Quality_Assurance_Surveillance_Plan.pdf

Quality Assurance Surveillance Plan

1. Quality Assurance Surveillance Plan:

The COR will monitor contractor performance and complete the Quality Assurance Surveillance

Plan (QASP) Worksheet provided below on a monthly basis. The following information will be provided to the Contracting Officer to ensure service and/or deliverables support of the PWS objectives. If the performance rating for any task in this order is “Red” or “Yellow” during any time in the performance period, the COR will provide the Contracting Officer documentation and appropriate action will be taken to remedy the deficiency. The quality rating may change from

“Green” to “Red” or “Yellow” without notice. A “Yellow” quality rating will trigger an alert to the Contracting Officer of quality issues that have the potential for a “Red” quality rating if corrective action is not taken.

The Quality Assurance Surveillance Plan Worksheet will be submitted to the Contracting Officer with a copy saved by the COR following each month of performance. The Contracting Officer will assume a quality performance rating of “Green” on all measured deliverables unless otherwise notified. By approving service and/or deliverables that this form documents, the COR confirms the quality performance rating of “Green” unless otherwise annotated. The Contracting

Officer will forward a copy of each QASP worksheet to the contractor after review.

At the end of the contract period of performance or annually, the COR will be asked to complete an Annual Quality Performance Review to document the quality performance rating during the performance period. This will be submitted to the Contracting Officer by the COR. The COR may submit a Quality Assurance Surveillance Plan Worksheet at anytime and as often as necessary to document quality levels. If Contractor response to an identified quality deficiency is unsatisfactory, the Contracting Officer or COR will contact the appropriate Contractor representative to implement a plan of action to remedy the identified deficiency.

Rating Description

Green Yes, performance and technical specifications are being met at AQL.

Yellow

Yes, performance and technical specifications are currently being met at the minimum AQL, but the following service / deliverable needs contractor attention.

The Customer must identify what component of the deliverable and/or service requires attention.

Red

No, performance and technical specifications are not being met at AQL and the following service / deliverable needs immediate contractor resolution.

The Customer must identify what component of the deliverable and/or service is below the minimum AQL.

ATTACHMENT 1

QUALITY ASSURANCE SURVEILLANCE PLAN WORKSHEET

Performance Rating

Deliverable/Service

Quality

Rating

Causative

Factors

Effect on

Mission

Action Required

/ Date

Helpline Telephone

Number 4.1.1 Green Comments Unnecessary for “Green” QA Rating.

Yellow

Helpline Operation

4.1.2 4.1.6

4.1.3 4.1.7

4.1.4

4.1.5

Helpline Daily

Report

4.1.8

Helpline Monthly

Report

4.1.9

Case Intake Form

Date:

Name of Caller Initiating Case:

Relationship to Service Member:

Street Address, City, State, Zip Code

Phone Email

Service Member Information

Name / Rank

Service Branch

Unit

DOB

Street Address, City, State, Zip Code

Zip code:

Phone

Email

Children / Ages

Spouse/Significant Other

Street Address, City, State, Zip Code

Deployment History (For Categorizing Benefits)

Dates of Deployment and Location (If willing to disclose)

Issue Categories

Crisis Intervention and Referral Post Traumatic Stress

Suicide Intervention and Referral Behavioral/Mental Health

DEERS/ID Cards/Benefits Drug/Alcohol

Tricare Medical and Dental Relationship/Family Issues

Financial Assistance Spiritual

Legal Resource and Referral Not Referred

Community Outreach and Referral

ATTACHMENT 2

Hotline Calls Received - Monthly Report (Sample Format)

Notes:

1 Nov thru 30 Nov 2016 (Inclusive Dates)

* If the report is submitted

Hotline Calls Received Monthly Contract on a spread sheet, each

Category Total Total month must be on its own

1 Service Member deployed since 9-11-01 0 0 Tab.

2 Service Member 0 0

3 Family Member 0 0 *The information the

4 Other 0 0 Government requires may

5 NG Soldier 0 0 change from month to

6 NG Airman 0 0 month.

7 Not Identified 0 0

Total Calls 0 0

Monthly Contract

Referrals made from calls Received Total Total

1 Crisis Intervention and Suicide 0 0

Enter Below Also

2 Post Traumatic Stress 0 0

3 Behavioral Health 0 0

4 Medical/Tricare 0 0

5 Drug/Alcohol 0 0

6 Financial 0 0

7 Family/Relationship 0 0

8 Spiritual 0 0

9 Legal 0 0

10 Community Outreach 0 0

11 Not Referred 0 0

Monthly Contract

Total Total

Non- Operational Hours 0 0

This column is for the reporting month. The report needs to include the inclusive dates This column is a total of all referrals for the year or since the beginning of the contract.

Attachment 3

Risk Rating Protocols

The Oregon National Guard will receive a numerical rating in all Duty to Warn and Mandated

Reporting calls received to the Helpline. This will assist in determining the urgency of the case being reported.

Note: In ALL cases, the Helpline will have assessed and insured safety, and provided all resources to the Service Member and family prior to the case being referred to the Oregon

National Guard.

Risk Rating Protocols:

1. A crisis has recently occurred with a Service Member or family member. Potential harm to self or others was determined to be high, therefore the member was assisted with urgent care. The Helpline has assisted with steps to ensure immediate safety.

2. A duty to warn or mandated reporting situation with the Service Member or family member has placed the member or others in danger of harm. The member may have some existing support but may require additional support in the near future.

3. An incident has occurred with the Service Member or family member that meets the duty to warn or mandated reporting criteria therefore must be reported. However, no imminent risk to self or others was determined. This category may include domestic abuse within the past year.

For reference, the Oregon National Guard follows the state reporting requirements:

MANDATORY REPORTING for Child Abuse Or. Rev. Stat. §§ 419B.005, 419B.010, 419B.015, 419B.025

MANDATORY REPORTING for Elder/Disabled Abuse:

Elders: Or. Rev. Stat. §§ 124.050, 124.060, 124.065, 124.070, 124.075, 124.085, 124.095.

Disabled: Or. Rev. Stat. §§ 430.735, 430.743, 430.753, 430.765.

DUTY TO WARN Oregon (Or. Rev. Stat. §179.505) Duty to Warn status: Permissive.