radon levels within acceptable levels as identified in the contract?				Not Possible	No Impact	6	No		1727	8443		4
	Has radon testing (initial baseline) been done for the building?	N/A	Not applicable for Leased building		Not Possible	No Impact	6	No		1727	8444	3728695	4
	If a childcare center is present, has testing been performed in the past 3 years, as applicable?
(note: some state licensing agencies require testing every 3 yrs)"				Not Possible	No Impact	6	No		1727	8445		4
	Has the GSA-controlled space been retested for radon following any major construction work that affected the building foundation or involved penetrations from the building into the soil? If in leased space, this would only apply if included in the lease contract.				Not Possible	No Impact	6	No		1727	8446		4
	Other Findings
	Other Findings 1				Not Possible	No Impact	6	No		1726	8432		1
	Other Findings 2				Not Possible	No Impact	6	No		1726	8433		1
	Other Findings 3				Not Possible	No Impact	6	No		1726	8434		1
	Other Findings 4				Not Possible	No Impact	6	No		1726	8435		1
	Other Findings 5				Not Possible	No Impact	6	No		1726	8436		1
	Other Findings 6				Not Possible	No Impact	6	No		1726	8437		1
	Other Findings 7				Not Possible	No Impact	6	No		1726	8438		1
	Other Findings 8				Not Possible	No Impact	6	No		1726	8439		1
	Other Findings 9				Not Possible	No Impact	6	No		1726	8440		1
	Other Findings 10				Not Possible	No Impact	6	No		1726	8441		1
	Overall RAC
	Overall RAC	6						No		1725	8429		5
	User Adjusted RAC
: Once the surveyor has reviewed the findings and Overall RAC provided above, if the RAC does not represent the risk associated with the findings as a whole, please provide an adjusted RAC and explanation below.							No		1725	8430		6
	Explanation of User Adjusted RAC							No		1725	8431		1
	12445	EDITABLE	N	1725
	6	6	N

Walking-Work Surfaces

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GSA	Risk Management Survey

Walking-Work Surfaces

				Risk Assessment Code (RAC)			Recommended Corrective Actions
Questions	Response	Findings/Observations	Regulatory Citation	Probability	Severity	RAC	Repeat Findings	Repeat Condition ID	Localized or Building Wide	Recommendation

	Walking-Work Surfaces
	Are all observed open-sided floor or platforms at least 4 feet above the adjacent floor or ground level properly guarded by guardrail system or equivalent?	N/A	Not applicable for Leased building		Not Possible	No Impact	6	No		1735	8476	3728696	4
	Are there any tripping or fall hazards within the GSA controlled space, common areas, ramps, sidewalks, or entrance areas to the facility?				Not Possible	No Impact	6	No		1735	8477		4
	Were there any areas in the GSA controlled space that raised concerns regarding the employer's obligation to ensure that each walking-working surface can adequately support the maximum intended load for that surface per 29 CFR 1910.22(b)?				Not Possible	No Impact	6	No		1735	8478		4
	Is the roof properly guarded from falls through anchors, guardrails, fall protection plans?	N/A	Not applicable for Leased building		Not Possible	No Impact	6	No		1735	8479	3728697	4
	If present, have roof anchors used for rope descent systems been tested and certified per 29 CFR 1910.27?	N/A	Not applicable for Leased building		Not Possible	No Impact	6	No		1735	8480	3728698	4
	If present, have roof anchors used for personal fall arrest systems been confirmed capable of supporting at least 5,000 pounds (22.2 kN) for each employee attached per 29 CFR 1910.140(c)(13)(i)? Alternatively, have they been designed, installed, and used under the supervision of a qualified person as part of a complete personal fall protection system that maintains a safety factor of at least two per 29 CFR 1910.140(c)(13)(ii)?	N/A	Not applicable for Leased building		Not Possible	No Impact	6	No		1735	8698	3728699	4
	For buildings in high-risk seismic zones
	Does the building exterior appear free of visible damage or deterioration?				Not Possible	No Impact	6	No		1776	8659		4
	Are hanging objects (e.g. fixtures, decorations) in occupied areas secured to minimize swinging or falling?				Not Possible	No Impact	6	No		1776	8660		4
	Are wall-mounted objects (e.g., shelves, cabinets, monitors, etc.) in occupied areas greater than 6 feet or otherwise noted in FEMA E-74 secured to the wall?				Not Possible	No Impact	6	No		1776	8661		4
	Are free-standing objects (e.g., file cabinets, bookcases, machines, etc.) greater than 6 feet or otherwise noted in FEMA E-74 secured to the floor or wall?				Not Possible	No Impact	6	No		1776	8662		4
	Other Findings
	Other Findings 1				Not Possible	No Impact	6	No		1734	8466		1
	Other Findings 2				Not Possible	No Impact	6	No		1734	8467		1
	Other Findings 3				Not Possible	No Impact	6	No		1734	8468		1
	Other Findings 4				Not Possible	No Impact	6	No		1734	8469		1
	Other Findings 5				Not Possible	No Impact	6	No		1734	8470		1
	Other Findings 6				Not Possible	No Impact	6	No		1734	8471		1
	Other Findings 7				Not Possible	No Impact	6	No		1734	8472		1
	Other Findings 8				Not Possible	No Impact	6	No		1734	8473		1
	Other Findings 9				Not Possible	No Impact	6	No		1734	8474		1
	Other Findings 10				Not Possible	No Impact	6	No		1734	8475		1
	Overall RAC
	Overall RAC	6						No		1733	8463		5
	User Adjusted RAC
: Once the surveyor has reviewed the findings and Overall RAC provided above, if the RAC does not represent the risk associated with the findings as a whole, please provide an adjusted RAC and explanation below.							No		1733	8464		6
	Explanation of User Adjusted RAC							No		1733	8465		1
	12445	EDITABLE	N	1733
	6	6	N

