Attachment 12 Custodial Multi site Contractor Performance Checklist.xlsx
XLSX spreadsheet 2 MB Posted
- Solicitation number
- W911SA25QA009
About this file
This is a contractor performance inspection checklist for custodial services that includes detailed evaluation criteria across multiple facility locations. The checklist contains 43 evaluation items divided into categories including general requirements, annual requirements, semi-annual requirements, monthly requirements, weekly requirements, twice-weekly requirements, and deliverables compliance. Key inspection areas include employee identification compliance, janitorial closet maintenance, window cleaning, floor care (stripping, waxing, buffing), carpet cleaning, trash removal, restroom sanitation, and various cleaning tasks. The form includes spaces to track performance across 8 different facility IDs, with a scoring system of satisfactory/unsatisfactory and yes/no responses.
The checklist is designed to support a custodial services contract administered by the Department of the Army Material Command at Fort McCoy for locations in Parsons and Pittsburg, Kansas. It includes sections for documenting contractor information, contract numbers, and sign-off areas for both the Designated Representative and Contracting Officer Representative (COR). The form also contains integrated spreadsheets to track monthly performance metrics and compliance rates throughout the fiscal year.
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Other files
| File | Type | Posted |
|---|---|---|
| Attachment 13 Questions and Answers.docx | DOCX document | |
| W911SA25QA0090001 Amendment 0001.pdf | ||
| Attachment 5 Wage Determination Log updated 20250117.xlsx | XLSX spreadsheet | |
| W911SA25QA009.pdf | ||
| Attachment 02 - AT-OPSEC Coversheet.pdf | ||
| Attachment 10 Custodial Contractor Rest Room Cleaning Sheet.docx | DOCX document | |
| Attachment 01 - PWS.docx | DOCX document | |
| Attachment 08 Drawings KS027 Custodial.docx | DOCX document | |
| Attachment 07 Drawings KS026 Custodial.docx | DOCX document | |
| Attachment 11 Custodial Service Ticket Template.docx | DOCX document | |
| Attachment 03 - PRS.xlsx | XLSX spreadsheet | |
| Attachment 04 - Deliverables.docx | DOCX document | |
| Attachment 06 - KS065 Custodial Price Schedule Blank.xlsx | XLSX spreadsheet | |
| Attachment 5 Wage Determination Log.xlsx | XLSX spreadsheet | |
| Attachment 09 Custodial Room Chart Task Frequency.xlsx | XLSX spreadsheet |
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Text version
FACID CHECKLIST
| CONTRACTOR PERFORMANCE INSPECTION CHECKLIST & SUMMARY REPORT V 2.2 | Method of Surveillance: Periodic Surveillance |
| Service Provided: Custodial Services | |
| Contractor Name: | |
| Contract Number: Contractor email: | |
| FAC ID: | |
| Building Number(s): | |
| Contracting Officer Representative: | Meeting Contract Requirements |
| Designated Representative: | |
| Contracting Officer: | |
| Contract Specialist: |
| Fac ID: XX000 | Fac ID: XX000 | Fac ID: XX000 | Fac ID: XX000 | Fac ID: XX000 | Fac ID: XX000 | Fac ID: XX000 | Fac ID: XX000 | ||||||||||
| PWS PART 1 General, Yes, No, or n/a | Yes | No | Yes | No | Yes | No | Yes | No | Yes | No | Yes | No | Yes | No | Yes | No | |
| 1 | PWS # 1.6.18 ID OF EMPLOYEE'S: Are contractor personnel wearing ID badges in a conspicuous place on the front exterior clothing above the waist and are the contractor personnel wearing the ID badges on the employee list provided by the contractor? | Yes | No | Yes | No | Yes | No | Yes | No | Yes | No | Yes | No | Yes | No | Yes | No |
| COMMENTS: | |||||||||||||||||
| PWS PART 5 Specific Tasks: General Requirements, 1, 0, n/a, n/o | SAT | UNSAT | SAT | UNSAT | SAT | UNSAT | SAT | UNSAT | SAT | UNSAT | SAT | UNSAT | SAT | UNSAT | SAT | UNSAT | |
