Employee details
Employee name, e-mail address, date requested, division, telephone number, department and room number.
GSA3698
Employee Requesting Evacuation Assistance
- Agency
- GSA
- Revision
- Rev. 10/2009
- Fillable fields
- 16
- Pages
- 1
- Official source
- GSA form page
- Checked
- October 20, 2026
GSA Form 3698: Employee Requesting Evacuation Assistance
GSA Form 3698, Employee Requesting Evacuation Assistance, is a one-page General Services Administration form, GSA 3698 (10/2009). GSA hosts it in its forms library.
The employee lists their name, e-mail address, date requested, division, telephone number, department and room number, then signs a statement asking that GSA provide assistance in exiting the building in the event of an emergency or evacuation. The statement says the employee may but is not required to explain why they are requesting assistance or divulge any medical condition, and that the information will be confidential and used to determine how best to assist them.
An immediate supervisor approves and signs, and the form says it should be forwarded to the Security Division, which keeps a block for its own use. You can fill it out free in your browser on this page and download the result without an account.
What's on GSA Form 3698
Request statement
A printed paragraph asking GSA for assistance in exiting the building in an emergency or evacuation, with the note that explaining the reason or any medical condition is not required.
Employee's signature
The employee signs and dates the request.
Supervisor approval
Approved by, for the immediate supervisor, and the Supervisor's Signature line, each with a date.
Security Division Use Only
Date received, received by and special notes, filled in by the Security Division.
The form is a single page with these blocks.
How to complete GSA Form 3698
- 1
Fill in the employee details
Enter the name, e-mail address, date requested, division, telephone number, department and room number.
- 2
Read the statement
The statement says the employee may but is not required to explain why assistance is requested or divulge any medical condition.
- 3
Sign and date it
The employee signs the Employee's Signature line and adds the date.
- 4
Get the supervisor's approval
The immediate supervisor completes the Approved by line and the Supervisor's Signature line, each with a date.
- 5
Forward it to the Security Division
The form says it should be forwarded to the Security Division, which fills in its own block.
Why fill Form GSA3698 on indox
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Where it goes and what the form says
Where it goes
The form says it should be forwarded to the Security Division. It prints no address.
Medical information
The statement says the employee may but is not required to explain why assistance is requested or divulge any medical condition.
Confidentiality
The statement says information provided with the request will be confidential and used to determine how best to assist the employee in the event of an emergency or evacuation.
What the form does not print
No OMB number, time estimate or deadline. GSA's page lists the current revision date as 10/2009 and no authority or regulation.
Related forms
Who uses GSA Form 3698?
The form prints a line or block for each person who completes, approves and receives it.
Official sources and the blank
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Questions about Form GSA3698
Who issues GSA Form 3698?
It is a General Services Administration form. The footer reads GSA 3698 (10/2009), and GSA hosts it in its forms library.
Does the form ask for a medical reason?
The statement says the employee may but is not required to explain why assistance is requested or divulge any medical condition.
Who approves the request?
The Approved by line is labeled Immediate Supervisor. The supervisor also signs the Supervisor's Signature line, and both lines are dated.
Where does GSA Form 3698 go?
The form says it should be forwarded to the Security Division. That office records the date received, who received it and any special notes.
Is the information kept confidential?
The statement says information provided with the request will be confidential and used to determine how best to assist the employee in the event of an emergency or evacuation.