D.2 ATTACHMENT 2 QUALITY ASSURANCE MONITORING FORM.docx

This is a Quality Assurance Monitoring Form template designed to track and document the performance of service providers against established standards. The form provides a structured framework for conducting surveillance of services during defined survey periods using multiple monitoring methodologies: random sampling, 100% inspection, periodic inspection, or customer complaint-based reviews. Surveillance frequency options include monthly, quarterly, or as-needed intervals, with provision for recording the percentage of items sampled during each survey period.

The form requires documentation of observed performance measurement rates and a determination of whether the service provider meets or does not meet established standards, along with a narrative summary of performance findings during the survey period. The completed form must be signed and dated by the preparer. As a template document attached to the solicitation for J045--CFA Exhaust Fan Repair and Maintenance services under the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 21, this form establishes the quality assurance methodology that will be applied to monitor contractor performance throughout the contract period.