Title Page

  • Company Name
  • Assessment Sponsor

  • Facility/Plant Manager

  • Purchasing Manager

  • Date/Time

  • Number of Buildings

  • Ground/Property Size (Areas)

  • Total Number Employees/Occupants at this site

Major Building Summary

  • Please summarize information for major buildings (constituting 5% or more of the total area) below, noting which buildings have air conditioning (AC) and which are heated.

  • Major Buildings
  • Building Name

  • Area (SF)

  • Year Built

  • Cleanable SF

  • Days of Operation

  • Hours of Operation

  • Occupancy

  • Major Function/Processes

Space Type*

  • * For Space Type, indicate whether building is Administrative, Laboratory/R&D, Manufacturing/Production, Storage/Warehouse, Vacant, or Other.

Facilities Operations Pre-Site Data Needs

Costs (Current Year's Budget)

Internal Labor

  • Facilities Managment

  • Maintenance

  • Cleaning

  • Mail Services

  • Copy Services

  • Landscaping

  • Snow Removal

  • Project Management

  • Other

Internal Materials

  • Facilities Managment

  • Maintenance

  • Cleaning

  • Mail Services

  • Copy Services

  • Landscaping

  • Snow Removal

  • Project Management

  • Other

Internal Overtime

  • Facilities Managment

  • Maintenance

  • Cleaning

  • Mail Services

  • Copy Services

  • Landscaping

  • Snow Removal

  • Project Management

  • Other

Internal Benefits Costs

  • Facilities Managment

  • Maintenance

  • Cleaning

  • Mail Services

  • Copy Services

  • Landscaping

  • Snow Removal

  • Project Management

  • Other

Contracted Labor

  • Facilities Managment

  • Maintenance

  • Cleaning

  • Mail Services

  • Copy Services

  • Landscaping

  • Snow Removal

  • Project Management

  • Other

Contracted Materials

  • Facilities Managment

  • Maintenance

  • Cleaning

  • Mail Services

  • Copy Services

  • Landscaping

  • Snow Removal

  • Project Management

  • Other

Costs (Previous Year's Actuals)

Internal Labor

  • Facilities Managment

  • Maintenance

  • Cleaning

  • Mail Services

  • Copy Services

  • Landscaping

  • Snow Removal

  • Project Management

  • Other

Internal Materials

  • Facilities Managment

  • Maintenance

  • Cleaning

  • Mail Services

  • Copy Services

  • Landscaping

  • Snow Removal

  • Project Management

  • Other

Internal Overtime

  • Facilities Managment

  • Maintenance

  • Cleaning

  • Mail Services

  • Copy Services

  • Landscaping

  • Snow Removal

  • Project Management

  • Other

Internal Benefits Costs

  • Facilities Managment

  • Maintenance

  • Cleaning

  • Mail Services

  • Copy Services

  • Landscaping

  • Snow Removal

  • Project Management

  • Other

Contracted Labor

  • Facilities Managment

  • Maintenance

  • Cleaning

  • Mail Services

  • Copy Services

  • Landscaping

  • Snow Removal

  • Project Management

  • Other

Contracted Materials

  • Facilities Managment

  • Maintenance

  • Cleaning

  • Mail Services

  • Copy Services

  • Landscaping

  • Snow Removal

  • Project Management

  • Other

Staffing

Organization Chart

  • Facilities Managment

  • Maintenance

  • Cleaning

  • Mail Services

  • Copy Services

  • Landscaping

  • Snow Removal

  • Project Management

  • Other

Internal Craft Full Time Equivalents

  • Facilities Managment

  • Maintenance

  • Cleaning

  • Mail Services

  • Copy Services

  • Landscaping

  • Snow Removal

  • Project Management

  • Other

Internal Mgr/Sup FTE

  • Facilities Managment

  • Maintenance

  • Cleaning

  • Mail Services

  • Copy Services

  • Landscaping

  • Snow Removal

  • Project Management

  • Other

Contracted FTE

  • Facilities Managment

  • Maintenance

  • Cleaning

  • Mail Services

  • Copy Services

  • Landscaping

  • Snow Removal

  • Project Management

  • Other

Average Internal Wage Rate

  • Facilities Managment

  • Maintenance

  • Cleaning

  • Mail Services

  • Copy Services

  • Landscaping

  • Snow Removal

  • Project Management

  • Other

Average Internal Burden Rate

  • Facilities Managment

  • Maintenance

  • Cleaning

  • Mail Services

  • Copy Services

  • Landscaping

  • Snow Removal

  • Project Management

  • Other

Unionized (Attach CBA & Roster)

