Employee details
Name of employee, title, grade, organization and location.
GSA225
Record of Infraction
- Agency
- GSA
- Revision
- Rev. 6/1962
- Fillable fields
- 21
- Pages
- 2
- Official source
- GSA form page
- Checked
- October 20, 2026
GSA Form 225: Record of Infraction
GSA Form 225, Record of Infraction, is a General Services Administration form dated 6-62 in its footer. GSA hosts it in its forms library, and GSA's page lists OAD P 5410.1 as its authority.
The instructions on the back say the immediate supervisor is normally the one responsible for initiating corrective action when an employee violates regulations or GSA Standards of Conduct. The form is for reporting violations under Table I of the Penalty Guide, according to the instructions in the GSA Administrative Manual 3-111.
The front has the employee's name, title, grade, organization and location, then five numbered blocks: the supervisor's report, the employee's statement, previous infractions, action taken or recommended by a supervisor, and action by a higher level supervisor. You can fill it out free in your browser on this page and download the result without an account.
What's on GSA Form 225
Block 1: supervisor's report
The facts of the infraction, with the supervisor's signature, title and date.
Block 2: employee's statement
Printed as I HAVE READ THE ABOVE REPORT AND MAKE THE FOLLOWING COMMENT, with the employee's signature and date.
Block 3: previous infractions
The nature of each offense, the penalty action taken and the date of the penalty action.
Block 4: action taken or recommended
The supervisor's action or recommendation, with reasons for any deviations from the Penalty Guide, and a signature, title and date.
Block 5: higher level action
Action taken or recommended by a higher level supervisor, with any appropriate comments, signature, title and date.
How to complete GSA Form 225
- 1
Write the report in block 1
State the facts simply and in logical order, and fully identify all persons, places, dates and records. If more space is needed, attach a sheet of paper.
- 2
Get the employee's statement
The supervisor asks the employee to read the report in block 1 and give comments and a signature in block 2. Any witness statements secured are attached.
- 3
List previous infractions
In block 3, list only Table I offenses with penalty action imposed within the last three years, and Table II offenses without regard to the date they occurred.
- 4
Decide the action in block 4
The supervisor consults the Penalty Guide. If no penalty action is warranted, the form says to advise the employee and destroy the form. A penalty the supervisor is not authorized to take is recommended and forwarded through channels.
- 5
Higher level action in block 5
A higher level supervisor acts as needed. If suspension, demotion or removal is believed warranted, the form goes to the Personnel Division for action.
- 6
Notify the employee
The instructions say the employee is to be advised of the final decision on any infraction written up on the form.
The instructions on the back describe these steps.
Why fill Form GSA225 on indox
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Where it goes and what the form says
Warning notice or official reprimand
A copy of the notice, the original of the form and any statement received from the employee within 10 days go to the Personnel Division for the employee's official personnel folder.
No penalty action
If the supervisor decides no penalty action is warranted, the form says to advise the employee and destroy the form.
Adverse personnel action
If suspension, demotion or removal is believed warranted, the form says it is forwarded to the Personnel Division for action.
References on the form
The instructions refer to Table I and Table II of the Penalty Guide, GSA Standards of Conduct and the GSA Administrative Manual 3-111. GSA's page lists OAD P 5410.1.
Not a public filing
The form is completed by GSA supervisors and employees. The PDF prints no OMB number, burden statement or privacy notice.
Related forms
Who uses GSA Form 225?
The form is used inside GSA by supervisors and the employee concerned. The instructions on the back name these people.
Official sources and the blank
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Questions about Form GSA225
Who fills out GSA Form 225?
The immediate supervisor writes the report in block 1, the employee adds a statement in block 2, and a supervisor completes block 4. A higher level supervisor uses block 5 as needed.
What violations does the form cover?
The instructions say it is for reporting violations under Table I of the Penalty Guide, according to the instructions in the GSA Administrative Manual 3-111, when an employee violates regulations or GSA Standards of Conduct.
Can the employee respond?
Yes. Block 2 is the employee's statement. The form says the employee may admit, deny or explain the alleged infraction, and any further statement received within 10 days goes with the form to the Personnel Division.
Which previous infractions are listed?
The form says only Table I offenses with penalty action imposed within the last three years are listed, and Table II offenses are listed without regard to the date they occurred.
What happens if no penalty is warranted?
The instructions say the supervisor advises the employee and destroys the form.
Is the employee told the outcome?
The instructions say the employee is to be advised of the final decision on any infraction written up on the form.