2.04d Attachment IV - Contractor_Discrepancy_Form.pdf

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CONSTRUCTION SAFETY COURSES
Solicitation number
N0018922Q0120
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CONTRACTOR DISCREPANCY REPORT

CONTRACT NO.: TBD

TASK ORDER NO: N/A

DATE:

TO: (Contractor’s name and address)

FROM: (Facility Name and address, including COR)

DISCREPANCY (INCLUDE REFERENCE):

SIGNATURE OF COR: DATE:

TO: (Facility name and address, including COR)

FROM : (Contractor’s name and address)

CONTRACTOR RESPONSE AS TO CAUSE AND CORRECTIVE ACTION TAKEN:

SIGNATURE OF CONTRACTOR’S REP: DATE:

GOVERNMENT COMMENT ON RESPONSE:

SIGNATURE OF COR: DATE:

SIGNATURE OF CONTRACTING OFFICER: DATE:

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