Header
Reports Control Symbol PB-39, region, month, and page of pages.
GSA159
Monthly Log and Summary of Occupational Injuries and Illnesses, GSA Regional Employees
- Agency
- GSA
- Revision
- Rev. 10/1987
- Fillable fields
- 362
- Pages
- 1
- Official source
- GSA form page
- Checked
- October 20, 2026
GSA Form 159: Monthly Log and Summary of Occupational Injuries and Illnesses
GSA Form 159, Monthly Log and Summary of Occupational Injuries and Illnesses, GSA Regional Employees, is a General Services Administration form, Rev. 10/1987 (printed REV. 10-87), and GSA hosts it in its forms library. The footer reads GENERAL SERVICE ADMINISTRATION. The header shows Reports Control Symbol PB-39, and GSA's page lists no authority or regulation.
The one-page landscape form has a header for region, month and page count. Section I, Summary of Monthly Experience, gives cases and days for IRMS, FSS, PBS, CO and Staff, with a total, on rows that refer to columns 10 to 16 of Section II, plus man hours worked. Section II, Log of Injuries, lists each case in columns 1 to 18 and says to continue on GSA Form 159 - A if necessary. The Regional Administrator signs it. It prints no instructions, OMB number or privacy statement.
You can fill it out free in your browser on this page and download the result without an account.
What's on GSA Form 159
Section I: summary of monthly experience
Cases and days for each group and in total, on rows that refer to columns 10 to 16 of Section II. The days cells are shaded on every row except 11 and 13.
Man hours worked
A Section I row for man hours worked in each group and in total.
Section II, columns 1 to 6
Entry number, service and organization code, date of injury, name, GS series and grade, and name of occupation.
Section II, columns 7 to 9
Nature of injury or illness, types of injury or illness, and parts of body injured.
Section II, columns 10 to 18
Numbered columns, with 11 to 13 grouped under Traumatic Injury and 14 to 16 under Illness/Diseases. Columns 10, 17 and 18 carry no printed heading.
How to complete GSA Form 159
- 1
Fill in the header
Enter the region, the month and the page numbers.
- 2
Log each case
Add one Section II row per entry, using columns 1 to 9 for the employee, the date of injury and the injury or illness.
- 3
Complete the numbered columns
Fill in columns 10 to 18 for each entry. The form prints no instructions for these columns.
- 4
Summarize the month
Enter cases and days by group in Section I on the rows that refer to Section II columns 10 to 16, and enter man hours worked.
- 5
Continue if needed
Section II says to continue on GSA Form 159 - A if necessary.
- 6
Prepare and sign
The preparer enters a name, title and date prepared, and the Regional Administrator signs and enters the date signed.
Why fill Form GSA159 on indox
You get the real form, filled in a browser tab, with nothing standing between you and the finished PDF.
- Fill the form right in your browser, no software to install
- Free to fill and free to download, with no account
- 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 form prints no address. It ends with the Regional Administrator's signature and the date signed.
Reports control symbol
The header prints Reports Control Symbol PB-39.
Edition and authority
The footer reads GSA FORM 159 (REV. 10-87). GSA's page lists a current revision date of 10/1987 and no authority or regulation.
Continuation sheet
Section II names GSA Form 159 - A for entries that do not fit.
Related forms
Who fills out GSA Form 159?
The form covers GSA regional employees. Its blocks show these roles.
Official sources and the blank
Do it all with indox
No tool matches that search.
Questions about Form GSA159
Who issues GSA Form 159?
The footer reads GENERAL SERVICE ADMINISTRATION and GSA FORM 159 (REV. 10-87). GSA hosts it in its forms library. The header shows Reports Control Symbol PB-39.
Who signs GSA Form 159?
The Regional Administrator signs and dates it. The person who prepared the report gives a name, title and date prepared.
Whose injuries and illnesses does it log?
The title says GSA Regional Employees. Each Section II entry has the person's name, GS series and grade, and occupation.
What does Section I summarize?
Cases and days for IRMS, FSS, PBS, CO, Staff and a total, on rows that refer to columns 10 to 16 of Section II, plus man hours worked.
What if there are more entries than lines?
Section II says to continue on GSA Form 159 - A if necessary.
Are there instructions for GSA Form 159?
The PDF prints none, and it prints no OMB number or privacy statement. GSA's page lists no authority or regulation.