PP Questionnaire.pdf

Attachment 3

FA3010-12-R-0005

May 2012

PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

SUBJECT: Request for Past Performance Evaluation

TO:

You have been identified as a point of contact for a past and/or present performance evaluation of the firm listed on the attached questionnaire. This firm is currently being considered for a Full Food Service contract at Keesler AFB, MS.

Your prompt attention to this questionnaire will be greatly appreciated. If you have any questions concerning this request, I can be contacted at (insert contractor phone number).

Please submit completed questionnaire to the Contracting Officer identified on the attached questionnaire.

Contractor Signature

1 Atch

Past and Present Performance Questionnaire

PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

A. GENERAL INFORMATION:

Contractor’s Name: ___________________ Telephone Number:___________________

Address: _________________________ Fax Number:________________________

Point of Contact: _____________________________

Project Title and Brief Description of Work:

Contract Number Provided by Offeror: _________________ Dollar Amount:_________*

Contract Period or Dates of Performance Provided by Offeror: ______________________

Contractor performed as the Prime Contractor Sub-Contractor Key Personnel

* Note: If offeror holds or has held other contracts with your agency/organization in the last 3 years, please complete separate evaluation forms for those contracts as well.

B. RESPONDENT INFORMATION:

Name of Respondent: _____________________ Title: ___________________________

Address: _____________________ Telephone Number: ___________________

_____________________________ Fax Number: ________________________

_____________________________ Email Address: _______________________

C. SEND COMPLETED SURVEY FORM TO:

81 CONS/LGCB, Attn: Ms. Carlet Jones

Fax: (228) 377-3298

D. PERFORMANCE INFORMATION: Choose the appropriate letter on the scale (E, G, S, M, U, and N) that most accurately describes the contractor’s performance or situation. PLEASE

PROVIDE A NARRATIVE EXPLANATION FOR ANY RATINGS OF M or U.

E

Exceptional

G

Good

S

Satisfactory

M

Marginal

U

Unsatisfactory

N

Neutral

Performance meets contractual requirements with many exceeded to the

Government’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with no more than a few minor problems for which corrective actions taken by the contractor were highly effective.

Performance meets contractual requirements with some exceeded to the

Government’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with no more than some minor problems for which corrective actions taken by the contractor were effective.

Performance meets contractual requirements.

The contractual performance of the element or sub-element contains some minor problems for which corrective actions taken by the contractor were satisfactory.

Performance does not meet some contractual requirements.

The contractual performance of the element or sub-element being assessed reflects a serious problem for which the contractor has not yet identified corrective actions or the contractor’s proposed actions appear only marginally effective or were not fully implemented.

Performance does not meet most contractual requirements and recovery is not likely in a timely manner.

The contractual performance of the element or sub-element contains a serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

Performance was not observed or not applicable to the current effort being reported against.

CONTRACTOR’S NAME: _______________ CONTRACT #: _______________

Place an “X” in the appropriate column using the definitions matrix above.

The contractor: E G S M U

1. How well did the Supervisor/Dining Facility Services Manager ensure conformance to contract, staffing, and quality requirements?

2. How well did the Supervisor/Dining Facility Services Manager ensure proper cash handling, inventory control, and accounting procedures?

3. How well did the contractor supervise and train personnel.

4. How well did the contractor ensure guest flow rate and customer service?

5. How well did the contractor place orders for food and supplies in appropriate quantities based on projected number of diners?

6. How well did the contractor verify quantities received/inventory shipment of food and supplies adequately and store items properly and timely?

7. How well did the contractor take care to identify any items that should not be accepted due to spoilage improper refrigeration, etc?

8. How well did the contractor take all precautions according to the contract to prevent food-borne illnesses?

9. How well did the contractor serve quality food with regards to freshness, flavor, color, texture, and nutritional value.

10. How well did the contractor cook and maintain food items at appropriate temperatures (both hot and cold)?

11. How well did contractor replenish entrée items, beverages, & supplies in a timely manner?

12. How well did the contractor keep the kitchen and dining area clean & orderly at all times?

13. How well did the contractor/contract employees present a neat, well-groomed, and orderly appearance? (i.e. proper uniform; hand washing;

personal hygiene)

14. Did the contractor have a Quality Control Plan ___ YES _____ NO?

How well did the contractor follow and monitor the Quality Control

Plan.

15. How well did the contractor care for facilities and equipment provided for use under contract?

16. How well did the contractor maintain and repair the equipment provided for use under contract?

17. How well did the contractor promptly report damage to equipment/facilities or submit work orders regarding need for maintenance and repair to equipment & facilities?

18. How effective was the contractor’s safety program to ensure compliance with federal, state, local regulations and create a safe job site?

19. Did the contractor use OSHA’s Voluntary Protection Programs to promote effective worksite-based safety and health? ___YES ___NO

If yes

What was the contractors Total Case Incident Rate (TCIR) _____

What was the contractors Days Away, Restricted or Transferred

(DART) rate________

20. Did the contractor perform any meal service during an emergency or contingency operation _______YES ________NO

How well did the contractor perform emergency/contingency meal service?

21. How flexible, cooperative, and reasonable was the contractor in meeting mission requirements, particularly when faced with short-notice mission changes?

22. Provide overall rating for this contractor. Would you contract with them again if given the choice? ________YES _____NO

Please provide any additional information you feel is important and not covered elsewhere*:

*If applicable, please reference the appropriate question number.

Thank you for your remarks, and be sure to return this form to the Contracting Agency and not to the Contractor you are providing a reference for.

Name of Company Being Evaluated: ___________________________

Respondent’s Signature: ______________________________________

Date Completed: ___________________