36C25518Q0199-012.docx

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Wheelchair/Litter Contract 589-18-2-1106-0001 (VA-17-109913) KC
Solicitation number
36C25518Q0199
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36C25518Q0199 ATTACHMENT QUALITY ASSURANCE SURVEILLANCE PLAN - QASP.docx

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ATTACHMENT 1: PERFORMANCE REQUIREMENTS SUMMARY

Performance Objective
Acceptable Quality Level (AQL)
Method of Performance Assessment
Incentive / Disincentive
1 - Meet scheduled response times
Performance criteria equals 99% or better
Random, observations, customer feedback
When AQL is not met: 1st offense is written notice to the contractor to correct the deficiency. 2nd offense will result in another than positive CPARS evaluation
2 - Meet non-scheduled response times
Performance criteria equals 98% or better
Random, observations, customer feedback
When AQL is not met: 1st offense is written notice to the contractor to correct the deficiency. 2nd offense will result in an other than positive CPARS evaluation
3. Response to call-backs per
Performance criteria equals 99% or better
Observations, customer feedback
When AQL is not met: 1st offense is written notice to the contractor to correct the deficiency. 2nd offense will result in an other than positive CPARS evaluation.
4. Contractor personnel performance
Performance criteria equals 95% or better
Random, observations, customer feedback
When AQL is not met: 1st offense is written notice to the contractor to correct the deficiency. 2nd offense will result in an other than positive CPARS evaluation
5. - Inspection of contractor’s facilities/equipment
No more than three discrepancies noted
On-site inspection
When AQL is not met: 1st offense is written notice to the contractor to correct the deficiency. 2nd offense will result in an other than positive CPARS evaluation

Quality Assurance Surveillance Plan (QASP)

ATTACHMENT 2: SAMPLE QUALITY ASSURANCE MONITORING FORM

Contract #: ____________________________________ Contractor: ____________________________________

SERVICE or STANDARD: _______________________________________________________________

SURVEY PERIOD: _____________________________________________________________________

SURVEILLANCE METHOD (Check):

[__] Periodic Inspection [__] Customer Complaint [__] Review of documents

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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