Final_1_A1g_QASP_FAP_USAFE_-_16Oct14_(2)_(2).pdf

AIR FORCE MEDICAL OPERATIONS AGENCY

QUALITY ASSURANCE SURVEILLANCE PLAN (QASP)

FOR

AIR FORCE FAMILY ADVOCACY PROGRAM (FAP)

OUTSIDE THE CONTINENTAL UNITED STATES (OCONUS) UNITED

STATES AIR FORCE EUROPE (USAFE)

23 OCTOBER 2014

QUALITY ASSURANCE SURVEILLANCE PLAN (QASP) For

AIR FORCE FAMILY ADVOCACY PROGRAM (FAP)

OUTSIDE THE CONTINENTAL UNITED STATES (OCONUS) UNITED STATES AIR

FORCE EUROPE (USAFE)

TABLE OF CONTENTS:

Page #

1.0 Mission 3

2.0 Purpose 3

3.0 Authority 4

4.0 Roles and Responsibilities 4

5.0 Contractor’s Quality Control Plan (QCP) 5

6.0 Performance Requirements and Method(s) of Surveillance 6

7.0 Surveillance Documentation 8

8.0 Acceptance of Services 9

9.0 Contract Management 9

10.0 Coordination and Approval 11

Appendices:

1. Services Summary (SS) and Method of Surveillance 12

2. Corrective Action Report (CAR) 17

3. Customer Complaint Record 19

4. Performance Assessment Report (PAR) 20

5. Sample COR Services Summary Surveillance Report 21

5.a Performance Ratings used for COR Services Summary Surveillance 27

Report

6. Contracting Officer’s Annual COR File Inspection Checklist and COR 28 Contract File Index

Quality Assurance Surveillance Plan (QASP)

1.0 Mission

The Air Force (AF) Family Advocacy Program (FAP) is a medical program that enhances AF readiness by promoting family and community health and resilience. AF FAP also advocates for nonviolent communities. These objectives are accomplished through the use of broad-based education and awareness activities along with the identification and treatment of family maltreatment incidents. These services prevent family maltreatment from reducing the duty performance of AF members.

2.0 Purpose

This Quality Assurance Surveillance Plan (QASP) is a government-developed document used to determine if the contractor’s performance meets the performance standards outlined in the contract. The QASP establishes procedures on how to conduct surveillance/inspection process to ensure successful PWS performance. It provides a systematic method for 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 are documented.

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.

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.

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.

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

3.0 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 (also reference 52.212-4 Contract

Terms & Conditions—Commercial Items Paragraph (a) Inspection/Acceptance), 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.

4.0 Roles and Responsibilities

Multi-Functional Team Roles and Responsibilities. The purpose of the multi-functional team is to create an environment that shapes and effectively executes acquisitions within their purview. The emphasis is on teamwork, trust, common sense and agility. These stakeholders are responsible for the acquisition throughout the life of the requirement, instituted under the authority of the senior leadership; every representative within the multi-functional team brings to the team their unique level of expertise. The following personnel comprise the Multi-Functional

Team (MFT) and shall oversee and coordinate surveillance activities.

Government Representatives:

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 ensure that the contractor receives impartial, fair, and equitable treatment under this contract and shall determine the final assessment of the contractor’s performance. The CO shall designate a primary and alternate COR prior to contract award. Upon request, the CO shall provide an assessment on COR performance to the COR Supervisor. The CO is the only person with the authority to make interpretations of and changes to the contract.

Specific duties of the CO include:

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

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

Periodically assessing the COR’s performance.

Managing contractor performance surveillance data, including submitting Contractor

Performance Assessment Reporting System (CPARS) reports.

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

Providing contract-specific training (to include refresher training) administered by CO or

CO’s designee to all appointed CORs.

Contracting Officer Representative (COR) Supervisor– The COR Supervisor nominates the

COR, ensures the COR is trained before performing any COR duties and supports the COR’s surveillance activities.

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 contractor performance.

Specific duties of the COR include:

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

Recommending any changes necessary to the contract, PWS, QASP, or other items to provide operations that are more effective or eliminate unnecessary costs.

