QASP_Dosemetrist_June_15.pdf

Quality Assurance Surveillance Plan (QASP) Dosimetrist Services

Medical Treatment Facility, David Grant Medical Center Travis AFB, CA

REVIEW & ACCEPTANCE

_____________________________ Date:____________________

Print Name:

Functional Commander/Director

_____________________________ Date:____________________ Print Name:

Contracting Officer Representative

______________________________ Date: ___________________ Print Name: Nancy Ekblad Quality Assurance Program Coordinator

______________________________ Date:____________________ Print Name: Bryan Armstrong Contracting Officer

1 June 2015

TABLE OF CONTENTS

1. Mission

2. Purpose

3. Authority

4. Roles and Responsibilities

5. Performance Requirements and Method(s) of Surveillance

6. Service Summary (SS)

7. Assessment Schedule

8. Assessment of Service Delivery Summary (SS) Items

9. Performance Management

10. Performance Feedback

11. Contract Performance Review

Appendices:

1. Customer Complaint Record

2. Corrective Action Report (CAR)

QUALITY ASSURANCE SURVEILLANCE PLAN (QASP)

FOR

DOSIMETRIST SERVICES

1. Mission. To provide Dosimetrist services at David Grant Medical Center, Travis Air Force Base.

2. Purpose. This Quality Assurance Surveillance Plan (QASP) is a Government-developed document used to determine if the contractor’s performance meets the performance standards contained in the contract. The QASP establishes procedures on how this surveillance/inspection process will be conducted to ensure successful PWS performance. It provides a systematic method for a continuous oversight process to determine conformity with the technical requirements of the contract. The QASP establishes:

What will be monitored.

How monitoring will take place.

Who will conduct monitoring.

How monitoring efforts and results will be documented.

2.1. The contractor is responsible for implementing and delivering performance that meets contract objectives using its Quality Control Plan (QCP). The QASP provides the structure for the Government’s surveillance of the contractor’s performance to assure that it meets contract requirements. It is the Government’s responsibility to be objective, fair and consistent in evaluating contractor performance. The Contracting Officer (CO) shall also ensure that the contractor receives impartial, fair, and equitable treatment under this contract and determines the final assessment of contractor performance.

2.2. The QASP is not part of the contract nor is it intended to duplicate the contractor’s QCP. This QASP is a living document. Flexibility in the QASP is required to allow for an increase or decrease in the level of surveillance necessary based on contractor performance.

2.3. The Government may provide a copy of the QASP to the contractor to facilitate open communication. In addition, the QASP should recognize that unforeseen or uncontrollable circumstances might occur that are outside the control of the contractor.

2.4. The QASP should ensure early identification and resolution of performance issues to minimize impact on mission performance.

3. Authority. Authority for issuance of this QASP is provided under Part 37.604 and 46.4 of the Federal Acquisition Regulation (FAR), Inspection of Services clauses, which provides for inspection, acceptance and documentation of the service called for in the contract or order. This acceptance is to be executed by the Contracting Officer (CO) or a duly authorized representative.

4. Roles and Responsibilities.

The following personnel comprise the Multi-Functional Team (MFT) and shall oversee and coordinate surveillance activities.

4.1. Government Representatives.

4.1.1. 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. Specific duties of the CO include:

4.1.1.1. Delegating authority for inspection and/or acceptance to COR in accordance with the terms and conditions of the contract.

4.1.1.2. Informing the contractor of the names, duties, and limitations of authority for all COR assigned to the contract.

4.1.1.3. Periodically assessing COR’s performance.

4.1.1.4. Managing contractor performance surveillance data, including submitting Contractor Performance Assessment Reporting System (CPARS) reports.

4.1.1.5. Ensuring the MFT reviews this QASP annually (at a minimum) for recommended changes.

4.1.1.6. Providing contract-specific training (to include refresher training) administered by CO or CO’s designee to all appointed CORs.

Assigned CO: Bryan Armstrong Organization or Agency: 60 CONS, Contracting Officer Telephone: DSN 837-7727 COMM (707) 424-7727 Email: bryan.armstrong@us.af.mil

4.1.2. Contracting Specialist. The Contracting Specialist assists the CO with execution of duties and acts as the primary POC at 60 CONS.