High Risk Operations

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GSA	Risk Management Survey

High Risk Operations

				Risk Assessment Code (RAC)			Recommended Corrective Actions
Questions	Response	Findings/Observations	Regulatory Citation	Probability	Severity	RAC	Repeat Findings	Repeat Condition ID	Localized or Building Wide	Recommendation

	High Risk Laboratories
	If a High Risk Laboratory Space exists in GSA controlled space, does it create an incompatible grouping as defined in PBS 1000.4B? (If "Yes" or "No", Include in the "Finding / Observation" Column: Tenant Agency, Floor, Room Number, and Square Footage.)				Not Possible	No Impact	6	No		1788	8717		3
	If a second (#2) High Risk Laboratory Space exists in GSA controlled space, does it create an incompatible grouping as defined in PBS 1000.4B?
(If "Yes" or "No", Include in the "Finding / Observation" Column: Tenant Agency, Floor, Room Number, and Square Footage.)				Not Possible	No Impact	6	No		1788	8718		3
	If a third (#3) High Risk Laboratory Space exists in GSA controlled space, does it create an incompatible grouping as defined in PBS 1000.4B?
(If "Yes" or "No", Include in the "Finding / Observation" Column: Tenant Agency, Floor, Room Number, and Square Footage.)				Not Possible	No Impact	6	No		1788	8719		3
	If a fourth (#4) High Risk Laboratory Space exists in GSA controlled space, does it create an incompatible grouping as defined in PBS 1000.4B?
(If "Yes" or "No", Include in the "Finding / Observation" Column: Tenant Agency, Floor, Room Number, and Square Footage.)				Not Possible	No Impact	6	No		1788	8720		3
	High Risk Firing Range or Shoot Houses
	If a High Risk Firing Range or Shoot House Space exists in GSA controlled space, does it create an incompatible grouping as defined in PBS 1000.4B? (If "Yes" or "No", Include in the "Finding / Observation" Column: Tenant Agency, Floor, Room Number, and Square Footage.)				Not Possible	No Impact	6	No		1789	8715		3
	If a second (#2) High Risk Firing Range or Shoot House Space #2 exists in GSA controlled space, does it create an incompatible grouping as defined in PBS 1000.4B? (If "Yes" or "No", Include in the "Finding / Observation" Column: Tenant Agency, Floor, Room Number, and Square Footage.)				Not Possible	No Impact	6	No		1789	8716		3
	High Risk Explosives & Explosive Materials
	If a High Risk Explosives or Explosive Materials Storage Space exists in GSA controlled space, does it create an incompatible grouping as defined in PBS 1000.4B? (If "Yes" or "No", Include in the "Finding / Observation" Column: Tenant Agency, Floor, Room Number, and Square Footage.) NOTE: Storage of ammunition is not considered explosives or explosive materials storage.				Not Possible	No Impact	6	No		1790	8712		3
	If a second (#2) High Risk Explosives or Explosive Materials Storage Space exists in GSA controlled space, does it create an incompatible grouping as defined in PBS 1000.4B? (If "Yes" or "No", Include in the "Finding / Observation" Column: Tenant Agency, Floor, Room Number, and Square Footage.) NOTE: Storage of ammunition is not considered explosives or explosive materials storage.				Not Possible	No Impact	6	No		1790	8713		3
	If a third (#3) High Risk Explosives or Explosive Materials Storage Space exists in GSA controlled space, does it create an incompatible grouping as defined in PBS 1000.4B? (If "Yes" or "No", Include in the "Finding / Observation" Column: Tenant Agency, Floor, Room Number, and Square Footage.) NOTE: Storage of ammunition is not considered explosives or explosive materials storage.				Not Possible	No Impact	6	No		1790	8714		3
	Other Findings
	Other Findings 1				Not Possible	No Impact	6	No		1787	8702		1
	Other Findings 2				Not Possible	No Impact	6	No		1787	8703		1
	Other Findings 3				Not Possible	No Impact	6	No		1787	8704		1
	Other Findings 4				Not Possible	No Impact	6	No		1787	8705		1
	Other Findings 5				Not Possible	No Impact	6	No		1787	8706		1
	Other Findings 6				Not Possible	No Impact	6	No		1787	8707		1
	Other Findings 7				Not Possible	No Impact	6	No		1787	8708		1
	Other Findings 8				Not Possible	No Impact	6	No		1787	8709		1
	Other Findings 9				Not Possible	No Impact	6	No		1787	8710		1
	Other Findings 10				Not Possible	No Impact	6	No		1787	8711		1
	Overall RAC
	Overall RAC	6						No		1786	8699		5
	User Adjusted RAC
: Once the surveyor has reviewed the findings and Overall RAC provided above, if the RAC does not represent the risk associated with the findings as a whole, please provide an adjusted RAC and explanation below.							No		1786	8700		6
	Explanation of User Adjusted RAC							No		1786	8701		1
	12445	EDITABLE	N	1786
	6	6	N

