Attachment_4_Quality_Assurance_Surveillance_Plan_(QASP)_28_May_2014.pdf

Quality Assurance Surveillance Plan Clinical Support Services IDIQ

Contract No. FA7000-14-C-xxxx 28 May 2014

Attachment 4

CLINICLAL SUPPORT HEALTHCARE SERVICES FOR THE

COLORADO SPRINGS MILITARY HEALTH SYSTEM

10 MDG, United States Air Force Academy

21 MDG, Peterson Air Force Base

Evans Army Community Hospital (EACH), Fort Carson Army Post

TABLE OF CONTENTS

1.0 PURPOSE

2.0 OBJECTIVES

3.0 RESULTS THE MULTI-FUNCTIONAL TEAM IS STRIVING TO ACHIEVE

4.0 MULTI-FUNCTIONAL TEAM MEMBERS’ ROLES & RESPONSIBILITIES

5.0 CONTRACTING OFFICER REPRESENTATIV (COR) APPOINTMENT AND TRAINING

6.0 APPROACH, METHOD, AND TOOLS USED TO ASSESS CONTRACTOR

PERFORMANCE

7.0 NON SERVICE SUMMARY (SS) ITEMS

8.0 UNACCEPTABLE PERFORMANCE

9.0 CERTIFICATION/ACCEPTANCE OF SERVICES

10.0 INITIAL CONTRACT PERFORMANCE REVIEW

11.0 CONTRACTING RATING (CPARS)

12.0 MULTI-FUNCTIONAL TEAM SIGNATURE PAGE

APPENDICES

Appendix A – COR Monthly Report

Appendix B – Government Supervisor Monthly Surveillance Report

Appendix C – 30-Day Multi-Functional Team Evaluation

Appendix D – Customer Complaint Record

Appendix E – Corrective Action Report

Appendix F – Performance Assessment Report

1. PURPOSE:

This Quality Assurance Surveillance Plan (QASP) has been developed and adheres to AFI 63-138, Acquisition of Services guidelines. This QASP will be used by the Government to ensure contractor compliance for the clinical support healthcare services provided. It provides Government supervisors and the

Contracting Officer Representative (COR) with an effective and systematic method of evaluating contractor provided services as required by the terms and conditions of the contract.

2. OBJECTIVES:

This QASP prescribes how the Government will assess contractor performance and manage the contract. It is based on the premise that the Contractor is responsible for contract management and quality control. The

Government’s objective in contracting for clinical support services is to supplement the medical staff with qualified Healthcare Workers (HCWs) who provide direct patient care services in the treatment of military health system beneficiaries to the Colorado Springs Military Health System to include 10 MDG, United

States Air Force Academy, 21 MDG Peterson Air Force Base, and Evans Army Community Hospital, Fort

Carson Army Post.

3. RESULTS:

This QASP describes the method(s) used to evaluate contractor provided services rather than the details of how the contractor accomplishes the work. Because this contract is a personal services contract, the

Government supervisor, as the subject matter expert, shall use monthly surveillance as a means to evaluate contracted healthcare worker’s performance. The surveillance procedures identified in this QASP, will assure the Government of acceptable contractor performance.

The role of Government surveillance is to ensure contract standards are achieved. In conducting surveillance, Government supervisors and CORs are to be objective, fair, and consistent in evaluating contractor performance against the performance standards.

This QASP is a living document and shall be revised or modified by members of the Multi-Functional Team

(MFT) throughout the life of the contract to ensure adequate oversight of contractor performance is maintained.

4. MULTI-FUNCTIONAL TEAM ROLES & RESPONSIBILITIES:

The following government officials will participate in performance management of this contract. Their roles and responsibilities are described as follows:

4.1 Senior Leadership, MTF Commander: Developing, implementing and executing a performance management assessment program that satisfies mission requirements, fosters innovation, and includes defined metrics. Appointing a MFT of key stakeholders possessing the necessary set of skills to ensure that all service acquisitions integrate the needs of the mission with the requirement to procure performance-based services.

