Attachment_F_-_Quality_Assurance_Monitoring_Form.docx

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Fuels Reduction and Roadway Management Project - VCNP
Solicitation number
P15PS02505
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Attachment F - Quality Assurance Monitoring Form

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QUALITY ASSURANCE MONITORING FORM

SERVICE or STANDARD:

SURVEY PERIOD:

SURVEILLANCE METHOD (Check):

Random Sampling 100% Inspection Periodic Inspection Customer Complaint LEVEL OF SURVEILLANCE (Check):

MonthlyQuarterlyAs needed
PERCENTAGE OF ITEMS SAMPLED DURING SURVEY PERIOD:______ %

ANALYSIS OF RESULTS:

Observed Service Provider Performance Measurement Rate: ______%

Service Provider’s Performance (Check):Meets Standards
Does Not Meet Standards

Narrative of Performance during Survey Period:

PREPARED BY: ___________________________________ DATE: _________________

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