QASP NAL Janitorial Services 2-27-2026.docx

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Annual NAL Facilities Janitorial Services with 4 Option Years
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This is a Quality Assurance Surveillance Plan (QASP) for janitorial support services at the National Agricultural Library (NAL) in Beltsville, Maryland, establishing performance monitoring procedures and standards for the contract period. The QASP defines a performance-based approach where the contractor's compensation and continuation depend on meeting specified quality standards rather than process compliance. The plan establishes seven primary service areas: Quality Control Program, Trash Collection/Recycling/Removal, Non-Carpet Floor Maintenance, Carpeted Floor Maintenance, Restroom Maintenance, Miscellaneous Cleaning, and Other Service Requirements, with an additional Special Collections area. Each service category maintains a 95% Acceptable Quality Level (AQL) standard, except the QC Program which requires 100% accuracy and completeness.

The QASP implements performance monitoring through random checks, periodic inspections, customer complaint investigations, and work quality observations conducted by the Contracting Officer's Representative (COR). Performance deficiencies are tracked through semi-annual inspections with specific thresholds—for example, no more than 18 combined deficiencies for the QC Program and 12 for each service area—with financial deductions of $500 per deficiency exceeding thresholds applied to the first invoice following the review period. Contractors must maintain a Quality Control Plan (QCP) with self-inspection procedures and submit monthly performance reports by the 10th of each month, with the COR providing a summary assessment by the 15th. The government reserves the right to impose corrective action deductions, withhold payment portions, or terminate the contract for failure to meet performance standards. Additional requirements include maintaining one person on duty for 30-minute emergency response times, notification procedures for various situations, and meeting specific quality benchmarks such as passing the "white glove test" for surface cleanliness in restrooms and specialized areas.

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United States Department of Agriculture Agriculture Research Services

QUALITY ASSURANCE SURVEILLANCE PLAN (QASP)

National Agricultural Library 10301 Baltimore Ave., Beltsville, MD 20705 Phone: (301) 301-1670 https://www.nal.usda.gov/

QUALITY ASSURANCE SURVEILLANCE PLAN (QASP)

FOR

JANITORIAL

SUPPORT SERVICES

AT THE

NATIONAL AGRICULTURAL LIBRARY

BELTSVILLE, MARYLAND

TABLE OF CONTENTS

I.INTRODUCTION3
II.PURPOSE3
III.PERFORMANCE MANAGEMENT STRATEGY3
IV.MONITORING PERFORMANCE3
V.ANALYSIS OF QUALITY ASSURANCE MONITORING RESULTS3
VI.QASP PERFORMANCE REQUIREMENT SUMMARY (PRS) TABLE:4
VII.APPROACH7
VIII.STRATEGY7
IX.ROLES AND RESPONSIBILITIES7
X.IDENTIFICATION OF SERVICES TO BE PERFORMED8
XI.METHODOLOGIES TO MONITOR PERFORMANCE8
XII.QUALITY ASSURANCE REPORTING9
XIII.REPORTING DUE DATES10
EXHIBIT 111
PERFORMANCE MONITORING PROCEDURES11
EXHIBIT 213
QUALITY ASSURANCE MONITORING FORM13
EXHIBIT 314
QUALITY ASSURANCE MONITORING FORM - CUSTOMER COMPLAINT INVESTIGATION14
EXHIBIT 415
INSPECTION CHECKLIST15

I. INTRODUCTION

This Quality Assurance Surveillance Plan (QASP) is pursuant to the requirements listed in the United States Department of Agriculture (USDA) Performance Work Statement (PWS) entitled "PWS NAL Janitorial Services 1-7-26" at the National Agricultural Library (NAL) in Beltsville, Maryland. This performance-based plan sets forth the procedures and guidelines that the NAL will use in monitoring the contractor's compliance with the Statement of Work technical performance.

II. PURPOSE

The contractor through innovation, technology, and other means, shall perform the required cleaning services in building spaces. The frequencies shall be determined by the contractor. Performance will be based on the Government's evaluation of results, not the frequency or method of performance. The purpose of the QASP is to describe the systematic methods used to measure performance, identify the reports required and the government roles and responsibilities. The QASP provides a means for evaluating whether the contractor is meeting the performance standards set forth in the PWS. The results of the evaluation, reflected in the reports generated by implementing the QASP, become the basis for determining the service provider's revised compensation. Final results meeting the performance standards will be the determining factor for the success or failure of performance under this contract.

