Attachment 4 - Solicitation Attachments.pdf

SAMPLE COMPONENTS OF QUALITY CONTROL PLAN

1. Describe inspection process for each section of the contract.

2. List names of inspectors.

3. Describe process to identify deficiencies in quality of services performed before the level of performance is unacceptable.

4. Describe process for retaining records of inspections and corrective actions taken.

5. Accident Prevention:

a. Policy Statement for accident prevention signed by the Contractor (program and enforcement)

b. Emergency phone numbers

c. Equipment inspections

d. Safety training

e. Personal protective equipment required

ATTACHMENT 4 - SOLICITATION ATTACHMENTS

ACCIDENT PREVENTION PLAN

Pittsburgh Engineer Warehouse and Repair Shops

GROUNDS MAINTENANCE SERVICES

Contract Number Contractor Name

1. SIGNATURE SHEET.

This Accident Prevention Plan was

Prepared By:

Name Title of corporate safety staff person

Approved By:

Name President

2. BACKGROUND INFORMATION

a. Contractor :Name Address City, State Zip

b. Contract Number W911WN-##-#-####

c. Project Name: Enter Name of Project

d. Project Description: Enter description of work

e. Name of Company’s recent accident history is included as Attachment # to this Accident Prevention Plan. Information included includes EMR, OSHA 200 Forms and corporate safety trend analyses.

f. The Major definable features of work are: ______________________________. An Activity Hazard Analysis (AHA) will be prepared for each Major Definable Feature of Work. AHAs will be prepared in accordance with the format shown on page 4 of EM 385-1-1 and will be presented and discussed at the Preparatory Phase Inspection for the applicable feature of work.

3. STATEMENT OF SAFETY AND HEALTH POLICY

Enter statement which describes the company‘s commitment to safety.

4. RESPONSIBILITIES AND LINES OF AUTHORITIES

a. Name - Describe responsibility and accountability of personnel responsible for safety at corporate level.

b. Name - Describe responsibility and accountability of personnel responsible for safety at project level.

c. Lines of authority - Describe lines of authority (as related to safety) for this project.

5. SUBCONTRACTORS AND SUPPLIERS.

a. The following subcontractors will be working on this project:

1. List

b. The CQC System Manger (if someone else, identify) will be responsible for controlling and coordinating subcontractors and suppliers.

c. All subcontractors and suppliers performing work on site will be expected to conform to the requirements of this Accident Prevention Plan and to the requirements of EM 385-1-1.

6. TRAINING.

a. Each employee will receive a safety indoctrination consisting of a thorough review of applicable AHA’s.

b. The following is a list of mandatory training and certifications which are applicable to this project:

1. Vehicle Operator

2. Personal Protective Equipment)

3. Other

c. The following identifies requirements for periodic retraining or recertification relating to item b above.

1. List

d. The following individuals shall be trained in the contents of the Emergency Response Plan discussed in Section 12 of this Accident Prevention Plan:

1. List

e. Weekly toolbox safety meeting will be conducted at TIME every ENTER DAY OF WEEK.

Each on site worker will be required to attend. Attendance will be documented. Name will be responsible for conducting these meetings.

7. SAFETY AND HEALTH INSPECTIONS.

a. Name will conduct site safety inspections on a daily basis. Any noted deficiencies will be identified on that day’s CQC Report. Deficiencies will be tracked using the table included as Attachment # to this Accident Prevention Plan.

b. The following external inspections/certifications are required for this project:

List or enter “None Required”.

8. SAFETY AND HEALTH EXPECTATIONS, INCENTIVE PROGRAMS, AND

COMPLIANCE

a. Provide a statement or statements describing the company's written safety program goals, objectives, and accident experience goals for this contract.

b. Provide a brief description of the company's safety incentive programs (if any). If none, so state.

c. Provide a discussion of the company’s policies and procedures regarding noncompliance with safety requirements (to include disciplinary actions for violation of safety requirements).

d. Provide written company procedures for holding managers and supervisors accountable for safety.