4.2. The Contracting Officer (CO): has overall responsibility for overseeing the contractor’s performance.

The CO will also be responsible for the day-to-day monitoring of the contractor’s performance in the areas of contract compliance, contract administration, cost control, and property control; reviewing the COR assessment of the contractor’s performance; and resolving all differences between the COR version and the contractor’s version of events. The CO is the only person with the authority to direct the contractor in the performance of their duties under the contract and to make interpretations of and changes to the contract.

The CO will facilitate Multi-Functional Team meetings.

4.3. Contracting Officer Representative (COR): is responsible for monitoring, assessing, recording and reporting on contractor compliance with the terms and conditions of the contract. The COR is responsible for completing monthly COR reports (Appendix B) and posting these reports to the COR Tracking Tool.

The COR has the primary responsibility for completing quality assurance monitoring forms that will be used to document the inspection and evaluation of the contractor’s performance. The COR will maintain surveillance documentation, notify the Contracting Officer (CO) of any significant deficiencies and recommend improvements to the QASP and Performance Work Statement (PWS) throughout the life of the acquisition.

4.4. The COR Management/Supervisor: has overall responsibility for developing the PWS and the Quality

Assurance Surveillance Plan and ensuring they satisfy mission requirements, are performance-based, foster innovation, and define metrics. The COR Management/Supervisor may also assign an alternate COR. The

COR Management/Supervisor shall notify the CO of any changes to this designation. The COR

Management/Supervisor will review contractor performance documentation, prepared by the COR on a regular basis to ensure performance is compatible with contract and mission objectives. The COR

Management/Supervisor is also responsible for identifying mission essential services and developing the necessary documents for Continuation of Essential DoD Contractor Services During Crisis.

4.5. The Quality Assurance Program Coordinator (QAPC): develops, manages and implements the United

States Air Force Academy’s Quality Assurance Program; supports the Multi-Functional Team in the development of contract requirements, ensuring requirements are clearly stated and enforceable; aids in development of the Service Summary (SS) and Quality Assurance Surveillance Plan and provides training to all COR Management/Supervisors, CORs and others that interact with this contract as needed.

4.6. The Contract Administrator (CA): is the focal point for issues regarding the contract; prepares and processes modifications to the contract; assists the CO in ensuring contractor performance meets contract standards; records and transcribes minutes for meetings.

4.6.1. The Contract Administrator will perform COR personnel assessment on a periodic basis as determined by the CO. The CA will verify that the COR is accomplishing their surveillance according to this Quality Assurance Surveillance Plan. Observation of one or two checks will be sufficient to verify the

COR’s procedures. If deficiencies are discovered in COR surveillance procedures, the contracting officer will notify COR Management/Supervisor and provide any assistance the COR Management/Supervisor may request, such as additional training for COR. The CA will ensure that the COR is documenting their surveillances on a timely basis. A check of the COR files will also be performed annually.

4.7. Government Supervisor: is the Government employee who supervises the personal services contracted healthcare worker. The Government Supervisor evaluates and documents the Contractor’s performance on a monthly basis on a Government Supervisor Monthly Surveillance Report (Appendix B) and provides the surveillance documentation to the COR by the 5 th of the month following the evaluation month.

4.8. The Contractor: is the service provider who complies fully with the terms and conditions of the contract, ensures non-conformance of the contract requirements are identified, corrected and prevented from recurrence, and recommends any changes to the contract that will provide more effective operations or eliminate unnecessary costs.

5. COR APPOINTMENT AND TRAINING:

5.1. A primary COR will be appointed for this contract. The COR Management/Supervisor is the designating authority.

5.2. The COR will be available to receive QAPC provided training (previously referred to as Phase 1), CO

Led Training (previously referred to as Phase 2), Defense Acquisition University (DAU) Continuous

Learning Module (CLM) 003 (Ethics), and DAU Continuous Learning Course (CLC) 106 (COR Basic) or

DAU CLC 222 (COR Course). DAU 106 or 222 will be determined by the category of contract (A, B, or

C).