| 2 | PWS 5.1 MANAGEMENT: For required cleaning services not scheduled via the T&F, has the contractor met with the COR and determined a schedule for the days of the week these services will be perfomed? | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | ||||||||
| COMMENTS: | |||||||||||||||||
| 3 | PWS 5.2.19 JANITOR CLOSET: is the closet kept neat and clean and odor free? | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | ||||||||
| COMMENTS: | |||||||||||||||||
| PWS PART 5 Specific Tasks: Annual Requirements (April), 1, 0, n/a, n/o | SAT | UNSAT | SAT | UNSAT | SAT | UNSAT | SAT | UNSAT | SAT | UNSAT | SAT | UNSAT | SAT | UNSAT | SAT | UNSAT | |
| 4 | PWS 5.2.1 INTERIOR WINDOW SURFACES: Are the interior window frames, casings, sills and glass free of cobwebs, film, dirt, smudges, water and other foreign matter? | n/a | n/a | n/a | n/a | n/a | n/a | n/a | n/a | ||||||||
| COMMENTS: | |||||||||||||||||
| 5 | PWS 5.2.2 EXTERIOR WINDOWS SURFACES: Are the exterior window frames, casings, sills and glass free of cobwebs, film, dirt, smudges, water and other foreign matter? | n/a | n/a | n/a | n/a | n/a | n/a | n/a | n/a | ||||||||
| COMMENTS: | |||||||||||||||||
| 6 | PWS 5.2.7 STRIPPING: Did the Contractor strip wax from floors completely removing all marks, scuffs, stains, heel marks, etc. (except in cases in which there is damage to the floor surface), and did the Contractor remove all non-fixed/movable items (defined in 2.1.12) prior to stripping and replace these items after waxing and buffing was completed? | n/a | n/a | n/a | n/a | n/a | n/a | n/a | n/a | ||||||||
| COMMENTS: | |||||||||||||||||
| 7 | PWS 5.2.8 SEAL, POLISH, or WAX AFTER STRIPPING: Was a sufficient amount of wax and coats of wax used to fully protect the floor surface and once wax dried was the reflectance uniform with no visible streaks or swirls, and were the baseboards, doors and other adjacent surfaces wax free from floor finish or residue upon completion? | n/a | n/a | n/a | n/a | n/a | n/a | n/a | n/a | ||||||||
| COMMENTS: | |||||||||||||||||
| 8 | PWS 5.2.9 BUFFING / BURNISHING: Did the Contractor buff all floors to a glossy appearance free of scuff marks, heel marks, and other stains and have a uniform coating? | n/a | n/a | n/a | n/a | n/a | n/a | n/a | n/a | ||||||||
| COMMENTS: | |||||||||||||||||
| 9 | PWS 5.2.12 EXTRACTION CLEANING, CARPET SHAMPOO: Did the Contractor shampoo carpet free of visible litter, stains, soils, deeply embedded dirt, and other residue? | n/a | n/a | n/a | n/a | n/a | n/a | n/a | n/a | ||||||||
| COMMENTS: | |||||||||||||||||
| 10 | PWS 5.2.28 TILE & GROUT: Did the Contractor use an approved cleaner on tile and grout, remove tile finish, rinse, and apply tile protector and grout sealer? | n/a | n/a | n/a | n/a | n/a | n/a | n/a | n/a | ||||||||
| COMMENTS: | |||||||||||||||||
| PWS PART 5 Specific Tasks: Semi-Annual Requirements, 1, 0, n/a, n/o | SAT | UNSAT | SAT | UNSAT | SAT | UNSAT | SAT | UNSAT | SAT | UNSAT | SAT | UNSAT | SAT | UNSAT | SAT | UNSAT | |
| 11 | PWS 5.2.10 SPRAY BUFFING: Did the Contractor spray buff the floor surface and restore a uniform gloss and protective finish to the resilient tile? | n/a | n/a | n/a | n/a | n/a | n/a | n/a | n/a | ||||||||
| COMMENTS: | |||||||||||||||||
| 12 | PWS 5.2.17 HIGH DUSTING: Were all high dusting areas free of cobwebs, dust, lint, litter, soil and smudges? | n/a | n/a | n/a | n/a | n/a | n/a | n/a | n/a | ||||||||
| COMMENTS: | |||||||||||||||||
| PWS PART 5 Specific Tasks: Monthly Requirements (Monday after BA), 1, 0, n/a, n/o | SAT | UNSAT | SAT | UNSAT | SAT | UNSAT | SAT | UNSAT | SAT | UNSAT | SAT | UNSAT | SAT | UNSAT | SAT | UNSAT | |
| 13 | PWS 5.2.3 REMOVE TRASH & RECYCLABLES: Did the Contractor remove trash and recyclables after Drill Weekend? | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | ||||||||
| COMMENTS: | |||||||||||||||||