9. ACCIDENT REPORTING

a. Name will submit Monthly Manhour Exposure Reports to the Contracting Officer no later than the 5th work day of each month. The report encompasses on-site work including all hourly and salaried employees. The report will include all subcontractors working on this project.

b. Name will complete the report and submit it to the Contracting Officer within five (5) workdays.

c. Name will immediately notify the Contracting Officer and District Safety Officer of any incidents involving a fatality or permanent total disability, accidents in which three or more persons are hospitalized, accidents that result in property damage in excess of $100,000 or any accident regardless of the consequences, if it is suspected that it will result in unfavorable criticism of the Corps of Engineers..

10. MEDICAL SUPPORT

a. A list of emergency telephone numbers and a map of directions to the nearest hospital(s) is included in the Emergency Response Plan section of this Accident Prevention Plan.

b. First aid kits will be maintained on site as required in Section 3 of EM 385-1-1.

c. At least two employees on each shift will be qualified to administer first aid and CPR.

Individuals who are required to work alone in remote areas shall be trained in first aid. The following employees are certified in First Aid and CPR and a copy of their current certificates are included as Attachment # to this Accident Prevention Plan:

1. List

11. PERSONAL PROTECTIVE EQUIPMENT.

a. Outline procedures (who, when, how) for conducting hazard assessments and written certifications for use of personal protective equipment.

12. PLANS (PROGRAMS, PROCEDURES) REQUIRED BY THE SAFETY MANUAL (as applicable)

a. Hazard Communication (HAZCOM) Program (01.B.04)

Included as Attachment #????? to this Accident Prevention Plan is a written hazard communication program addressing as a minimum, the following: training (to include potential safety and health effects from exposure), labeling, current inventory of hazardous chemicals on site, and the location and use of Material Safety Data Sheets (MSDSs).

b. Emergency Response Plans (01.E.01, 01.E.05, 06.A.02, 19.A.04, 09.K.01 and 09.K.02)

An Emergency Response Plan is included as Attachment # to this Accident Prevention Plan. This Emergency Response Plan includes:

An Emergency Response Plan to ensure employee safety in case of fire or other emergency.

Emergency telephone numbers and reporting instructions for ambulance, physician, hospital, fire, and police. Also included is a map of directions to the nearest hospital(s). This list and map shall be conspicuously posted at the work site.

c. Respiratory Protection Plan (05.E.01)

Name of Company‘s Respiratory Protection Plan is included as Attachment # to this Accident Prevention Plan.

d. Health Hazard Control Program (06.A.02)

Activity Hazard Analyses (AHA’s) shall consider all substances, agents and environments that present a hazard and will recommend hazard control measures. Engineering and administrative controls shall be used to control hazards. In cases where engineering or administrative controls are not feasible, PPE may be used. The AHA shall serve as certification that a hazard assessment has been conducted.

e. Plan for Prevention of Alcohol and Drug Abuse (Defense Federal Acquisition Regulation Supplement Subpart 252.223-7004, Drug-Free Work Force)

Name of Company‘s plan for prevention of Alcohol and Drug Abuse is included as Attachment # to the Accident Prevention Plan. This plan meets the minimum requirements of

DFAR 252.223-7004.

13. Detailed site specific hazards and controls will be provided in the activity hazard analysis (AHA) for each phase of the operation (each Major Definable Feature of Work as defined by the Contractor Quality Control Plan). The AHA’s will provide information on how the requirements of major sections of EM 385-1-1 will be met. Particular attention shall be paid to excavations, scaffolding, medical and first aid requirements, sanitation, personal protective equipment, fire prevention, machinery and mechanized equipment, electrical safety, public safety requirements, and chemical, physical agent, and biological occupational exposure prevention requirements.

AHA’s will be prepared utilizing the format shown on page 4 of EM 385-1-1.