5.3. Each COR will be available to receive Refresher training provided by the QAPC as required and maintain the appropriate number of COR specific training hours every three years as determined by the category of contract. This contract is determined a B-type contract and the COR must maintain 16 hours every three years and Ethics (CLM 003) every year.

6. APPROACH, METHODS, AND TOOLS OF INSPECTION APPLICABLE TO THIS

CONTRACT:

6. 1. The MFT team is responsible to measure outcomes and focus on performance results. The QASP provides a systematic method to measure outcomes the contractor is required to furnish, rather than focusing on the details of how the Contractor accomplishes the work.

6.2. SERVICES SUMMARY (SS) AND METHOD OF ASSESSMENT. This section identifies the process that measures success towards achieving defined performance objectives or goals defined within the performance thresholds in the below Services Summaries, or the process of assessing progress towards achieving the objectives/goals developed in this QASP. The SS elements are often considered the most mission critical service characteristics of the contract. The assessment methods shown in the tables below for each SS element are the primary means to evaluate the performance objectives, and assess whether the performance thresholds were met.

Performance Objective (General) PWS

Paragraph

Performance Measure Method of Surveillance

1. The contractor shall provide personnel who are competent, qualified, and adequately trained to perform assigned duties

1.6.1 Maintain a 80% or above

mission support status.

Mission support status is measured as Number of

Positions Filled/Number of

Positions Available for Fill.

Periodic Inspection

(Monthly)

2. The contractor shall perform services in accordance with the ethical, professional, and technical standards of the health care industry.

1.0 The contractor’s healthcare

worker employee staff receive no more than 2 validated patient or MTF complaints per month.

Customer Complaint

3. Possess and maintain current certifications and licenses and complete all MTF-specified orientation programs and annual training requirements.

1.4 and 1.5

100% compliance

Periodic Inspection

(Annual)

4. Credentialed healthcare workers physically begin performance within

90 days after contract award and Non-credentialed healthcare workers begin within 60 days.

1.6.4.3

1.6.4.4

No more than 1 credentialed healthcare worker starts performance later than 90 days within a 12-month period. No more than 1 non-credentialed Healthcare

Worker starts performance later than 60 days within a

12-month period.

Period Inspection

(Monthly)

5. Contractor Manpower Report

(CMR)

Appendix D 100% compliance Period Inspection

(Annual)

6.3. SURVEILLANCE:

6.3.1. Technical contract surveillance of the contracted healthcare worker (HCW) is performed by the

Government supervisor. The Government supervisor monitors performance of a contracted HCW through supervision. The Government supervisor conducts surveillance of the contracted HCW’s performance on a daily basis by determining whether or not the performance meets the standards contained in the contract and reports that performance information to the Contracting Officer’s Representative (COR) on the Government

Supervisor Monthly Surveillance Report provided to the COR no later than 5 calendar days following the month in which the surveillance occurred. When complete, the Government supervisor should file this form in their 6-part folder as outlined in AFI 41-209. Surveillance reports, when completed, shall be marked “For

Official use Only” and shall not be shown to the contracted health care worker.

6.3.2. Performance Measure Review. The COR will review reports to determine compliance of work performed by the contractor, as measured against the SS. The contractor will be notified if the performance measure is not within the SS stated thresholds. The contractor shall take the necessary measures to correct the performance.

7. NON-SS ITEMS:

7.1 The Government has the right to inspect all services called for by the contract, to the extent practicable at all times and places during the performance of the contract. Therefore, the COR and Government supervisors have the right to conduct surveillance for Service Summary (SS) items and non-SS items. When either identifies unacceptable performance, the procedures in paragraph 8 below shall be followed.

