A.03.09 Appendix E - Inspection Checklist.pdf

INSPECTION CHECKLIST LAW ENFORCEMENT

The proponent agency is CELRH-CT.

Routine Uses: Validation of Services and Maintenance Performed to the Contractual Standard.

1. PROJECT (Location)

RATING CODES

c. SIGNATURE (CR or QCI Who Reviewed)

2. DATE SERVICE PERFORMED

(YYYYMMDD)

CELRH FORM 2773-13, MAY 2010 PREVIOUS EDITIONS ARE OBSOLETE. Page 1 of 2

VERSION 1.1

3. CONTRACT NUMBER 4. CONTRACTOR 5. WORK ORDER NUMBER 6. WEATHER CONDITIONS

1 ACCEPTABLE 2 UNACCEPTABLE 3 IN PROGRESS 4 NOT STARTED

b. SPECIFIC TASK(S) OR ITEMS(S) LIST

SAFE WORKING HABITS

SERVICEABLE EQUIPMENT

COMPLETE BLOCKS BELOW ONLY IF

DEFICIENCIES ARE NOTED

8a. DATE (YYYYMMDD)

b. TIME (0001 - 2400 Hours)

c. SIGNATURE (CR or QCI Who Received a Copy)

b. TIME (0001 - 2400 Hours)

9a. DATE (YYYYMMDD)

10. SEE PAGE 2 FOR NOTED

DEFICIENCY DESCRIPTION(S) (If Applicable)

ITEM

NUMBER

1.

2.

3.

4.

8.

7.

6.

5.

13.

12.

11.

10.

9.

16.

15.

14.

LAW ENFORCEMENT

7a. SERVICE CONTRACT REQUIREMENT

LAW ENFORCEMENT:

ENFORCEMENT ACTIONS AND PUBLIC

CONTACTS

OFFICERS APPEARANCE AND

QUALIFICATIONS

MARKED VEHICLE

REQUIRED NUMBER OF OFFICERS ON DUTY

OFFICER IN SCHEDULED AREA AT

SCHEDULED TIME

SECURITY OF DOORS AND GATES

COOPERATION WITH CORPS

SIGNING LOG BOOKS AND PUNCHING TIME

CLOCK

ADMINISTRATION:

RADIO CONTACT

NOTIFICATION - LEAVING AREA AND

RESUMPTION OF DUTY

COMPLETION AND SUBMISSION OF LOG

SHEETS

14. COMMENTS AND DEFICIENCIES, WHICH SHALL BE CORRECTED BEFORE WORK WILL BE ACCEPTABLE AND SATISFACTORY ARE AS FOLLOWS

(Continuation)

CELRH FORM 2773-13, MAY 2010 Page 2 of 2

RATING CODES 1 ACCEPTABLE 2 UNACCEPTABLE 3 IN PROGRESS 4 NOT STARTED

b. SPECIFIC TASK(S) OR ITEMS(S) LISTITEM

NUMBER

17.

18.

19.

21.

22.

c. TIME

b. SIGNATURE (Inspector)11a. DATE (YYYYMMDD) b. SIGNATURE (COR)12a. DATE (YYYYMMDD)

13. PROJECT (Location)

THIS NOTICE IS TO ADVISE YOU OF

DEFICIENCIES FOUND DURING

INSPECTION. THE DEFICIENCIES FOUND

ARE IN THE PERFORMANCE AND OR

QUANTITY OF WORK. THE

DEFICIENCIES ARE TO BE CORRECTED

AS SPECIFIED. (See Item Numbers 14 and

15)

17a. DATE (YYYYMMDD) b. SIGNATURE FINAL (Inspector)

15. COMMENTS ON CORRECTION OF DEFICIENCIES.

16. INSPECTOR'S E-MAIL ADDRESS

LAW ENFORCEMENT

7a. SERVICE CONTRACT REQUIREMENT

20.

INSPECTION CHECKLIST LAW ENFORCEMENT

The proponent agency is CELRH-CT.

Routine Uses: Validation of Services and Maintenance Performed to the Contractual Standard.

RATING CODES

CELRH FORM 2773-13, MAY 2010 PREVIOUS EDITIONS ARE OBSOLETE. Page 1 of 2

VERSION 1.1

1 ACCEPTABLE

2 UNACCEPTABLE

3 IN PROGRESS

4 NOT STARTED

b. SPECIFIC TASK(S) OR ITEMS(S) LIST

SAFE WORKING HABITS

SERVICEABLE EQUIPMENT

COMPLETE BLOCKS BELOW ONLY IF DEFICIENCIES ARE NOTED

ITEM NUMBER

1.

2.

3.

4.

8.

7.

6.

5.

13.

12.

11.

10.

9.

16.

15.

14.

LAW ENFORCEMENT

7a. SERVICE CONTRACT REQUIREMENT

LAW ENFORCEMENT:

ENFORCEMENT ACTIONS AND PUBLIC

CONTACTS

OFFICERS APPEARANCE AND

QUALIFICATIONS

MARKED VEHICLE

REQUIRED NUMBER OF OFFICERS ON DUTY

OFFICER IN SCHEDULED AREA AT

SCHEDULED TIME

SECURITY OF DOORS AND GATES

COOPERATION WITH CORPS

SIGNING LOG BOOKS AND PUNCHING TIME

CLOCK

ADMINISTRATION:

RADIO CONTACT

NOTIFICATION - LEAVING AREA AND

RESUMPTION OF DUTY

COMPLETION AND SUBMISSION OF LOG

SHEETS

(Continuation) CELRH FORM 2773-13, MAY 2010 Page 2 of 2

RATING CODES

1 ACCEPTABLE

2 UNACCEPTABLE

3 IN PROGRESS

4 NOT STARTED

b. SPECIFIC TASK(S) OR ITEMS(S) LIST

ITEM NUMBER

17.

18.

19.

21.

22.

c. TIME THIS NOTICE IS TO ADVISE YOU OF DEFICIENCIES FOUND DURING INSPECTION. THE DEFICIENCIES FOUND ARE IN THE PERFORMANCE AND OR QUANTITY OF WORK. THE DEFICIENCIES ARE TO BE CORRECTED AS SPECIFIED. (See Item Numbers 14 and 15)

LAW ENFORCEMENT

7a. SERVICE CONTRACT REQUIREMENT 20.

1.0 mark.a.cooper@usace.army.mil 20110421 Form Design Team CEIT-PMO-I CELRH FORM 2773-13 Inspection Checklist Law Enforcement MAY 2010 Mark Cooper CELRH FORM 2773-13 Inspection Checklist Law Enforcement MAY 2010 20110421