Attachments Attachment # - Accident History Attachment # - Safety Deficiency Tracking Table Attachment # - Emergency Response Plan Attachment # - First Aid and CPR certificates Attachment # - Hazard Communication (HAZCOM) Program Attachment # - Emergency Response Plan Attachment # - Plan for Prevention of Alcohol and Drug Abuse

Add Personnel

NAME

X

X

X

Version 1.0 July 2019

U.S. ARMY CORPS OF ENGINEERS, PITTSBURGH DISTRICT

ACTIVITY HAZARD ANALYSIS (AHA)

For use of this form, see EM 385-1-1 Section 01.A.15; the proponent agency is CELRP-SO.

EMPLOYEE DOCUMENTATION SHEET

OCCUPATIUN / DESIGNATIUN

(Job Title) / (Competent or Qualified Person)

SIGNATURE DATE

AT/OPSEC 2 Fax Information Sheet

USACE Pittsburgh District Security Office

Attn: Joe Bali Steve Davidson

Phone: 412-395-7162 Fax: 412-395-7173 Email: Joseph.m.bali@usace.army.mil

Stephen.davidson@usace.army.mil

Background checks are being requested for the following personnel in order to perform work onsite at:

Project Information:

Contract Officer’s Representative (COR): ___________ Project Name: _____________ Contract Number: ____________ Task Order: ___________

Personnel Information:

Full Legal Name: ______________________________________

Social Security Number: ________________________________

Date of Birth: _________________________________________

Place of Birth: ________________________________________

Full Legal Name: ______________________________________

Social Security Number: ________________________________

Date of Birth: _________________________________________

Place of Birth: ________________________________________

Full Legal Name: ______________________________________

Social Security Number: ________________________________

Date of Birth: _________________________________________

Place of Birth: ________________________________________

AT/OPSEC 2 Fax Information Sheet

Full Legal Name: ______________________________________

Social Security Number: ________________________________

Date of Birth: _________________________________________

Place of Birth: ________________________________________

Full Legal Name: ______________________________________

Social Security Number: ________________________________

Date of Birth: _________________________________________

Place of Birth: ________________________________________

Full Legal Name: ______________________________________

Social Security Number: ________________________________

Date of Birth: _________________________________________

Place of Birth: ________________________________________

Full Legal Name: ______________________________________

Social Security Number: ________________________________

Date of Birth: _________________________________________

Place of Birth: ________________________________________

Full Legal Name: ______________________________________

Social Security Number: ________________________________

Date of Birth: _________________________________________

Place of Birth: ________________________________________

(Last 4 or 0000)

Page 1 of 4 pages (Proponent: CESWT-SO)

CONTRACT DISCREPANCY REPORT

1. CONTRACT NUMBER 2. REPORT NUMBER FOR THIS DISCREPANCY

3. TO (Contractor and Manager's Name) 4. FROM (Name of QAE)

5. DATES (YYYYMMDD)

a. PREPARED

I

b. RETURNED BY CONTRACTOR

I

c. ACTION COMPLETE

6. DISCREPANCY OR PROBLEM (Describe in detail. Include reference to PWS Directive; attach continuation sheet if necessary.)

7. SIGNATURE OF CONTRACTING OFFICER

Sa. TO (Contracting Officer) b. FROM (Contractor)

9. CONTRACTOR RESPONSE AS TO CAUSE, CORRECTIVE ACTION AND ACTIONS TO PREVENT RECURRENCE. (Cite applicable Q.C.

program procedures or new Q. C. procedures. Attach continuation sheet(s) if necessary.)

10. SIGNATURE OF CONTRACTOR REPRESENTATIVE b. DATE (YYYYMMDD)

11. GOVERNMENT EVALUATION (Acceptance, partial acceptance, reflection. Attach continuation sheet(s) if necessary)

12. GOVERNMENT ACTIONS (Reduced payment, cure notice, show cause, other)

13. CLOSE OUT

NAME TITLE SIGNATURE DATE (YYYYMMDD)

(1) (2) (3) (4)

a. CONTRACTOR

NOTIFIED

b. QAE

c. ACO

DD FORM 2772, SEP 1998 (EG) REPLACES MT FORM 352-R, WHICH IS OBSOLETE. Designed using Perform Pro, WHS/DIOR, Sep 98

QUALITY ASSURANCE SURVEILLANCE PLAN

1. QUALITY ASSURANCE SURVEILLANCE PLAN (QASP). This plan will be used to assure the Government that the work specified under this contract is completed satisfactorily. This plan is included for i nformation purposes and will not be made part of any resulting contract. Payment analysis will be conducted by using the Random, Periodic Inspection, or 100% sampling methods; however, the Government has the right to change or modify surveillance methods at its discretion.

