Items 1 to 3: region, date and report number
The region reporting the accident, the date of the accident and the accident report number, plus a report control number box.
GSA3620
Report of GSA Property Damage or Non-GSA Employee Personal Injury
- Agency
- GSA
- Revision
- Rev. 02/1991
- Fillable fields
- 38
- Pages
- 2
- Official source
- GSA form page
- Checked
- October 20, 2026
GSA Form 3620: Report of GSA Property Damage or Non-GSA Employee Personal Injury
GSA Form 3620, Report of GSA Property Damage or Non-GSA Employee Personal Injury, is a two-page GSA form, with the report on the front and item-by-item instructions on the back. GSA hosts it in its forms library.
The form says it is not to be used for reporting GSA motor vehicle accidents or GSA employee occupational injuries/illnesses, and points to Standard Form 91 or 91A or CA-1 or CA-2 respectively. The instructions say the person preparing the report is the supervisor in charge of the area or equipment involved. The report covers the person involved, the reason for the report, the location and GSA facility, any injury, the equipment and its owner, a detailed description, and corrective action. A reviewing official and a Safety and Environmental Management (S&EM) clearance official then comment and sign.
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What's on GSA Form 3620
Items 4 to 9: person, reason and place
The person's name, home address and telephone number, the reason for the report, the time and exact location of the accident, and the name and address of the GSA facility.
Items 10 to 13: injury, equipment and account
The medical expectation for any injury, the equipment involved, the owner of the equipment or vehicle with name, address and phone, and a detailed description of the accident.
Item 14: corrective action
A description of the corrective action, the responsible person and the action date.
Items 15 to 18: supervisor
Name and title of the supervisor, signature, telephone number and date.
Items 19 to 25: review and clearance
Comments from the reviewing official and the S&EM clearance official, then the name, title, signature and date of each.
The front has 25 numbered items. The back has the instructions.
How to complete GSA Form 3620
- 1
Check that this is the right form
The form says not to use it for GSA motor vehicle accidents or GSA employee occupational injuries/illnesses, and names SF 91 or 91A or CA-1 or CA-2 for those.
- 2
Fill in items 1 and 2, leave item 3 blank
List the region reporting the accident and the date. The Regional S&EM Office enters the report number in item 3.
- 3
Identify the person and the reason
Identify the person most responsible or involved, using separate blank paper if more than one. State precisely why the report is being completed, for example Non-Federal personal injury, Federal property damage, or Non-Federal property damage.
- 4
Describe any injury
For a personal injury, item 10 asks for the exact nature of the injury and the actual or expected result, and to note if hospitalized and where.
- 5
Describe the accident and the fix
Complete items 11 to 13, using additional paper if necessary, then item 14: what needs doing or was done to correct the cause, who is responsible, and when it was or will be complete.
- 6
Sign, review and clear
The supervisor signs items 15 to 18. The reviewing official and the S&EM clearance official then add comments and sign their items.
The instructions say to print or type all entries except where signatures are required.
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Routing and related forms
Where it goes
The PDF gives no filing address. Its signature blocks run from the supervisor to the reviewing official (the facility manager or equivalent) and the Regional Safety and Environmental Management Branch Chief.
Forms for other incidents
The form says to use Standard Form 91 or 91A for GSA motor vehicle accidents, and CA-1 or CA-2 for GSA employee occupational injuries/illnesses.
Edition
The PDF prints no edition date. GSA's page lists a current revision date of 02/1991 and no authority or regulation.
Related forms
SF91
Motor Vehicle Accident (Crash) Report
182 fields, 5 pages
SF94
Statement of Witness
26 fields, 3 pages
SF95
Claim for Damage, Injury, or Death
36 fields, 2 pages
GSA2116
Employee Claim for Loss or Damage to Personal Property
53 fields, 1 page
GSA3624
Log of Federal Occupational Injuries and Illnesses
404 fields, 3 pages
Who fills out GSA Form 3620?
The instructions on the back say who prepares, reviews and clears the report.
Official sources and the blank
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Questions about Form GSA3620
Who issues GSA Form 3620?
It is a GSA form; the instructions are headed Instructions for Completing GSA Form 3620. GSA hosts it in its forms library and lists a current revision date of 02/1991.
Who prepares GSA Form 3620?
The instructions say the person preparing the report is the supervisor in charge of the area or equipment involved.
When is GSA Form 3620 not used?
The form says it is not to be used for reporting GSA motor vehicle accidents or GSA employee occupational injuries/illnesses, and points to Standard Form 91 or 91A or CA-1 or CA-2 respectively.
What goes in item 5, reason for report?
The instructions say to state precisely why the report is being completed, giving the examples Non-Federal personal injury, Federal property damage, and Non-Federal property damage.
What if more than one person was involved?
The instructions for item 4 say to use separate blank paper, and the item 6 instructions say that if more than one person, make sure this number is included with item 4.
Who are the reviewing and clearance officials?
The instructions say the reviewing official is the facility manager or equivalent, and the Regional Safety and Environmental Management Branch Chief is considered the clearance official.