Attachment 0011- Contractor Quality Control Report.pdf

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CONTRACTOR QUALITY CONTROL REPORT

(ATTACH ADDITIONAL SHEETS IF NECESSARY)

DATE

REPORT

NO

PHASE CONTRACT NO CONTRACT TITLE

PR

EP

A R

A

TO

R Y

WAS PREPARATORY PHASE WORK PERFORMED TODAY? YES NO

IF YES, FILL OUT AND ATTACH SUPPLEMENTAL PREPARATORY PHASE CHECKLIST.

Schedule

Activity No. Definable Feature of Work Index #

IN

IT

IA

L

WAS INITIAL PHASE WORK PERFORMED TODAY? YES NO

IF YES, FILL OUT AND ATTACH SUPPLEMENTAL INITIAL PHASE CHECKLIST.

Activity No. Definable Feature of Work Index #

FO

LL

O W

-U P

WORK COMPLIES WITH CONTRACT AS APPROVED DURING INITIAL PHASE? YES NO

WORK COMPLIES WITH SAFETY REQUIREMENTS? YES NO

Activity No.

Description of Work, Testing Performed & By Whom, Definable Feature of Work, Specification Section, Location and List of Personnel Present

REWORK ITEMS IDENTIFIED TODAY (NOT CORRECTED BY CLOSE OF BUSINESS) REWORK ITEMS CORRECTED TODAY (FROM REWORK ITEMS LIST)

Activity No. Description Schedule Activity No. Description

REMARKS (Also Explain Any Follow-Up Phase Checklist Item From Above That Was Answered "NO"), Manuf. Rep On-Site, etc.

On behalf of the contractor, I certify that this report is complete and correct and equipment and material used and work performed during this reporting period is in compliance with the contract drawings and specifications to the best of my knowledge except as noted in this report. AUTHORIZED QC MANAGER AT SITE DATE

GOVERNMENT QUALITY ASSURANCE REPORT DATE

QUALITY ASSURANCE REPRESENTATIVE'S REMARKS AND/OR EXCEPTIONS TO THE REPORT

GOVERNMENT QUALITY ASSURANCE MANAGER DATE