Attachment_3_QASP_-_FAP_West_-_30_Dec_15.pdf

AIR FORCE MEDICAL OPERATIONS AGENCY

QUALITY ASSURANCE SURVEILLANCE PLAN

FOR

FAMILY ADVOCACY PROGRAM (FAP) Western Region of the Continental United States (CONUS)

AFMOA/SGHW

30 December 2015

QUALITY ASSURANCE SURVEILLANCE PLAN (QASP) For

FAMILY ADVOCACY PROGRAM (FAP) Continental United States (CONUS) West

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) 6

6.0 Performance Requirements and Method(s) of Surveillance 6

7.0 Surveillance Documentation 7

8.0 Acceptance of Services 8

9.0 Contract Management 8

10.0 Coordination and Approval 10

Appendices:

1. Services Summary (SS) and Method of Surveillance 13

2. Corrective Action Report (CAR) 20

3. Customer Complaint Record 22

4. Performance Assessment Report (PAR) 20

5. Sample COR Services Summary Surveillance Report 25

6. Performance Ratings used for COR Services Summary 25

Surveillance Report

7. COR File Table of Contents

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 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

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.

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

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.

Methods of Surveillance:

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.

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.

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

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 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 5 th business day of each month. The CO may agree to print 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 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 MTF 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 contractors 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.

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 4.

10.0 Coordination & Approval: The multi-functional team member signatures below indicate their coordination and acceptance/approval of the QASP for the FAMILY ADVOCACY PROGRAM (FAP) Continental United States

(CONUS) West. 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

AF Family Advocacy Program

ROBERT E. FAUST, GS-13, DAF Date

Alternate COR

Director of Operations

AF Family Advocacy Program

NATHANIEL DECKER, Lt Col, USAF, MSC, Date

Chief, Medical Logistics - San Antonio

Air Force Medical Operations Agency (AFMOA/SGAL)

Joint Base San Antonio – Lackland

KARLA F. DODD, GS-13, DAF Date

Contracting Officer

773 ESS/PKB

1145507428C Typewritten Text 22 Jan 16

1145507428C

CHRISTAL E. JACKSON, GS 12, DAF Date

QAPC

1111795386C

25 Jan 16

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

Staffing:

Performance Objectives PWS Para

Reference

Performance Threshold Surveillance

Method Maintain contract staffing levels IAW FAP West

Personnel Requirements & location Table

2.2.18 Appendix A

At least 95% staffed 100% of the time

Periodic Inspection Quarterly

Submit Staffing Report 2.2.19 No more than five (5) late

Deliverables during the l ife of the contract

100% Inspection

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

2.7 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. Document all follow-up actions in FAPNET database

2.1.1.7

AF FAP

Standard M-18

Appendix J

At least 90% accountability of data files

Customer Feedback (Valid Complaint Record)

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

Standard M-17

At least 90% accountability of data files

Customer Feedback (Valid Complaint Record)

Acceptable Peer Review results

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 Feedback (Valid Complaint Record)

Maintain current U.S license in jurisdiction assigned

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

Input all training data into

FAPNET database

Provide New Leader Orientation

Training identified in referenced paragraph within 60 days of

2.1.2.1

AF FAP Standard

P-7

Minimum of 80% total personnel trained within timeframe

Periodic

Monthly

Inspection

Input all training data into FAPNET database

Provide Annual Leader Training

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

Administer Leadership

Annual Family Violence

Education And Training

PWS Para 2.1.2.1

Minimum of 80% total leadership personnel trained within timeframe

Periodic

Monthly

Inspection

Manage Outreach Prevention

Automated Log Data Entry

Document all relevant activities in

FAPNET

Update database monthly

2.1.2.17

P-13

100% Compliance

Inspection (As event occurs)

Maintain current license in the state in which the individual’s license is issued

2.1.2.1 100% compliance 100% Inspection (As event occurs)

FAIS:

Reference

Performance Threshold Surveillance

Method

Meet with each military

(Active Duty) “Offender” categorized as “met criteria” at least monthly and document all follow-up actions in FAPNET

Para 2.1.3.19

At least 90% accountability of data files

Customer Feedback (Valid Complaint Record)

Follows up monthly with adult “victims” of “met criteria” cases Document all follow-up actions in

FAPNET database.