| 14 | PWS 5.2.11 VACUUM: Did the contractor vacum carpets free of visable litter, grit and stains? | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | ||||||||
| COMMENTS: | |||||||||||||||||
| 15 | PWS 5.2.4 SWEEP/DUST MOP: Did the Contractor sweep/dust mop floors after Drill Weekend? | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | ||||||||
| COMMENTS: | |||||||||||||||||
| 16 | PWS 5.2.5 DAMP MOP: Did the Contractor Damp Mop all required floors after after Drill Weekend? | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | ||||||||
| COMMENTS: | |||||||||||||||||
| 17 | PWS 5.2.16 LOW DUSTING: Were all low dusting areas free of dust, lint, litter, and soil? | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | ||||||||
| COMMENTS: | |||||||||||||||||
| 18 | PWS 5.2.22.4 RESTROOM WALLS AND PARTITIONS: Do wall and partitions have have a clean, uniform appearance, free of streaks, spots and any evidence of soil? | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | ||||||||
| COMMENTS: | |||||||||||||||||
| 19 | PWS 5.2.29 INTERIOR GLASS: Is glass free of film, dirt, smudges, water and other foreign matter? | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | ||||||||
| COMMENTS: | |||||||||||||||||
| PWS PART 5 Specific Tasks: Weekly Requirements (Monday), 1, 0, n/a, n/o | SAT | UNSAT | SAT | UNSAT | SAT | UNSAT | SAT | UNSAT | SAT | UNSAT | SAT | UNSAT | SAT | UNSAT | SAT | UNSAT | |
| 20 | PWS 5.2.3 REMOVE TRASH & RECYCLABLES: Did the Contractor remove trash and recyclables? | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | ||||||||
| COMMENTS: | |||||||||||||||||
| 21 | PWS 5.2.11 VACUUM: Did the contractor vacum carpets free of visable litter, grit and stains? | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | ||||||||
| COMMENTS: | |||||||||||||||||
| 22 | PWS 5.2.4 SWEEP/DUSTMOP: Did the Contractor sweep/dust mopfloors free of litter, dust, foreign debris and spots caused by spills? | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | ||||||||
| COMMENTS: | |||||||||||||||||
| 23 | PWS 5.2.5 DAMP MOP: Did the Contractor damp mop floors so that they have a uniform appearance, with no streaks, swirl marks, detergent residue, or any evidence of soil, stains, film, debris, or standing water? | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | ||||||||
| COMMENTS: | |||||||||||||||||
| 24 | PWS 5.2.6 WALK OFF MATT CLEANING: Were the mats free of soil and grit? | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | ||||||||
| COMMENTS: | |||||||||||||||||
| 25 | PWS 5.2.13, 5.3.14, 5.2.15 STAIRWELL / STAIRWAYS: Is surface area free of litter, dust and foreign debris? | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | ||||||||
| COMMENTS: | |||||||||||||||||
| 26 | PWS 5.2.18 CLEAN DRINKING FOUNTAINS & SINKS: were all fountains & sinks disinfeced and free of streaks, stains, spots, smudges, and other obvious soil residue? | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | ||||||||
| COMMENTS: | |||||||||||||||||
| PWS PART 5 Specific Tasks: Twice Weekly Requirements (Monday & Thursday), 1, 0, n/a, n/o | SAT | UNSAT | SAT | UNSAT | SAT | UNSAT | SAT | UNSAT | SAT | UNSAT | SAT | UNSAT | SAT | UNSAT | SAT | UNSAT | |
| 27 | PWS 5.2.3 REMOVE TRASH & RECYCLABLES: Did the Contractor remove trash and recyclables? | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | ||||||||
| COMMENTS: | |||||||||||||||||
| 28 | PWS 5.2.22.1 TOILET BOWLS AND URINALS: Is the the surface, including fittings and plumbing pipes, free of scale, scum, mineral deposits, rust, stains, dirt and grime? | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | ||||||||
| COMMENTS: | |||||||||||||||||
| 29 | PWS 5.2.22.2 RESTROOM WASH BOWLS: is the surface, including fixtures and plumbing pipes, free of grease, dirt, soil, stains? | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | ||||||||
| COMMENTS: | |||||||||||||||||