III. PERFORMANCE MANAGEMENT STRATEGY

The contractor's Quality Control Plan (QCP) shall set forth the staffing and procedures for self inspecting the quality, timeliness, responsiveness, customer satisfaction, and other performance requirements listed in the Performance Requirements Summary (PRS). The contractor will develop and implement a simplified performance management system with processes to assess and report their performance to the Contracting Officer Representative (COR).

IV. MONITORING PERFORMANCE

This QASP will define the approach taken by the COR/alternate to monitor, manage, and take appropriate action on the Contractor's performance against expected outcomes or performance objectives and standards communicated in the PWS and QASP. The primary methods of surveillance are random checks, observations, planned inspections, customer complaints, customer surveys, timeliness of corrective actions, work quality and review of records and files that are required to be maintained and delivered under this PWS (See Exhibit 1). The COR/alternates will meet bi-annually to review the reports and obtain input from government employees as sources of comments on the contractor's performance.

V. ANALYSIS OF QUALITY ASSURANCE MONITORING RESULTS

A. The Contracting Officer will work with the contractor in a collaborative manner to make decisions and take action based on performance evaluation information to ensure:

i. Corrective actions are being taken

ii. Customer expectations are being met

iii. The Contractor is presented with a look ahead to achieve proactive management including being alerted on upcoming events based on customer developments.

B. Failure to perform may result in deductions to the contractor's monthly invoice or termination of the contract.

i. Notifications: Consistent with FAR Part 49, the Contract Officer shall notify the contractor of failure to meet standards.

ii. Deductions: The Government has the right to withhold a portion of payment for the monthly cost of performing particular services based on failure to meet performance standards.

iii. Termination: If the Contracting Officer determines that the contractor has failed to perform to the extent that a termination for default is justified, the Contracting Officer shall issue a notice of termination, consistent with FAR Part 49.

iv. Failure to perform: The contractor may receive deductions or even termination based on failure to perform.