2.1.3.19

Customer Feedback (Valid Complaint Record)

Operations, Chapter 8

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

Customer Feedback (Valid Complaint Record)

Maintain U.S license in jurisdiction assigned

2.1.3.3 100% compliance 100% Inspection (As event occurs)

Train all newly assigned personnel (i.e. active duty) identified in referenced paragraph within 60-days of arrival on Base Input all training data into FAPNET database

2.1.3.14.1

Minimum of 80% total personnel trained within 60- days of arrival on Base

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 Input all training data into

Minimum of 80% total leadership personnel trained within 60 days of arrival

Periodic

Monthly

Inspection

Manage Outreach Prevention

Automated Log Data Entry

Standard P-13

Document all relevant activities in

FAPNET.

Update database monthly

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

Update FAPNET database For all

“clients” enrolled cases

(grid green; color code status)

Review FAPNET

2.1.4.6 Minimum 95% of all case

assigned shall be current

Periodic Monthly

Customer Feedback (Valid Complaint Record)

Administer “high-needs” record review checklist quarterly

2.1.4

P-14

Review 10% of assigned client records.

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

Periodic

Quarterly

(Valid Complaint Record)

Maintain unrestricted state license in jurisdiction assigned

2.1.4.3 100% compliance 100%

FAPA:

Reference

Performance Threshold Surveillance

Method

Submits maltreatment data to HQ AFMOA/SGHW after Clinical Case Staffing Submit all validated cases to background check in FAPNET database NLT the 15 calendar days after the CCS

2.1.5.2

Minimum of 90% accountability of files

Periodic Monthly

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

2.1.5.6 No more than three (3) validated

complaints per quarter.

Customer Feedback (Valid Complaint Record) Research, manage and provide data to FAP staff personnel

2.1.5.6 Research data as required for

FAP staff.

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

Customer Feedback (Valid Complaint Record)

Compile maltreatment records and completes forms for Peer Review.

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

Customer Feedback (Valid

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 6. CONTROL

DATE 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 West):

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

2.2.18

Staff all locations at required levels throughout contract

Period of Performance

At least 90% of the time

Periodic

See Appendix 5.a for Ratings & definitions

Submit contract Deliverables IAW PWS

2.2.19 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

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

2.7 Hiring of prospective

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

(as event

FATM:

Reference

Performance Threshold Surveillance

Method

Performance

Rating

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

Appendix J

At least 90% accountability of data files

Customer Feedback (Valid

Follows up monthly with each adult “victims” of

“met criteria” cases

At least 90% accountability of data files

Customer Feedback (Valid

Operations, Chapter 8

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

Customer Feedback (Valid

Maintain current license in jurisdiction assigned

2.1.1.2 100% compliance 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

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

Standard P-8

Provide Annual Leader Training (commanders and first sergeants) within 180 days of new fiscal year

Periodic leadership personnel trained within timeframe

Manage Outreach Prevention Automated Log Data Entry

2.1.2.17

Document all relevant activities in FAPNET

At least 90% data shall be

Periodic

Maintain license in jurisdiction assigned

2.1.2.1 100% compliance 100% Inspection

FAIS:

Reference

Performance Threshold Surveillance

Method

Performance

Rating

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

Document all follow-up actions in FAPNET

Customer Feedback (Valid

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

Document all follow-up actions in FAPNET

Customer Feedback (Valid

Operations, Chapter 8

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

Customer Feedback (Valid

Maintain license in jurisdiction assigned

2.1.3.3 100% compliance 100%

Administer New Personnel Family

Violence Education

And Training

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

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

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

2.1.4.6 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

(Valid

Administer “high-needs” record review checklist quarterly

Standard P-14

Review 10% of assigned client records.

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

Periodic

(Valid

Maintain unrestricted state license in jurisdiction assigned

2.1.4.3 100% compliance 100% Inspection

FAPA:

Reference

Performance Threshold Surveillance

Method

Performance

Rating

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

2.1.5.2

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

2.1.5.6 No more than three (3)

validated complaints per quarter.

Research, manage and provide data to FAP staff personnel

2.1.5.6 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.

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

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:

(COR Name/Office Symbol)

DATE:

CONTRACTING OFFICER: DATE:

(CO Name/Office Symbol)

Appendix 5.a

“Performance Ratings used for COR Services Summary Surveillan ce 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

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

Reque st for

COR

Suppo rt Ltr (Date)

CLC

or

CLC

Cert (Dat e)

CLM

Cert

(Date)

QAPC

COR

(COR I)

Training (Date)

CO Contract Specific

(COR II)

Training

(Date)

Nominati on

Complete (Dates) (Ltr &

CORT)

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

Terminati on 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

WAW

F

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

CONTRACT NUMBER

COMMENTS:

Printed Name

SIGNATURE DATE

COR

CO or Contract Administrator

Contracting person performing inspection

QAPC