Header
Building, year and month.
GSA139
Record of Arrival and Departure from Buildings During Security Hours
- Agency
- GSA
- Revision
- Rev. 12/2006
- Fillable fields
- 323
- Pages
- 2
- Official source
- GSA form page
- Checked
- October 20, 2026
GSA Form 139: Record of Time of Arrival and Departure from Buildings During Security Hours
GSA Form 139, Record of Time of Arrival and Departure from Buildings (During Security Hours), is a General Services Administration form, REV. 12/2006 in its footer. GSA hosts it in its forms library, where its page lists it as Record of Arrival and Departure from Buildings During Security Hours and names no authority or regulation.
The header records the building, the year and the month. Each row records the date, the printed name (last, first, initial), a signature, the agency or firm, the room number, the purpose of visit, a footnote column, and the time of arrival and departure.
The footnote says Federal Protective Service and Contract Administration personnel, when conducting an investigation, must place an "X" in column (g). The form says to continue on the reverse, which repeats the table. You can fill it out free in your browser on this page and download the result without an account.
What's on GSA Form 139
Columns (a) to (c): date, name and signature
The date, the printed name (last, first, initial) and a signature.
Columns (d) to (f): agency, room and purpose
The agency or firm, the room number and the purpose of visit.
Column (g): see footnote
The column the footnote reserves for an "X" by Federal Protective Service and Contract Administration personnel conducting an investigation.
Columns (h) and (i): times
The time of arrival and the time of departure.
Reverse side
The front says Continue on reverse. The back repeats columns (a) to (i) and the footnote and is marked GSA 139 (REV. 12/2006) BACK.
Columns (a) to (i) are lettered on the form.
How to complete GSA Form 139
- 1
Fill in the header
Enter the building, year and month at the top of the front page.
- 2
Enter the date and name
Write the date in column (a) and print the name in column (b), last name first, then first name and initial.
- 3
Sign and identify the visit
Sign in column (c), then enter the agency or firm, room number and purpose of visit in columns (d) to (f).
- 4
Record the times
Enter the time of arrival in column (h) and the time of departure in column (i).
- 5
Mark column (g) when it applies
The footnote says Federal Protective Service and Contract Administration personnel conducting an investigation place an "X" in column (g).
- 6
Continue on the reverse
When the front is full, the form says to continue on the reverse, which has the same columns.
Why fill Form GSA139 on indox
You get the real form, filled in a browser tab, with nothing standing between you and the finished PDF.
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- The official blank straight from the GSA, not a copy someone retyped
- Works on a phone, tablet or computer
Routing and what the form says
Where it goes
The PDF gives no filing address or routing, and it prints no instructions beyond the footnote.
Authority
GSA's page lists no authority or regulation for this form.
Front and back
The PDF has two pages. The footer marks the second one as GSA 139 (REV. 12/2006) BACK.
Notices
The PDF prints no Privacy Act notice, OMB number or burden estimate.
Related forms
Who uses GSA Form 139?
The PDF prints no instructions beyond its footnote. These are the people its columns name.
Official sources and the blank
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Questions about Form GSA139
Who issues GSA Form 139?
The form is printed as a General Services Administration form, REV. 12/2006 in its footer. GSA's page names no authority or regulation.
What is column (g) for?
The footnote says Federal Protective Service and Contract Administration personnel, when conducting an investigation, must place an "X" in this column.
How is the name written on GSA Form 139?
Column (b) asks for the printed name as last name, first name and initial. Column (c) is for the signature.
Does GSA Form 139 have a back page?
Yes. The front says Continue on reverse, and the back repeats columns (a) to (i) with the same footnote.
Where does the completed form go?
The PDF does not say. It gives no filing address and does not name who keeps the record.