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

COR surveillance reports).

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

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

To notify the CO immediately regarding contractor non-compliance with FAR 52.222-

50, “Combating Trafficking in Persons.”

o The Contractor shall comply with FAR 52.222-50, Combating Trafficking in

Persons. Additional information about Trafficking in Persons can be found at the site for the Department of State’s Office to Monitor and Combat Trafficking in

Persons below.

http://www.state.gov/j/tip o In accordance with the Defense Contingency COR Handbook section on

Combating Trafficking in Persons, the COR must inform the PCO if the

Contractor/subcontractor and/or Contractor/subcontractor personnel fail to comply with the requirements of FAR 52.222.50.

o The PCO must convey the information to DoD Combat Trafficking in Persons

(CTIP) Law Enforcement and Support / Office of Under Secretary of Defense

(OUSD) Personnel and Readiness (P&R) Defense Human Resources Activity

(DHRA).

Quality Assurance Program Coordinator (QAPC) - The QAPC is responsible for developing, managing, and implementing the Quality Assurance Program. The QAPC provides the QAPC

Led Training & may provide refresher training, as needed.

Other Key Government Personnel http://www.state.gov/j/tip http://www.acq.osd.mil/dpap/ccap/cc/corhb/Files/DCCOR_Handbook_2012.pdf

Chief Medical Logistics Officer - Has overall responsibility for identifying mission essential services and developing the necessary documents in accordance with DFARS 237.76, Continuation of Essential Contractor Services. Coordinates with and requests supervisors assign primary and alternate Contracting Officer Representatives (CORs) who will be available full time or as warranted by the procurement cycle. Reviews contractor performance documentation on a regular basis to ensure performance is compatible with contract and mission objectives while supporting a higher level of contractor performance, and fostering synergistic partnerships.

The Program Manager (PM) - Has the overall responsibility for initiating, managing, and tracking the various programs/projects that support the contract. The PM is the primary liaison of the contractor employees’ performance and the Contracting Officer (CO) and the COR. The PM is responsible for assisting in the preparation of requirements documents providing customers with a single contact point, monitoring the contractor’s overall performance of all assigned contracts, task orders and recommending contract changes and other supporting documentation.

The CO and PM share joint responsibility in facilitating the multi-functional team meetings.

Contractor Representatives:

Contractor – Complies fully with the terms and conditions of the contract and ensures non-conforming contract services are identified and corrected.

Specific duties of the Contractor include:

Participating as a member of the MFT in the post-award management phase.

Maintaining and implementing their commercial quality procedures that ensure contract requirements are met.

Ensuring that the QCP is revised when necessary to prevent recurrence of non-conforming contract services.

Tendering to the government for acceptance, only those services that conform to contract requirements.

Recommending any changes to the contract that will provide operations that are more effective or eliminate unnecessary costs.

5.0 Contractor’s Quality Control Plan (QCP)

A Contractor’s QCP, and updates a needed, is provided in accordance with the terms and conditions of the contract. The Contractor’s QCP compliments this QASP and is located in the contract file.

6.0 Performance Requirements and Method(s) of Surveillance

6.1 Contract Surveillance

The goal of the QASP is to ensure that contractor performance is effectively monitored and documented. The COR’s contribution is their professional, non-adversarial relationships with the CO and the contractor, which enables positive, open and timely communications. The COR uses the methods contained in this QASP to ensure the contractor complies with contract requirements. The COR 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 meet the terms of the contract.

Incentives. Performance that continually exceeds the performance objectives as outlined in the

PWS may result in reduced surveillance and favorable Contractor Performance Assessment

Reports (CPAR). Performance that does not meet the performance objectives as outlined in the

PWS may result in re-performance of the defective service in accordance with the Inspection of

Services clause, reduction of fee/price, negative CPAR reporting and/or increased surveillance.

Non-Service Summary (SS) Items. Quality performance is expected on all contract requirements by the contractor and is not limited to just SS items. All Non-SS items may be inspected by the COR.