RAC Guidance Risk Management Survey Severity and Probability Assessment Guidance

SEVERITY ASSESSMENT GUIDANCE
SCOPE and APPLICABILITY
	Environmental Risk	Fire Protection Risk	Safety & Health Risk
	Contamination of air, water soil, and biota or non-compliance with environmental regulations	Effects to occupants or facility as a result of a condition or potential event.	Adverse health effects or injury to facility occupants, contractors or visitors in response to a condition or event

SEVERITY LEVEL DEFINITIONS
CATASTROPHIC	Irreversible long-term impacts.	(1) Death, permanent disability or irreversible health effect to occupants or (2) a loss of an entire facility.	Permanent disability, irreversible health effect or death.

SEVERE Reversible long-term damage (5+ years to remediate). (1) Severe injury, potential long-term health effect or (2) major loss or impact to a facility. Potential long-term health effect or severe injury.

SIGNIFICANT Reversible medium-term damage (1-5 years to remediate). (1) Minor injury or reversible health effect or (2) damage to a portion of a facility requiring an extended period of time to repair. Reversible health effect or minor injury.

MODERATE Reversible short-term impact (<1 year to remediate). (1) First aid, no lost time or (2) damage to a facility requiring a minimal amount of time to repair. First aid or no lost time.

MINOR De minimis regulatory violation. De minimis code violation. De minimis code violation.

NO IMPACT	No risk of impact.	No risk of impact to the occupants or facility.	No risk of impact.
PROBABILITY ASSESSMENT GUIDANCE
PROBABILITY LEVEL DEFINITIONS
Likely	Imminent

