Attachment 6 Daily Headstone Marker Raise Realign Verification Survey.pdf

This is a verification survey form template for quality assurance and work completion documentation in cemetery maintenance operations. The form, titled "Daily Headstone/Marker Raise & Realign Verification Survey," serves as a re-verification instrument that must be completed prior to workday conclusion by designated cemetery personnel including the Cemetery Director, Contracting Officer Representative (COR), Foreman, Work Leader, or their designee. The survey requires documentation of the station number, date, cemetery name, cemetery director name, and COR identification at the top of the form.

The form mandates that personnel conducting the re-verification survey utilize the original Burial Register Report and Gravesite Layout Map from the initial verification survey to ensure accuracy and consistency. Key completion requirements include listing the sections and headstones/markers that received raise and realign (R&R) work, documenting any discrepancies or issues encountered, and confirming whether all identified discrepancies have been resolved through yes/no indicators. If discrepancies remain unresolved, the Cemetery Director, COR, Foreman, Work Leader, or designee must notify both the District Office Director and the Contracting Officer. The form concludes with signature and certification blocks requiring the authorized representative to provide their signature, the completion date, and the time completed as attestation that the daily headstone/marker re-verification survey was performed.