Header
Name, location, room and date.
GSA3699
Safe Haven Inspection Checklist
- Agency
- GSA
- Revision
- Rev. 1/2010
- Fillable fields
- 47
- Pages
- 1
- Official source
- GSA form page
- Checked
- October 20, 2026
GSA Form 3699: Safe Haven Inspection Checklist
GSA Form 3699, Safe Haven Inspection Checklist, is a one-page General Services Administration form. The footer reads GSA 3699 1/2010, and GSA hosts it in its forms library.
The checklist opens with name, location, room and date lines, then asks 14 numbered questions about the room, each answered YES, NO or N/A. The questions cover trip and fall hazards, aisle width, exit paths, lighting, cords, tidiness, windows, space to take cover under desks, emergency telephone numbers, a first aid kit, a battery-powered radio and Safe Haven Signs. The form says to provide specific information in the comment section, and it ends with a Comments/Recommendations space.
The form has no signature line and does not say who completes it or where it goes. You can fill it out free in your browser on this page and download the result without an account.
What's on GSA Form 3699
Questions 1 to 3: hazards and exits
Whether aisles, walkways and work areas are free of trip and fall hazards, whether aisles are wide enough for easy movement, and whether exit paths are free of boxes and materials at all times.
Questions 4 to 8: the room and windows
Lighting, whether electric and telephone cords are placed where they might trip a passerby, whether the room is neat and orderly, whether windows are blocked by furniture or fixtures, and whether windows are clear of boxes, papers and books.
Question 9: space to take cover
Whether there is adequate space under the desks or workstations for employees to take cover in the event of an emergency.
Questions 10 to 14: supplies and signs
Emergency telephone numbers near telephones, a first aid kit, a battery-powered radio with extra batteries, and Safe Haven Signs outside the room and near the exit windows.
Comments/Recommendations
Open space at the bottom of the page for specific information and recommendations.
Each numbered question has a YES, a NO and an N/A column.
How to complete GSA Form 3699
- 1
Fill in the header
Enter the name, location, room and date at the top of the page.
- 2
Answer each question
Check YES, NO or N/A for each of the 14 questions. Some are worded so that YES describes a problem, such as question 5 on cords and question 7 on blocked windows.
- 3
Add specific information
The form says to provide specific information in the comment section.
- 4
Write any recommendations
Use the Comments/Recommendations space at the bottom. The form prints no signature line or routing step after it.
Why fill Form GSA3699 on indox
You get the real form, filled in a browser tab, with nothing standing between you and the finished PDF.
- Fill the form right in your browser, no software to install
- Free to fill and free to download, with no account
- The official blank straight from the GSA, not a copy someone retyped
- Works on a phone, tablet or computer
Where it goes and what the form says
Where it goes
The checklist prints no address, recipient or routing step, and no signature line.
Comment section
The only instruction printed on the form is to provide specific information in the comment section.
What the form does not print
No OMB number, time estimate or deadline. GSA's page lists the current revision date as 01/2010 and no authority or regulation.
Related forms
Who uses GSA Form 3699?
The checklist does not name who completes, signs or receives it. These are the blocks it prints.
Official sources and the blank
Do it all with indox
No tool matches that search.
Questions about Form GSA3699
Who issues GSA Form 3699?
It is a General Services Administration form. The footer reads GSA 3699 1/2010, and GSA hosts it in its forms library.
How many questions are on the checklist?
Fourteen numbered questions, each with a YES, a NO and an N/A column, followed by a Comments/Recommendations space.
Who completes GSA Form 3699?
The form does not say. It has a Name line at the top but no signature line, and it prints no instructions on who carries out the inspection.
Where does the completed checklist go?
The form prints no address, recipient or routing step.
What does the checklist look for in the room?
Trip and fall hazards, aisle width, clear exit paths, lighting, cords, tidiness, windows, space under desks to take cover, emergency telephone numbers, a first aid kit, a battery-powered radio and Safe Haven Signs.