Information

  • Audit Title

  • Inspection Number

  • Inspector

  • Type of inspection

  • Conducted on

Lease Location & Information

  • Lease Contract Number

  • Lease expiration date

  • Fully Serviced Lease

  • Building Number

  • Building Name

  • Building Address

  • Square footage (RSF)

  • Number of Employees

  • HSPD-12

  • LAM/COTR Name / Telephone / Email

  • LCO Name / Telephone / Email

  • Energy Star requirement met?

  • LEED Certified?

  • Computer / Server Room Present?

  • Date of last TSS Survey / Next Survey Date

  • Score % and Response Rate %

  • Agency Name / Representative / Telephone Number / Email

  • Lessor Name / Telephone Number

  • Management Company / Address / Email

  • After Hours Telephone Number

  • Deficiency Identified

  • Pictures Taken

  • "Building Rules and Regulations" Posted

Cyclical & Fire Safety Maintenance

  • CYCLICAL MAINTENANCE

  • Carpet Replacement Last Completed

  • Carpet Replacement Next Due Date

  • Cyclical Painting Last Completed

  • Cyclical Painting Next Due Date

  • FIRE LIFE & SAFETY

  • Date of Last Safety Inspection

  • Date of Last Fire Drill

  • Date of Last OEP

  • Fire Extinguishers Serviced

  • Date Fire Extinguishers Serviced

  • NON-FULLY SERVICED LEASES

  • Additional Services Provided

  • Type of utilities (gas, water, electric)

  • Meter Number and Location(s)

  • Notes

Periodic Services

  • Instructions: Utilize this form to document lease inspection finding(s). Provide the lease information as indicated within each field. In the Periodic Services section, verify when and if the lease requirements listed are satisfactorily fulfilled per the Lease. In the following sections, document the room location and specific details for each finding. For every applicable section, designate if the condition of the lease requirement is “A” Acceptable or “U” Unacceptable, using the “A/U” field. During re-inspection use the follow-up section to document if the deficiency(s) were addressed. Depending on the Lease, additional requirements can be documented under the “Notes” Section at the end of each page. Utilize the field directly under each item to make comments or remarks as needed.

  • A. Mop & spray buff resilient floor

  • “A” Acceptable or “U” Unacceptable

  • Follow-up

  • B. Damp wipe toilet partitions, etc.

  • “A” Acceptable or “U” Unacceptable

  • Follow-up

  • C. Entrance mats

  • “A” Acceptable or “U” Unacceptable

  • Follow-up

  • D. High cleaning

  • “A” Acceptable or “U” Unacceptable

  • Follow-up

  • E. Stripping and waxing floors

  • “A” Acceptable or “U” Unacceptable

  • Follow-up

  • F. Shampoo corridor and lobby carpets

  • “A” Acceptable or “U” Unacceptable

  • Follow-up

  • G. Shampoo other office carpets

  • “A” Acceptable or “U” Unacceptable

  • Follow-up

  • H. Drapery cleaning

  • “A” Acceptable or “U” Unacceptable

  • Follow-up

  • I. Venetian blind cleaning

  • “A” Acceptable or “U” Unacceptable

  • Follow-up

  • J. Wall covering replacement

  • “A” Acceptable or “U” Unacceptable

  • Follow-up

  • K. Window washing

  • “A” Acceptable or “U” Unacceptable

  • Follow-up

  • L. Other

  • “A” Acceptable or “U” Unacceptable

  • Follow-up

  • Notes

First Impressions & Grounds / Finishes & Stairwells

  • First Impressions: Grounds/Parking Lot/Lobby

  • 1. The exterior of the building appears in good condition. Roofing appears in place with no missing shingles/tiles; no chipping cracked or damaged walls in need of repair and/or paint. Entry doors are clean and without damage. Entry doors clean; no damage; no broken/cracked glass; overhead lights intact. Handicapped door available/functional. Garbage cans/cigarette receptacles available and clean. Overall appearance is not run down.

  • Follow-up

  • 2. Parking lot and loading dock is free of debris and parking spaces are clearly marked with bumpers/curbs in place. Landscaping is well maintained. Lighting/lens are intact and not burning during daylight hours.

  • Follow-up

  • 3. Sidewalks, steps, ramps, driveways, and parking areas are free from snow, ice or other debris. Directional signs are adequate.

  • Follow-up

  • 4. Main lobby and public areas are clean and litter free. Trash cans available and clean. Interior signage is adequate.<br>

  • Follow-up

  • Finishes and Stairwells

  • 1. Ceilings-Ceiling tiles not stained, cracked, broken or missing.

  • Follow-up

  • 2. Ceilings-Light fixtures working; lenses not cracked, broken or missing. Bulbs/tubes in place.

  • Follow-up

  • 3. Floors-Carpet in good condition without rips, tears, stains, or badly worn areas.

  • Follow-up

  • 4. Floors-Floor tile in good condition without loose, cracked or missing tiles.

  • Follow-up

  • 5. Floors-Cove base is securely fastened to the wall; no missing sections; colors matching.

  • Follow-up

  • 6. Walls-Walls in good condition; no holes or sloppy patching.

  • Follow-up

  • 7. Walls-Paint is not peeling, flaking or mismatched; not too badly soiled for cleaning.

  • Follow-up

  • 8. Walls-Electrical outlets appear to be in working order (spot checked).<br>

  • Follow-up

  • 9. Walls-Wall covering is not torn, stained, or peeling from the surface. Repairs match.

  • Follow-up

  • 10. Windows-Window coverings are in good condition, without tears, sagging hems, or missing hooks or panels.

  • Follow-up

  • 11. Windows-Windows and window seals are without cracks, holes or drafts.