VI. QASP PERFORMANCE REQUIREMENT SUMMARY (PRS) TABLE:

Section
Requirement
AQL
Standard
QASP
Deduction
9
QC Program
100%
Accuracy/Completeness: Maintain a complete and accurate Quality Control Plan (QCP) and reporting system that will meet the requirements of the PWS. Maintain a current QCP by updating as the need arises. Performance deficiencies resulting from an inadequate QCP shall not exceed three (3) per month.
Random checks. Planned inspections and reporting. Document review every six months
$500 per incident noted two times or more shall be deducted from the first invoice following the review of the six-month evaluation.
11.1
Trash Collection Recycling and Removal
95%
Observations/Customer Complaints/Pleasant Visual Appearance: All requirements shall be performed in a manner to maintain odor free, trash free areas in a visually pleasant appearance in accordance with the requirements above. Appropriate materials shall be placed in the marked containers and deposited into the appropriate designated recycling storage bins. Documented Customer Complaints shall not exceed two (2) per month
Random Checks, Customer Feedback
$500 per incident noted two times or more shall be deducted from the first invoice following the review of the six-month evaluation.
11.2
Non-Carpet Floor Maintenance
95%
Quality/Customer Complaints/Pleasant Visual Appearance/Timeliness of corrective action: Non-carpeted floor areas shall be free of dirt, litter, debris, etc. to ensure a clean appearance meeting the requirements above. Spills, wet, sticky, etc. areas (with appropriate signed posted) shall be mopped within one (I) hour of discovery or notification. Buffing notification shall be provided the COR one (1) week in advance of being performed. Valid documented customer complaints shall not exceed three (3) per month. Missed notification requirements shall not exceed one (1) per month.
Random Checks, Customer Feedback
$500 per incident noted two times or more shall be deducted from the first invoice following the review of the six-month evaluation.
11.3
Carpeted Floor Maintenance
95%
Quality/Pleasant Visual Appearance/Customer Complaints/timeliness of corrective action: Carpeted areas shall be free of dirt, debris, etc. meeting the above requirements in a manner that avoids customer complaints. Clean (with allowable cleaning agents) within two (2) hours of discovery or notification, carpeted areas displaying stains, spills, soils etc. to avoid discoloration. Notify the COR by the end of the work day of any spots or stains that were not removed. Valid documented customer complaints shall not exceed three (3) per month.
Random Checks, Customer Feedback
$500 per incident noted two times or more shall be deducted from the first invoice following the review of the six-month evaluation.
11.4
Restroom Maintenance
95%
Work Quality/Observations/Customer Complaints, Pleasant Visual Appearance/timeliness of corrective action: Restrooms shall be cleaned to be free of foul odors, trash, dirt, grime, debris, etc. in a manner meeting the requirements of this section. Surface areas shall pass the "white glove test" and be visually clean. Ensure restroom supplies and toiletries are consistently available. Defective dispensers shall be reported to the COR by the end of the work day. All defective government furnished properly/equipment shall be reported to the COR immediately upon discovery, Valid documented customer complaints shall not exceed two (2) per month
Random Checks, Customer Feedback
$500 per incident noted two times or more shall be deducted from the first invoice following the review of the six-month evaluation.
11.5
Miscellaneous Cleaning
95%
Work Quality/Observations/Customer Complaints, Pleasant Visual Appearance/timeliness of corrective action: All doors and walls shall be free of debris, smudges, fingerprints, cleaning marks, cobwebs, stains, etc in accordance with this section requirements, All surface areas requiring dusting or cleaning shall pass the "white glove test" and be visually clean, Lenses shall have 110 more than five (5) insects per square foot. Notify COR by the end of the work day of any chipped, cracked or broken glass found and of worn, frayed or damaged blinds, drapes or curtains, Failing to meet mandatory requirements shall not exceed 2 per month. Valid documented customer complaints shall not exceed two (2) per month.
Random Checks, Customer Feedback
$500 per incident noted two times or more shall be deducted from the first invoice following the review of the six-month evaluation.
11.6
Other Service Requirements
95%
Customer complaints/Timeliness of corrective action: Ensure a minimum of one (1) person is on duty during normal working hours to handle emergencies. Urgent response time is 30 minutes from notification or as agreed to by COR or within 20 minutes in the case of life threatening or property damaging situations. Notify requestor within one (1) hour of completing an emergency or conference room setup, Notify the COR within one (1) working day of any personnel terminations with documented reasons for termination. Lost or unclaimed items shall be turned over to the COR within 24 hours of discovery, Clogged toilets, sinks, and drinking fountains shall be unclogged within one hour of COR notification. Failing to timely and efficiently setup for special events shall not exceed one (1) per month, Failing to follow mandatory requirements shall not exceed two (2) per month. Valid documented customer complaints and missed notifications shall not exceed two (2) per month.
Random Checks, Customer Feedback
$500 per incident noted two times or more shall be deducted from the first invoice following the review of the six-month evaluation.
11.7
Special Collection
95%
Work Quality/Observations/Customer Complaints, Pleasant Visual Appearance/timeliness of corrective action: All doors and walls shall be free of debris, smudges, fingerprints, cleaning marks, cobwebs, stains, etc in accordance with this section requirements. All surface areas requiring dusting or cleaning shall pass the "white glove test" and be visually clean. All areas shall have no more than five (5) insects per square foot. Notify COR by the end of the workday of any chipped, cracked or broken glass found and of worn, frayed or damaged blinds, drapes or curtains, failing to meet mandatory requirements shall not exceed 2 per month. Valid documented customer complaints shall not exceed two (2) per month.
Random Checks, Customer Feedback
$500 per incident noted two times or more shall be deducted from the first invoice following the review of the six-month evaluation.

VII. APPROACH

A. The PWS structures the acquisition around "what" services are required as opposed to "how" the contractor should perform the work. The data generated in a performance management approach provides information that indicates whether or not expected outcomes and standards for required services are being achieved adequately by the contractor. The interim process steps are delegated to the contractor, who will be responsible for managing the internal processes and practices used to achieve contractual outcomes. An effective system (QCP) with processes that generate well-defined performance data is central to performance management.