	1 in 10
Probable	Probable

	1 in 100
Possible	Possible

	1 in 1000
Remote	Remote

	1 in 10,000
Unlikely	Unlikely

	1 in 100,000
Not Possible	Non-existent

Help Text

RAC Summary
RAC Summary
IRIS Building Profile
IRIS Building Profile
Region
GSA Building Number
GSA Building Name
Building Street Address
Building City
Date of Building Construction
Building State
Building Size (RSF)
Building Size (GSF)
Total Number of Floors Above Grade
Total Number of Floors Below Grade
Building Information
Building Profile
Date(s) of Onsite Survey
Surveyor
Type of Occupancies
Building Point(s) of Contact for Survey
Lease Number
Lease Expiration Date
Property Type
What is the tenant breakdown?
Primary Tenants
Identify any Unique Space Type(s). If "other" is chosen, please describe the "other" unique space in the comments section.
Identify any Unique Space Type #2.
Identify any Unique Space Type #3.
Identify any Unique Space Type #4.
Asbestos
Asbestos
If required in the lease contract, has the lessor provided a written statement that no asbestos is present?
If asbestos is present, is there a current asbestos management plan or O&M plan?
Are visual inspections of the asbestos inventory conducted annually?
Are asbestos notifications documented (e.g., annual, the start of a contract, and before an abatement project)?
Is asbestos maintenance or renovation done in accordance with Federal, state and local regulations?
Are pre-alteration assessments done before work that could disturb asbestos, as verified through the asbestos program manager? If in leased space, this would only apply to GSA-managed projects.
Other Findings
Other Findings 1
Other Findings 2
Other Findings 3
Other Findings 4
Other Findings 5
Other Findings 6
Other Findings 7
Other Findings 8
Other Findings 9
Other Findings 10
Overall RAC
Overall RAC
User Adjusted RAC	Once the surveyor has reviewed the findings and Overall RAC provided above, if the RAC does not represent the risk associated with the findings as a whole, please provide an adjusted RAC and explanation below.
Explanation of User Adjusted RAC
Drinking Water
Drinking Water
Is the water from a public or municipal provider?
If the water is from a well source, is it tested regularly in accordance with State or local requirements?
Have there been any unresolved drinking water complaints from GSA tenants since the last survey?
Is chlorine testing and flushing conducted per PBS Guidance to Avoid Water Stagnation?
If a GSA-managed child care center is present, has testing been performed for lead and copper per PBS Drinking Water Policy requirements?
If a GSA-managed child care center is present, are all outlets flushed weekly?
Are backflow prevention devices certified as prescribed by applicable Federal, state, and local laws, ordinances, and regulations? If no regulations exist, at least annually per the O&M contract requirements.
Other Findings
Other Findings 1
Other Findings 2
Other Findings 3
Other Findings 4
Other Findings 5
Other Findings 6
Other Findings 7
Other Findings 8
Other Findings 9
Other Findings 10
Overall RAC
Overall RAC
User Adjusted RAC	Once the surveyor has reviewed the findings and Overall RAC provided above, if the RAC does not represent the risk associated with the findings as a whole, please provide an adjusted RAC and explanation below.
Explanation of User Adjusted RAC
Electrical
Electrical
Are there any visible electrical safety hazards in the GSA controlled space?
Has an Arc Flash analysis for the building been conducted?
Are proper Arc Flash warning labels posted on the appropriate electrical equipment?
Have electrical spaces been limited to qualified personnel only per OSHA requirements?
Is there a plan to replace electrical equipment that has reached the end of its life?
Other Findings
Other Findings 1
Other Findings 2
Other Findings 3
Other Findings 4
Other Findings 5
Other Findings 6
Other Findings 7
Other Findings 8
Other Findings 9
Other Findings 10
Overall RAC
Overall RAC
User Adjusted RAC	Once the surveyor has reviewed the findings and Overall RAC provided above, if the RAC does not represent the risk associated with the findings as a whole, please provide an adjusted RAC and explanation below.
Explanation of User Adjusted RAC
Emergency Planning
Emergency Planning
Is there a current occupant emergency plan (OEP) in place?
Are emergency drills performed (e.g., fire, tornado, etc)?
Other Findings
Other Findings 1
Other Findings 2
Other Findings 3
Other Findings 4
Other Findings 5
Other Findings 6
Other Findings 7
Other Findings 8
Other Findings 9
Other Findings 10
Overall RAC
Overall RAC
User Adjusted RAC	Once the surveyor has reviewed the findings and Overall RAC provided above, if the RAC does not represent the risk associated with the findings as a whole, please provide an adjusted RAC and explanation below.
Explanation of User Adjusted RAC
Equipment Machine Guard
Equipment Machine Guard
Is the facility machinery properly guarded and/or interlocked?
Other Findings
Other Findings 1
Other Findings 2
Other Findings 3
Other Findings 4
Other Findings 5
Other Findings 6
Other Findings 7
Other Findings 8
Other Findings 9