6.2 Surveillance Summary

The Services Summary (SS) and Method of Surveillance (Appendix 1) 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 file.

Performance objectives define the desired outcomes. Performance thresholds define the level of service required under the contract to 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’s inspection.

Method(s) of Surveillance:

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

Periodic Inspection: These items are inspected using periodic surveillance (daily, weekly, monthly, quarterly, etc.) as determined by the COR. The results of the periodic surveillance inspections may be used as the basis for actions (other than payment deductions) toward the contractor. In such cases, the Inspection of Services clause becomes the basis for the CO’s actions. The schedules (if applicable) are submitted to the CA for review prior to the month being inspected.

Customer Complaint: The COR is the point of contact and must collect all customer complaints.

The Customer Complaint Record below will be used for this purpose. All complaints and any resulting resolution of such complaints must be documented with the information required on the customer complaint form. Customer complaint forms become a permanent part of the COR file.

7.0 Surveillance Documentation

7.1 Corrective Action Report (CAR) (Appendix 2)

Corrective Action reporting is divided into two categories, which are as follows: minor and major.

Minor: A minor discrepancy is a departure from established standards having little bearing on the service provided. Some examples would be data deliverables with minor grammatical or spelling errors or insufficient copies of documents. When the COR identifies a minor discrepancy, the COR shall document the discrepancy and verbally contact the designated contractor representatives, but is not required to notify the CO. However, if the same minor discrepancy is identified more than once, it may be an indication that a major discrepancy 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, which may include e-mail.

Major: If at any time the COR identifies a condition as having a significant adverse effect on the quality of the service, such as those stated below, the COR shall document their findings and notify the CO immediately in writing. E-mail is acceptable. Major discrepancies will be reported by the COR to the designated contractor representative in writing; however, copies of written correspondence will be coordinated with the CO prior to issuance to the contactor representative. Some examples are contractor failure to meet a performance objective, failure to provide adequate corrective action to preclude recurrence of government-identified findings, failure to provide corrective action to deficiencies identified by the COR within a prescribed suspense period or failure to adhere to security regulations that results in a security incident.

7.2 Customer Complaint Record (Appendix 3)

The COR shall ensure complaint procedures and forms are made available to all customers (See

Customer Complaint Record below). Any personnel that observe questionable or incomplete services or services not performed, or performed improperly, should immediately contact the

COR. The COR shall receive, document, and validate or invalidate all complaints. If the complaint is invalid, the COR shall contact the complainant and explain why the complaint was invalid. The COR shall fully document the resolution for each complaint on the Customer

Complaint Record. Complaints will be tracked and if the performance threshold is exceeded, the

COR shall notify the CO in writing. The CO will notify the contractor and appropriate action can be taken.

7.3 Performance Assessment Report (PAR) (Appendix 4)

PARs will be used to report all minor discrepancies and will be generated by the COR and sent to the contractor for corrective action. Contractor will be given 10 days to correct PARs unless they have requested an extension. If 2 minor discrepancies are found, combine them and process a CAR.

7.4 Sample COR Services Summary Surveillance Report (Appendix 5)

The communication of expected outcomes begins the performance management feedback loop.

Performance standards are expressed in the PWS and are assessed using the methods of surveillance shown in the SS surveillance. This report shall be submitted to the Contracting

Officer (CO) (through the Contract Specialist) and uploaded into the CORT Tool no later than the 5th business day of each month. The CO may agree to printing this report from the

CORT Tool each month in lieu of a separate submittal.

8.0 Acceptance of Services

Before acceptance of product(s) or service(s) and/or approval of an invoice, the COR shall prepare a COR Services Summary Surveillance Report (Appendix 5) in accordance with the

QASP and FAR 52.212-4 (Contract Terms and Conditions – Commercial Items), Inspection and

Acceptance Clause or FAR 52.246-4 Inspection of Services—Fixed Price (or -5 for Cost

Reimbursement/-6 T&M & LH, etc.). The report can be tailored to meet the surveillance needs for the requirement but as a minimum, it must contain the Services Summary with Performance

Ratings & explanation(s) for any PWS requirement rated above or below “Satisfactory” (See

Attachment 1 to Appendix 5 for definitions of Performance Ratings). The report shall identify both positive and negative performance. The report shall be signed and dated by the COR & CO and uploaded to the CORT Tool.

