D.4 QUALITY ASSURANCE SURVEILLANCE PLAN _QASP.docx

The contractor will be evaluated in accordance with the following:

1. PURPOSE

This Quality Assurance Surveillance Plan (QASP) provides a systematic method to evaluate performance for the stated contract. This QASP explains the following:

· What will be monitored?

· How will monitoring take place?

· Who will conduct the monitoring?

· How will monitoring efforts and results be documented?

This QASP does not detail how the contractor accomplishes the work. Rather, the QASP is created with the premise that the contractor is responsible for management and quality control actions to meet the terms of the contract. It is the Government’s responsibility to be objective, fair, and consistent in evaluating performance.

This QASP is a “living document” and the Government may review and revise it on a regular basis. However, the Government shall coordinate changes with the contractor through contract modification. Copies of the original QASP and revisions shall be provided to the contractor and Government officials implementing surveillance activities.

2. GOVERNMENT ROLES AND RESPONSIBILITIES

The following personnel shall oversee and coordinate surveillance activities.

a. Contracting Officer (CO) – The CO shall ensure performance of all necessary actions for effective contracting, ensure compliance with the contract terms, and shall safeguard the interests of the United States in the contractual relationship. The CO shall also assure that the contractor receives impartial, fair, and equitable treatment under this contract. The CO is ultimately responsible for the final determination of the adequacy of the contractor’s performance.

Assigned CO: NCO 19 Healthcare Resources Organization or Agency: OALC

b. Contracting Officer’s Representative (COR) – The COR is responsible for technical administration of the contract and shall assure proper Government surveillance of the contractor’s performance. The COR shall keep a quality assurance file. The COR is not empowered to make any contractual commitments or to authorize any contractual changes on the Government’s behalf.

Assigned COR: Eastern Oklahoma Veteran Affairs Healthcare System Organization or Agency: VHA

3. CONTRACTOR REPRESENTATIVES

The following employee(s) of the contractor serve as the contractor’s program manager(s) for this contract:

Primary Program Manager:

Alternate Program Manager:

4. PERFORMANCE STANDARDS

The contractor is responsible for performance of ALL terms and conditions of the contract. CORs will provide contract progress reports quarterly to the CO reflecting performance on this plan and all other aspects of the resultant contract. The performance standards outlined in this QASP shall be used to determine the level of contractor performance in the elements defined. Performance standards define desired services. The Government performs surveillance to determine the level of Contractor performance to these standards.

Performance standards align to the PWS requirements, including:

• Radiation Protection Program oversight

• Routine radiation surveys

• Dosimetry monitoring and reporting

• Radiation Safety Committee (RSC) participation and documentation

• Incident and SRDL reporting

• Equipment protocol and QA compliance oversight

• Construction and shielding review documentation

• Timeliness of required deliverables

The Performance Requirements are listed below in Section 6. The Government shall use these standards to determine contractor performance and shall compare contractor performance to the standard and assign a rating. At the end of the performance period, these ratings will be used, in part, to establish the past performance of the contractor on the contract.

5. METHODS OF QA SURVEILLANCE

Various methods exist to monitor performance. The COR shall use the surveillance methods listed below in the administration of this QASP.

a. DIRECT OBSERVATION. 100% surveillance:

Direct observation may occur during:

· COR attendance at Radiation Safety Committee meetings

· Observation of contractor participation in incident follow‑up

· Observation during on‑site responses requiring RSO presence

· Real‑time monitoring of contractor communication and responsiveness The COR will document observations using QASP monitoring notes and ensure all observations comply with VA privacy and information security policies.

b. PERIODIC INSPECTION.

Inspections scheduled and reported quarterly per COR delegation or as needed. Inspections will be conducted quarterly or as delegated by the COR. Inspections may include review of:

· Radiation survey documentation

· Dosimetry monitoring reports

· Quarterly equipment QA/protocol compliance reports

· Construction/shielding review submissions

· RSC meeting minutes and attendance

· Incident/SRDL reports Each inspection will confirm timeliness, completeness, and accuracy. All reviews will comply with VA privacy and information security requirements.

c. VALIDATED USER/CUSTOMER COMPLAINTS.

Validated complaints may originate from:

· Radiology leadership

· CT/MRI/Nuclear Medicine managers

· ED/OR/ICU or other radiation‑producing areas

· Facility Safety or Radiation Safety staff The COR will validate any complaint before documenting it. Validated complaints will be used to assess compliance with performance standards and will be recorded in the COR’s Quality Assurance File.

d. RANDOM SAMPLING.

Random sampling may be used to periodically verify:

· Routine radiation survey completion

· Dosimetry badge issuance or ALARA review accuracy

· Equipment protocol validation reports

· Incident reporting accuracy Sampling frequency: random selection of deliverables each quarter or as directed by the COR.