B. Performance management focuses on assessing whether or not outcomes are being achieved and migrates away from scrutiny on compliance with the processes and practices used to achieve the outcome. The only exceptions to process reviews are those required by law (local, state, and federal) and compelling business situations such as safety and health. An outcome focus provides flexibility for the service provider to continuously improve and innovate over the course of the contract as long as the critical outcomes expected are being achieved at the desired levels of performance. By focusing scrutiny on the desired outcomes rather than processes, performance management unlocks the contractor's potential for innovation and continuous performance improvement.

VIII. STRATEGY

A. The Government will communicate performance objectives and standards expected from the contractor through the PWS. These performance objectives are summarized in the performance requirements summary (PRS) table of this QASP.

B. The Government representative will monitor performance and review performance reports furnished by the contractor on a regular interval basis to determine how the contractor is performing against communicated performance objectives and standards. The government will make decisions based on performance monitoring data and notify the contractor of those decisions. Note: the contractor shall be responsible for making required changes in processes and practices to ensure performance is effectively managed.

IX. ROLES AND RESPONSIBILITIES

A. The relationship between the Contractor and the Government will be a partnership committed to the mutual success of each patty.

B. The Contracting Officer (CO) will designate the Contracting Officer's Technical Representative (COR) as the government authority for performance monitoring.

C. The COR is responsible for developing insight into the specific required services and provide assistance to the Contractor to understand the performance expectations as stated in the PWS. The COR is specifically responsible for monitoring, assessing, and communicating the technical performance of the Contractor. The COR will have the responsibility for completing QA monitoring forms (refer to Exhibits 2 and 3) used to document the inspection and evaluation of the Contractor’s performance. Government surveillance may occur under the Inspection of Services clause for any service relating to the contract.

D. The COR is required to ensure changes in work are not initiated before a written authorization or a modification is issued by the CO. The CO will be responsible for overall monitoring of contract compliance and issuing modifications thereto.

X. IDENTIFICATION OF SERVICES TO BE PERFORMED

A. The contractor shall perform the specific NAL requirements listed in the PWS for the following service areas:

i. Trash collection, recycling and removal

ii. Non-carpet floor maintenance

iii. Carpeted floor maintenance

iv. Restroom maintenance

v. Miscellaneous cleaning

vi. Service requirements

XI. METHODOLOGIES TO MONITOR PERFORMANCE

A. According to the inspection of services clause, federal acquisition regulation (FAR) 52.246-4, the government may evaluate the performance of the contractor. Such surveillance will be done according to standard inspection procedures or other contract provisions and any action taken by the CO, as a result of surveillance, will be in accordance with the terms of this contract. The government, through the COR, will monitor the contractor's performance on a continuous basis throughout the life of the contract to determine if they meet contract standards. See Section IV.

B. The performance monitoring process depends upon free and open communication between the government and the Contractor. As such, the COR will coordinate with the Contractor to explore means to maintain or improve the overall service level within the constraints of the contract and the level of funding.

C. The contractor is expected to establish and maintain professional communication between its employees and customers. The primary objective of professional communication between employees and customers is customer satisfaction. Performance monitoring drives the contractor to be customer focused through initially addressing valid customer complaints and investigating the issues and/or problems. During the investigation, the contractor should document and report the following to the COR:

i. The nature of the complaint

ii. The results of the investigation

iii. Corrective actions taken on valid customer complaints.

(Note: customers will communicate complaints to the COR by using the established customer complaint collection process.) The COR will provide the Contractor with a copy for corrective action. The COR will accept customer complaints and will investigate using the quality assurance monitoring form customer complaint investigation in Exhibit 3. This form documents the nature of the complaint, the results of the COR investigation, and the corrective action taken by the contractor to resolve the complaint.

D. The Contractor shall submit a Quality Control Plan (QCP) that tracks performance against standards identified in the PRS. In the QCP, the Contractor shall detail how data will be gathered to identify how standards will be met. On the first day of the phase-in period, the Contractor shall implement the government approved QCP. The Contractor's QCP shall specifically address:

i. How the requirements of the PWS are provided as specified.

ii. The processes used by the Contractor to collect data shall include an inspection system covering all required performance asks;

iii. A method of identifying deficiencies in the quality of services performed;

iv. A list of corrective action or measures used to prevent deficient or unsatisfactory performance (should be included, if necessary in each monthly report).

v. The sources that will be used to collect data.

vi. The tools that will be used to collect data -e.g. information systems or other.

vii. How the supplier proposes to validate the data collected.

viii. Maintain a record of all inspection reports and have them available for the COR upon request.