The COR will certify that acceptable services were received, in accordance with the terms and conditions of the contract. The COR will certify receipt of contractor services via the Wide Area

Workflow (WAWF) website. Certification of services shall be accomplished no later than seven

(7) calendar days after receipt of the invoice. To avoid payment of interest penalties, if the invoice is unacceptable, it should be rejected in WAWF within the first seven (7) calendar days after receipt of the invoice, and the CO should be notified immediately.

9.0 Contract Management

The MFT shall conduct periodic progress meetings to review the contractor’s performance. At these meetings, the CO will apprise the contractor of how the Government views the contractor’s performance and the contractor will apprise the Government of problems, if any, being experienced. The contractor will immediately notify the CO and/or COR of any work being performed that the contractor considers over and above the requirements of the contract.

Appropriate action shall be taken to resolve any outstanding issues (i.e. CPARS, customer complaint reports, etc.).

The MFT shall also provide any recommended changes to the QASP to the CO at the progress meetings or on an annual basis (at a minimum).

Initial Contract Performance Review: This evaluation shall take place within 30 days after the contractor assumes full performance responsibilities (i.e. after completion of transition/mobilization) to ensure the contractor has successfully started performance, completed transition, is fully operations, and is within the estimated cost, schedule, and performance parameters of the contract.

Initial Contract Performance Review Criteria

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

Schedule. Assess the timeliness of the contractor against contract requirements;

task orders, milestones, delivery schedule, administrative requirements, and sample negative and positive turnaround times (e.g., efforts that contribute to or affect the schedule variance).

Management/Performance. Assess the integration and coordination of all activity needed to execute the contract, specifically the completeness and quality of problem identification, corrective action plans, the contractor’s history of reasonable and cooperative behavior, customer satisfaction and management of subcontracts including progress on small business subcontracting goals.

Staffing. Assess the contractor’s performance in selecting, retaining, supporting and replacing when necessary, personnel.

Special Interest Items. N/A

COR Contract File: A contract file must be established and maintained by the COR. The COR shall maintain the file in a computer data base system using the Contractor Officer

Representative Tracking (CORT) Tool. Until notified otherwise, the COR shall also maintain a hard copy (paper) file. The COR will create a profile, complete the required training, and upload their certificates into the CORT Tool and then self-nominate by selecting their supervisor who will approve this action. Final approval, in CORT, is accomplished by the CO. Upon Approval, The CORT tool will be used to track CORs, contract documents, reports and all other documentation maintained in the hard copy COR file. The contents of the COR Contract file are shown at Appendix 6.

10.0 Coordination & Approval: The multi-functional team member signatures below indicate their coordination and acceptance/approval of the QASP for FAP USAFE. These signatures indicate coordination on the plan at the time of development and will remain in effect until the plan is changed.

QASP COORDINATION:

SHIRLEY M. HARRIS, GS-12, DAF Date

Primary COR/Program Manager

AF Family Advocacy Program

HQ AFMOA/SGHW

ROBERT E. FAUST, GS-13, DAF Date

Alternate COR/Director of Operations

AF Family Advocacy Program

AFMOA/SGHW

PERRY STANSBURY, Lt Col, USAF, MSC, CFAAMA Date

Chief, Medical Logistics – San Antonio

Air Force Medical Operations Agency (AFMOA/SGAL)

Joint Base San Antonio—Lackland

________________________________________ ___27 Oct 2014_

MS KARLA F. DODD, GS-13 Date

Contracting Officer

773 ESS/PKB

QASP APPROVAL:

________________________________________ ___27 Oct 2014__

MS KARLA F. DODD, GS-13 Date

QAPC

Appendix 1 – Services Summary (SS) and Method of Surveillance:

773 ESS/PKB

Staffing:

Performance Objectives PWS Para

Reference

Performance Threshold Surveillance

Method

Maintain contract staffing levels in accordance with

FAP OCONUS (USAFE)

Personnel Requirements and Locations Table

PWS Para 2.2.18.