Assigned Contracting Specialist: SrA Amanda Scheer (Primary Contracting POC) Organization or Agency: 60 CONS, Contracting Specialist Telephone: DSN 837-7744 COMM (707) 424-7744 Email: amanda.scheer@us.af.mil

4.1.3. Quality Assurance Program Coordinator (QAPC). The QAPC is responsible for developing, managing, and implementing the Quality Assurance Program. The QAPC may also provide refresher training, as needed.

Assigned QAPC: Ms. Nancy Ekblad Organization or Agency: 60 CONS, Quality Assurance Program Coordinator Telephone: DSN 837-3726 COMM (707) 424-3726 Email: nancy.ekblad.1@us.af.mil

4.1.4. Contracting Officer’s Representative (COR). The COR is responsible for providing continuous program and technical oversight of the contractor’s performance.

While the COR may serve as a direct conduit to provide Government guidance and feedback to the contractor on technical matters, they are not empowered to make any contractual commitments or any contract changes on the Government’s behalf. The COR is responsible for reporting early identification of performance problems to the CO and may use the applicable appendix items for documenting the contractor’s performance. Specific duties of the COR include:

4.1.4.1. Evaluating and documenting the contractor’s performance in accordance with the procedures set forth in the QASP.

4.1.4.2. Recommending any changes necessary to the contract, Performance Work Statement (PWS), QASP, or other items to provide more effective operations or eliminate unnecessary costs.

4.1.4.3. Keeping a COR file that accurately documents the contractor’s actual performance (i.e. COR surveillance reports).

4.1.4.4. Utilizing COR file data (i.e. performance and COR surveillance reports) to assist the CO in the preparation of the CPARS reports.

4.1.4.5. Receiving required training before performing any COR duties (IAW MP5301.602-2(d)).

4.1.4.6. Notifying the CO immediately regarding contractor’s non-compliance with FAR 52.222-50, “Combating Trafficking in Persons.”

Assigned COR/ QAE: SrA Jesse Lamanna Organization or Agency: 60 MDSS/SGSLM Telephone: DSN COMM (707) 423-5153 Email: jesse.lamanna@us.af.mil

4.1.5. Functional Requirements Evaluator Designees (FREDs). David Grant Medical Center is required to appoint FREDs for this requirement. FRED will serve as the technical expert in the functional area that they quality assure. The FRED will carry out inspection and surveillance duties and report these inspections to the COR who will document performance and provide monthly surveillance results to the functional commander (FC) and CO.

5. Performance Requirements and Methods of Surveillance.

5.1. Contract Surveillance. This QASP outlines the various methods COR may utilize to ensure the contractor is in compliance with contract requirements. The COR’s function is responsible for a wide range of surveillance requirements that effectively measure and evaluate the contractor’s performance. Additionally, this QASP is based on the premise that the contractor, not the Government, is responsible for management and quality control/quality assurance actions to successfully meet the terms of the contract.

5.2. Surveillance Summary. The Services Summary (SS) and Method of Surveillance is the list of performance objectives and thresholds that must be performed by the contractor. This summary details the method(s) of surveillance the COR will use to validate and inspect these performance objectives. Inspection of each objective will be documented in the COR database.

5.2.1. Performance objectives define the desired outcomes. Performance thresholds define the level of service required under the contract to successfully meet the performance objective. The Government performs surveillance, using this QASP, to determine the quality of the contractor’s performance as it relates to the performance thresholds. The PWS and QASP should be used to form the foundation of the COR inspections.

5.3. Method(s) of Surveillance. The COR may inspect services provided by observing actual service, after a service has been completed and interviews with the customers. The contractor will be monitored and assessed throughout the period of performance of the contract with a combination of the following methods:

5.3.1. 100% Inspection. The COR will inspect and evaluate the contractor’s performance each time it is performed. The result of the contractor’s overall performance is then evaluated to determine acceptability of the service provided. Under most circumstances the 100% inspection method is utilized during the first 30 days of the contract or until the amount of acceptable vs. unacceptable services is sufficient to warrant less evaluation.

5.3.2. Random/Periodic Inspections. Random or periodic inspections consists of the bulk of evaluations accomplished by the COR. The COR must ensure the amount of inspections are accomplished as set by the monthly surveillance schedule. The Government reserves the right to increase or decrease inspections of the contractor's performance. The decision will be based on whether the contractor's performance is in alignment with performance thresholds/standards in the PWS.

5.3.3. Customer Complaint. The COR is the point of contact and must collect all customer complaints. The Customer Complaint Record (Appendix 1) will be used for this purpose.

