Attachment_9 - KTR Work Surveillance Checklist - Placement or Removal Empty of ROB or Vac Box.pdf
PDF 38 KB Posted
- Attached to
- South Carolina Regional Hazardous Waste Disposal
- Solicitation number
- SP450026R0014
- Issued by
-
Defense Logistics Agency
About this file
This is a Contractor Work Surveillance Checklist used to monitor the initial placement or removal of empty rented Rolloff Boxes (ROBs) or Vacuum Boxes under CLIN 1200RE of federal contracts numbered SP4500.
The checklist is completed by a Designated Government Representative and documents surveillance activities for waste container delivery and pickup services. It captures essential contract compliance information including the date and time of work surveillance, contract and task order numbers, and the name, title, and contact information of the government representative conducting the inspection. The form requires verification of nine key performance criteria: timely driver arrival; delivery of all requisite equipment including properly sized containers, plastic liners (ROB only), and watertight tarp covers (ROB only); provision of empty weight tickets; container inspection upon arrival; acceptable condition and integrity of equipment upon delivery; freedom from defects or damage beyond normal wear and tear; proper equipment operation without work delays; and overall satisfaction with work performance. The checklist includes a comments section for documenting noteworthy defects or damage that must be acknowledged by the driver, with failure to acknowledge serving as grounds for equipment rejection. The form concludes with signature and date lines for the Designated Government Representative.
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Other files
| File | Type | Posted |
|---|---|---|
| Attachment_3 - Pick-up Locations Solicitation.xlsx | XLSX spreadsheet | |
| Attachment _13 Order History.xlsx | XLSX spreadsheet | |
| Attachment_11 - FAR Provision Fill-Ins .docx | DOCX document | |
| Attachment_2 - Price Schedule.xlsx | XLSX spreadsheet | |
| Attachment_12 - Wage Determination.pdf | ||
| Attachment_4 - PPI Questionnaire.pdf | ||
| Attachment_10 - Terms and Conditions.docx | DOCX document | |
| Attachment_6 - Addenda to 52.212‐1 Instructions.docx | DOCX document | |
| Attachment_1 - PWS.docx | DOCX document | |
| Attachment_7 - Addenda to 52.212-2 Evaluation.docx | DOCX document | |
| Attachment_3 - Pick-up Locations.xlsx | XLSX spreadsheet | |
| Attachment_8 - KTR Work Surveillance Checklist - ICS Work..pdf | ||
| Attachment_5 - CAC Application Process.pdf |
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Text version
Contractor Work Surveillance Checklist
Initial Placement or Removal of Empty Rented Rolloff Box (ROB) or Vacuum Box - CLIN 1200RE
Date(s) of Work Surveillance: _________________ Start Time: ___________ Stop Time: ___________
Contract Number: SP4500-______-D-___________ TO #: ________________ CLIN: ______________
Name of Designated Government Representative: ___________________________________________
Title of Designated Government Representative: ____________________________________________
Phone Number of Designated Government Representative: (______) _______-___________ Ext.______
Yes No N/A Description of Contractor Work Surveillance: [ROB] or [Vac Box] (Circle one)
Did the truck driver arrive on site at the scheduled time and date?
Did the driver arrive on site with all of the requisite equipment, including
- One ROB or Vacuum Box container of the appropriately ordered size, with
- One plastic liner of sufficient size and thickness to adequately contain the waste for which it was intended (ROB only), and
- One watertight tarp cover that was generally free of rips and tears (ROB only)?
Did the driver provide a weight ticket showing the empty (tare) weight of the container prior to placement?
Was the container inspected by a Designated Government Representative upon arrival at the designated location?
Was the container of acceptable appearance and integrity, with minimal evidence of corrosion, visibly void of waste residue and legible/offensive graffiti upon delivery?
Was the ROB, bows and cover free of any defects or damage, other than those attributable to normal wear and tear, and determined acceptable for Government use? Please document below any noteworthy defects or damage and have driver initial for acknowledgment. Note: Failure of the driver to acknowledge any existing noteworthy defects or damage will be cause for rejection of the ROB and liner.
Did the equipment operate properly without causing a delay in work?
Was the work performed and did the equipment meet the satisfaction of the
Designated Government Representative?
Comments:
Signature of Designated Government Representative Date
File details come from the government source that posted it. Updated .