Attachment 6 Daily HeadstoneMarker Raise Realign Verification Survey.pdf
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- Solicitation number
- 36C78626B0009
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This document is a Daily Headstone/Marker Raise & Realign Verification Survey form template used for cemetery maintenance contract work.
The form requires the Cemetery Director, Contracting Officer's Representative (COR), Foreman, Work Leader, or designee to perform a re-verification survey prior to workday completion for all headstones and markers that have undergone raise and realign work within the contract scope. The survey utilizes the original Burial Register Report and Gravesite Layout Map from the Initial Verification Survey as reference documents. Required information includes station number, date, cemetery name, cemetery director identification, COR identification, sections and specific headstones/markers that received raise and realign work, and documentation of any discrepancies or issues encountered. The form requires affirmation of whether all discrepancies have been resolved and whether unresolved issues were communicated to the District Office Director and Contracting Officer. Completion is certified by signature of the authorized representative along with the date and time the verification survey was completed.
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ATTACHMENT 6
DAILY HEADSTONE/MARKER RAISE & REALIGN VERIFICATION SURVEY
Station Number:__________ Date:_____________________
Cemetery: _______________ Cemetery Director: _______________
COR: ___________________
Instructions: Prior to the completion of the workday, the Cemetery Director/COR/Foreman/Work Leader/designee MUST perform a re-verification survey for ALL completed work of headstones/markers included in the scope of work. The Cemetery Director/COR/Foreman/Work Leader/designee will use the original Burial Register Report and Gravesite Layout Map used for the Initial Verification Survey.
List Sections and Headstones/Markers R&R: __________________________________
List discrepancy/issue: ___________________________________________________
All discrepancies/issues resolved: Y/N ______
Cemetery Director/COR/Foreman/ Work Leader/designee informed District Office Director and Contracting Officer of all unresolved discrepancies/issues: Y/N _______
By signing below, I certify the Headstone/Marker re-verification survey was completed.
Daily Headstone Verification:
Date: __________ Time Completed: ______________
COR/Director/Foreman/Work Leader/designee Signature: ________________________
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