QASP_Maintenance_of_Gov_owned_Washers__Dryers_2018.docx

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Maintenance of Government owned Washers & Dryers

Quality Assurance Surveillance Plan

Version #1 dated 8 Aug 2018

SUMMARY OF CHANGES

Revision History

REV
Description of Change
Author/ Editor
Effective Date
Rafael Duarte
08 Aug 2018

TABLE OF CONTENTS

Subject Page

1. Overview

1.1. Purpose4
1.2. Intent4
1.3. Scope4

2. Description of Services

2.1. Scope of Work5
2.2. Contract5

3. Roles and Responsibilities

3.1. Contracting Officer5
3.2. Contractions Specialist/Administrator5
3.3. Contracting Officer’s Representative5

4. Roles and Responsibilities of Contractor 6

5. Contract Quality Requirements 6

6. Government Surveillance

6.1. Methods of Quality Assurance7
6.2. Monthly Surveillance Schedule7
6.3. Inspection Instructions/Checklists8
6.4. Documentation of Inspections8
6.5. Combat Trafficking in Persons8

7. Conformance Standards

7.1. Rating Criteria10
7.2. Non-Conforming Performance11
7.3. Contract Deficiency Reports11

8. Data Analysis 11

9. Acceptance of Services 12

10. Monthly COR Activity Report 12

11. Contractor Manpower Reporting (CMR) 12

12. Quality Assurance Surveillance File 12

13. Contractor Performance Assessment Reporting System (CPARS) 12

14. Reference Materials 13

1. OVERVIEW

1.1. Purpose. The purpose of the QASP is to describe the systematic methods used to monitor performance and to identify the required documentation and the resources to be employed. The QASP provides a means for evaluating whether the Contractor is meeting the performance standards/quality levels identified in the PWS and the Contractor’s quality control plan (QCP), and to ensure that the Government pays only for the level of services received.

1.1.1. This QASP does not detail how the Contractor accomplishes the work. Rather, the QASP is created with the premise that the Contractor is responsible for management and quality control actions to meet the terms of the contract. It is the Government’s responsibility to be objective, fair, and consistent in evaluating performance. In addition, the QASP should recognize that unforeseen and uncontrollable situations may occur.

1.2. Intent. The intent of this plan is to hold the Contractor accountable for quality control and to encourage the Contractor to take appropriate steps to control and improve quality. The Contractor is responsible to develop an efficient methodology to ensure they meet and/or exceed the required thresholds of service as outlined in this acquisition. The Government intends to perform surveillance on this contract in accordance with this Quality Assurance Surveillance Plan (QASP), but reserves the right to monitor the contract in any manner necessary, at any times necessary, and at all places necessary to ensure that the rendered services conform to contract requirements. The Government reserves the right to perform quality assurance at the subcontract level and perform quality assurance at the Contractor's place of business, if applicable. Non-conforming services discovered with subcontractors will be addressed with the prime Contractor for resolution.

1.3. Scope. It is important to understand the responsibilities of the parties and distinguish between the quality control plan and the QASP. The Contractor is responsible for managing and developing a quality control (QC) plan to meet the quality standards established in the performance work statement (PWS). The QASP is put in place to provide the Government surveillance and oversight of the Contractor’s efforts in fulfilling the terms of the contract. The QASP is not part of the contract nor is it intended to duplicate the Contractor’s quality control plan.

1.3.1. This QASP is a “living document” and the Government may review and revise it on a regular basis. However, the Government shall coordinate changes with the Contractor. Updates shall ensure that the QASP remains a valid, useful, and enforceable document. Copies of the original QASP and revisions shall be provided to the Government officials implementing surveillance activities.

1.3.2. Revisions to this QASP are the joint responsibility of the Requiring Activity, Contracting Officer and Contracting Officer’s Representative. The Contracting Officer’s Representative reviews the PWS and QASP annually or as issued modification change a need and will provide proposed changes through the Requiring Activity Command to the Contracting Officer for review and approval.

2. DESCRIPTION OF SERVICES

2.1. Scope of Work. This contract includes all functions, tasks and responsibilities normally performed by a Washer and Dryer maintenance service provider. Contractor will provide all equipment, which will comply with the specifications as outlined herein. Equipment which is marred, deeply scratched, dented, broken or substandard in any way, will not be accepted for use. Equipment shall be coin-free service, in multiple operational types such as electric and gas. The number and types of machines specified to replace those unserviceable while in use. Contractor shall have the capability of replacing machines in new, random locations and/or additional machines in location where machines are currently in operation. Contractor shall remove or install and maintain washers and dryers throughout Fort Bliss Operational Area as indicated in attachment 2. Note: Locations and quantities may change pending Troop Movement and fluctuations, average change is 5% per year IAW historical data. Contractor shall exercise reasonable care to avoid any practices that may adversely affect the environment which may, in turn place the Government in a controversial position. Contractor shall comply with all applicable laws and regulations, including but not limited to Federal Law, New Mexico and Texas State Law(s), Occupational Safety and Health Administration (OSHA) regulations, Army and installation regulations.

