12445023Q0052_Attach6_DRAFT QASP_22May23.pdf

US Department of Agriculture (USDA)

Quality Assurance Surveillance Plan

Janitorial Service for USDA Forest Service, Cordesville, SC

May 22, 2023

Contents Project Name Solicitation / Contract Number Section 1: Introduction

1.1 Purpose

1.2 QASP Relation to the Contract

1.2.1 QASP Revisions

1.2.2 Surveillance of Performance Progression

1.3 QASP Relation to the Quality Control Plan (QCP)

Section 2: Performance Description

2.1 Performance Standards and Acceptable Quality Levels (AQLs)

2.1.1 Allowable Deviation

2.1.2 Substantially Complete

2.2 Non-Performance

2.2.1 Documentation

2.2.2 Remedial Actions

Section 3: Contractor and Government Responsibilities

3.1 Contractor Responsibility

3.2 Government Responsibility

3.2.1 Contracting Officer (CO)

3.2.2 Contracting Officer Representative (COR)

3.2.3 Customers

Section 4: Surveillance Methods to Perform Quality Assurance

4.1 Surveillance Methods

4.1.1 100 Percent Inspection

4.1.1.1 Performance Standards and AQLs

4.2 Analysis and Results

Appendix A: Performance Requirement Summaries Appendix B: Example Discrepancy Report Appendix C: Customer Feedback Record Appendix D: Example Guide / Inspection List Appendix E: Example Quality Assurance Monitoring Appendix F: Example Customer Complaint Investigation Appendix G: Example Surveillance Activity Checklist

Project Name Janitorial Service for Center for Forested Wetlands Research in Cordesville, South Carolina

Solicitation / Contract Number Insert Solicitation / Contract Number

Section 1: Introduction This Quality Assurance Surveillance Plan (QASP) is pursuant to the requirements listed in the performance work statement (PWS) entitled Janitorial Service for Center for Forested Wetlands Research in Cordesville, South Carolina.

This plan sets forth the procedures and guidelines that the USDA, Southern Research Station will use in ensuring the required performance standards or services levels are achieved by the contractor.

1.1 Purpose

The purpose of the QASP is to describe the systematic methods used to measure performance and to identify the reports required and the resources to be employed. The QASP provides a means for evaluating whether the contractor is meeting the performance standards identified in the PWS. This QASP is designed to define roles and responsibilities, identify the performance objectives, define the methodologies used to monitor and evaluate the contractor’s performance, describe quality assurance reporting, and describe the analysis of quality assurance monitoring results.

1.2 QASP Relation to the Contract

1.2.1 QASP Revisions

The Contracting Officer Representative (COR) may make revisions or changes to the QASP procedures and surveillance methods or increase or decrease the degree of surveillance methods at any time during the contract performance period. Changes to the Metric must be incorporated into the PWS, Performance Requirement Summary (PRS) and QASP by a bilateral modification to contract that is issued by the Contracting Officer (CO). A copy of the QASP is provided to the contractor to enable the contractor to enhance its Quality Control (QC) program to perform in accordance with its Quality Control Plan (QCP).

1.2.2 Surveillance of Performance Progression

As the performance period progresses, the levels of surveillance may be altered for service areas where performance is either consistently excellent or unsatisfactory. If consistently good performance, then the amount of surveillance may be reduced. If observations reveal consistent deficiencies, increased surveillance may be implemented.

1.3 QASP Relation to the Quality Control Plan (QCP)

The QCP is a required element of contract and the Contractor shall adhere to its established quality control processes and procedures in managing and performing work as described in the contract. While the QCP represents the way in which the Contractor will ensure its quality and timeliness of services, as defined in the PWS, the QASP represents the way in which the Government personnel specified in Section 3: Contractor and Government Responsibilities, Paragraph 3.2, Government Responsibilities will evaluate the contractor’s performance. The contractor’s QC program and the residual organization’s QASP should be complementary programs that ensure successful contractor performance.

Section 2: Performance Description Performance of the contractor will be monitored through the surveillance methods described in Section 4: Surveillance Methods to Perform Quality Assurance to assess the Contractor’s performance against PWS requirements.

2.1 Performance Standards and Acceptable Quality Levels (AQLs) For selected activities in the PWS, the PRS provides a performance standard and an AQL. A performance standard is the expected level of contractor performance. An AQL defines the level of performance that is satisfactory. Depending on the service evaluated and the evaluation method selected, performance standards and AQLs may be stated as a number of occurrences or as a percentage. Performance standards and AQLs for random sampling and 100 percent inspection are generally stated as percentages. For periodic inspections, performance standards may be stated as either percentages or as absolute numbers.

