2.2.1 Attachment K Quality Assurance Monitoring Form_2023-03-13.pdf

624 KB Posted

Attached to
CONUS Vehicle & Equipment Maintenance
Solicitation number
70FB7023R00000012
Issued by

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This document is a quality assurance monitoring form template to be used for evaluating maintenance services provided under Federal Emergency Management Agency solicitation number 70FB7023R00000012 for CONUS Vehicle & Equipment Maintenance. The form includes fields for identifying the service or standard being monitored, survey period, surveillance method, level of surveillance, barcodes of items sampled, percentage of items sampled, analysis of results indicating whether the service provider's performance met standards, narrative of performance, preparer information, and additional comments. While the form is a template, the related solicitation provides context that it is for evaluating vehicle and equipment maintenance services under an FEMA contract for services within the continental United States.

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QUALITY ASSURANCE MONITORING FORM

SERVICE or STANDARD:

SURVEY PERIOD:

SURVEILLANCE METHOD (Check One):

Random Sampling Periodic Inspection 100% Inspection Customer Complaint

LEVEL OF SURVEILLANCE (Check One):

Monthly Quarterly Annually As needed

BARCODES SAMPLED:

PERCENTAGE OF ITEMS SAMPLED DURING SURVEY PERIOD: %

ANALYSIS OF RESULTS:

Service Provider’s Name:

Observed Service Provider Performance Measurement Rate: %

Service Provider’s Performance (Check One): Meets Standards Does Not Meet Standards

Narrative of Performance During Survey Period:

PREPARED BY (Print): DATE:

PREPARED BY (Sign):

QASP Quality Assurance Monitoring Form

As of: 3/13/2023

QASP Quality Assurance Monitoring Form

As of: 3/13/2023

Service or Standard: []
Survey Period:
Random Sampling: Off
Periodic Inspection: Off
100% Inspection: Off
Customer Complaint: Off
Monthly: Off
Quarterly: Off
Annually: Off
As needed: Off
Service Provider: [ ]
Analysis:
Meet Standards: Off
Does Not Meet Standards: Off
Narrative:
Print:
Date:
LOCATION: [MAINTENANCE LOCATION:]
LOCATION2: [ ]
Percentage:
Additional Comments:
Comments: [Additional Comments:]
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PAGE2: 2
clear1:
PAGE: 1

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