Building and address
Building, street address, city, state and region.
GSA376
Elevator Inspection Report
- Agency
- GSA
- Revision
- Rev. 11/1967
- Fillable fields
- 22
- Pages
- 2
- Official source
- GSA form page
- Checked
- October 20, 2026
GSA Form 376: Elevator Inspection Report (Including Escalators and Dumbwaiters)
GSA Form 376, Elevator Inspection Report (Including Escalators and Dumbwaiters), is a General Services Administration form dated 11-67 in its footer. GSA's forms page gives a current revision date of 11/1967, and GSA hosts it in its forms library.
The instructions on the back say a separate report shall be made for each building for which PBS is responsible for elevator inspections. The front records the building, address and region, the inspection dates and the number of units. The inspector's statement says all elevators, escalators and dumbwaiters were inspected and found in a satisfactory condition, except as noted. Section A lists work the building manager or custodian is requested to have performed, and Section B lists repair and maintenance items outside the scope or responsibility of the buildings manager or custodian.
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What's on GSA Form 376
Inspection dates
Date inspection ordered, date inspection started and completed, and date inspection certificates signed.
Number of units in building
Counts of passenger, FRT. OR SERV., escalator and dumbwaiter units.
Section A: work requested
Work the building manager or custodian is requested to have performed. The form says to list items that can be properly performed by force account, and to use the reverse when more space is required.
Completion signatures
The mechanic's signature, the buildings manager's signature and the date, confirming the Section A work is done and the equipment is ready for reinspection, if required.
Section B and inspector sign off
Repair and maintenance items outside the scope or responsibility of the buildings manager or custodian, then the inspector's signature, title and date.
How to complete GSA Form 376
- 1
Use one report per building
The instructions say a separate report shall be made for each building for which PBS is responsible for elevator inspections. The heading asks to read the instructions on the reverse first.
- 2
Enter the building and dates
Fill in the building, street address, city, state and region, and the dates the inspection was ordered, started, completed and the certificates were signed.
- 3
Count the units
Enter the number of passenger, FRT. OR SERV., escalator and dumbwaiter units in the building.
- 4
List the Section A work
List the work the building manager or custodian is requested to have performed, limited to items that can be properly performed by force account. Use the reverse when more space is required.
- 5
List Section B items and sign
List repair and maintenance items outside the scope or responsibility of the buildings manager or custodian. The inspector then signs, enters a title and dates the report.
- 6
Distribute the copies
The back lists copies to the Design and Construction Division as determined by regional requirements, and 2 to the Buildings Manager, forwarded through the regional Buildings Management Division.
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Copies and what the form says
Distribution of copies
The back lists the Design and Construction Division, with copies as determined by regional requirements, and the Buildings Manager, with 2 copies forwarded through the regional Buildings Management Division.
Return copy
The instructions say one copy is to be signed by the mechanic and the Buildings Manager upon completion of the work listed in Section A, and returned to the inspector.
Authority
GSA's forms page lists no authority or regulation for this form. The PDF prints no OMB number, address or privacy statement.
Edition
The footer reads GSA FORM 376 (11-67). GSA's forms page gives the current revision date as 11/1967.
Related forms
Who fills out GSA Form 376?
The form has signature lines for three roles, and the back lists who receives copies.
Official sources and the blank
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Questions about Form GSA376
Who issues GSA Form 376?
The footer reads GENERAL SERVICES ADMINISTRATION, GSA FORM 376 (11-67). GSA hosts it in its forms library.
Does GSA Form 376 cover escalators and dumbwaiters?
Yes. The heading says Including Escalators and Dumbwaiters, and the unit count has columns for passenger, FRT. OR SERV., escalator and dumbwaiter units.
What is the difference between Section A and Section B?
Section A lists work the building manager or custodian is requested to have performed, limited to items that can be properly performed by force account. Section B lists repair and maintenance items outside the scope or responsibility of the buildings manager or custodian.
Is one report enough for several buildings?
The instructions say a separate report shall be made for each building for which PBS is responsible for elevator inspections.
What if Section A needs more space?
The form says to use the reverse when more space is required.
Which copy goes back to the inspector?
The instructions say one of the Buildings Manager's copies is signed by the mechanic and the Buildings Manager when the Section A work is completed, and returned to the inspector.