The contract requires the Contractor to perform all work as specified. Any inaccuracies or omissions in services or products are referred to as “defects” on the part of the Contractor. The Contractor shall be responsible for all identified defects and may be required to perform the work at no cost to the government. The AQLs take into account that in some instances an allowable level of deficiencies (deviations) is possible while overall performance continues to meet the government’s desired level of service.

2.1.1 Allowable Deviation

The AQLs define the level or number of performance deficiencies the Contractor is permitted to reach under this contract. AQLs take into account the difference between an occasional defect and a gross number of defects. AQLs can be expressed as a percentage of or as an absolute number (e.g., three per month). There may be instances where 100 percent compliance is required, and no deviation is acceptable (e.g., where safety is involved).

2.1.2 Substantially Complete

In some cases, service outputs are evaluated using subjective values (e.g., excellent, satisfactory, unsatisfactory). The criteria for acceptable performance and for defects must be defined for these service outputs. The concept of “substantially complete” should be the basis for inspections based on subjective scales. Work is considered “substantially complete” where there has been no significant departure from the terms of the contract and no omission of essential work. In addition, the Contractor has performed the work required to the best of its ability and the only variance consists of minor omissions or deficiencies.

2.2 Non-Performance

Non-performance occurs when the contractor’s performance does not meet the AQL for a given requirement.

Requirements may contain multiple performance elements, and therefore, deficiencies may occur in one or more aspects of performance (e.g., timeliness, accuracy, completeness, etc.) or subject areas of effort.

When surveillance indicates that the contractor's service output is not in compliance with the contract requirements, the Contracting Officer’s Representative (COR) must determine whether the Contractor or the Government caused the deficiency. If the cause of the defect rests with the Government, corrective action must be taken through Government channels. If the cause of the defect is due to action or inaction by the contractor, the contractor is responsible for correction of the problem at no additional expense to the Government.

2.2.1 Documentation

Documentation of work non-performed or unacceptable work is essential for tracking Contractor performance. The COR will document deficient work by compiling facts describing the inspection methods and results and to substantiate nonconformance with the contract. A sample documentation reporting form is provided in Appendix’s B thru G. The documentation, with any recommendations, will be forwarded to the CO. In the case of the Contractor, the COR will decide whether to elevate the problem to the CO for corrective action.

2.2.2 Remedial Actions

The Federal Acquisition Regulation allows for penalties in the event that the Contractor fails to perform the required services. Penalties are defined as those actions taken under the direction of the CO against the contractor within the general provisions of the contract for nonconformance to the PWS and PRS.

Section 3: Contractor and Government Responsibilities

3.1 Contractor Responsibility

The Contractor is responsible for delivering products or services in accordance with the contract. Implementing its QCP, which describes the Contractor’s methods for ensuring all products and services under the contract meet established performance standards and AQLs. Maintaining, and providing for audit, quality control records and reports and all records associated with the investigation and complaint resolutions. Appointing a single quality control point-of-contact to act as a central recipient of communication from the COR or CO.

3.2 Government Responsibility

3.2.1 Contracting Officer (CO)

The CO is responsible for administering and monitoring contract compliance, contract administration, and cost control and for resolving any differences between the observations documented by COR and the contractor’s performance. The CO may delegate various day-to-day contract administration duties to a Administering ACO (ACO) and/or the COR for performance management and administrative actions such as invoice approval and issuance of Contract Discrepancy Reports may be, and normally are, delegated by the CO to the COR. The CO shall approve any revisions to the QASP processes or standards.

3.2.2 Contracting Officer Representative (COR)

The COR, is designated in writing, by the CO. The COR will ensure that the QA function is properly executed, plays a key role in contract administration and performs the contract surveillance and monitoring. Some key contract administration duties include, but are not limited to, performs surveillance as required by this QASP; make recommendations to the CO for issuance of Contract Discrepancy Reports or letters of commendation and acceptance or rejection of completed work and for administrative actions based on unsatisfactory or non-performed work, and revisions or changes to the QASP;

and assists the CO in identifying necessary contract modifications and preparing reports of Contractor performance and cost.

The COR may use the form(s) included in the Appendices to perform the inspection or other forms as approved by the CO. The Contractor overall guidance is also provided by FAR.