Appendix A

Staff all locations at required levels throughout contract Period of Performance

At least 90% of the time

Periodic Inspection Quarterly

Submit contract Deliverables

IAW PWS

PWS Para 2.7 Submit reports to COR by 15th calendar day of each month.

Staffing Reports shall accurately reflect the current number of filled contract positions and the projected fill dates of vacancies at each location 100% Compliance

100%

Notify AFMOA/SGHW with name, position, location, and start date for new hires

PWS Para 2.2.23

Hiring of prospective contract employees shall be coordinated through the FAO unless delegated otherwise. 100% Compliance

Inspection (as event occurs)

FATM:

Reference

Performance Threshold Surveillance

Method

Meet with each military

(Active Duty) “Offender” categorized as “met criteria” at least monthly

PWS Para 2.1.1.7

AF FAP

Standard M-18

(Attachment 4)

Document all follow-up actions in FAPNET database.

At least 90% accountability of data files

Customer

Complaint

Follows up monthly with each adult “victims” of “met criteria” cases

Standard M-17

(Attachment 3)

Document all follow-up actions in FAPNETdatabase.

At least 90% accountability of data files

Customer

Complaint

Acceptable Peer Review results

PWS Para 1.2.1

AFI 44-119,

Medical Quality

Operations, Chapter 8

At least 85% of cases inspected are in compliance with standards of professional clinical therapies.

Customer

Complaint

Maintain current license in jurisdiction assigned

PWS Para 2.1.1.2

100% compliance

No Deviation 100% Inspection (As

*(note) Any administrative discrepancy or defect found in sample records constitutes an additional 10% of inspection sample up to 100% of total records in FAPNET database.

FAOM:

Performance Objective PWS Para

Reference

Performance Threshold Surveillance

Method

Administer New Personnel

Family Violence Education

And Training

PWS Para 2.1.2.1

AF FAP Standard

P-7

(Attachment 5)

Input all training data into

FAPNET database

Provide New Leader Orientation

Training identified in referenced paragraph within 60-days of arrival on Base

Minimum of 80% total personnel trained within timeframe

Periodic

Monthly

Inspection

Administer Leadership

Annual Family Violence

Education And Training

P-8

Provide Annual Leader Training

(commanders and first sergeants) within 180 days of new fiscal year

Minimum of 80% total leadership personnel trained within timeframe

Periodic

Monthly

Inspection

Manage Outreach Prevention

Automated Log Data Entry

PWS Para 2.1.2.17

P-13

(Attachment 8)

Document all relevant activities in

FAPNET

Update database monthly

At least 90% data shall be current

Monthly

Inspection

Maintain license in

PWS 2.2.1 100% compliance

(As event occurs)

FAIS:

Reference

Performance Threshold Surveillance

Method

Meet with each military

(Active Duty) “Offender” categorized as “met criteria” at least monthly

& 2.1.3.1

(Attachment 4)

Document all follow-up actions in FAPNET database.

At least 90% accountability of data files

Follows up monthly with

(Attachment 3)

Document all follow-up actions in FAPNET database.

At least 90% accountability of data files

Customer

Complaint

Operations, Chapter 8

At least 85% of cases inspected are in compliance with standard of professional clinical therapies.

Customer

Complaint

Maintain license in

PWS Para 2.1.3.3 event occurs)

Administer New Personnel

Family Violence Education

And Training

Input all training data into FAPNET database

Train all newly assigned personnel

(i.e, active duty) identified in referenced paragraph within 60-days of arrival on Base

Minimum of 80% total personnel trained within timeframe

Periodic

Monthly

Administer Leadership

Annual Family Violence

Education And Training

Train all squadron leadership

(commanders and first sergeants) within 180 days of new fiscal year

Minimum of 80% total leadership personnel trained within timeframe

Periodic

Monthly

Inspection

Manage Outreach Prevention

Automated Log Data Entry

PWS Para 2.1.2.17

Standard P-13

(Attachment 8)

Document all relevant activities in

FAPNET.

