ATTACHMENT D CONTRACT DEFICIENCY REPORT.pdf

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Attached to
Q515--Pathology Physician Services VA Pittsburgh Healthcare System
Solicitation number
36C24423Q1090
Issued by

About this file

This document is a template for a Contract Deficiency Report used to identify and track issues with contractor performance on a federal contract. The report form includes fields to document the contract and report numbers, dates, the issue identified along with reference to the applicable Performance Work Statement directive. Signatures are included for the Contracting Officer Representative and Contracting Officer. The related federal contract opportunity is a solicitation from the Department of Veterans Affairs for pathology physician services at the VA Pittsburgh Healthcare System, with responses due under solicitation number 36C24423Q1090. The report form would be used to track any performance issues under the pathology physician services contract.

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CONTRACT DEFICIENCY REPORT

1. CONTRACT NUMBER 2. Report Number for this Discrepancy

3. TO: (Contracting Officer) 4. FROM: (Name of COR)

5. DATES

a. CR PREPARED

b. Returned by Contractor: c. Action Complete

6. Issue Identified (Describe in detail. Include reference to PWS Directive; attach continuation sheet if necessary.)

7. SIGNATURE OF COR Date:

8. SIGNATURE OF CONTRACTING OFFICER Date:

9a. TO (Contracting Officer) 9a. FROM (Contractor)

10. CONTRACTOR RESPONSE AS TO CAUSE AND ACTIONS TO PREVENT RECURRENCE. (Cite applicable quality control program procedures or new procedures. Attach continuation sheet(s) if necessary.)

11. SIGNATURE OF CONTRACTOR REPRESENTATIVE Date:

12. GOVERNMENT EVALUATION.

13. GOVERNMENT ACTIONS

14. CLOSE OUT

NAME TITLE SIGNATURE DATE

Contractor notified

COR

Contracting Officer

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