  • Follow-up

  • 12. Windows-Window blinds are clean and in good shape, i.e. blinds are not bent; tapes and cords are not damaged, drapes in good shape without holes, tears or missing sections.

  • Follow-up

  • 13. Doors in good condition; clean, open, close, and latch properly without scraping the doorframe; not warped.

  • Follow-up

  • 14. Stairwells - No egress obstructions, well maintained, illuminated, emergency lighting, directional signage in place, and clean.

  • Follow-up

  • 15. Locks are intact and easily operable.

  • Follow-up

  • Notes

Offices & Corridors / Breakrooms / Restrooms

  • Offices and Corridors

  • 1. Trash cans not overflowing and appear to be emptied daily.

  • Follow-up

  • 2. Main traffic areas (floors) are clean showing only a day of accumulated dirt, dust, and debris.

  • Follow-up

  • 3. Carpet not spotted or having appearance of not being cleaned over a one week period.

  • Follow-up

  • 4. Horizontal furniture surfaces, chair rails, are dust free or appear to have less than a one week period.<br>

  • Follow-up

  • 5. Drinking fountains have no soil or lime deposits. Fountains show no visible signs of damage and the water pressure is adequate.

  • Follow-up

  • Breakrooms and Kitchenette

  • 1. Sink is in good condition; hot & cold water working, faucets not dripping or badly worn. Sink is not stained, chipped, dented, nor badly worn. Back-splash is clean and without spots. Paper & Soup dispensers are working & stocked. Trash cans are clean.

  • Follow-up

  • 2. Floor tile/carpet clean; no spots/stains/tears/missing pieces. Cupboards and counter tops clean; hardware intact. No signs of pest infestation.

  • Follow-up

  • 3. Ceiling tiles and lighting in good condition. No missing tiles; light lenses. Overall condition clean.

  • Follow-up

  • Restrooms/Locker Rooms

  • 1. Sinks are clean and in good condition. Faucets provide hot and cold water, are securely fastened, and are not leaking. Exposed piping under ADA sink is properly wrapped.

  • Follow-up

  • 2. Toilets are in good condition, can be flushed, and are not leaking or running. The toilet seat and bowl are securely fastened to its fixture (wall or floor) and are not broken. Toilet paper holder is properly secured without damage, and is stocked.

  • Follow-up

  • 3. Partitions and stalls are in good condition, clean condition. Floor Drains are clean, no odors.<br>

  • Follow-up

  • 4. Adequate supplies, i.e. soap, paper towels, toilet seat covers and sanitary napkins all with working dispensers in good condition.

  • Follow-up

  • 5. Shower stalls are in good working order and cleaned regularly.<br>

  • Follow-up

  • Notes

Safety & Environmental / Elevators

  • Safety and Environmental

  • 1. Tenant agency is not engaged in unsafe work practices, i.e. permanent use of extension cords,<br>improper storage of chemicals or blocking exits, isles, or stairwells.<br>1a. Has any spill or release of hazardous materials occurred?<br>1b. Is any disposal of hazardous waste planned?

  • Follow-up

  • 2. Lessor is not engaged in unsafe work practices, i.e. permanent use of extension cords, improper storage of chemicals, or blocking exits, isles, or stairwells.

  • Follow-up

  • 3. Sprinkler heads are intact, clean, and unobstructed.

  • Follow-up

  • 4. Deficient items from last Safety and Environmental Survey have been corrected.<br>

  • Follow-up

  • 5. Fire extinguishers in common areas are wall mounted; inspection tags current (spot checks).

  • Follow-up

  • 6. Battery pack emergency lighting appears effective (spot checks).

  • Follow-up

  • 7. Exit signs are illuminated for egress.

  • Follow-up

  • 8. Integrated Pest Management Plan in place.

  • Follow-up

  • Elevators

  • 1. Elevators- Well Maintained, illuminated, clean, leveling properly, emergency phones are operational.<br>

  • Follow-up

  • 2. Emergency elevator telephone tested to reach operator.

  • Follow-up

  • 3. Elevator inspection certificate posted & current.

  • Follow-up

  • Notes

Utility / Preventative maintenance / Sustainability

  • Utility/Energy

  • 1. The HVAC system fans are quiet and operating properly. Temperatures are consistent throughout space; no areas noticeably warmer or colder than balance of the area.

  • Follow-up

  • 2. The temperature settings/actual temperatures within lease requirements (if applicable).

  • Follow-up

  • 3. The HVAC system operates during the agency’s official working hours.

  • Follow-up

  • 4. Meter readings were taken for GSA contracted utilities only. They are above/below the readings given on the most recent invoices.

  • Follow-up

  • Preventative Maintenance

  • 1. Preventative Maintenance for Above Standard Lease Equipment is Being Performed Properly in accordance with manufacturer's recommendations.

  • Follow-up

  • Sustainability

  • 1. Recycling program is operating effectively, with containers & service in place. Tenants are aware and informed of the program.

  • Follow-up

  • 2. The lessor has provided recycling records. (GSA's waste diversion goal is 30% or better).

  • Follow-up

  • 3. The lessor's service providers, notably for janitorial and landscaping work are using Comprehensive Procurement Guideline Items (CPG), environmentally preferable products, equipment and practices. (The lessor has responded to the environmental products<br>and recycling letter.)

  • Follow-up

  • 4. If required in the lease, the lessor has made energy efficient upgrades or achieved Energy Star certification and provided documentation within the required time frame.

  • Follow-up

  • 5. If required in the lease, the lessor has obtained LEED certification and provided documentation within the required time frame. GSA's goal is LEED-NC Silver or LEED-CI Certified.

  • Follow-up

  • Notes

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.