Before submitting this form to the contractor, the COR will first investigate the complaint to verify validity and if there were any contributory factors or Government delays attributable to complaints. If, after investigation, the COR determines there were no contributory factors or Government delays, the COR will validate the complaint and submit the customer complaint record to the contractor POC to resolve the complaint. Validated customer complaints must be resolved within 24-hours of the contractor POC's receipt of the complaint form. If additional time is needed, the contractor shall request, in writing, additional time to resolve complaints and obtain approval from the COR. If the contractor challenges the validity of the complaint and the COR and contractor cannot come to agreement, the customer complaint will be forwarded to the CO for resolution. All the circumstances and actions taken must be documented (in writing) by the Government and contractor on the Customer Complaint Record. Validated customer complaint forms become a permanent part of the COR file.

5.3.4. Third Party Audits. Third Party Audits will be conducted by federal, state, and local agencies (i.e. DGMC Public Health, Food Service Accountant, OSHA, Environmental Management etc.).

5.4 Performance Requirements

5.4.1. Acceptable Performance (Excellent, Very Good, or Satisfactory Performance Rating).

The COR shall document the contractor’s performance using the surveillance monitoring methods in paragraph 5.4 of this plan. Performance ratings must describe the specific reason(s) for the ratings.

The monthly COR report may become a part of the supporting documentation for any contractual action.

5.4.2. Unacceptable performance (Marginal or Unsatisfactory Performance Rating).

If a COR determines that contractor performance is unacceptable, the specific reason for the unacceptable performance shall be recorded on the COR’s surveillance documentation.

Unsatisfactory performance must be addressed early on through the CO in order to give the contractor an opportunity to resolve any on-going issues, and re-perform unacceptable performance, if possible. Contractor feedback information is imperative and will be a significant basis for the contractor’s annual CPAR evaluation.

5.4.3. Remedies for Unacceptable Performance.

In accordance with FAR 52.212-4(a), Contract Terms and Conditions – Commercial Items, Inspection/Acceptance, if any of the services do not conform to contract requirements; the CO may require the contractor to perform the services again in conformity with contract requirements, at no increase in contract amount. This includes but is not limited to contractor termination of contractor personnel and recruitment of substitute personnel that are equally qualified within established timeframes. When defects in services cannot be corrected by re-performance, the Government may:

• Require the contractor to take necessary action to ensure that future performance conforms to contract requirements; and

• Reduce the contract price to reflect the reduced value of the services performed;

• If the contractor fails to promptly perform the services again or to take the necessary action to ensure future performance in conformity with contract requirements, the government may; by contract or otherwise, perform the services and charge to the contractor any cost incurred by the government that is directly related to the performance of such service; or decrement invoices related to performance; or terminate the contract.

5.4.4. Contracting Officer Notification.

5.4.4.1. Major Finding. If at any time the COR identifies a condition as having a significant adverse effect on the quality of the activity, such as those stated below, the COR shall document findings and notify the contracting officer immediately in writing. Email is acceptable.

5.4.4.2. Contractor failure to meet a Performance Threshold/Standard.

5.4.4.3. Failure to provide adequate corrective action to preclude reoccurrence of Government identified findings.

5.4.4.4. Failure to provide corrective action to deficiencies identified by the contractor within a prescribed suspense period.

5.4.4.5. Any failure to adhere to security regulations that results in a security incident.

5.4.5. Minor Finding. A departure from established standards having little bearing on the service provided. When the COR identifies a minor finding, he or she shall document the findings, but is not required to notify the CO. However, if the same minor finding is repeatedly identified, it may be an indication that a major finding is occurring or has occurred because the contractor has not taken proper steps to prevent recurrence. In this case, the COR shall notify the CO in writing.

5.4.6 Forms and other standardized documentation. The following forms and form letters may be used to provide standardized documentation (objective quality evidence). Air Force and Department of Defense forms are available on line at http://afpubs.hq.af.mil/electronicforms. AF Form 714, Customer Complaint Record, DD Form 2772, Contract Discrepancy Report, and the local COR Surveillance Report for this contract.

6. SERVICE SUMMARY (SS):

The contract service requirements are summarized in performance objectives that relate directly to the mission. The performance threshold briefly describes the minimally acceptable levels of service required for each requirement. The SS and the contractor’s Quality Control Plan provide information on contract requirements, the expected level of contractor performance and the expected method of Government surveillance and confirmation of services provided. These thresholds are critical to mission success. Procedures as set forth in the FAR 52.212-4 (a), Contract Terms and Conditions - Commercial Items, Inspection/Acceptance, will be used to remedy all deficiencies.

