GSA Form 3559B: Follow-up Status Report for Safety, Health, or Fire Protection Survey

GSA Form 3559B prints the heading Follow-up Status Report for Facility Safety, Health, or Fire Protection Survey (Part III). GSA's forms page lists it as Follow-up Status Report for Facility Safety, Health or Fire Protection Survey, with a current revision date of 10/1985. The footer reads GENERAL SERVICES ADMINISTRATION and GSA FORM 3559B (10-85), and GSA hosts it in its forms library.

The one-page form has header blocks for a report control number, the building name and address, the field office, a status report number, a status as of date and the survey report date. Below them is a table with an item number, the status of recommendations (revised or completed) and a revision or completion date. It ends with the signature of the approving official (Assistant Regional Administrator) and the date signed. It prints no instructions, no OMB number and no privacy statement.

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Top of page 1 of GSA Form 3559B: Follow-up Status Report for Safety, Health, or Fire Protection Survey, as printed by GSA

What's on GSA Form 3559B

Report control number

A Report Control No. box in the top right corner, beside the heading.

Building and field office

The building name and address, and the field office.

Report numbers and dates

The status report number, the date the status is given as of, and the survey report date.

Status of recommendations table

Three columns: item number, status of recommendations (revised or completed), and revision or completion date.

Approval

Signature of approving official (Assistant Regional Administrator) and the date signed.

How to complete GSA Form 3559B

1
Identify the building
Enter the building name and address and the field office at the top of the form.
2
Link it to the survey
Fill in the report control number, the status report number, the status as of date and the survey report date.
3
List each recommendation
In the table, give each recommendation an item number and describe its status, revised or completed.
4
Date each change
Enter the revision or completion date for each item in the right column.
5
Get the approval signature
The approving official, named on the form as the Assistant Regional Administrator, signs and enters the date signed.

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Routing and what the form says

Where it goes

The form prints no address or routing instructions.

Part III

The heading marks this form as Part III of a facility safety, health, or fire protection survey. The PDF does not describe the other parts.

Edition

The footer reads GSA FORM 3559B (10-85). The form prints no OMB number or privacy statement, and GSA's page lists no authority or regulation.

Who fills out GSA Form 3559B?

The approving official
The signature line reads Signature of Approving Official (Assistant Regional Administrator), with a Date Signed box beside it.
The field office
A Field Office block sits beside the building name and address. The form does not say which office prepares the report.
The surveyed building
The report covers the building named in the Building Name and Address block, and the Survey Report Date block ties it to the earlier survey.
Whoever tracks the recommendations
Each table row records a recommendation's status, revised or completed, and its date. The form does not say who enters them.

The form prints no instructions. Its blocks and signature line show these roles.

Official sources and the blank

Official GSA form page
The agency’s own page for Form GSA3559B.
Blank PDF
The official blank form, to print or fill by hand.

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Questions about Form GSA3559B

Who issues GSA Form 3559B?

The footer reads GENERAL SERVICES ADMINISTRATION and GSA FORM 3559B (10-85). GSA hosts it in its forms library.

What does Part III mean?

The heading reads Follow-up Status Report for Facility Safety, Health, or Fire Protection Survey (Part III). The PDF does not describe Parts I and II.

What does each table row record?

An item number, the status of a recommendation, revised or completed, and the revision or completion date.

Who signs GSA Form 3559B?

The signature line is for the approving official, which the form names as the Assistant Regional Administrator, with a Date Signed box.

Are there instructions for GSA Form 3559B?

The PDF prints none. GSA's page lists the current revision date as 10/1985 and gives no authority or regulation.

GSA Form 3559B: Follow-up Status Report for Safety, Health, or Fire Protection Survey