At least 90% of data shall be current

Periodic

Monthly

Inspection

*(note) Any administrative discrepancy or defect found in sample records constitutes an additional 10% of inspection sample up to 100% of total records in FAPNET database.

FAN:

Reference

Performance Threshold Surveillance

Method

Conduct home-visits for

“high-needs” clients

PWS Para 2.1.4.14 Update FAPNET database

For all “clients” enrolled cases (grid green; color code status)

Review FAPNET minimum 95% of all case assigned shall be current

Periodic Monthly

Administer “high-needs” record review checklist quarterly

PWS Para 2.1.4.11

P-14

Review 10% of assigned client records.

No more than four (4) discrepancies per record allowed.

Periodic

Quarterly

Maintain unrestricted state license in jurisdiction assigned

PWS Para’s 2.1.4.3 100% compliance

FAPA:

Reference

Performance Threshold Surveillance

Method

Submits maltreatment data to HQ AFMOA/SGHW after Clinical Case Staffing

PWS Para 2.1.5.2

Submit all validated cases to background check in

FAPNET database NLT the

Periodic Monthly

P-14 (Attachment 9)

15 calendar days after the CCS

Minimum of 90% accountability of files

Administer, process, and score quality control assessments/client questionnaires

PWS Para 2.1.5.6 No more than three (3) validated complaints per quarter.

Customer Complaint

Research, manage and provide data to FAP staff personnel

PWS Para 2.1.5.4 Research data as required for FAP staff.

No more than two (2) missed suspense’s per month

Compile maltreatment records and completes forms for Peer Review.

PWS Para 2.1.5.2 & 2.1.5.5

Comply with FAO suspense date set for Peer Reviews

No more than two (2) missed suspense’s per year and

Minimum of 90% accuracy required for pertinent forms

DAVA:

Reference

Performance Threshold Surveillance

Method

Develop Safety Plan & Document victim file

Review Safety Plan and document the file every time the victim meets with the DAVA

PWS Para 2.1.6.2

All victims shall be presented a tailored safety plan.

No deviations

100% Inspection (As event occurs)

Report changes in victim circumstances to designated authority if imminent risk of serious harm or death is established

PWS Para 2.1.6.4

Mandatory; up-channel changes under any circumstance of imminent risk of serious harm or death

Inspection (As event occurs)

Establish and maintain 24-hr contact/access for program victims/potential victims

PWS Para 2.1.6.1

Victims/potential victims are able to contact the DAVA when required 100% of the time

100%

Appendix 2 – Corrective Action Report

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’S 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

Appendix 3 – Customer Complaint Record

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

Appendix 4 – Performance Assessment Report

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’S 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 PWS 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

Appendix 5 -

“COR Services Summary Surveillance Report”

CONTRACT #:_______________________

SERVICE (FAP USAFE): ____________________________________________________

SURVEY PERIOD :_( sample: 1 – 31 Jan 2014) ________________________________

Staffing:

Reference

Performance Threshold Surveillance

Method

Performance

Rating

Maintain contract staffing levels in accordance with FAP

OCONUS (USAFE)

Personnel Requirements and Locations Table

PWS Para 2.2.18

Appendix A

Staff all locations at required levels throughout contract

Period of Performance

At least 90% of the time

See Appendix 5.a for Ratings & definitions

Submit contract Deliverables IAW PWS

PWS Para 2.7 Submit to COR by 15th calendar day of each month Staffing Reports shall accurately reflect the current number of filled contract positions and the projected fill dates of vacancies at each location 100% Compliance

Notify AFMOA/SGHW with name, position, location, and start date for new hires

PWS Para 2.2.23

Hiring of prospective contract employees shall be coordinated through the FAO unless delegated otherwise.

100% Compliance

(as event

FATM:

Reference

Performance Threshold Surveillance

Method

Performance

Rating

Meet with each military (Active Duty) “Offender” categorized as “met criteria” at least monthly

2.1.1.7

(Attachment 4)

Document all follow-up

At least 90% accountability of data files

Follows up monthly with each adult “victims” of

“met criteria” cases

2.1.1.7

(Attachment 3)

Document all follow-up

At least 90% accountability of data files

Operations, Chapter 8

At least 85% of cases inspected are in compliance with standards of professional clinical therapies.

