Attachment 5 Initial HeadstoneMarker Raise and Realign Verification Survey.pdf
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- Solicitation number
- 36C78626B0009
About this file
This is a verification survey form template for federal cemetery contracting activities involving headstone and marker raise and realign (R&R) work.
The form documents the initial inspection and verification of all headstones and markers included in the scope of work before any work performance begins. The Contracting Officer's Representative (COR), Cemetery Director, Cemetery Foreman, Work Leader, or designee must conduct this survey using the Burial Register Report and Gravesite Layout Map(s) as reference documents. The form requires completion of basic identifying information including station number, date, cemetery name, cemetery director name, and the COR's name. Survey personnel must document whether any discrepancies or issues are identified during the initial inspection and record the date such discrepancies were found. The form includes certification language confirming that the initial survey was completed by authorized personnel and that the required reference documents were used. Additionally, the form mandates that a daily headstone and marker R&R verification survey be completed by the same authorized personnel before the end of each workday for all completed work, using the same reference documents as the initial survey. All discrepancies or issues identified must be resolved and documented with corresponding dates prior to certification.
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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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