36C24718R0165-004.pdf

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Attached to
Shuttle Transportation Service Federal contract opportunity
Solicitation number
36C24718R0165
Issued by
Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 7

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36C24718R0165 ATTACHMENT 1 -SAMPLE QUALITY ASSURANCE MONITORING FORM.pdf

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ATTACHMENT B: SAMPLE QUALITY ASSURANCE

MONITORING FORM

SERVICE or STANDARD:

SURVEY PERIOD:

SURVEILLANCE METHOD (Check):

Random Sampling 100% Inspection Periodic Inspection Customer Complaint

LEVEL OF SURVEILLANCE (Check):

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): Meets Standards

Does Not Meet Standards

Narrative of Performance During Survey Period:

PREPARED BY: ___________________________________ DATE: _________________

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