D.5 ATTACHMENT 5 CONTRACT DISCREPANCY REPORT.docx

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Q523--Autotransfusion Services- Kansas City VAMC
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36C25521R0020
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Attachment D.5 CONTRACT DISCREPANCY REPORT 36C25521R0020

CONTRACT DISCREPANCY REPORT

1. CONTRACT NUMBER
2. REPORT NUMBER FOR THIS DISCREPANCY
3. TO: (Contracting Officer)
4. FROM: (Name of COR)

5. DATES

a. CDR PREPARED

b. RETURNED BY CONTRACTOR:
c. ACTION COMPLETE

6. DISCREPANCY OR PROBLEM (Describe in detail. Include reference to PWS Directive; attach continuation sheet if necessary.)

7. SIGNATURE OF COR
Date:
8. SIGNATURE OF CONTRACTING OFFICER
Date:
9a. TO (Contracting Officer)
9a. FROM (Contractor)

10. CONTRACTOR RESPONSE AS TO CAUSE, CORRECTIVE ACTION AND ACTIONS TO PREVENT RECURRENCE. (Cite applicable quality control program procedures or new procedures. Attach continuation sheet(s) if necessary.)

11. SIGNATURE OF CONTRACTOR REPRESENTATIVE
Date:

12. GOVERNMENT EVALUATION. (Acceptance, partial acceptance, reflection. Attach continuation sheet(s) if necessary.)

13. GOVERNMENT ACTIONS (Acceptance, partial acceptance, reflection. Attach continuation sheet(s) if necessary.)

14. CLOSE OUT

NAME
TITLE
SIGNATURE
DATE

a. CONTRACTOR NOTIFIED

b. COR

c. CONTRACTING OFFICER

VHAPM Part801.603-70 COR SOP Revision 07 Page 1 of 1 Original Date: 05/20/2011 Revision 07 Date: 02/07/2020

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