8. UNACCEPTABLE PERFORMANCE:

8.1. When the Contractor’s performance is deemed unacceptable, the Government supervisor and/or COR shall attempt to determine the cause of the unacceptable performance. If any Government action, or lack or action, caused the unacceptable performance, the unacceptable performance shall not be counted against the

Contractor. The Government supervisor and/or the COR shall take action to ensure Government action, or lack of action, does not interfere with the Contractor’s performance in the future. When the unacceptable performance is not the result of a Government action, or lack of action, the Government supervisor shall document the specific reason for the unacceptable performance on the Government Supervisor Surveillance

Report and forward to the COR. The COR will document the unacceptable performance on the COR

Report. The COR will also notify the Contracting Officer. If the Contractor challenges the validity of the unacceptable surveillance findings, the COR shall refer the surveillance dispute to the Contracting Officer for resolution.

8.2. In accordance with the contract Inspection of Services clause, if any services do not conform to the contract requirements, the Government may require the Contractor to perform the services again in conformity with contract requirements—at no increase in contract amount.

9. CERTIFICATION/ACCEPTANCE OF SERVICES:

9.1. The Government supervisor shall track the number of billable hours on the contracted healthcare worker and forward the total number of billable hours to the COR with the Government Supervisor Surveillance

Report on a monthly basis. The COR shall match the hours provided by the Government

Supervisor to the Contractor invoice via the Wide Area Workflow (WAWF) website. If correct, the COR shall certify receipt of contract services. Certification of services shall be accomplished as soon as possible following the completion of the contract payment period to avoid payment of interest penalties.

10. INITIAL CONTRACT PERFORMANCE REVIEW:

10.1. Air Force Instruction 63-138, paragraph 6.4, requires initial contract performance review within 30 days after contractor assumes full performance responsibility (Appendix C)

11. CONTRACTOR RATING (CPARS):

Contractor’s Performance Assessment Rating (CPAR) is applicable to this contract. The COR narrates the initial CPARS past performance report and forwards to the CO. Guidance on CPARS is available from the

Department of the Air Force CPARS Guide and the 10th Contracting Division CPARS representative (Mr.

Ralph Tisdale).

12. MULTI-FUNCTIONAL TEAM SIGNATURES: The following Multi-Functional Team member signatures indicate their review and acceptance of the Quality Assurance Surveillance Plan for the Colorado

Springs Military Health System Clinical Healthcare Worker Support Services. These signatures indicate coordination on this Quality Assurance Surveillance Plan at the time of development. These team members are not the only individuals on the MFT but are the individuals that will have continual interface with this contract. No further Multi-Functional Team coordination is needed unless the intent of the Quality

Assurance Surveillance Plan is changed.

SIGNATURES

This Quality Assurance Surveillance Plan represents the 10th Medical Group’s requirement to provide sufficient and qualified functional resources to oversee the Radiologists, Case Managers, Orthopedic

Surgical Technicians, Pre/Post RNs, Utilization Review Nurses and Operating Room RNs services contract.

Properly trained, properly appointed Contracting Officer Representative (COR) will help effectively assess contractually performed mission requirements and report sufficiently on contractor performance.

COR Management/Supervisor Date

This QASP establishes the Contracting Officer’s requirement to provide sufficient contract administration resources in support of the functional area’s contracted mission requirements. The QASP also provides instructions for effectively responding when negative performance indicators are present.

Contracting Officer Date

This QASP meets the responsibilities to establish a Multi-Functional Team for a service contract and describes how performance is measured, assessed, and managed upon contract award (IAW AFI 63-138, Acquisition of Services).

Quality Assurance Program Coordinator Date

Additional Team Members Signature:

Contract Specialist: _____________________________________

Contracting Officer Representatives (Primary): _____________________________________

Other: _____________________________________

APPENDIX A

Sample Contracting Officer’s Representative (COR) Surveillance Report

COR MONTLY SURVEILLANCE REPORT

Company Name Contract Number Month/Yr

Please mark appropriate box for each DESCRIPTION N/A Unsatisfactory Marginal Satisfactory Very Good Exceptional

Provides competent, qualified, adequately trained health care workers.