E. During the contract period of performance, the government may modify or change the performance objectives and standards that the Contractor is required to maintain as the mission and priorities evolve. In addition, all changes to the QCP proposed by the Contractor shall be submitted to the CO and COR for review. After the Government grants approval, the Contractor shall begin using the QCP to monitor performance levels. The COR will review outcome expectations with the Contractor. Such changes will be accomplished in consultation with the CO and COR, and Contractor.

F. The contractor shall be required to report the overall service level via customer satisfaction results to the government. The contractor may propose satisfaction measurements with ratings that shall distinguish between the various levels of satisfaction as follows: excellent, very good, good, satisfactory, and poor/unsatisfactory. The contractor shall discuss with the COR, any satisfaction ratings receiving a "poor/unsatisfactory" rating. For such cases, the contractor should highlight its perspective on factors driving customer satisfaction and present plans to adjust methods for corrective action accordingly to bring the satisfaction rating up to an acceptable level.

XII. QUALITY ASSURANCE REPORTING

A. The performance management feedback loop begins with the communication of expected outcomes. Expectations of service levels are expressed in the PWS and measured by the required performance monitoring procedures in Exhibit 1. The contractor will develop a performance management process to assess and report their performance to the COR, which will be submitted in a monthly performance management report.

i. The performance management report shall include all required performance monitoring procedures (Exhibit 1) with a description of performance trends. The COR and the contractor will jointly define the manner in which the information should be presented.

B. The Government’s QA monitoring, accomplished by the COR, will be reported using the monitoring forms in Exhibit 2, 3 and 4. The forms, when completed, will document the COR's understanding of the contractor's performance under the contract to ensure that the PWS requirements are met.

i. In addition to QA monitoring, the COR will use the performance management report to assess the contractor's level of performance for each performance objective measured in this QASP (detailed in Exhibit 1). The COR must coordinate and communicate with the contractor to resolve issues and concerns of marginal or unacceptable performance.

ii. The COR will retain a copy of all completed QA monitoring forms and forward copies to the CO and contractor in a timely manner. The contractor is required to respond in writing to the COR regarding the QA monitoring forms recording performance that "does not meet standards" within 5 working days after receipt of the forms.

XIII. REPORTING DUE DATES

A. The CO will review each QA monitoring form prepared by the COR. When appropriate, the CO may investigate the contractor through quality assurance evaluation form (QAE) surveillance, which focuses on a functional task review (how the work was performed).

B. By the 10th of each month, the contractor shall compile a summary assessment of the contractor's performance for the previous month. By the 15th of each month, the COR will compile a summary of the previous month's performance using the contractor's monthly performance management report, for the CO. The overall performance management report shall consist of the contractor's monthly report and the COR's inspection report summary and any completed quality assurance monitoring forms. This report will become part of the overall QA documentation to assess performance.

C. The COR may require the contractor supervisor, or a designated alternate, to meet with the CO, COR, and other Government personnel as deemed necessary to discuss performance evaluation. Decisions regarding any changes to standards or performance monitoring procedures should be clearly documented. Any approved changes will be incorporated as a contract modification by the CO. Final decisions on the results of the overall evaluation report shall rest with the CO.

EXHIBIT 1

PERFORMANCE MONITORING PROCEDURES

The following performance monitoring procedures shall be reported to the COR in the monthly performance management report. The contractor is encouraged to leverage technology in the compilation of performance data. The COR and contractor must coordinate and communicate to resolve issues and concerns of marginal or unacceptable performance. While the quality of all services of the PWS are important, standards for specific work requirements must be met.

I. QUALITY CONTROL PROGRAM (Performance Objectives And PWS References) A. Maintain a current inspection system for all required services and retain complete inspection records to ensure requirements of the PWS are met. (PWS Section 9)

i. PROCEDURE: The contractor's performance will be measured by verifying that records are maintained complete and are available 100 percent of the time. The contractor shall establish a process to ensure performance deficiencies, corrective actions are identified and quality of the service requirements are being met and that the associated records are correctly completed and continuously available. The COR will review the customer complaints and inspection records each month and will conduct periodic inspections of the work requirements to verify that records and the QCP are current and are correctly maintained 100 percent of the time. The number of inspections may be increased or decreased, as determined by the COR, based on inspection results. The contractor's performance will be measured by the total number of pertinent deficiencies identified as a result of each semi-annual inspection, which shall not exceed a combined total of 18 deficiencies per report. If more than 18 deficiencies are cited, $500 per deficiency will be deducted from the first monthly invoice following the report.