| 30 | PWS 5.2.22.3 RESTROOM FLOORS: Does the floor have a clean uniform appearance with no streaks, swirl marks, detergent residue or any evidence of soil remaining on the floor surface? | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | ||||||||
| COMMENTS: | |||||||||||||||||
| 31 | PWS 5.2.22.5 GLASS CLEANING IN RESTROOM: Do the mirrors and glass surfaces have a clean uniform appearance free of streaks, spots and cleaning solution residue? | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | ||||||||
| COMMENTS: | |||||||||||||||||
| 32 | PWS 5.2.22.6 SHOWERS & STALLS: Do the showers and stalls have a clean uniform surface free of all soil and residue? | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | ||||||||
| COMMENTS: | |||||||||||||||||
| 33 | PWS 5.2.23 SINKS HAND WASHING AREAS: Is the surface area free of grease, dirt, soil, stains and residue? | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | ||||||||
| COMMENTS: | |||||||||||||||||
| PWS PART 7 Deliverables, (Yes, No, or n/a) | Yes | No | Yes | No | Yes | No | Yes | No | Yes | No | Yes | No | Yes | No | Yes | No | |
| 34 | PWS 1.6.2 Quality Assurance: When issued an CAR did the contractor provide corrective action and/or provide an acceptable corrective action plan by the suspense date? | Yes | No | Yes | No | Yes | No | Yes | No | Yes | No | Yes | No | Yes | No | Yes | No |
| COMMENTS: | |||||||||||||||||
| 35 | PWS 1.6.13 Hazardous Materials: Is the Safety Data Sheet (SDS) maintained in the same location as stored cleaning materials and chemicals? | Yes | No | Yes | No | Yes | No | Yes | No | Yes | No | Yes | No | Yes | No | Yes | No |
| COMMENTS: | |||||||||||||||||
| 36 | PWS 1.6.17 Key Personnel: Did the contractor provide contact information of the designated and alternate POC 5 days after contract award and update this contact information as changes occur? | Yes | No | Yes | No | Yes | No | Yes | No | Yes | No | Yes | No | Yes | No | Yes | No |
| COMMENTS: | |||||||||||||||||
| 37 | PWS 1.6.18 ID Badge List: Did the contractor provide an employee list of issued ID cards prior to contractor empolyee(s) entering the building(s), and if changes occurred did the contractor provide an updated list prior to new employee's entering the building(s)? | Yes | No | Yes | No | Yes | No | Yes | No | Yes | No | Yes | No | Yes | No | Yes | No |
| COMMENTS: | |||||||||||||||||
| 38 | PWS 1.7.1 AT Level 1 Training: Did Contractor provide the COR certificates verifying all employees completed AT Level 1 Training within 30 days of the contract start date or new hire start date? | Yes | No | Yes | No | Yes | No | Yes | No | Yes | No | Yes | No | Yes | No | Yes | No |
| COMMENTS: | |||||||||||||||||
| 39 | PWS 1.7.2.1 NCIC-III/TSDB: Did the contractor request via COR, a background check for all contractor employees, including subcontractor employees, requiring unescorted access to government facilities? | Yes | No | Yes | No | Yes | No | Yes | No | Yes | No | Yes | No | Yes | No | Yes | No |
| COMMENTS: | |||||||||||||||||
| 40 | PWS 1.7.2.1.1.a Did the COR receive completed 88th RD Forms 451 and 452 from Contractor Project Manager? | Yes | No | Yes | No | Yes | No | Yes | No | Yes | No | Yes | No | Yes | No | Yes | No |
| COMMENTS: | |||||||||||||||||
| 41 | PWS 1.7.5 iWATCH Training: Was this training to be completed within 30 calendar days of Notice to Proceed and within 30 calendar days of new employees commencing performance with the results reported to the Contracting Officer no later than 60 calendar days after Notice to Proceed? | Yes | No | Yes | No | Yes | No | Yes | No | Yes | No | Yes | No | Yes | No | Yes | No |
| COMMENTS: | |||||||||||||||||
| 42 | PWS 5.4 Did the Contractor submit a service ticket the end of the month after the service occurred? | Yes | No | Yes | No | Yes | No | Yes | No | Yes | No | Yes | No | Yes | No | Yes | No |
