J.3 Contractor Performance Self-Assessment Template.pdf

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Environmental Health and Safety Services Support
Solicitation number
PSC-FOH-EHSS-PSC337177
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This is a Contractor Performance Self-Assessment template form used to evaluate contractor performance across multiple evaluation areas. The form includes rating categories for Quality, Schedule, Cost Control, Management, Small Business Subcontracting, Regulatory Compliance, and up to four additional "Other Areas" that can be customized.

The template provides a standardized rating scale (Exceptional, Very Good, Satisfactory, Marginal, Unsatisfactory, or N/A) for each evaluation area and requires detailed narrative comments to substantiate the ratings. The form includes comprehensive rating definitions explaining the criteria for each performance level. For example, an "Exceptional" rating requires identifying multiple significant beneficial events for the government with no significant weaknesses, while an "Unsatisfactory" rating indicates serious problems with ineffective corrective actions. The form must be completed with contractor information, contract/order numbers, performance period dates, and requires signature by an authorized representative.

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CONTRACTOR PERFORMANCE SELF-ASSESSMENT

INSTRUCTIONS: Provide a detailed narrative and rating for each of the relevant evaluation areas. Narratives must substantiate your rating selection. The contractor should use the Guidance for the Contractor Performance Assessment Reporting System (CPARS) to assist in preparation of the self-assessment. If further direction is required on how to complete this self-assessment or where to submit it, please contact your Contracting Officer.

CONTRACTOR

CONTRACT

NUMBER

ADDRESS

ORDER

NUMBER

CITY / STATE/ ZIP

PERIOD OF

PERFORMANCE

BEING

ASSESSED

FROM TO

CONTRACTING

OFFICER’S REP

CONTRACTING

OFFICER

1. Quality N/A Exceptional Very Good Satisfactory Marginal Unsatisfactory

COMMENTS:

2. Schedule N/A Exceptional Very Good Satisfactory Marginal Unsatisfactory

3. Cost Control N/A Exceptional Very Good Satisfactory Marginal Unsatisfactory

4. Management N/A Exceptional Very Good Satisfactory Marginal Unsatisfactory https://cpars.gov/documents/CPARS-Guidance.pdf

5. Small Business Subcontracting N/A Exceptional Very Good Satisfactory Marginal Unsatisfactory

6. Regulatory Compliance N/A Exceptional Very Good Satisfactory Marginal Unsatisfactory

7. Other Area:

N/A Exceptional Very Good Satisfactory Marginal Unsatisfactory

8. Other Area:

N/A Exceptional Very Good Satisfactory Marginal Unsatisfactory

9. Other Area:

N/A Exceptional Very Good Satisfactory Marginal Unsatisfactory

10. Other Area:

N/A Exceptional Very Good Satisfactory Marginal Unsatisfactory

Additional comments to support your response to any item above.

Completed by:

Name:

Title:

Phone Number:

Email Address:

Signature:

Date:

EVALUATION RATING DEFINITIONS

RATING

DEFINITION

NOTE

Exceptional Performance meets contractual requirements and exceeds many to the Government’s benefit. The contractual performance of the element or sub-element being evaluated was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

To justify an Exceptional rating, identify multiple significant events and state how they were of benefit to the Government. A singular benefit, however, 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 evaluated was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

To justify a Very Good rating, identify a significant event and state how it was a benefit to the Government. 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.

To justify a Satisfactory rating, there should have been only minor problems, or major problems the contractor recovered from without impact to the contract/order.

There should have been NO significant weaknesses identified. A fundamental principle of assigning ratings is that contractors will not be evaluated with a rating lower than Satisfactory solely for not performing beyond the requirements of the contract/order.

Marginal Performance does not meet some contractual requirements. The contractual performance of the element being assessed 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.

To justify Marginal performance, 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 management tool that notified the contractor of the contractual deficiency (e.g., management, quality, safety, or environmental deficiency report or letter).

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.

To justify an Unsatisfactory rating, identify multiple significant events in each category that the contractor had trouble overcoming and state how it impacted the Government. A singular problem, however, 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).

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