B. Trash Collection/Recycling/Removal (PWS Section 11.1)

i. PROCEDURE: The contractor will be measured by the number of deficiencies noted through scheduled and periodic inspections, customer complaints and how effective the contractor resolves work deficiencies. The contractor shall develop an efficient process for the collection, recycling and removal of trash so that the performance standard is met 95% of the time. Any pertinent deficiencies resulting from non-compliance with the QCP shall be corrected and the QCP shall be updated with new procedures to avoid reoccurrence. The contractor's performance will be measured by the total number of pertinent deficiencies identified as a result of each semi-annual inspection, which shall not exceed a combined total of 12 deficiencies per report. If more than 12 deficiencies are cited, $500 per deficiency will be deducted from the first monthly invoice following the report.

C. Non-Carpet Floor Maintenance (PWS Section 11.2)

i. PROCEDURE: The contractor's performance will be measured specifically by the quality/effectiveness of the contractor's techniques in meeting the standards and performance objectives of the PWS, using schedule and periodic inspections and customer complaints to determine if the acceptable quality level was maintained 95% of the time. The contractor's performance will be measured by the total number of pertinent deficiencies identified as a result of each semi-annual inspection, which shall not exceed a combined total of 12 deficiencies per report. If more than 12 deficiencies are cited, $500 per deficiency will be deducted from the first monthly invoice following the report. Missed notifications shall not exceed a combined total of 6 per report.

D. Carpeted Floor Maintenance (PWS Section 11.3)

i. PROCEDURE: The contractor's performance will be measured specifically by the quality/effectiveness of the contractor's techniques in meeting the standards and performance objectives of the PWS, using schedule and periodic inspections and customer complaints to determine if the acceptable quality level was maintained 95% of the time. The contractor's performance will be measured by the total number of pertinent deficiencies identified as a result of each semi-annual inspection, which shall not exceed a combined total of 12 deficiencies per report. If more than 12 deficiencies are cited, $500 per deficiency will be deducted from the first monthly invoice following the report.

E. Restroom Maintenance (PWS Section 11.4)

i. PROCEDURE: The contractor's performance will be measured by how effective work quality is maintained by meeting the performance standards and requirements of the PWS 95% of the time, using schedule and periodic inspections and customer complaints. The contractor's performance will be measured by the total number of pertinent deficiencies identified as a result of each semi-annual inspection, which shall not exceed a combined total of 12 deficiencies per report. If more than 12 deficiencies are cited, $500 per deficiency will be deducted from the first monthly invoice following the report.

F. Miscellaneous Cleaning (PWS Section 11.5)

i. PROCEDURE: The contractor's performance will be measured by scheduled and periodic inspections and customer complaints as to how effective work quality was maintained meeting the standards and requirements of the PWS, at the acceptable quality level of 95%. The contractor's performance will be measured by the total number of pertinent deficiencies identified as a result of each semi-annual inspection, which shall not exceed a combined total of 12 deficiencies per report. If more than 12 deficiencies are cited, $500 per deficiency will be deducted from the first monthly invoice following the report.

G. Service Requirements (PWS Section 11.6)

i. PROCEDURE: The contractor's performance will be measured on the quality and effectiveness of the work performed, emergency response time of 30 minutes or as agreed to by COR and other notification requirements of the PWS using inspections and customer complaints. The contractor's performance will be measured by the total number of pertinent deficiencies identified as a result of each semi-annual inspection, which shall not exceed a combined total of 12 deficiencies per report. If more than 12 deficiencies are cited, $500 per deficiency will be deducted from the first monthly invoice following the report.