Maintain current license in jurisdiction assigned

2.1.1.2

No Deviation

100% Inspection

*(note) Any administrative discrepancy or defect found in sample records constitutes an additional 10% of inspection sample up to 100% of total records in FAPNET database.

FAOM:

Reference

Performance Threshold Surveillance

Method

Performance

Rating

Administer New Personnel Family

Violence Education

And Training

2.1.2.1

Standard P-7

Provide New Leader Orientation Training identified in referenced paragraph within 60-days of arrival on Base

Minimum of 80% total personnel trained within timeframe

Periodic

Education And Training

2.1.2.1

Standard P-8

Provide Annual Leader

Training (commanders and first sergeants) within 180 days of new fiscal year leadership personnel trained within timeframe

Manage Outreach Prevention Automated Log Data Entry

2.1.2.17

(Attachment 8)

Document all relevant activities in FAPNET

At least 90% data shall be

Periodic

Maintain license in

PWS 2.2.1 100% compliance

FAIS:

Reference

Performance Threshold Surveillance

Method

Performance

Rating

Meet with each military (Active Duty) “Offender” categorized as “met criteria” at least monthly

2.1.1.7 & 2.1.3.1

(Attachment 4)

Document all follow-up

Follows up monthly with

2.1.1.7 & 2.1.3.1

(Attachment 3)

Document all follow-up

1.2.1

Operations, Chapter 8

At least 85% of cases inspected are in compliance with standard of professional clinical therapies.

Maintain license in

2.1.3.3

Administer New Personnel Family

Violence Education

And Training

2.1.2.1 & 2.1.3.1

Standard

Train all newly assigned personnel (i.e, active duty) identified in referenced paragraph within 60-days of arrival on Base personnel trained within timeframe

Periodic

Education And Training

2.1.2.1 & 2.1.3.1

Standard

Train all squadron leadership (commanders and first sergeants) within 180 days of new fiscal year leadership personnel trained within timeframe

Periodic

Manage Outreach Prevention Automated Log Data Entry

2.1.2.17

(Attachment 8)

Document all relevant activities in FAPNET.

At least 90% of data shall be

Periodic

*(note) Any administrative discrepancy or defect found in sample records constitutes an additional 10% of inspection sample up to 100% of total records in FAPNET database.

FAN:

Reference

Performance Threshold Surveillance

Method

Performance

Rating

Conduct home-visits for “high-needs” clients

2.1.4.14

Update FAPNET database For all “clients” enrolled cases (grid green; color code status)

Review FAPNET minimum 95% of all case assigned shall be current

Periodic Monthly

Inspection

Administer “high-needs” record review checklist quarterly

2.1.4.11

Standard P-14

Review 10% of assigned client records.

No more than four (4) discrepancies per record allowed.

Periodic

Maintain unrestricted state license in jurisdiction assigned

PWS Para’s 2.1.4.3

FAPA:

Reference

Performance Threshold Surveillance

Method

Performance

Rating

Submits maltreatment data to HQ AFMOA/SGHW after Clinical Case Staffing

PWS Para 2.1.5.2

P-14

(Attachment 9)

Submit all validated cases to background check in

FAPNET database NLT the 15 calendar days after the

CCS

Minimum of 90% accountability of files

Periodic

Administer, process, and score quality control assessments/client questionnaires

PWS Para 2.1.5.6 No more than three (3) validated complaints per quarter.

Research, manage and provide data to FAP staff personnel

PWS Para 2.1.5.4 Research data as required for FAP staff.

No more than two (2) missed suspense’s per month

Compile maltreatment records and completes forms for Peer Review.

