Title Page
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Company Name
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Assessment Sponsor
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Facility/Plant Manager
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Purchasing Manager
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Date/Time
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Number of Buildings
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Ground/Property Size (Areas)
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Total Number Employees/Occupants at this site
Major Building Summary
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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
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Building Name
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Area (SF)
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Year Built
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Cleanable SF
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Days of Operation
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Hours of Operation
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Occupancy
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Major Function/Processes
Space Type*
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* 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
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Facilities Managment
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Maintenance
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Cleaning
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Mail Services
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Copy Services
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Landscaping
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Snow Removal
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Project Management
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Other
Internal Materials
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Facilities Managment
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Maintenance
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Cleaning
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Mail Services
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Copy Services
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Landscaping
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Snow Removal
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Project Management
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Other
Internal Overtime
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Facilities Managment
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Maintenance
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Cleaning
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Mail Services
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Copy Services
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Landscaping
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Snow Removal
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Project Management
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Other
Internal Benefits Costs
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Facilities Managment
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Maintenance
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Cleaning
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Mail Services
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Copy Services
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Landscaping
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Snow Removal
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Project Management
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Other
Contracted Labor
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Facilities Managment
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Maintenance
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Cleaning
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Mail Services
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Copy Services
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Landscaping
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Snow Removal
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Project Management
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Other
Contracted Materials
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Facilities Managment
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Maintenance
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Cleaning
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Mail Services
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Copy Services
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Landscaping
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Snow Removal
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Project Management
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Other
Costs (Previous Year's Actuals)
Internal Labor
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Facilities Managment
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Maintenance
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Cleaning
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Mail Services
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Copy Services
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Landscaping
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Snow Removal
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Project Management
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Other
Internal Materials
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Facilities Managment
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Maintenance
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Cleaning
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Mail Services
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Copy Services
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Landscaping
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Snow Removal
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Project Management
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Other
Internal Overtime
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Facilities Managment
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Maintenance
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Cleaning
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Mail Services
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Copy Services
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Landscaping
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Snow Removal
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Project Management
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Other
Internal Benefits Costs
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Facilities Managment
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Maintenance
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Cleaning
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Mail Services
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Copy Services
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Landscaping
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Snow Removal
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Project Management
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Other
Contracted Labor
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Facilities Managment
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Maintenance
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Cleaning
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Mail Services
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Copy Services
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Landscaping
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Snow Removal
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Project Management
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Other
Contracted Materials
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Facilities Managment
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Maintenance
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Cleaning
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Mail Services
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Copy Services
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Landscaping
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Snow Removal
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Project Management
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Other
Staffing
Organization Chart
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Facilities Managment
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Maintenance
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Cleaning
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Mail Services
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Copy Services
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Landscaping
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Snow Removal
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Project Management
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Other
Internal Craft Full Time Equivalents
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Facilities Managment
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Maintenance
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Cleaning
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Mail Services
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Copy Services
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Landscaping
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Snow Removal
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Project Management
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Other
Internal Mgr/Sup FTE
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Facilities Managment
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Maintenance
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Cleaning
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Mail Services
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Copy Services
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Landscaping
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Snow Removal
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Project Management
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Other
Contracted FTE
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Facilities Managment
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Maintenance
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Cleaning
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Mail Services
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Copy Services
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Landscaping
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Snow Removal
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Project Management
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Other
Average Internal Wage Rate
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Facilities Managment
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Maintenance
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Cleaning
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Mail Services
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Copy Services
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Landscaping
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Snow Removal
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Project Management
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Other
Average Internal Burden Rate
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Facilities Managment
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Maintenance
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Cleaning
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Mail Services
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Copy Services
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Landscaping
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Snow Removal
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Project Management
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Other
Unionized (Attach CBA & Roster)
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Facilities Managment
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Maintenance
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Cleaning
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Mail Services
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Copy Services
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Landscaping
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Snow Removal
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Project Management
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Other
Contract Management
Provide copies of current service contracts
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Facilities Managment
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Maintenance
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Cleaning
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Mail Services
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Copy Services
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Landscaping
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Snow Removal
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Project Management
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Other
Detailed scopes of work
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Facilities Managment
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Maintenance
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Cleaning
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Mail Services
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Copy Services
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Landscaping
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Snow Removal
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Project Management
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Other
Total number of contracts
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Facilities Managment
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Maintenance
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Cleaning
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Mail Services
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Copy Services
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Landscaping
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Snow Removal
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Project Management
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Other
Total value of contracts
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Facilities Managment
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Maintenance
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Cleaning
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Mail Services
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Copy Services
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Landscaping
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Snow Removal
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Project Management
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Other
Service Levels/Work Volume
Days of Service
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Facilities Managment
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Maintenance
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Cleaning
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Mail Services
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Copy Services
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Landscaping
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Snow Removal
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Project Management
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Other
Frequency/Hrs of Service
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Facilities Managment
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Maintenance
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Cleaning
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Mail Services
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Copy Services
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Landscaping
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Snow Removal
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Project Management
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Other
Required watchstanding/staffing hours
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Facilities Managment
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Maintenance
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Cleaning
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Mail Services
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Copy Services
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Landscaping
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Snow Removal
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Project Management
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Other
In-scope repair threshold (ex. $2500)
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Facilities Managment
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Maintenance
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Cleaning
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Mail Services
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Copy Services
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Landscaping
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Snow Removal
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Project Management
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Other
CMMS Asset Data
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Facilities Managment
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Maintenance
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Cleaning
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Mail Services
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Copy Services
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Landscaping
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Snow Removal
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Project Management
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Other
CMMS PM History
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Facilities Managment
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Maintenance
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Cleaning
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Mail Services
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Copy Services
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Landscaping
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Snow Removal
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Project Management
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Other
CMMS Service request history
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Facilities Managment
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Maintenance
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Cleaning
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Mail Services
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Copy Services
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Landscaping
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Snow Removal
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Project Management
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Other
Response/Delivery Time SLAs
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Facilities Managment
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Maintenance
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Cleaning
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Mail Services
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Copy Services
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Landscaping
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Snow Removal
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Project Management
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Other
Work Volume (specific to each service line)
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Facilities Managment
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Maintenance
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Cleaning
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Mail Services
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Copy Services
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Landscaping
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Snow Removal
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Project Management
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Other
Equipment & Tool Inventory
Client owned equipment & tools
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Facilities Managment
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Maintenance
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Cleaning
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Mail Services
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Copy Services
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Landscaping
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Snow Removal
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Project Management
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Other
Client leased equipment & tools
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Facilities Managment
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Maintenance
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Cleaning
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Mail Services
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Copy Services
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Landscaping
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Snow Removal
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Project Management
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Other
Vendor owned equipment & tools
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Facilities Managment
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Maintenance
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Cleaning
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Mail Services
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Copy Services
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Landscaping
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Snow Removal
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Project Management
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Other
Vehicles utilized in service delivery
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Facilities Managment
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Maintenance
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Cleaning
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Mail Services
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Copy Services
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Landscaping
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Snow Removal
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Project Management
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Other
Software utilized for each service
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Facilities Managment
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Maintenance
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Cleaning
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Mail Services
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Copy Services
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Landscaping
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Snow Removal
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Project Management
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Other
Technology utilized for each service
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Facilities Managment
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Maintenance
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Cleaning
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Mail Services
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Copy Services
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Landscaping
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Snow Removal
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Project Management
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Other
Project Management & Capital Planning
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Provide 5-year capital plan
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Provide summary of past & current capital projects