Completes security paperwork

Provides complete credentials package

Performs services in accordance with ethical, professional and technical standards of the health care industry and the Air Force medical department

Maintains HCW qualifications

Effectively addresses

MTF/Patient complaints

(Resolves Issues)

Other:

Assessment Definitions NA

Performance cannot be resolved in a timely manner

(Major)

Minor

Performance issue

Meets performance standards

Performance adds some value to

MTF

Performance adds much value to

MTF

The COR will assess Contractor performance IAW the terms and conditions of the contract/task order. Other-than-satisfactory assessments (i.e., Exceptional, Very Good, Marginal, and Unsatisfactory) must include comments to explain the assessment.

Overview of Performance/Comments:

Print Name of COR: Signature COR: Date:

Print Name of Contract Specialist: Signature of Contract Specialist: Date:

APPENDIX B

Sample Government Supervisor Surveillance Report

GOVERNMENT SUPERVISOR MONTHLY SURVEILLANCE REPORT

*(Note: A monthly surveillance report shall be submitted by the 5 th calendar day of the month to the COR).

HCW Name: Company Name: Month/YR Contract & Task Order Number

Please mark appropriate box for each DESCRIPTION N/A Unsatisfactory Marginal Satisfactory Very Good Exceptional

Overall Performance

Maintains Qualifications

Performs IAW work schedule

Patient Satisfaction

Customer Satisfaction

Assessment Definitions N/A

Performance cannot be resolved in a timely manner even with discrepancy notice (Major)

Minor

Performance issue (needs discrepancy notice to resolve)

Meets performance standards

Performance adds some value to MTF

Performance adds much value to MTF

NA

Duty Hours

Worked*

Overage Hours

Worked

On-Call Hours

Worked

Approved

Leave Hours**

Monthly Hours

* Duty hours are actual hours worked at the place of performance including hours from directed training, unplanned closures, or administrative duties ** Leave hours are hours the Government supervisor scheduled, and HCW took, as leave during the month.

The Government supervisor will assess Contractor Performance IAW the terms and conditions of the contract. Other-than-satisfactory assessments (i.e., Exceptional, Very Good, Marginal, and Unsatisfactory) must include comments to explain the assessment.

Comments:

Print Name of Government

Supervisor:

Signature Government Supervisor: Date:

Print Name of COR Reviewer: Signature of COR: Date:

APPENDIX C

MEMORANDUM FOR RECORD

FROM: 10 CONS

SUBJECT: 30-Day Multi-Functional Team (MFT) Service Contract Evaluation

1. AFI 63-138 requires MFT initial evaluation of contractor performance with 30 days after the contractor assumes full performance responsibilities. The following evaluation is for contract

___________________________________________________ and utilizes Green, Yellow, and Red assessment values. Green—No issues. Yellow—Issue(s) but contractor has an adequate mitigation or corrective action plan in place. Red—Issue(s) with inadequate or no contractor’s mitigation or corrective action plan. Any “Red” assessment shall include the government proposed actions with respect to the failing contractor.

Contractor Successfully Started Performance – Circle one: Green Yellow Red

Comments:______________________________________________________________________________

Contractor Successfully Completed Transition – Circle one: Green Yellow Red

Contractor Is Fully Operational – Circle one: Green Yellow Red

Contractor Is Within Estimated Cost – Circle one: Green Yellow Red

Contractor Is On Schedule – Circle One: Green Yellow Red

Contractor Is Operating Within The Performance Parameters – Circle one: Green Yellow Red

2. Oversight and management in accordance with AFI 63-138 is an important tool for ensuring taxpayer dollars are managed responsibly. The MFT signatures below reflect team member agreement with this evaluation and compliance with AFI 63-138, paragraph 6.4.

