Appendix B Example Discrepancy Report.docx

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Attached to
Air Quality Monitoring Support for Mark Twain National Forest
Solicitation number
12444524Q0015
Issued by

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This document provides an example discrepancy report template for use in a Quality Assurance Surveillance Plan (QASP) to document any issues with contractor performance on a federal contract. The template includes sections for the discrepancy report number, parties involved, contract details, a description of the problem with references to the Performance Work Statement, signatures from the Contracting Officer's Representative (COR) and contractor, the contractor's response and proposed corrective actions, a section for government evaluation and acceptance or rejection of the response, and areas for any subsequent government actions.

The related federal contract opportunity is a solicitation to provide operational service support to an air quality testing station located in the Mark Twain National Forest. The support includes site maintenance, on-ground operations, and troubleshooting or replacement of air quality testing instruments. The procurement will be a 100% small business set-aside conducted according to FAR Parts 12, 13, and 19. The contracting agency is the Department of Agriculture Forest Service.

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Appendix B: Example Discrepancy Report The following document is only an example, which is not all inclusive, that can be revised and used, if applicable, in the QASP as attachments or exhibits.

DISCREPANCY REPORT
1. DISCREPENCY REPORT NO.
2. TO: (Contractor / Project Manager Name)
3. FROM: (Name of COR)

CONTRACT NUMBER: DATE:

PREPARED
ORAL NOTIFICATION
RETURNED BY CONTRACTOR
ACTION COMPLETE

4. DISCREPENCY OR PROBLEM (Describe in Detail. Include PWS references. Attach Continuation Sheet if Necessary)

5. SIGNATURE OF COR

6. TO: (Name of COR)
7. FROM: (Contractor / Project Manager)

8. CONTRACTOR RESPONSE AS TO CAUSE, EFFECT, CORRECTIVE ACTION AND ACTIONS TO PREVENT RECURRENCE (Attach Continuation Sheet if necessary. Cite applicable Contractor QC program procedures or new QC procedures)

9. SIGNATURE OF CONTRACTOR REPRESENTIVE
10. DATE

11. GOVERNMENT EVALUATION (Acceptance, partial acceptance, or rejection. Attach Coordination Sheet if necessary)

12. GOVERNMENT ACTIONS (Cure notice, show cause, other)

CLOSE OUT

KTR NOTIFIED

NAME AND TITLE
SIGNATURE
DATE

COR

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