3.2.3 Customers

Not used

Section 4: Surveillance Methods to Perform Quality Assurance

4.1 Surveillance Methods

The surveillance methods used in the QA process are the Government’s tools to monitor the Contractor’s products and services. The best means of determining whether the Contractor has met all contract requirements is to inspect the Contractor’s service products and analyze the results. Further, documented inspection results are an effective tool in contract administration that can confirm the successful achievement of all performance requirements or highlight areas where defects exist, and improvements are necessary.

4.1.1 100 Percent Inspection The 100 percent inspection method requires complete inspection and will be used for critical contract requirements.

4.1.1.1 Performance Standards and AQLs

Calculating Acceptable Quality Level, AQL: Acceptable quality levels AQL will be calculated by dividing the number of acceptable occurrences observed by the number of possible occurrences observed. For example: Paragraph 3.2 in month one the COR observed 20 janitorial services. Of the 20 observed services, 18 ere satisfactory. 18 satisfactory observations divided by 20 possible observation equals 0.9 or 90%. The surveillance methods used in this contract is periodic and random inspections along with validated customer complaints by the COR. Each performance objective along with the Acceptable Quality Level (AQL) is noted in this contract.

4.2 Analysis and Results

When the inspections and complaints have been validated within the appropriate timeframe, the COR will report to the CO and the Contractor of the performance. The Government shall monitor the Contractor’s performance in each of the different performance objective and PWS references and reserves the right to use additional surveillance procedures as is deemed appropriate. The purpose is to ensure Government is receiving high-quality services from the Contractor. If the Contractor fails to complete a portion of work, or the work performed is unsatisfactory for any given PWS reference, the Contractor shall immediately correct the deficient work at no additional cost to the Government. Work not satisfactorily completed, as required, shall be subject in the deduction of that service month in accordance with payment schedule.

Performance Rating

Definition

Exceptional Performance meets contractual requirements and exceeds many to the government’s benefit. The contractual performance of the element or sub-element being evaluated was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

Very Good Performance meets contractual requirements and exceeds some to the Government’s benefit. The contractual performance of the element or sub-element being evaluated was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

Satisfactory Performance meets contractual requirements. The contractual performance of the element or sub-element contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

Marginal Performance does not meet some contractual requirements. The contractual performance of the element or sub-element being evaluated reflects a serious problem for which the contractor has not yet identified corrective actions. The contractor’s proposed actions appear only marginally effective or were not fully implemented.

Unsatisfactory Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance of the element or sub-element contains a serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

Appendix A: Performance Requirement Summaries

Objective

PWS

Reference

Performance Standard

Acceptable Quality Level

(AQL)

Incentive (+ /-) Impact on Contractor Payment

Method of Surveillance

Clean and Empty Trash cans, with at least 1 spare trash bag in bottom of trash can. 3.1.1

Trash removed, with no visible dirt, odors, left behind. Leaving at least 1 clean trash bag in bottom of can

No more than 1 validated complaint or failed Inspection monthly

Rework of line items at no cost to the government.

Positive/Negative performance rating.

Exercise Option Years.

Periodic inspections, random inspections, and customer complaints within 2 workdays of performance.

Stock and replenish all paper products and soap dispensers 3.1.2

Supply levels are to be full and prepared for the daily business operation

No more than 1 validated complaint or failed Inspection monthly

Rework of line items at no cost to the government.

Positive/Negative performance rating.

Exercise Option Years.

Periodic inspections, random inspections, and customer complaints within 2 workdays of performance.

Clean all floors.

Vacuum, sweep, mop, and disinfect all floors and carpets, including hallways. 3.1.3

Floors should be clean, free of debris, dirt, litter, or any other foreign matter

No more than 1 validated complaint or failed Inspection monthly

Rework of line items at no cost to the government.

Positive/Negative performance rating.

Exercise Option Years.

Periodic inspections, random inspections, and customer complaints within 2 workdays of performance.

Clean and disinfect all toilets, urinals, patricians, clean mirrors, sinks, and bathroom fixtures.

Includes the outside areas of the toilet or urinals in addition to the handle, seat, tank, and lid. 3.1.4

Bathroom should clean and disinfected.

Areas should be free of dirt, deposits, streaks, and odors

No more than 1 validated complaint or failed Inspection monthly

Rework of line items at no cost to the government.

Positive/Negative performance rating.

Exercise Option Years.

Periodic inspections, random inspections, and customer complaints within 2 workdays of performance.

