GSA Form 2648: EEO Counseling Report

GSA Form 2648, EEO Counseling Report, is a General Services Administration form. Its footer reads GSA FORM 2648 (REV. 1-85), it carries Reports Control Symbol AAD-15.1, and GSA hosts it in its forms library.

The one-page report has five numbered sections: the complainant, the EEO counselor, a summary of the complaint with checklists of complaint bases and alleged issues, a summary of the counselor's efforts to informally resolve the complaint, and the disposition. It ends with the number of hours counseled, the number of employees counseled and the number informally resolved, and a Prepared By line. Many blocks carry a short data code in parentheses, such as (GRF) beside the complainant's name. The form prints no instructions, no OMB number and no privacy statement.

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Top of page 1 of GSA Form 2648: EEO Counseling Report, as printed by GSA

What's on GSA Form 2648

Section 1: complainant

Name, position title, civilian grade, occupational series, GSA organization structure ID, GSA region code and the name of the complainant's representative.

Section 2: EEO counselor

Counselor's name, SSAN, region and organization location, the date of initial contact and the date of the final interview.

Section 3: summary of complaint

Checklists of complaint bases, such as race/color, national origin, handicap, reprisal, religion, sex and age, and of alleged issues from appointment to working conditions, then the issues in the complaint and the complainant's requested resolution.

Section 4: counselor's efforts

The facts uncovered, then the specific efforts to resolve the complaint: persons interviewed, content of conversations, and actions and advice to the agency and the aggrieved person.

Section 5: disposition

Whether and to what extent the issues were resolved, the terms of any resolution, and the number of hours counseled, employees counseled and the number informally resolved.

How to complete GSA Form 2648

1
Record the complainant
Fill in Section 1, including the representative's name if there is one.
2
Record the counselor and dates
Fill in Section 2, with the date of initial contact with the counselor and the date of the final interview.
3
Mark bases and issues
Check each complaint basis and alleged issue that applies in Section 3.
4
Describe the complaint
The form asks for specific details of the action or actions giving rise to the complaint, with dates and names, including the last instance of alleged discrimination and the date it occurred, and for the complainant's requested resolution.
5
Report facts in Section 4
The form says this section must be limited to a report of facts uncovered with no judgments or conclusions included.
6
State the disposition
Indicate whether and to what extent the issues were resolved, give the terms of any resolution, enter the counts and complete the Prepared By line.

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What the form says

Where it goes

The form prints no address, routing or filing instructions.

Reports control symbol

The top right corner prints Reports Control Symbol AAD-15.1.

Edition

The footer reads GSA FORM 2648 (REV. 1-85). GSA's page gives a current revision date of 01/1985 and lists no authority or regulation.

Privacy

Section 2 asks for the counselor's SSAN, but the PDF prints no Privacy Act statement and no OMB number.

Who fills out GSA Form 2648?

The EEO counselor
Section 2 takes the counselor's name, SSAN, region and organization location, the date of initial contact with the counselor and the date of the final interview. Section 4 summarizes the counselor's efforts to resolve the complaint.
The complainant
Section 1 records the complainant's name, position title, civilian grade, occupational series, GSA organization structure ID and GSA region code.
The complainant's representative
Section 1 has a block for the name of the complainant's representative.
The preparer
The last line takes the name, title, telephone number and date of the person who prepared the report. The form does not say which office receives it.

The form prints no instructions. These are the people its sections name.

Official sources and the blank

Official GSA form page
The agency’s own page for Form GSA2648.
Blank PDF
The official blank form, to print or fill by hand.

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Questions about Form GSA2648

Who issues GSA Form 2648?

The footer names the General Services Administration and reads GSA FORM 2648 (REV. 1-85). GSA hosts it in its forms library, and its page lists no authority or regulation.

What complaint bases does GSA Form 2648 list?

Race/color (black, white, other), national origin (Hispanic, other), handicap (mental, physical), reprisal, religion, sex (female, male), age and color.

Which issues can be checked?

Appointment, assigned duties, awards, conversion to full-time, duty hours, merit pay and non-merit pay evaluations, examination test, non-sexual harassment, pay, promotion, reassignment, reinstatement, reprimand, retirement, separation, sexual harassment, suspension, time and attendance, training, working conditions, detail, reprisal and other.

What goes in Section 4?

The form says it must be limited to a report of facts uncovered with no judgments or conclusions included. It asks for persons interviewed, content of conversations, and actions and advice to the agency and the aggrieved person.

What counts does the report ask for?

The number of hours counseled, the number of employees counseled and the number informally resolved.

Does GSA Form 2648 have instructions?

The PDF prints no instructions, no filing address, no OMB number and no privacy statement.

GSA Form 2648: EEO Counseling Report