GSA Form 2722: FSS Facility Security Checklist

GSA Form 2722, FSS Facility Security Checklist, is a General Services Administration form. Its footer reads GSA FORM 2722 (12-71), and GSA hosts it in its forms library, where the listing calls it the PBS Facility Security Checklist.

The one-page checklist takes the facility location and a date, then asks 29 yes or no questions about signature registers for passes, escorts, visitors, identification badges, the perimeter, guard reports, shipping and receiving checks, seals on trucks, employee parking, keys and locks, theft reporting and badge inventories. A comments box follows. Two questions refer to subparagraph 23c and paragraph 4 of a document the form does not name. The form prints no instructions, no signature line, no OMB number and no privacy statement.

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Top of page 1 of GSA Form 2722: FSS Facility Security Checklist, as printed by GSA

What's on GSA Form 2722

Header

Facility location and date.

Questions 1 to 7: access and passes

Signature register for passes, escorts in security areas, visitor sign in and check out, identification badges, perimeter gaps, passes to leave before the end of the day and guard reports.

Questions 8 to 15: stock, shipping and keys

Open packs in the bulk area, shipping procedures, seals on trucks left overnight or weekends, employee parking, the key register, lock changes, signs outside the warehouse and the vehicle register.

Questions 16 to 22: checks and theft

Monthly 100 percent checks of outbound shipments and receipts, records of these checks, discussions to help eliminate pilferage and an Ad Hoc committee on warehouse thefts.

Questions 23 to 29: doors, reports and badges

Material access doors, locked doors, windows and doors secured before departing for the day, the prohibited area, theft reporting, the telephone number and badge inventories.

Comments

A free text box below question 29.

How to complete GSA Form 2722

1
Enter the facility and date
Fill in the facility location and the date at the top right.
2
Answer each question
Mark YES or NO for each of the 29 questions.
3
Note the referenced paragraphs
Question 15 refers to subparagraph 23c and question 29 to paragraph 4. The form does not print or name the document they come from.
4
Add comments
Use the comments box for anything to note about the answers. The form prints no signature line.

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What the form says

Where it goes

The form prints no address, routing instructions or signature line.

Edition and title

The footer reads GSA FORM 2722 (12-71). GSA's page gives a current revision date of 12/1971 and lists the form as the PBS Facility Security Checklist. The form itself is headed FSS Facility Security Checklist.

Instructions and privacy

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

Who fills out GSA Form 2722?

The facility being checked
The header takes the facility location and the date of the check.
The facility manager
Questions 7, 27 and 28 ask whether guard reports reach the facility manager, whether thefts are reported to the facility manager, and whether facility managers have been given the telephone number.
Management
Questions 16 to 19 ask whether management performs a 100 percent check of outbound shipments and of one day's receipts at least monthly, and whether records are kept of these checks.
FSS employees and supervisors
Question 27 asks whether they are instructed to immediately report in writing all thefts or suspected thefts to the facility manager, who in turn notifies by telephone the area investigative office.

The form prints no preparer, signature or instructions. These are the people its questions name.

Official sources and the blank

Official GSA form page
The agency’s own page for Form GSA2722.
Blank PDF
The official blank form, to print or fill by hand.

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Questions about Form GSA2722

Who issues GSA Form 2722?

The footer names the General Services Administration and reads GSA FORM 2722 (12-71). GSA hosts it in its forms library, and its page lists no authority or regulation.

Is the PBS Facility Security Checklist the same form?

GSA's forms library lists GSA Form 2722 as the PBS Facility Security Checklist. The PDF it links is headed FSS Facility Security Checklist.

How many questions does GSA Form 2722 have?

29 numbered questions, each with YES and NO boxes, followed by a comments box.

What does the checklist ask about theft?

Question 27 asks whether all FSS employees and supervisors are instructed to immediately report in writing all thefts or suspected thefts to the facility manager, who in turn notifies by telephone the area investigative office. Questions 20 to 22 ask about discussions to help eliminate pilferage and an Ad Hoc committee on warehouse thefts.

Who signs GSA Form 2722?

The PDF prints no signature, preparer or approval line, and no instructions, OMB number or privacy statement.

GSA Form 2722: FSS Facility Security Checklist