| COMMENTS: | |||||||||||||||||
| 43 | PWS 5.5 Did the contractor invoice in the appropriate invoicing system? | Yes | No | Yes | No | Yes | No | Yes | No | Yes | No | Yes | No | Yes | No | Yes | No |
| COMMENTS: | |||||||||||||||||
| Total: | 23 | 0 | 23 | 0 | 23 | 0 | 23 | 0 | 23 | 0 | 23 | 0 | 23 | 0 | 23 | 0 | |
| Found Acceptable | 100.00% | 100.00% | 100.00% | 100.00% | 100.00% | 100.00% | 100.00% | 100.00% | |||||||||
| Found Unacceptable | |||||||||||||||||
| All tasks have been inspected in accordance with this checklist per method of surveillance | Cumulative percentage: | 100.00% | |||||||||||||||
| Summary Report (Required): | |||||||||||||||||
| Designated Representative name and date of inspection: | |||||||||||||||||
| NAME: DATE: | |||||||||||||||||
| COR name and date of reviewed and accepted inspection results: | |||||||||||||||||
| NAME: DATE: |
W911SAXXXXXXX LOG
| W911SAXXXXXXX Performance FYXX | ||||||||||||||
| # | Month | Contract Number | Contractor Name | Contracting Office | Customer | Contract Value | Type Contract | KO Name | COR Supervisor Name | COR Name | Total PRS Factors | Compliant PRS Factors | Noncompliant PRS Factors | Compliant Rate |
| 1 | October | McCoy | 0 | ERROR:#DIV/0! | ||||||||||
| 2 | November | McCoy | 0 | ERROR:#DIV/0! | ||||||||||
| 3 | December | McCoy | 0 | ERROR:#DIV/0! | ||||||||||
| 4 | January | McCoy | 0 | ERROR:#DIV/0! | ||||||||||
| 5 | February | McCoy | 0 | ERROR:#DIV/0! | ||||||||||
| 6 | March | McCoy | 0 | ERROR:#DIV/0! | ||||||||||
| 7 | April | McCoy | 0 | ERROR:#DIV/0! | ||||||||||
| 8 | May | McCoy | 0 | ERROR:#DIV/0! | ||||||||||
| 9 | June | McCoy | 0 | ERROR:#DIV/0! | ||||||||||
| 10 | July | McCoy | 0 | ERROR:#DIV/0! | ||||||||||
| 11 | August | McCoy | 0 | ERROR:#DIV/0! | ||||||||||
| 12 | September | McCoy | 0 | ERROR:#DIV/0! | ||||||||||
| Totals | 0 | 0 | 0 | ERROR:#DIV/0! |
W911SAXXXXXXX Performance FYXX W911SAXXXXXXX Performance FYXX October November December January February March April May June July August September 0 0 0 0 0 0 0 0 0 0 0 0
W911SAXXXXXXX Performance
| Contractor Performance Inspection Checklist | FYXX | TOTALS | |||||||||||
| Oct | Nov | Dec | Jan | Feb | Mar | Apr | May | Jun | Jul | Aug | Sep |
| PERFORMANCE STANDARD | P | F | P | F | P | F | P | F | P | F | P | F | P | F | P | F | P | F | P | F | P | F | P | F | SAT | USAT |
| 1 | 0 | 0 | ||||||||||||||||||||||||
| 2 | 0 | 0 | ||||||||||||||||||||||||
| 3 | 0 | 0 | ||||||||||||||||||||||||
| 4 | 0 | 0 | ||||||||||||||||||||||||
| 5 | 0 | 0 | ||||||||||||||||||||||||
| 6 | 0 | 0 | ||||||||||||||||||||||||
| 7 | 0 | 0 | ||||||||||||||||||||||||
| 8 | 0 | 0 | ||||||||||||||||||||||||
| 9 | 0 | 0 | ||||||||||||||||||||||||
| 10 | 0 | 0 | ||||||||||||||||||||||||
| 11 | 0 | 0 | ||||||||||||||||||||||||
| 12 | 0 | 0 | ||||||||||||||||||||||||
| 13 | 0 | 0 | ||||||||||||||||||||||||
| 14 | 0 | 0 | ||||||||||||||||||||||||
| 15 | 0 | 0 | ||||||||||||||||||||||||
| 16 | 0 | 0 | ||||||||||||||||||||||||
| 17 | 0 | 0 | ||||||||||||||||||||||||
| 18 | 0 | 0 | ||||||||||||||||||||||||
| 19 | 0 | 0 | ||||||||||||||||||||||||
| 20 | 0 | 0 | ||||||||||||||||||||||||
| 21 | 0 | 0 | ||||||||||||||||||||||||
| 22 | 0 | 0 | ||||||||||||||||||||||||
| 23 | 0 | 0 | ||||||||||||||||||||||||
| 24 | 0 | 0 | ||||||||||||||||||||||||
| 25 | 0 | 0 | ||||||||||||||||||||||||
| 26 | 0 | 0 | ||||||||||||||||||||||||
| 27 | 0 | 0 | ||||||||||||||||||||||||
| 28 | 0 | 0 | ||||||||||||||||||||||||
| 29 | 0 | 0 | ||||||||||||||||||||||||
| 30 | 0 | 0 | ||||||||||||||||||||||||
| 31 | 0 | 0 | ||||||||||||||||||||||||
| 32 | 0 | 0 | ||||||||||||||||||||||||
| TOTALS | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
USAT Factors
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
W911SAXXXXXXX Compliance Rates
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