The SS cites the key performance objectives and the associated thresholds that must be attained, over which the Government shall exercise surveillance. The absence of any contract requirement from the SS shall not detract from its enforceability nor limit the rights or remedies of the Government under any other provision of the contract.

Performance Objective

PWS Paragraph Reference

Performance Threshold/Standard

Method of Surveillance/Evaluation

Design a treatment plan in accordance with Radiation Oncologist’s prescription

Para 2.1.3.1, Specific Tasks: a, b, c, & g

100% Physics and providers will review and evaluate plans during daily peer reviews and /or prior to treatment of patient and via use of competency checklist.

Coordinate / perform treatment simulations, beam modification device development & production.

Para 2.1.3.1, Specific Tasks: d, e, f, & n

100% Physics and providers will evaluate and review device development/production prior to treatment of patient, and evaluate treatment simulation performance by observing member during treatment process and by use of competency checklist.

Provide support to physics staff (clinical and administrative tasks).

Para 2.1.3.1, Specific Tasks: h & i.

95% Physics will evaluate by observing member’s performance while performing http://afpubs.hq.af.mil/electronicforms related physics duties and use of competency checklist.

Support the HDR brachytherapy program per direction of medical physics and JROC Director. Assist in Brachytherapy procedures including planning.

Para 2.1.3.1, Specific Task: j

95% Physics will evaluate by observing member’s performance while performing related HDR brachytherapy duties and uses of competency checklist.

Input billing and workload information

Para 2.1.3.1, Specific Task: t

95% Oncology Program Manager and JROC Director will evaluate during weekly chart round meeting.

7. Assessment Schedule.

7.1 The COR will develop a Monthly surveillance schedule based on this QASP’s requirements. A locally devised form may be used. The schedule shall be completed no later than 10 calendar days before the beginning of the period it covers. Copies of the surveillance schedule shall be provided to the COR Supervisor and the CO, and input into the CORT before the start of the surveillance period.

Surveillance schedules, when completed, shall be marked “For Official Use Only”, and shall not be shown to the contractor.

7.2 Changes to the surveillance schedule shall be posted promptly. Copies of the changed schedule shall be sent to the COR Supervisor and the CO. The COR shall document the reason(s) for changes of the surveillance schedule, and maintain the documentation in the COR files with the corresponding changed surveillance schedule.

7.3 Documentation. All surveillance activities must be documented to provide the required audit trail to justify Government acceptance and payment. The documented audit trail of the surveillance activities is required by FAR 46.104(c), Contract Administration Office Responsibilities, which states, “Maintain, as part of the performance records of the contract, suitable records reflecting, (1) The nature of Government contract quality assurance actions, including, when appropriate, the number of observations made and the number and type of defects; and (2) Decisions regarding the acceptability of the products, the processes, and the requirements, as well as action to correct defects.” All documentation resulting from surveillance is made a permanent part of the contract file. The COR must keep the documentation files during the term of the contract and at the conclusion of the contract, transfer the files through the FC to the CO for inclusion in the official contract file. It is the responsibility of the FC to establish and maintain this information in a Surveillance Folder as described below.

7.4 Corrective Action Report (CAR) (Appendix 2). If the need for a CAR is validated, the COR will fill out blocks 1-9 of the CAR form and attach a copy of the discrepancy from the COR database, AFIs, photos, customer complaints and any other relevant material to the contractor within 5 duty days. The contactor has 10 working days to respond with a written corrective action plan that details the corrective action of the cited deficiency, the cause of the deficiency, and actions taken to prevent recurrence. Validated CARs exceeding performance thresholds will result in less than satisfactory performance evaluations/ratings. Acknowledgement does not signify agreement. If the contractor disagrees with a CAR, the contractor will elevate the matter to the CO.

7.5 Quality Assurance. The Government shall inspect and evaluate the contractor’s performance to ensure services are received in accordance with requirements set forth in this contract. The COR shall inspect by watching actual task performance, physically checking an attribute of the completed task, checking a management information report, investigating customer complaints, conferring with facility managers, or otherwise inspecting the task or its results to determine whether or not performance meets the standards contained in the PWS. The COR will use the contractor’s work schedule or modified version thereof, to record surveillance results. Results of the surveillance then become the official Air Force record of the Contractor’s performance. When a performance threshold has not been met or contractor performance has not been accomplished, the COR will initiate and provide the Contractor a Corrective Action Report (CAR) and forward the CAR and the Contractor’s response to the Contracting Officer. The contractor shall respond to the CAR IAW instructions provided and return it to the CO within 10 calendar days of receipt.