MFT Signatures

APPENDIX D

CUSTOMER COMPLAINT RECORD

DATE/TIME OF COMPLAINT

SOURCE OF COMPLAINT

ORGANIZATION

BUILDING NUMBER

INDIVIDUAL

PHONE NUMBER

NATURE OF COMPLAINT

CONTRACT REFERENCE

VALIDATION

DATE/TIME CONTRACTOR INFORMED OF COMPLAINT

ACTION TAKEN BY CONTRACTOR

RECEIVED/VALIDATED BY

Customer Complaint Record Template, Feb 05 (SAF/AQCP)

APPENDIX E

CORRECTIVE ACTION REPORT (CAR)

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

1. CONTRACTOR

2. CONTRACT NUMBER

3. TYPE OF SERVICES

4. FUNCTIONAL AREA

5. SUSPENSE DATE

6. CONTROL NUMBER

7. DEFICIENCY MAJOR MINOR

FINDING:

FINDING IMPACT:

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.

8. CONTRACTING OFFICER REPRESENTATIVE (COR)

TYPED NAME AND GRADE

SIGNATURE AND DATE

9. ISSUING AUTHORITY

TYPED NAME AND GRADE

SIGNATURE AND DATE

10. COR RESPONSE TO CONTRACTOR CORRECTIVE ACTION AND ACTION TAKEN TO PREVENT RECURRENCE

11. COR DETERMINATION

ACCEPTED REJECTED

12. CLOSE DATE

Corrective Action Report (CAR) Template, Feb 05 (SAF/AQCP)

CORRECTIVE ACTION REPORT (CAR)

Continuation Sheet

(Number to correspond with applicable Item Number on reverse)

Corrective Action Report (CAR) Template, Feb 05 (SAF/AQCP)

Corrective Action Report (CAR) Instructions

Block 1. Enter Contractor Name.

Block 2. Enter Contract Number.

Block 3. Enter Contract Name or Type of Services.

Block 4. Enter Functional Area of the Contract.

Block 5. Enter the assigned suspense date given the contractor to provide a response to the CAR. A date must be entered for a

Major CAR. A date is optional at the discretion of the Contracting Officer Representative (COR) initiating the CAR if the finding is

Minor.

Block 6. All CARs will be tracked with a Control Number. The COR Management/Supervisor/functional director is the Issuing Authority for his/her contract Contracting Officer Representatives (CORs) generating CARs. By providing the control number to the COR originating the CAR, the Issuing Authority demonstrates concurrence with the finding. The control number will be made up of the first two letters of the name of the site or contract, the last two digits of the calendar year, and a three digit number starting with 001 and progressing upward throughout the calendar year (e.g., WP04-001).

Block 7.

1. Check the block that indicates whether the identified deficiency is assigned as a Major or Minor finding. See Quality Assurance Surveillance Plan (QASP), paragraph 6.1.4, for the definitions of Major and Minor findings and associated explanations.

2. Finding: Clearly state the details of the finding followed by a reference to the stated contractual requirement. The reference must state the portion of the contract, part, section, paragraph and subparagraph and must make a complete brief quotation of the contract reference.

3. State the impact that the finding has or could have on the accomplishment of the mission that the contract provides.

4. When determining how long to give the contractor to respond to the identified finding, the normal is 10 working days.

The suspense date should reflect this unless the finding requires a greater amount of time to come to solution. Major findings require a contractor response. Minor findings may require a contractor response at the discretion of the COR initiating the CAR and/or the Issuing Authority.

Blocks 8 and 9. Contract CORs initiating a CAR must sign in Block 8 and the Issuing Authority signs in Block 9. Each annotates the date at the time of signature.

Block 10. Upon review of the contractor’s reply, the originator of the CAR will enter comments regarding acceptance or rejection of the contractor’s response. This block may also contain any comments regarding follow-on inspections conducted or needed at a later date to validate that the finding has not reoccurred.

Block 11. The COR selects Accept or Reject after reviewing the contractor’s response.

Block 12. The COR enters a close date after advising the Issuing Authority that the contractor’s response is acceptable and the Issuing Authority concurs. The Issuing Authority will then forward the closed CAR to the contractor and report accordingly in the monthly Certificate of Service (COS) or other applicable contracting officer services report. This routing remains the same if the contractor response is unacceptable and the CAR remains open until an acceptable response is received except that the Issuing Authority forwards the open CAR back to the contractor for additional information.

