Attachment 5 - Initial Headstone-Marker Raise and Realign Verification Survey.pdf
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- 36C78626B0016
About this file
This is a template form used for documenting the initial verification survey of headstones and markers scheduled for raise and realign work at federal cemeteries.
The form requires the Contracting Officer's Representative (COR), Cemetery Director, Cemetery Foreman, or Work Leader to conduct a comprehensive initial survey of all headstones and markers included in the contract's scope of work before any work begins. The survey must utilize the Burial Register Report and Gravesite Layout Map(s) as reference documents. The form captures the station number, date, cemetery name, and cemetery director information at the top. It includes fields to document whether any discrepancies or issues were identified during the survey, with space to describe findings and record the date issues were identified. The form requires certification that all discrepancies have been resolved, along with the responsible official's signature and date. Additionally, the form establishes a requirement that a Daily Headstone/Marker Raise & Realign (R&R) Verification Survey must be completed by the same authorized personnel prior to the end of each workday, using the same reference documents to verify all completed work for that day.
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Text version
ATTACHMENT 5
INITIAL HEADSTONE/MARKER RAISE & REALIGN VERIFICATION
SURVEY
Station Number: __________ Date: __________________________
Cemetery: _______________ Cemetery Director: _______________
Contracting Officers Representative: ______________________________________
Instructions: The Contracting Officer’s Representative (COR) /Cemetery Director/Cemetery Foreman/ Work Leader/designee MUST conduct an initial survey of ALL headstones/markers included in the scope of work (SOW) before any work is performed. The COR/Cemetery Director/Cemetery Foreman/Cemetery Work Leader/designee will use the Burial Register Report and the Gravesite Layout Map(s) for the initial survey.
Discrepancy/Issue Identified: Y/N_______ Date: ____________________
All discrepancies/issues resolved Y/N ________ Date: ____________________
I certify that the Initial Headstone/Marker verification survey was completed by the COR/Cemetery Director/Foreman or Work Leader/designee. The Burial Register Report and the Gravesite Layout Map for the Cemetery and sections listed in the SOW were used to complete the survey.
COR/Director/Foreman/Work Leader/designee Signature: ______________________
Date: _________________
Prior to the completion of the workday, a Daily Headstone/Marker R&R Verification Survey MUST be completed by the COR/Cemetery Director/Cemetery Foreman/Work Leader/designee utilizing the same Burial Register Report and Gravesite Layout Map as used in the initial survey for ALL completed work.
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