ATT 13- KTR Work Surveillance Checklist - Placement or Removal Empty ROB or Vac Box.pdf

Contractor Work Surveillance Checklist

Placement or Removal of Empty Rented Rolloff Box (ROB) or Vacuum Box

Date(s) of Work Surveillance: _________________ Start Time: ___________ Stop Time: ___________

Contract Number: SP4500-______-D-___________ TO #: ________________ CLIN: ______________

Name of Designated Government Representative: ___________________________________________

Title of Designated Government Representative: ____________________________________________

Phone Number of Designated Government Representative: (______) _______-___________ Ext.______

Yes No N/A Description of Contractor Work Surveillance: [ROB] or [Vac Box] (Circle one)

Did the truck driver arrive on site at the scheduled time and date?

Did the driver arrive on site with all of the requisite equipment, including

- One ROB or Vacuum Box container of the appropriately ordered size, with

- One plastic liner of sufficient size and thickness to adequately contain the waste for which it was intended (ROB only), and

- One watertight tarp cover that was generally free of rips and tears (ROB only)?

Did the driver provide a weight ticket showing the empty (tare) weight of the container prior to placement?

Was the container inspected by a Designated Government Representative upon arrival at the designated location?

Was the container of acceptable appearance and integrity, with minimal evidence of corrosion, visibly void of waste residue and legible/offensive graffiti upon delivery?

Was the ROB, bows and cover free of any defects or damage, other than those attributable to normal wear and tear, and determined acceptable for Government use? Please document below any noteworthy defects or damage and have driver initial for acknowledgment. Note: Failure of the driver to acknowledge any existing noteworthy defects or damage will be cause for rejection of the ROB and liner.

Did the equipment operate properly without causing a delay in work?

Was the work performed and did the equipment meet the satisfaction of the

Designated Government Representative?

Comments:

Signature of Designated Government Representative Date