8. Assessment of Service Delivery Summary (SS) Items.

8.1 It is essential for the CORs to conduct surveillance in accordance with the projected surveillance schedule for an effective quality assurance program. Mission requirements may require deviations from the surveillance schedule. Surveillance should be performed as close to the schedule as is practicable. The COR shall document the surveillance as it is conducted and update in the CORT monthly.

8.2 The COR shall conduct surveillance of the contractor’s performance by determining whether or not the performance meets the standards contained in the contract, the PWS, and the SS items. The COR is required to notify the CA each month regarding the acceptability of service. The CA will review monthly Assessment Reports (AR) initiated by the COR to ensure the COR is documenting the number of acceptable/unacceptable observations/non-performance of Performance Work Statement requirements. The AR will be in the form of a letter signed by the COR. Any customer complaints and/or corrective action reports will be attached to the Assessment Report by the COR. If the contractor exceeds the performance threshold for any of the Service Summaries in any one month period the CO may take action.

8.3 Non-SS Items. For required tasks not shown on the SS, including all other tasks in the PWS and reference documents, the government still retains the right to inspect any item included in the contract in accordance with FAR 52.212-4(a) – Contract Terms and Conditions – Commercial Items, Inspection/ Acceptance. Inspection of these services will be performed in the same general manner as periodic surveillance mentioned above. The results of these inspections are documented and, if necessary, are provided to the CO for action. Should a discrepancy be observed, the CO will handle each documented discrepancy on a case-by-case basis.

9. Performance Management.

9.1 Periodic Progress Meetings. The CO, COR Supervisor, COR, other Government personnel from the MFT, and the Contractor shall periodically, but not less than annually, meet to discuss the Contractor’s performance. The following issues shall be discussed; opportunities to improve the contract, any modifications required of the contract, unsatisfactory inspections against each performance objective observed and steps taken by the Contractor to prevent occurrences in the future. The Contractor shall provide a summation of unsatisfactory inspections and provide insight into any identified trends.

9.1.1 At these meetings the CO will inform the contractor of how the Government views the contractor’s performance and the contractor will inform the Government of problems, if any, being experienced. The contractor will also notify the CO, in writing, of any work being performed, if any, that the contractor considers over and above the requirements of the contract. Appropriate action shall be taken to resolve any outstanding issues.

9.1.2 The minutes of these meetings will be reduced to writing, signed by the CO and any other signatures as deemed appropriate, distributed to the functional area and the contractor. Should the contractor not concur with the minutes, the Contractor will provide a written notification to the CO identifying areas of non-concurrence for resolution.

9.2 This section identifies the use of performance measurement information to effect positive change in organizational culture, systems, and processes, by helping to set agreed upon performance goals, allocating and prioritizing resources, informing managers to either confirm or change current policy or program directions to meet those goals, and sharing results of performance in pursuing those goals.

9.2.1. Market Research: On-going market research is conducted to ensure the contract requirements remain current with commercial standards, practices and industry performance evaluation methods.

9.3 COR Records Review: The CA will review the CORs files periodically, but no less than quarterly to ensure completeness and to ensure surveillance is properly conducted and documented, and contractor performance is within acceptable levels. This folder was typically contained in hard copy, but will now also be maintained in a web-accessible management application, DoD Contracting Officer Representative Tracking Tool (CORT). As a minimum, the file/CORT will contain the following:

(a) Contractor Quality Control Plan (QCP)

(b) Quality Assurance Surveillance Plan (QASP)

(c) Performance Work Statement (PWS)

(d) Request for CORs, COR Nomination Letters, COR Designation Letters, & COR Termination

Letters

(e) COR training certificates, refresher certificates, & COR Supervisor Certificates for each

COR (group by COR)

(f) Correspondence between COR and Contractor & Correspondence to or from the CO/CA

(g) COR Monthly Schedules

(h) Records of Inspections, Surveillances, Schedules (if applicable) and the results

(i) Progress Meeting Minutes – to include other meetings

(j) Contract and all Modifications (in sequence, with most current mod on top)

(k) Delivery/Task Orders (DO/TO) & all DO/TO Modifications (if a “D” Type Contract, sequentially, with most current mod on top)

(l) My Invoice & WAWF Documentation (if required)

(m) All other documentation of actions taken by COR (PARs, CARs, Safety Issues, etc.)

