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36C24419Q1121 ATTACHMENT C - COMPLAINT WORKSHEET.pdf

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Attachment C: Complaint Worksheet

Contractor/Manager’s Name:

From: (Name of Project Officer)

Dates

Prepared:

Returned by Contractor:

Action Complete:

Discrepancy or Problem:

Signature of Contracting Officer:

To: (Contracting Officer)

From: (Contractor)

Contractor Response as to Cause, Corrective Action and Actions to Prevent Recurrence (Attach Continuation Sheet if Necessary)

Signature of Contractor Representative:

Date:

Government Evaluation:

Government Actions:

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Name Title Signature Date

Contractor Notified

Project Officer

Contracting Officer

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