GSA12002

Fire protection, safety, and health programs: high risk use permit form

Agency
GSA
Revision
Rev. 10/2021
Fillable fields
33
Pages
1
Official source
GSA form page
Checked
October 20, 2026
Fill GSA12002 online
Page 1 of form GSA12002

GSA Form 12002: High Risk Operation (High Risk Use Permit Form)

GSA 12002, High Risk Operation, is a General Services Administration form, Rev. 10/2021. GSA's page lists it as the Fire protection, safety, and health programs: high risk use permit form, with PBS 1000.4A as its authority, and GSA hosts it in its forms library. The top of the form says CUI when filled in.

The form is completed by the project staff it names, not by the public. It says the Regional Planning Manager (Office of Portfolio Management and Customer Engagement) completes Parts A and B during the Project Planning stages for any new project that involves a High Risk Operation for the customer agency. The Project Management Team completes Part C during the Project Management stages.

The operations it lists are a high risk laboratory, explosive materials storage, and a firing range or shoot house. You can fill it out free in your browser on this page and download the result without an account.

Top of page 1 of GSA Form 12002: High Risk Operation (High Risk Use Permit Form), as printed by GSA

What's on GSA 12002

Part A: current occupancy information

Customer agency name, Agency Bureau (AB) code, building number, Occupancy Agreement (OA) number and expiration date, building name and address, and whether the building is GSA-Owned or GSA-Leased.

Part B: high risk operation information

Check boxes for High Risk Laboratory, Explosive Materials Storage, and Firing Range or Shoot House, each with the estimated size of occupancy, if known.

Size of occupancy

The form gives usable, ANSI/BOMA Office Area (ABOA) and rentable as examples of how the size may be stated.

Part C: technical requirements

Four yes or no questions on whether requirements were received from the agency, whether they are acceptable, whether the team provided its own, and whether the agency accepted them.

Signatures

Name, signature and date of the Project Manager, and signature and date of the Regional EHSF Project Management Team Representative.

How to complete GSA 12002

  1. 1

    Complete Part A at planning

    Enter the customer agency, building and occupancy agreement details, and check GSA-Owned or GSA-Leased. The form places Parts A and B in the Project Planning stages.

  2. 2

    Check the operation types

    In Part B, check all high risk operations that apply and enter the estimated size of occupancy, if known.

  3. 3

    Answer Part C

    During the Project Management stages, answer the yes or no questions on the high risk technical requirements.

  4. 4

    Sign when requirements are accepted

    The form says to sign once the high risk technical requirements have been found sufficient and acceptable to both the Project Management Team and the customer agency.

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Handling and what the form says

Where it goes

The PDF gives no filing address or routing beyond the signature blocks.

Marking

The top of the form says CUI when filled in.

When each part is completed

Parts A and B during the Project Planning stages of a new customer agency project, and Part C during the Project Management stages.

Authority

GSA's page lists PBS 1000.4A as the authority or regulation. The PDF prints no Privacy Act notice, OMB number or burden estimate.

Related forms

Who completes GSA 12002?

  • Regional Planning Manager

    The form says the Regional Planning Manager (Office of Portfolio Management and Customer Engagement) completes Parts A and B, and the RPLM block has its own date.

  • Project Management Team

    The form says the Project Management Team completes the Part C sections on high risk technical requirements.

  • Project Manager

    The Project Manager prints a name, signs and dates once the requirements are found sufficient and acceptable to the team and the customer agency.

  • Regional EHSF representative

    The Regional Environmental, Health, Safety, Fire (EHSF) Project Management Team Representative also signs and dates.

  • The customer agency

    Part C asks whether high risk technical requirements were received from the customer agency, and whether the agency accepted any provided by the project team.

The form names who completes each part and who signs.

Official sources and the blank

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Questions about Form GSA12002

Who issues GSA 12002?

The form is printed as a General Services Administration form, Rev. 10/2021. GSA's page lists PBS 1000.4A as its authority.

Who fills out GSA 12002?

The form says the Regional Planning Manager (Office of Portfolio Management and Customer Engagement) completes Parts A and B, and the Project Management Team completes Part C.

Which operations does the form treat as high risk?

Part B lists three check boxes: High Risk Laboratory, Explosive Materials Storage, and Firing Range or Shoot House.

When is the form signed?

The form says to sign once the high risk technical requirements have been found sufficient and acceptable to both the Project Management Team and the customer agency.

Is the completed form marked?

Yes. The top of the form says CUI when filled in.