(n) Customer Complaints

(o) Letters of Concern from CO (when applicable)

(p) Contractor Performance Assessment and Reporting System (CPARS) (when applicable – contract value over $1M)

(q) Past Documentation (use a Cross Reference Form or MFR when it’s maintained in a separate binder)

10. Performance Feedback.

Documentation is required to record, evaluate, and report contractor’s performance. On a monthly basis, the COR will complete an evaluation of contractor performance and forward it to the CO that includes the following assessment elements.

10.1. Performance Evaluation Areas.

Evaluation Areas Description

Quality

Assess the contractor’s conformance to contract/order requirements, specifications and standards of good workmanship (e.g., commonly accepted technical, professional, environmental, or safety health standards).

Schedule

Assess the timeliness of the contractor against the completion of the contract, task orders, milestones, delivery schedule, and administrative requirements (e.g., efforts that contribute to or effect the schedule variance).

Management Assess the timeliness, completeness and quality of problem identification, corrective action plans, proposal submittals, the contractor’s history or reasonable and cooperative behavior, effective business relations, and customer satisfaction.

Regulatory Compliance

Assess compliance with all terms and conditions in the contract/order relating to applicable regulations and codes.

10.2. Performance Ratings.

Rating Criteria

Exceptional Performance meets contractual requirements and exceeds many to the

Government’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

Very Good Performance meets contractual requirements and exceeds some to the

Government’s benefit. The contractual performance element or sub-element being evaluated was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

Satisfactory 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 appear or were satisfactory.

Marginal Performance does not meet some contractual requirements. The contractual performance of the element or sub-element being evaluated reflects a serious problem for which the contractor has not yet identified corrective actions.

The contractor’s proposed actions appear only marginally effective or were not fully implemented.

Unsatisfactory 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 serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

11. Contract Performance Review.

11.1. Initial Contract Performance Review. The initial evaluation of contractor performance is a joint determination by the MFT that the contractor has successfully started performance, completed transition, is fully operational, and is within the estimated cost, schedule, and performance parameters of the contract. The purpose of the review is to determine if the contractor successfully completed transition, is fully operational, and is within other performance parameters required by the contract. The COR will conduct the initial 30-day post award review utilizing the monthly COR report form and submit the report to the CO. The CO will determine if the contractor has or has not successfully completed transition, is fully operational, and is within other performance parameters required by the contract. In the event that the review indicates negative performance, the COR will identify the specific categories of non-compliance (i.e., negative variation in cost, schedule, and/or other significant performance metrics, etc.), and provide an explanation of the causes for the variance. The review shall take place within 30 days after the contractor assumes full performance responsibility (performance start date).

Appendix 1 – Customer Complaint Record

CUSTOMER COMPLAINT RECORD

DATE/TIME OF

COMPLAINT

SOURCE OF COMPLAINT

ORGANIZATION

BUILDING

NUMBER

INDIVIDUAL

PHONE

NATURE OF COMPLAINT

CONTRACT REFERENCE

VALIDATION

DATE/TIME CONTRACTOR INFORMED OF COMPLAINT

ACTION TAKEN BY CONTRACTOR

RECEIVED/VALIDATED BY

Appendix 2 – Corrective Action Report

1 CORRECTIVE ACTION REPORT (CAR)

(If more space is needed, use reverse and identify by number)

1. CONTRACTOR

2. CONTRACT

3. TYPE OF SERVICES

4. FUNCTIONAL AREA

5.

SUSPENSE

6. CONTROL

7. DEFICIENCY MAJOR MINOR

FINDING:

Please respond with a written corrective action plan that details the corrective action of the cited deficiency, the cause of the deficiency, and actions taken to prevent recurrence by Suspense Date in Block 5. If date was not entered in Block 5, the contractor is not required to provide a response.

1.1 8. QUALITY ASSURANCE PERSONNEL (QAP)

1.2 TYPED NAME AND GRADE

1.3 SIGNATURE AND DATE

1.4 9. ISSUING AUTHORITY

1.5 TYPED NAME AND GRADE

1.6 SIGNATURE AND DATE

10. QAP RESPONSE TO CONTRACTOR CORRECTIVE ACTION AND ACTION TAKEN TO

PREVENT RECURRENCE

11. QAP DETERMINATION

ACCEPTED REJECTED

12. CLOSE DATE