H. Special Collections (PWS Section 11.7)

i. PROCEDURE: The contractor's performance will be measured in terms of the quality and effectiveness of the work performed, emergency response time of 30 minutes or as agreed to by COR and other notification requirements of the PWS using inspections and customer complaints. The contractor's performance will be measured by the total number of pertinent deficiencies identified as a result of each semi-annual inspection, which shall not exceed a combined total of 12 deficiencies per report. If more than 12 deficiencies are cited, $500 per deficiency will be deducted from the first monthly invoice following the report.

EXHIBIT 2

QUALITY ASSURANCE MONITORING FORM

SERVICE: _____________________________________________________________________

SURVEY PERIOD: _______________________________________________________________

SURVEILLANCE METHOD (CHECK):______ 100% Inspection (Scheduled)
______ Periodic Inspection
______ Customer Complaint
______ Work Quality / Appearance
LEVEL OF SURVEILLANCE SELECTED (CHECK):______ Monthly
______ Quarterly
______ As Needed
PERCENTAGE OF ITEMS SAMPLED DURING SURVEY PERIOD:______ %
OBSERVED SERVICE PROVIDER PERFORMANCE MEASUREMENT RATE:______%
SERVICE PROVIDER’S PERFORMANCE (CHECK):______ Exceeds Standards
______ Meets Standards
______ Does Not Meet Standards

SECTION OF THE QUALITY CONTROL PERFORMANCE PLAN THE PROVIDER FAILED TO MEET:

NARRATIVE OF PERFORMANCE DURING THE SURVEY PERIOD: ________________________

PREPARED BY: _________________________________ DATE: ______________________

EXHIBIT 3

QUALITY ASSURANCE MONITORING FORM - CUSTOMER COMPLAINT INVESTIGATION

SERVICE: _____________________________________________________________________

SURVEY PERIOD: _______________________________________________________________

DATE & TIME COMPLAINT RECEIVED: _______________________________________________

SOURCE OF COMPLAINT:NAME _______________________________________
ORGANIZATION _______________________________
PHONE # _____________________________________
EMAIL _______________________________________

NATURE OF COMPLAINT: ________________________________________________________

RESULTS OF COMPLAINT INVESTIGATION: ___________________________________________

SECTION OF THE QUALITY CONTROL PERFORMANCE PLAN THE PROVIDER FAILED TO MEET:

DATE & TIME SERVICE PROVIDER INFORMED OF COMPLAINT: __________________________

CORRECTIVE ACTION TAKEN BY SERVICE PROVIDER: __________________________________

RECEIVED AND VALIDATED BY: ____________________________________________________

PREPARED BY: _________________________________ DATE: ______________________

EXHIBIT 4

INSPECTION CHECKLIST

LOCATION: _________________________ INSPECTED BY: _____________________________

DATE: _____________________________

REQUIREMENT
AQL
FINDINGS
COMMENTS
ACCEPT
REJECT
1
QC Program
100%
2
Trash Collection and Removal
95%

Cans/Liner

Paper/Cans/Bottles/Cardboard/newspaper

Ash Receptacles/ Polished/cleaned/emptied

3
Non-Carpet Floor Maintenance
95%

Sweep/Dust Mop-Corners/Edges

Spot Mop/Damp Mop

4
Carpeted Floor Maintenance
95%

Vacuum Corners Edges

Spot Cleaning

5
Restroom Maintenance
95%

Stocking Supplies

Toilets/Urinals/Sinks/Fixtures

Trash/Liners/Containers

Dusting/Vents/Partitions/Walls

Sweeping/Mopping

Showers/Walls/Floors

Dispensers/Sanitary napkin disposal

6
Miscellaneous Cleaning
95%

Elevators

Doors/Walls/Tracks

Floor Sweep/Mop/Vacuum

Fixtures Clean

Stairwells and Landing

Sweep/Stop Mop/Wet Mop/Comers

Handrails/Dusting/Marble

Drinking Fountains

Stainless steel/Outside/Orifice

Wall around fountain

Interior Carpet Mats

Vacuum

Exterior Entrances

Trash/Debris

Entrance Ways

Doors/Glass/Handles/Plates/Marbles

Vacuum/Sweep/Mop

Loading Docks

Sweep/Police Trash & Debris

Kitchens

Trash/Sweep/Mop

Ceilings

No Cobwebs

Chalkboards/writing boards

Telephone Areas

Walls/Fixtures/Corners

Laboratories

Floors

7
Service Requirements
95%

16 | QASP

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