Continuation Sheet. The Continuation Sheet is to be used to expand on any information that will not fit in the applicable numbered block.

APPENDIX F

PERFORMANCE ASSESSMENT REPORT (PAR)

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

1. CONTRACT/TASK ORDER NUMBER 2. CONTRACTOR 3. TYPE OF SERVICES

4. CONTRACTING OFFICER REPRESENTATIVE (COR) SIGNATURE AND DATE

5. COR PHONE 6. SUSPENSE DATE

I. PERFORMANCE

7. DEFICIENCY (CHECK ALL BOXES THAT APPLY)

NEW

REPEAT

NO DEFICIENCY NOTED

8. SERVICES SUMMARY or SOW PARAGRAPH ITEM REVIEWED

9. BRIEF DESCRIPTION OF DEFICIENCY (IF DEFICIENCY BOX WAS

CHECKED)

10. DETAILED PERFORMANCE ASSESSMENT

II. CONTRACTOR VALIDATION

11. CONTRACTOR REPRESENTATIVE CONCUR NON-CONCUR

12. CORRECTIVE ACTION ESTIMATED COMPLETION DATE

13. CONTRACTOR REPRESENTATIVE CORRECTIVE ACTION AND PREVENTION OF RECURRENCE OR REASON FOR NON-

CONCURRENCE OF COR CITED DEFICIENCY

III. ACTION CORRECTED

14. CONCUR NON-CONCUR COR SIGNATURE AND DATE

15. COR REMARKS (REQUIRED)

16. CONTRACTOR REPRESENTATIVE REMARKS

Performance Assessment Report (PAR) Template, Feb 05 (SAF/AQCP)

PERFORMANCE ASSESSMENT REPORT

Continuation Sheet

(Number to correspond with applicable Item Number on reverse)

Performance Assessment Report (PAR) Template, Feb 05 (SAF/AQC)

Performance Assessment Report (PAR) Instructions

Block 1. Contracting Officer Representative (COR) enters contract or task order number.

Block 2. COR enters contractor name.

Block 3. COR enters type of services.

Block 4. COR signs and dates.

Block 5. COR enters telephone number.

Block 6. COR assigns suspense date for Contractor Representative validation if a deficiency box was checked in Block 7.

Part I. Contractor Performance

Block 7. COR checks all boxes that apply.

Block 8. COR enters Services Summary or Statement of Work (SOW) paragraph item reviewed.

Block 9. COR enters brief description of deficiency and tracking number if the deficiency box was checked in Block 7.

Detailed description will be on Corrective Action Report (CAR).

Block 10. COR enters a detailed performance assessment if the deficiency box in Block 7 was not checked.

Parts II and III will be used only if a deficiency was documented in Part I.

Part II. Contractor Validation

Block 11. Contractor Representative checks one box in response to COR cited deficiency. If Concurrence is indicated, Contractor Representative continues to Block 12. If Non-Concurrence is indicated, continue to Block 13 and state reason(s) for Non-Concurrence with COR cited deficiency and return PAR to COR.

Block 12. Contractor Representative enters Estimated Completion Date of Corrective Action and continues to Block 13.

Block 13. Contractor Representative details Corrective Action and the Action Taken to Prevent Recurrence or Reason for Non-Concurrence of COR cited deficiency.

Part III. Deficiency Corrected

Block 14. COR checks appropriate block, signs, and dates.

Block 15. (Required Entry) COR remarks regarding the Corrective Action and the Action Taken to

Prevent Recurrence. If Non-Concur was checked, this block should be very detailed to explain why.

Block 16. Contractor Representative enters remarks if further discussion is needed about COR concurrence with Contractor’s

Corrective Action and Action Taken to Prevent Recurrence.

Continuation Sheet. The Continuation Sheet is to be used to expand on any information that will not fit in the applicable numbered block.

Quality Assurance Surveillance Plan for xxxxxxxxx Services

06 Sept 2006

Contract No. FA7000-xx-x-xxxx