Clean and disinfect all counters and work surfaces, inclusive of all items and areas that are routinely touched such as door handles, door plates, light switches, etc. 3.1.5

The counters and work surfaces should be clean, and disinfected, free of debris, deposits, streaks, scum, and odors

No more than 1 validated complaint or failed Inspection monthly

Rework of line items at no cost to the government.

Positive/Negative performance rating.

Exercise Option Years.

Periodic inspections, random inspections, and customer complaints within 2 workdays of performance.

All kitchen areas are to be clean disinfect/scour on all features including sink, microwave, coffee maker, toaster, counter tops, and refrigerator handles/doors. 3.1.6

The kitchen areas should be clean and disinfected.

They should be free of visible dirt, deposits, streaks, and odors

No more than 1 validated complaint or failed Inspection monthly

Rework of line items at no cost to the government.

Positive/Negative performance rating.

Exercise Option Years.

Periodic inspections, random inspections, and customer complaints within 2 workdays of performance.

Dust all horizontal surfaces of furniture and partitions in offices and lobby areas 3.1.7

These areas should be free of visible dust

No more than 1 validated complaint or failed Inspection monthly

Rework of line items at no cost to the government.

Positive/Negative performance rating.

Exercise Option Years.

Periodic inspections, random inspections, and customer complaints within 2 workdays of performance.

Clean all glass of entrances interior and exterior doors of the Work Center (office) doors and Laboratory building. 3.1.8

Glass doors should be clean, with no visible deposits, streaks, or smears

No more than 1 validated complaint or failed Inspection monthly

Rework of line items at no cost to the government.

Positive/Negative performance rating.

Exercise Option Years.

Periodic inspections, random inspections, and customer complaints within 2 workdays of performance.

Clean and disinfect all drinking fountains 3.1.10

Fountains should be clean, free of any visible dirt, deposits, streaks, and odors

No more than 1 validated complaint or failed Inspection monthly

Rework of line items at no cost to the government.

Positive/Negative performance rating.

Exercise Option Years.

Periodic inspections, random inspections, and customer complaints within 2

Entrance should be clean, presentable.

Sweep outside entry to the Work Center (office) removing cobwebs, trash, dirt, or any other objects. 3.1.11

Entrances should be free of trash, visible dirt, and cobwebs

No more than 1 validated complaint or failed Inspection monthly

Rework of line items at no cost to the government.

Positive/Negative performance rating.

Exercise Option Years.

Periodic inspections, random inspections, and customer complaints within 2 workdays of performance.

Clean windowpanes.

Ridding the interior windowpanes of dust or debris in all buildings. This includes Work Center (office) and Laboratory. Task is done Quarterly. 3.2.1

Windowpanes should be free of visible dust, foreign deposits, or bugs

Zero validated complaints or failed Inspections

Rework of line items at no cost to the government.

Positive/Negative performance rating.

Exercise Option Years.

Periodic inspections, random inspections, and customer complaints within 2 workdays of performance.

Clean baseboards in all in all buildings.

This includes Work Center (office) and Laboratory and in the Bunkhouse. Task is done Quarterly. 3.2.2

Baseboards should be free of visible dust, foreign deposits, or bugs

Zero validated complaints or failed Inspections

Rework of line items at no cost to the government.

Positive/Negative performance rating.

Exercise Option Years.

Periodic inspections, random inspections, and customer complaints within 2 workdays of performance.

Clean, Strip, Wax and Buff all tile and laminate floors has required by their specific commercial floor type twice a year. Floors of this type are in the Work Center (office), Laboratory and in the Bunkhouse. Task is done Quarterly. 3.3.1

Floors should maintain with a clean appearance and where applicable have a high sheen appearance.

Floors should be free of dust, dirt, stain wax build up, leaving no visible dirt or streaks. The Laboratory area dust must be maintained

Zero validated complaints or failed Inspections

Rework of line items at no cost to the government.

Positive/Negative performance rating.

Exercise Option Years.

100% inspections within 2 to very low level.

Clean carpet. Deep clean/shampoo all rugs and carpeted high traffic/walking areas using the specific commercial cleaning requirement for them. 3.3.2

Carpet shall be free of obvious removeable spots, stains, solid traffic pattern, dirt, debris, gum and any other foreign deposits or odor

Zero validated complaints or failed Inspections

Rework of line items at no cost to the government.

Positive/Negative performance rating.

Exercise Option Years.

100% inspections within 2 workdays of performance.

Clean all interior and exterior windows yearly ridding them of debris, dust, streaks, or smudges.

This includes Work Center (office) Laboratory and in the Bunkhouse. Task is done Yearly. 3.4.1

Windows should be clean with no visible deposits, foreign matter, streaks, or smears.