PWS Para 2.1.5.2 & 2.1.5.5

Comply with FAO suspense date set for Peer Reviews

No more than two (2) missed suspense’s per year and Minimum of 90% accuracy required for pertinent forms

DAVA:

Reference

Performance Threshold Surveillance

Method

Performance

Rating

Develop Safety Plan & Document victim file

Review Safety Plan and document the file every time the victim meets with the DAVA

PWS Para 2.1.6.2

All victims shall be presented a tailored safety plan.

No deviations

100%

Report changes in victim circumstances to designated authority if imminent risk of serious harm or death is established

PWS Para 2.1.6.4

Mandatory; up-channel changes under any circumstance of imminent risk of serious harm or death

Establish and maintain 24-hr contact/access for program victims/potential victims

PWS Para 2.1.6.1

Victims/potential victims are able to contact the DAVA when required 100% of the time

100% Inspection

SERVICE or STANDARD (For Non-Service Summary Items found not meeting standards):

Service Provider’s Performance (Check): Meets Standards

Does Not Meet Standards

Narrative of Performance during Survey Period:

PREPARED BY: ____________________________________ DATE: _________________

(COR Name/Office Symbol)

CONTRACTING OFFICER: ___________________________DATE:_________________

(CO Name/Office Symbol)

Appendix 5.a

“Performance Ratings used for COR Services Summary Surveillance Report”

The evaluation ratings are as follows:

Excellent/Outstanding – 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 no problems and the contractor actions were highly effective.

Very Good - Performance meets contractual requirements and exceeds some to the Government’s benefit.

The contractual performance was accomplished with few minor problems for which corrective actions taken by the contractor were effective.

Satisfactory - Performance meets contractual requirements. The contractual performance contain some minor problems for which corrective actions taken by the contractor were satisfactory.

Marginal - Performance does not meet contractual requirements. The contractual performance 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 contains a serious problem(s) for which the contractor’scorrective actions appear or were ineffective.

Appendix 6

CONTRACTING OFFICER'S ANNUAL COR FILE INSPECTION CHECKLIST

(to be accomplished in the anniversary month of appointment) AND COR CONTRACT FILE INDEX

Contract Type A B C

Date File Review Accomplished Contract Exp:

Position Name

Request for

COR

Support Ltr (Date)

CLC 106

or CLC

222 Cert (Date)

CLM 003

Cert

(Date)

QAPC

COR

(COR I)

Trainin g (Date)

CO

Contract Specific

(COR II)

Training

(Date)

Nominati on

Complete (Dates) (Ltr &

CORT)

Designati on Ltr signed by all parties (last date signed)

Termination Ltrs

(Date)

SDO

COR SUP

COR

Alt COR

Does the COR File contain the following, as applicable:

(mark one location for each of the following)

NOTES:

1. COR shall be able to show CO the document(s) in the system. Not just state that's where it is.

2. The CORT Tool is not DoD 5015.2 Record System compliant. Therefore cannot be used as a location for COR files. However, use of CORT Tool is mandatory.

TOPICS TO DISCUSS

WAWF EDA

COR File (Hard or

Soft)

Other (Specify)

A Basic contract and all attachments and Task Order

B All Modifications to Basic contract and Task Orders

C PWS

D QASP (have COR explain QASP)

E Contractor's Quality Control Plan (CQCP)

F Surveillance Inspection Reports

G QASP being followed? (SDS items, type of inspection, etc)

H Did the contractor receive formal notification of unacceptable inspections? Conversations with the contractor documented?

I Customer Complaint Records

J Corrective Action Report(s)

K Minutes of Post-Award Conference (if applicable)

L

Minutes of Initial Contract Performance Review IAW AFI 63-101

4.9 (taken place w/I 30 days after the contractor assumes full performance responsibilities or waiver from SDO).

M Documentation showing control/disposition/monitoring of GFP (if applicable)

N OPSEC CLC 107 training certificate

O Trafficking in Person certificate

P WAWF training certificate

CONTRACTING OFFICER'S ANNUAL COR FILE INSPECTION CHECKLIST Page 2 of 2

CONTRACT NUMBER

COMMENTS:

Printed Name

SIGNATURE DATE

COR

CO or Contract Administrator

Contracting person performing inspection

QAPC