Form_5.pdf

1. CONTRACT NUMBER

QUARTERLY ASSESSMENT REPORTMONTHLY or

Attach continuation sheet(s) if necessary

2. MONTH

3. OVERALL PERFORMANCE SUMMARY

ACCEPTABLE UNACCEPTABLE TO: AFOTEC/A-7K

Contractor:

5. Monthly Performance Assessment: (Utilize the Contractor Performance Assessment Reporting (CPAR) definitions and notes provided below.)

6. ASSESSMENT SUMMARY: (Describe any performance issues noted during the month/quarter, any corrective actions taken. Reference PWS para for each issue.)

EXCEPTIONAL

VERY GOOD

SATISFACTORY

MARGINAL

UNSATISFACTORY

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 was highly effective.

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 benefit could be of such magnitude that it alone constitutes an Exceptional rating. Also, there should have been NO significant weaknesses identified.

Very Good. Performance meets contractual requirements and exceeds some to the Government's benefit. The contractual performance of the element or sub-element being assessed was accomplished with some minor problems for which corrective actions taken by the contractor was effective.

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.

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.

Note: To justify a Satisfactory rating, there should have been only minor problems, or major problems the contracotr recovered from without impact to the contract. Also, there should have been NO significant weaknesses identified. Per DoD policy, a fundamental principle of assigning ratings is that contractors will not be assessed a rating lower than Safisfactory solely for not performing beyond the requirements of the contract.

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

Note: To justify an Unsatisfactory rating, you should identify multiple events in each category that the contractor had trouble overcoming and state how it impacted the GOVERNMENT. However, a singular prob lem 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).

RELEASABILITY: Access to this form is restricted: this form is For Official Use Only (FOUO) when filled in; requests for accessibility must be approved by the OPR.

AFOTEC Form 5

4. FROM: (NAME OF COR)

Performance does not meet some contractual requirements. The contractual performance of the element or sub-element being assessed was accomplished with some serious problems, but recovery was still possible. Corrective actions taken by the contractor were marginally effetive or were not fully implemented.

Marginal.

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 managment tool used to notify the contractor of the contractual deficiency (e.g. Managment, Quality, Safety, or Environmental Deficiency Report or letter).

AFOTEC Form 5, 20080301 (reverse) (Test Form)

7. POTENTIAL PROBLEM AREAS: (List areas of concern including the surveillance process now used, items should be discussed at next progress meeting.)

8. CHANGES: (Upcoming personnel changes, contractor or SOW changes, contract modification.)

RELEASABILITY: Access to this form is restricted: this form is For Official Use Only (FOUO) when filled in; requests for accessibility must be approved by the OPR.

Functional Commander/Director (FC/FD)

PRINT NAME & INDICATE TITLE

Contracting Officer's Representative (COR)

SIGNATURE DATE