  • Facilities Managment

  • Maintenance

  • Cleaning

  • Mail Services

  • Copy Services

  • Landscaping

  • Snow Removal

  • Project Management

  • Other

Contract Management

Provide copies of current service contracts

  • Facilities Managment

  • Maintenance

  • Cleaning

  • Mail Services

  • Copy Services

  • Landscaping

  • Snow Removal

  • Project Management

  • Other

Detailed scopes of work

  • Facilities Managment

  • Maintenance

  • Cleaning

  • Mail Services

  • Copy Services

  • Landscaping

  • Snow Removal

  • Project Management

  • Other

Total number of contracts

  • Facilities Managment

  • Maintenance

  • Cleaning

  • Mail Services

  • Copy Services

  • Landscaping

  • Snow Removal

  • Project Management

  • Other

Total value of contracts

  • Facilities Managment

  • Maintenance

  • Cleaning

  • Mail Services

  • Copy Services

  • Landscaping

  • Snow Removal

  • Project Management

  • Other

Service Levels/Work Volume

Days of Service

  • Facilities Managment

  • Maintenance

  • Cleaning

  • Mail Services

  • Copy Services

  • Landscaping

  • Snow Removal

  • Project Management

  • Other

Frequency/Hrs of Service

  • Facilities Managment

  • Maintenance

  • Cleaning

  • Mail Services

  • Copy Services

  • Landscaping

  • Snow Removal

  • Project Management

  • Other

Required watchstanding/staffing hours

  • Facilities Managment

  • Maintenance

  • Cleaning

  • Mail Services

  • Copy Services

  • Landscaping

  • Snow Removal

  • Project Management

  • Other

In-scope repair threshold (ex. $2500)

  • Facilities Managment

  • Maintenance

  • Cleaning

  • Mail Services

  • Copy Services

  • Landscaping

  • Snow Removal

  • Project Management

  • Other

CMMS Asset Data

  • Facilities Managment

  • Maintenance

  • Cleaning

  • Mail Services

  • Copy Services

  • Landscaping

  • Snow Removal

  • Project Management

  • Other

CMMS PM History

  • Facilities Managment

  • Maintenance

  • Cleaning

  • Mail Services

  • Copy Services

  • Landscaping

  • Snow Removal

  • Project Management

  • Other

CMMS Service request history

  • Facilities Managment

  • Maintenance

  • Cleaning

  • Mail Services

  • Copy Services

  • Landscaping

  • Snow Removal

  • Project Management

  • Other

Response/Delivery Time SLAs

  • Facilities Managment

  • Maintenance

  • Cleaning

  • Mail Services

  • Copy Services

  • Landscaping

  • Snow Removal

  • Project Management

  • Other

Work Volume (specific to each service line)

  • Facilities Managment

  • Maintenance

  • Cleaning

  • Mail Services

  • Copy Services

  • Landscaping

  • Snow Removal

  • Project Management

  • Other

Equipment & Tool Inventory

Client owned equipment & tools

  • Facilities Managment

  • Maintenance

  • Cleaning

  • Mail Services

  • Copy Services

  • Landscaping

  • Snow Removal

  • Project Management

  • Other

Client leased equipment & tools

  • Facilities Managment

  • Maintenance

  • Cleaning

  • Mail Services

  • Copy Services

  • Landscaping

  • Snow Removal

  • Project Management

  • Other

Vendor owned equipment & tools

  • Facilities Managment

  • Maintenance

  • Cleaning

  • Mail Services

  • Copy Services

  • Landscaping

  • Snow Removal

  • Project Management

  • Other

Vehicles utilized in service delivery

  • Facilities Managment

  • Maintenance

  • Cleaning

  • Mail Services

  • Copy Services

  • Landscaping

  • Snow Removal

  • Project Management

  • Other

Software utilized for each service

  • Facilities Managment

  • Maintenance

  • Cleaning

  • Mail Services

  • Copy Services

  • Landscaping

  • Snow Removal

  • Project Management

  • Other

Technology utilized for each service

  • Facilities Managment

  • Maintenance

  • Cleaning

  • Mail Services

  • Copy Services

  • Landscaping

  • Snow Removal

  • Project Management

  • Other

Project Management & Capital Planning

  • Provide 5-year capital plan

  • Provide summary of past & current capital projects

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.