Zero validated complaints or failed Inspections

Rework of line items at no cost to the government.

Positive/Negative performance rating.

Exercise Option Years.

100% inspections within 2 workdays of performance.

Empty, then re-line all waste containers every scheduled service.

Clean/disinfect container as needed.

(Recycle containers are not included) Leaving clean spare bags in bottom on container. 3.5.1

Trash removed, with no visible dirt, odors, left behind. Leaving at least 1 clean trash bag in bottom of can

No more than 1 validated complaint or failed Inspection monthly

Rework of line items at no cost to the government.

Positive/Negative performance rating.

Exercise Option Years.

100% inspections within 2

Stock, Replace and replenish all paper products and soap/disinfectant dispensers, each month. 3.5.2

Supply levels are to be full and prepared for the daily business operation

No more than 1 validated complaint or failed Inspection monthly

Rework of line items at no cost to the government.

Positive/Negative performance rating.

Exercise Option Years.

100% inspections within 2 workdays of performance.

Vacuum, sweep, mop, and disinfect all floors and carpets which includes hallways with every monthly scheduled service. 3.5.3

Floors should be clean, free of debris, dirt, litter, or any other foreign matter

No more than 1 validated complaint or failed Inspection monthly

Rework of line items at no cost to the government.

Positive/Negative performance rating.

Exercise Option Years.

100% inspections within 2 workdays of performance.

Clean and disinfect all toilets, urinals, patricians, clean mirrors, sinks, and bathroom fixtures.

This includes the outside areas of the toilet or urinals in addition to the handle, seat, tank, and lid. Scour and disinfect showers.

This is a monthly requirement. 3.5.4

Bathroom should clean and disinfected.

Areas should be free of dirt, deposits, streaks, and odors

No more than 1 validated complaint or failed Inspection monthly

Rework of line items at no cost to the government.

Positive/Negative performance rating.

Exercise Option Years.

100% inspections within 2 workdays of performance.

Clean and disinfect all counters and work surfaces, inclusive of all items and areas that are routinely touched such as door handles, door plates, light switches, etc. 3.5.5

The counters and work surfaces should be clean, and disinfected, free of debris, deposits, streaks, scum, and odors

No more than 1 validated complaint or failed Inspection monthly

Rework of line items at no cost to the government.

Positive/Negative performance rating.

Exercise Option Years.

100% inspections within 2 workdays of performance.

Kitchen area: Clean disinfect/scour on all features including sink, microwave, stove, coffee maker, toaster, counter tops, and refrigerator handles/doors. 3.5.6

The kitchen areas should be clean and disinfected.

They should be free of visible dirt, deposits, streaks, and odors

No more than 1 validated complaint or failed Inspection monthly

Rework of line items at no cost to the government.

Positive/Negative performance rating.

100% inspections within 2

Clean insides stove and refrigerator.

Exercise Option Years.

Dust all horizontal surfaces of furniture, lamps, in bedrooms and common areas. 3.5.7

These areas should be free of visible dust

No more than 1 validated complaint or failed Inspection monthly

Rework of line items at no cost to the government.

Positive/Negative performance rating.

Exercise Option Years.

100% inspections within 2 workdays of performance.

Staffing Retention 6.5

Personnel turnover shall not exceed more than one individual within any 12-month period

No more than 1 replacement individual within any 12-month period

Offset of invoice charges to recoup costs for additional background checks.

Positive/Negative performance rating.

Exercise Option Years

100% Inspection.

Appendix B: Example Discrepancy Report The following document is only an example, which is not all inclusive, that can be revised and used, if applicable, in the QASP as attachments or exhibits.

DISCREPANCY REPORT 1. DISCREPENCY REPORT NO.

2. TO: (Contractor / Project Manager Name) 3. FROM: (Name of COR)

CONTRACT NUMBER: DATE:

PREPARED ORAL NOTIFICATION RETURNED BY CONTRACTOR ACTION COMPLETE

4. DISCREPENCY OR PROBLEM (Describe in Detail. Include PWS references. Attach Continuation Sheet if Necessary)

5. SIGNATURE OF COR

6. TO: (Name of COR) 7. FROM: (Contractor / Project Manager)

8. CONTRACTOR RESPONSE AS TO CAUSE, EFFECT, CORRECTIVE ACTION AND ACTIONS TO PREVENT RECURRENCE (Attach Continuation Sheet if necessary. Cite applicable Contractor QC program procedures or new QC procedures)

9. SIGNATURE OF CONTRACTOR REPRESENTIVE 10. DATE

11. GOVERNMENT EVALUATION (Acceptance, partial acceptance, or rejection. Attach Coordination Sheet if necessary)

12. GOVERNMENT ACTIONS (Cure notice, show cause, other)

CLOSE OUT

KTR NOTIFIED

NAME AND TITLE SIGNATURE DATE

COR

Appendix C: Customer Feedback Record The following document is only an example, which is not all inclusive, that can be revised and used, if applicable, in the QASP as attachments or exhibits.