2. DEFINITIONS.

a. Acceptable Quality Level (AQL). The AQL is a predetermined value selected and used by the Government Quality Assurance Inspector to distinguish between satisfactory and unsatisfactory performance. For evaluation by Random sampling, AQLs are stated in percentages (i.e., 95%, 90%, etc.) in accordance with Table I. The AQL table has three parts: Population Size, sample size, and the allowable reject level.

i. Population Size - the total number of required services from which a sample is to be drawn. Example:

505 picnic sites to be cleaned each day x 20 cleaning days/mo. (inspection period) = Population Size of 10,000.

ii. Sample - the number of samples to be taken. Example: AQL is 90% and Population Size is 10,000 = Sample of 26.

iii. Reject level - the allowable margin of error allowed the Contractor under the Random sampling method. When the observed total number of defects per inspection period is equal to or below the Reject Level, the work will be considered satisfactory; if above, the work will be considered unsatisfactory. An unsatisfactory rating will require corrective action and/or deductions.

Notification of unsatisfactory performance will be provided in the form of a Contractor Discrepancy Report (CDR). Example: AQL of 90%, Population of 10,000, Sample Size of 26 = Reject Level of 6.

3. PAYMENT ANALYSIS

a. Random Sampling Method: Surveillance based on random sampling is a Government quality assurance evaluation method designed to evaluate some part, but not all, of the contract service requirements being monitored. This method is based on statistical theory and estimates the Contractor's overall level of performance for a given service requirement. Random sampling is considered where there is a large, homogeneous population and 100% surveillance is not feasible. Surveillance of the results of a scheduled service is based on samples from finished work using the Random Sample Table. These results are compared to the specified performance standards.

i. Monitoring: Inspection of all services performed under this method will be conducted according to a schedule developed by the Government. Inspection samples will be selected randomly from each lot.

Only those items appearing in the random samples will be used for evaluating performance.

ii. Deductions: Once a random sample has been taken of a lot, and the number of defective items exceeds the Reject Level for that lot, a deduction will be calculated as follows:

a) Population Size is 10,000 units.

b) Monthly contract price for cleaning picnic sites is $5,050.

c) Sample size, using an AQL of 90%, is 26.

d) Number of defects in the sample is 8 (Reject Level is 6)

e) Percentage of defects is 30.8% (8 +26 = 0.308)

f) Deduction from the current month's invoice is $1,555.54 ($5,050 x 0.308 = $1,554.54).

b. Periodic Inspection Method. Surveillance by Periodic Inspection, like Random Sampling, is designed to inspect some part, but not all of the contract service requirements being monitored. Periodic Inspection under this plan will differ from Random Sampling only in the way in which samples are selected. Periodic inspection will be used in lieu of random sampling when the population size is not large enough to make the random tables practical or the service is not critical enough to warrant 1 0 0% inspection or to avoid excessive travel and loss of productive time for the inspector. The results of these inspections, like random sampling, are then compared to the specific performance standards.

EXAMPLE: The inspector is to inspect bulletin boards. Bulletin board population size is only 38 and occurs in only one park and the headquarters area. If the random sampling method determines that the inspector must inspect the cleaning service of restrooms in a particular park that contains a bulletin board, then the inspector may chose to inspect the cleaning of that bulletin board in that same park rather than drive to another park to make a separate, similar inspection.