Sampling will be conducted in accordance with VA privacy and information security standards.

e. VERIFICATION AND/OR DOCUMENTATION PROVIDED BY CONTRACTOR.

The contractor will submit documentation required by the PWS, including:

· Routine surveys

· Dosimetry reports

· Incident/SRDL notifications

· RSC minutes and participation records

· QA/protocol compliance reports

· Construction and shielding assessments The COR will verify documentation through review of completeness, regulatory compliance, and adherence to PWS timelines. For remote‑monitoring portions of the contract, the contractor must provide electronic copies or system‑based verification of all required documents.

Quality Assurance Surveillance Plan (QASP) a.

6. SAMPLE QASP PERFORMANCE REPORT DATE: _______6/11/2026___________

PERFORMANCE REQUIREMENTS SUMMARY MATRIX:

7. CPARS RATINGS ASSIGNED TO QASP ITEMS:

Metrics and methods are designed to determine rating for a given standard and acceptable quality level. The following ratings shall be used (Reference: CPARS User Manual: https://www.cpars.gov/cparsweb/assets/documents/CPARS_User_Manual.pdf

Note: To justify an Exceptional rating, you should identify multiple significant events in each category and state how it was a benefit to the GOVERNMENT. However, a singular event could be of such magnitude that it alone constitutes an Exceptional rating. Also, there should have been NO significant weaknesses identified.

Note: To justify a Very Good rating, you should identify a significant event in each category and state how it was a benefit to the GOVERNMENT. Also, there should have been NO significant weaknesses identified.

Note: To justify a Satisfactory rating, there should have been only minor problems, or major problems the contractor recovered from without impact to the contract. Also, there should have been NO significant weaknesses identified.

Note: To justify Marginal performance, you should identify a significant event in each category that the contractor had trouble overcoming and state how it impacted the GOVERNMENT. A Marginal rating should be supported by referencing the management tool that notified the contractor of the contractual deficiency (e.g. Management, Quality, Safety or Environmental Deficiency Report or letter).

Note: To justify an Unsatisfactory rating, you should identify multiple significant events in each category that the contractor had trouble overcoming and state how it impacted the GOVERNMENT. However, a singular problem could be of such serious magnitude that it alone constitutes an unsatisfactory rating. An Unsatisfactory rating should be supported by referencing the management tools used to notify the contractor of the contractual deficiencies (e.g. Management, Quality, Safety or Environmental Deficiency Reports, or letters).

8. DOCUMENTING PERFORMANCE

a. The VA shall document positive and/or negative performance. Any report may become a part of the supporting documentation for any contractual action and preparing annual past performance using CONTRACTOR PERFORMANCE ASSESSMENT REPORTING SYSTEM (CPARS).

b. If contractor performance does not meet the Acceptable Quality level, the CO shall inform the contractor. This shall normally be in writing unless circumstances necessitate verbal communication. In any case the CO shall document the discussion and place it in the contract file. When the COR and the CO determines formal written communication is required, the COR shall prepare a Contract Discrepancy Report (CDR), and present it to CO. The CO shall in turn review and shall present to the contractor's program manager for corrective action.

The contractor shall acknowledge receipt of the CDR in writing. The CDR shall specify if the contractor is required to prepare a corrective action plan to document how the contractor shall correct the unacceptable performance and avoid a recurrence. The CDR shall also state how long after receipt the contractor has to present this corrective action plan to the CO. The VA shall review the contractor's corrective action plan to determine acceptability. The CO shall also assure that the contractor receives impartial, fair, and equitable treatment. The CO is ultimately responsible for the final determination of the adequacy of the contractor’s performance and the acceptability of the Contractor’s corrective action plan.

Any CDRs may become a part of the supporting documentation for any contractual action deemed necessary by the CO. See Sample on following page.

9. COR AND CONTRACTOR ACKNOWLEDGEMENT OF QASP

SIGNED:

COR NAME/TITLE DATE

SIGNED:

CONTRACTOR NAME/TITLE DATE

CONTRACT DISCREPANCY REPORT

5. DATES

a. CDR PREPARED

6. DISCREPANCY OR PROBLEM (Describe in detail. Include reference to PWS Directive; attach continuation sheet if necessary.)

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

12. GOVERNMENT EVALUATION. (Acceptance, partial acceptance, reflection. Attach continuation sheet(s) if necessary.)

13. GOVERNMENT ACTIONS (Acceptance, partial acceptance, reflection. Attach continuation sheet(s) if necessary.)

14. CLOSE OUT

a. CONTRACTOR NOTIFIED

b. COR

c. CONTRACTING OFFICER