Other Findings 10
Overall RAC
Overall RAC
User Adjusted RAC	Once the surveyor has reviewed the findings and Overall RAC provided above, if the RAC does not represent the risk associated with the findings as a whole, please provide an adjusted RAC and explanation below.
Explanation of User Adjusted RAC
HazMat HazCom
HazMat HazCom
Does the O&M contractor have a written hazard communication program per 1910.1200(e)?
Does the O&M contractor maintain a chemical inventory, and SDSs for each chemical per 1910.1200(e)(1)(i)?
Does the O&M contractor properly label and store their chemicals?
Does the Custodial contractor have a written hazard communication program per 1910.1200(e)
Does the Custodial contractor maintain a chemical inventory and SDSs for each chemical per 1910.1200(e)(1)(i)?
Does the Custodial contractor properly label and store their chemicals?
If emergency eyewash and shower equipment are used to treat chemical splashes or eye injuries in the workplace, is the equipment activated weekly and inspected per the ANSI/ISEA Z358.1 standard?
If applicable, do the GSA tenants have a written hazard communication program per 1910.1200(e)?
If applicable, do the GSA tenants maintain a chemical inventory, and SDSs for each chemical per 1910.1200(e)(1)(i)?
If applicable, do the GSA tenants properly label and store their chemicals?
Other Findings
Other Findings 1
Other Findings 2
Other Findings 3
Other Findings 4
Other Findings 5
Other Findings 6
Other Findings 7
Other Findings 8
Other Findings 9
Other Findings 10
Overall RAC
Overall RAC
User Adjusted RAC	Once the surveyor has reviewed the findings and Overall RAC provided above, if the RAC does not represent the risk associated with the findings as a whole, please provide an adjusted RAC and explanation below.
Explanation of User Adjusted RAC
Hazardous Energy Control
Hazardous Energy Control
Does the O&M Contractor have a written hazardous energy control program?
If observed, are proper lockout/tagout practices and procedures followed?
Other Findings
Other Findings 1
Other Findings 2
Other Findings 3
Other Findings 4
Other Findings 5
Other Findings 6
Other Findings 7
Other Findings 8
Other Findings 9
Other Findings 10
Overall RAC
Overall RAC
User Adjusted RAC	Once the surveyor has reviewed the findings and Overall RAC provided above, if the RAC does not represent the risk associated with the findings as a whole, please provide an adjusted RAC and explanation below.
Explanation of User Adjusted RAC
Indoor Air Quality
Indoor Air Quality
Have there been any unresolved IAQ complaints from GSA tenants since the last survey?
Does the building management office maintain a log of IAQ issues or complaints in NCMMS?
Is the GSA Lease Administration Manager familiar with the IAQ portion of the contract?
Are there visible signs of water damage or mold?
If present, is the building dealing with water intrusion or visible mold growth per industry standards (e.g., ANSI / IICRC S500 & S520)?
Other Findings
Other Findings 1
Other Findings 2
Other Findings 3
Other Findings 4
Other Findings 5
Other Findings 6
Other Findings 7
Other Findings 8
Other Findings 9
Other Findings 10
Overall RAC
Overall RAC
User Adjusted RAC	Once the surveyor has reviewed the findings and Overall RAC provided above, if the RAC does not represent the risk associated with the findings as a whole, please provide an adjusted RAC and explanation below.
Explanation of User Adjusted RAC
Lead
Lead
Does the building contain damaged paint, similar surface coatings, or accumulated dust that contains lead?
Are pre-alteration assessments done before work that disturb paint, similar surface coatings, or accumulated dust that could contain lead? If in leased space, this would only apply to GSA-managed projects.
Other Findings
Other Findings 1
Other Findings 2
Other Findings 3
Other Findings 4
Other Findings 5
Other Findings 6
Other Findings 7
Other Findings 8
Other Findings 9
Other Findings 10
Overall RAC
Overall RAC
User Adjusted RAC	Once the surveyor has reviewed the findings and Overall RAC provided above, if the RAC does not represent the risk associated with the findings as a whole, please provide an adjusted RAC and explanation below.
Explanation of User Adjusted RAC
Non-ionizing Radiation
Non-ionizing Radiation
Are radio frequency (RF) transmitting devices on the facility's roof?
Are safety zones established and proper danger signage posted?
If applicable, is the FCC license and RF emissions analysis report from the device owner documented?
Other Findings
Other Findings 1
Other Findings 2
Other Findings 3
Other Findings 4
Other Findings 5
Other Findings 6
Other Findings 7
Other Findings 8
Other Findings 9
Other Findings 10
Overall RAC
Overall RAC
User Adjusted RAC	Once the surveyor has reviewed the findings and Overall RAC provided above, if the RAC does not represent the risk associated with the findings as a whole, please provide an adjusted RAC and explanation below.
Explanation of User Adjusted RAC
Confined Spaces
Confined Spaces

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File details come from the government source that posted it. Updated Jun 26, 2024.