1. Monitoring: Inspection of all services performed under this method will be conducted according to a schedule developed by the Government. The Government may, however, choose facilities it wishes to inspect without randomly selecting. Only those samples will be used for evaluating performance.

ii. Deductions: Once a periodic inspection has been performed, and the number of defective items exceeds the Maximum Allowable Deviation from Requirement for that population (see Table 2), a deduction will be made based on the following example:

a) Contract price for bulletin boards is 19.00

b) Number in sample is 15 services/month

c) Number of deviations/defects in the sample is 6 (Max. Allowable Deviation is 4)

d) Percentage of sample defective is 40% (6/15 = 0.40)

e) Deduction for the current month is $7.60 ($19.00 x 0.40 = $7.60)

c. 100% Inspection Method: Surveillance by this method requires that every occurrence of a performed service be monitored. Contract requirements using these evaluations are generally that occur infrequently, are essential, or are costly to perform. These results are then compared to the specific performance standards.

i. Monitoring: Inspection of all services performed under this method will be conducted according to a schedule developed by the Government. All services in a Population will be inspected and used for evaluation purposes.

ii. Deductions: Below is an example of deductions taken under this method:

a) Population size is 60

b) Monthly lot contract price for cleaning campsites in a park is $1,200.

c) Sample size is 100% or 60

d) Number of defects is 15

e) Percentage of sample defective is 25% (15 +60 = .25)

f) Deduction for the current month is $300 ($1,200 x 0.25)

TABLE I - RANDOM SAMPLING

ACCEPTABLE QUALITY LEVELS (AQLs) 95% 90% 85% 80%

Population Size

Sample Size

Reject Level

Sample Size

Reject Level

Sample Size

Reject Level

Sample Size

Reject Level

50 I5 3 I7 4 19 5 2I 7 75 I6 3 19 4 22 6 24 8

IOO I7 3 2I 5 24 6 26 8

125 18 3 22 5 25 7 28 9 I50 I8 3 22 5 26 7 29 9 175 I9 3 23 5 26 4 29 9 200 I9 3 23 5 27 7 30 9 225 I9 3 24 5 27 7 30 9 250 I9 3 24 5 27 7 31 10 275 I9 3 24 5 28 7 3I 10 300 20 3 24 5 28 7 31 10 325 20 3 24 5 28 7 32 10 350 20 3 24 5 28 7 32 10 375 20 3 25 5 28 7 32 10 400 20 3 25 5 29 8 32 10 450 20 3 25 5 29 8 33 10

500 20 3 25 5 29 8 33 IO

550 20 3 29. 5 29 8 33 10 600 20 3 25 5 29 8 33 10 650 20 3 25 5 29 8 33 10 700 20 3 25 5 29 8 33 10 750 20 3 25 5 30 8 33 10 800 20 3 25 5 30 8 34 11

900 20 3 26 6 30 8 34 II

I,OOO 2I 4 26 6 30 8 34 II

I,200 21 4 26 6 30 8 34 I1 1,400 21 4 26 6 30 8 34 11

I,600 2I 4 26 6 30 8 34 II

I,800 21 4 26 6 30 8 34 11

2,000 2I 4 26 6 30 8 34 II

2,500 2I 4 26 6 30 8 35 1I 3,000 2I 4 26 6 30 8 35 11 3,500 21 4 26 6 3I 8 35 1I

4,000 2I 4 26 6 31 8 35 II

5,000 2I 4 26 6 31 8 35 II

6,000 2I 4 26 6 3I 8 35 II

8,000 2I 4 26 6 31 8 35 II

10,000 2I 4 26 6 31 8 35 II

TABLE 2 - QASP for PEWARS Lawn Maintenance

REQUIRED SERVICE STANDARD METHOD OF

SURVEILLANCE

Timeliness (Weekly, Monthly and By Request) Performance Work Statement, Paragraph 2 (b).

100% Inspection

Contractor-provided labor and equipment is satisfactory.

Performance Work Statement, paragraph 2 (b).

Random Sample

Completed mowing, trimmings, and shrubbery shearing are neat and areas are trash-free.

Performance Work Statement, paragraph 2(b).

Random Sample

Annual application of fertilizer and as requested weed control.

Performance Work Statement, paragraph 2(b)

100% Inspection