CUSTOMER FEEDBACK RECORD

DATE AND TIME OF COMPLAINT CONTRACT NUMBER/ OR PROJECT:

SOURCE OF COMPLAINT

ORGANIZATION

INDIVIDUAL

NATURE OF COMPLAINT

PWS REFERENCE

VALIDATION

DATE AND TIME CONTRACTOR INFORMED OF COMPLAINT NAME OF CONTRACTOR REPRESENTATIVE INFORMED OF COMPLAINT

ACTION TAKEN BY CONTRACTOR (Responsible officer):

RECEIVED AND VALIDATED BY

Determination: Complaint Valid Complaint Invalid

Appendix D: Example Guide / Inspection List The following document is only an example, which is not all inclusive, that can be revised and used, if applicable, in the QASP as attachments or exhibits.

CONTRACT NUMBER: ___________________________________

SERVICE FUNCTION:

PWS SECTION:

1 Method of Surveillance:

2 Lot Size:

3 Sample Size:

4 Performance Requirement: Performance is Excellent (E) when ___________or fewer defects are discovered per month. Performance is Satisfactory (S) when ________ or fewer defects are discovered per month. Performance is Unsatisfactory (U) when _______ or more defects are discovered per month.

5 Sampling Procedure: Instructions on how to select the sample must be clear and complete

6 Inspection Procedure: The procedure must be detailed enough to allow a yes/no objective decision as to the acceptability of performance by anyone making the inspection. Explain when evaluation is to occur and what is acceptable/unacceptable

Performance: Excellent (E), Satisfactory (S), Unsatisfactory (U), Not Applicable (N/A)

PRS Requirements Timeliness Quality of Work Notes

Overall Rating Of Inspection (E, S, U or N/A)

COR/Inspector Comments:

Contractor Signature: ___ Date: __

COR Signature: ____________________Date: _________________

Appendix E: Example Quality Assurance Monitoring The following document is only an example, which is not all inclusive, that can be revised and used, if applicable, in the QASP as attachments or exhibits.

CONTRACT NUMBER: ______________________________________

SERVICE or STANDARD:

SURVEY PERIOD:

SURVEILLANCE METHOD (Check the applicable item):

Random Sampling 100% Inspection Periodic Inspection Customer Complaint

LEVEL OF SURVEILLANCE (Check the applicable item):

Monthly Quarterly As needed

PERCENTAGE OF ITEMS SAMPLED DURING SURVEY PERIOD: ______ %

ANALYSIS OF RESULTS:

Observed Service Provider Performance Measurement Rate: ______%

Service Provider’s Performance (Check the applicable item):

Meets Standards

Does Not Meet Standards

Narrative of Performance During Survey Period:

Prepared By: _______________________________ Date: ______________

Appendix F: Example Customer Complaint Investigation The following document is only an example, which is not all inclusive, that can be revised and used, if applicable, in the QASP as attachments or exhibits.

CONTRACT NUMBER: _________________________

SERVICE or STANDARD:

SURVEY PERIOD: ___________________

DATE COMPLAINT RECEIVED: ____________

SOURCE OF COMPLAINT: _________________________________________ (Name) _______________________________________________________________ (Organization) ___________________ (Phone No.) _________________________________ (Email Address)

NATURE OF COMPLAINT:

RESULTS OF COMPLAINT INVESTIGATION:

DATE SERVICE PROVIDER INFORMED OF COMPLAINT: _____________

CORRECTIVE ACTION TAKEN BY SERVICE PROVIDER:

Received and Validated By: __________________________________________ Prepared By: _____________________________ Date: _________________

Appendix G: Example Surveillance Activity Checklist The following document is only an example, which is not all inclusive, that can be revised and used, if applicable, in the QASP as attachments or exhibits.

Performance Requirement

Performance Standard

Method of Measurement

Metrics

Method of Surveillance

Date Accomplished

Compliance (Exceed, Met, Partial Met)