004 - Quality Control Report Form.pdf
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- Solicitation number
- N4008524R2666
About this file
This document is a Contractor Quality Control Report form. It is used to document the preparatory, initial, and follow-up phases of construction work performed under a federal contract. The form requires the contractor to certify that the work complies with contract requirements and safety standards. It includes sections to report rework items, describe the work performed, and document the government's quality assurance review and any exceptions. This form would be used in conjunction with a federal construction contract, such as the one described in the related federal contract opportunity summary provided.
The related federal contract opportunity is a solicitation from the Department of the Navy Naval Facilities Engineering Command for the removal and disposal of Zebra Mussels and marine deposits from a raw water intake and associated timber crib structure. The contractor shall furnish all labor, tools, transportation, supervision, materials, inspections, equipment, and safety compliance necessary to ensure unrestricted water flow to a Great Lakes water treatment plant.
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CONTRACTOR QUALITY CONTROL REPORT
(ATTACH ADDITIONAL SHEETS IF NECESSARY)
DATE
REPORT NO
PHASE CONTRACT NO CONTRACT TITLE
4296/2C (9/98)
WAS PREPARATORY PHASE WORK PREFORMED TODAY?
IF YES, FILL OUT AND ATTACH SUPPLEMENTAL PREPARATORY PHASE CHECKLIST.
PREPARATORY NOYES
Schedule Activity No Definable Feature of Work (DFOW) Index #
WAS INITIAL PHASE WORK PREFORMED TODAY?
IF YES, FILL OUT AND ATTACH SUPPLEMENTAL INITIAL PHASE CHECKLIST.
INITIAL YES NO
Schedule Activity No Definable Feature of Work (DFOW) Index #
WORK COMPLIES WITH CONTRACT AS APPROVED DURING INITIAL PHASE?
WORK COMPLIES WITH SAFETY REQUIREMENTS AND INSPECTION COMPLIES WITH EM385-1-1?
FOLLOW-UP NOYES
YES NO
Schedule Activity No
Description of Work, Testing Performed & By Whom, Definable Feature of Work, Specification Section, Location and List of Personnel Present
REWORK ITEMS IDENTIFIED TODAY (NOT CORRECTED BY CLOSE OF BUSINESS) REWORK ITEMS CORRECTED TODAY (FROM REWORK ITEMS LIST)
Schedule Activity No Description Schedule
Activity No Description
REMARKS (Also Explain Any Follow-Up Phase checklist Item From Above That Was Answered "NO"; Work Deficiency, Safety Deficiency.) Manuf. Rep On-Site, etc.
Schedule Activity No Description
On behalf of the contractor, I certify that this report is complete and correct and equipment and material used and work performed during this reporting period is in compliance with the contract drawings and specifications to the best of my knowledge except as noted in this report. AUTHORIZED QC MANAGER AT SITE DATE
GOVERNMENT QUALITY ASSURANCE REPORT DATE
QUALITY ASSURANCE REPRESENTATIVE'S REMARKS AND/OR EXCEPTIONS TO THE REPORT: FOR GOVERNMENT USE ONLY.
Schedule Activity No Description
DATEGOVERNMENT QUALITY ASSURANCE MANAGER
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