2.2. Contract. This contract has been issued as a Firm Fixed Price (FFP). IAW contract regulation this QASP is designed to ensure and identify quality services are provided as acquired under this contract. The following clauses apply specifically toward quality assurance and require COR specific attention: FAR Part 4 – Administrative Matters, Part 37 – Service Contracting, Part 43 – Contract Administration and Audit, Part 45 – Government Property, Part 46 – Quality Assurance, Part 52.246-4 – Inspection of Services - - Fixed Price.

3. ROLES AND RESPONSIBILITIES

3.1. Contracting Officer (KO). The KO has overall responsibility for overseeing the Contractor’s performance. The KO is responsible for the day-to-day monitoring of the Contractor’s performance in the areas of contract compliance, and contract administration; reviewing the COR’s assessment of the Contractor’s performance; and resolving all differences between the COR’s assessment and the Contractor’s assessment of performance. The KO ensures compliance with the terms of the contract and safeguards the interests of the United States in the contractual relationship. Only the KO is authorized to bind the Government and then, only to the extent of the authority delegated to them through the issuance of a warrant. It is the KO that assures the Contractor receives impartial, fair and equitable treatment under the contract. The Contracting Officer is ultimately responsible for the final determination of the adequacy of the Contractor’s performance.

3.2. Contract Specialist/Administrator. The official Government representative delegated authority by the Contracting Officer to administer a contract. This individual is normally a member of the appropriate Contracting/Procurement career field and advises on all technical contractual matters.

3.3. Contracting Officer’s Representative (COR). The COR is an individual designated in writing by the KO to provide detailed technical oversight of the Contractor’s performance and reports his or her findings to the Contracting Officer in a timely, complete and impartial fashion to ensure the Government receives the services procured in accordance with the PWS. While the COR may serve as a direct conduit to provide Government surveillance and feedback to the Contracting Officer on the Contractor’s technical performance, he or she is not empowered to make any contractual commitments or authorize any contractual changes on the Government’s behalf. Any changes that may affect contract price, terms, or conditions shall be referred to the Contracting Officer for action.

3.3.1. The COR conducts and maintains surveillance documentation.

3.3.2. The COR recommends improvements to the QASP and PWS throughout the life of the contract.

4. ROLES AND RESPONSIBILITIES OF CONTRACTOR

4.1. Onsite Supervisor (OS). Responsible for running complex programs and projects. Supervises the project team and manages conflicts within different departments. Plans and sets project goals and milestones and develops risk management strategies. Defines resources and schedules for the implementation of the program. Clearly defines requirements and sets targets accordingly. Recognizes areas for internal improvement and develops plans for implementing the improvements. The Contractor shall provide in writing a contract manager and alternate to the Contracting Officer within 10 calendar days after contract award, thereafter any changes shall be provided five (5) business days prior to expected change and no less than 24-hours after unplanned changes. The OS or alternate shall have full authority to act for the Contractor on all contract matters relating to daily operation of this contract. Appointed employee will be available for consultation with the Contracting Officer Representative (COR) or their representative. The OS or alternate shall be available between 0730 to 1630 hours, Monday through Friday except Federal holidays or when the Government facility is closed for administrative reasons.

5. CONTRACT QUALITY CONTROL REQUIREMENTS

5.1. Quality Control Plan. The Contractor's Quality Control Plan (QCP) requirements are defined in paragraph 1.6 of the PWS. The Contractor shall develop and maintain an effective QCP which incorporates the development and implementation of procedures to identify, prevent, and ensure non-recurrence of defective services. As a minimum the QC plan will address the areas identified in the Performance Requirements Summary (PRS). The application of the QC program/procedures will assure the Contractor meets the requirements of this contract. The Contractor shall provide to the Government their quality control documentation within 30 calendar days after contract award; changes to the QCP after award shall be submitted to the Contracting Officer (KO) and Contracting Officer’s Representative (COR) within five (5) working days prior to the proposed changes thereafter. After acceptance of the quality control plan the Contractor shall receive the Contracting Officer’s acceptance in writing of any proposed change to their QC System in regard to this contract

5.2. Government Quality Assurance. The Government will perform Quality Assurance oversight of the Contractor and Contractor’s QCP IAW with this QASP to ensure acceptable levels of contract performance are achieved and that the Contractor is performing acceptable levels of Quality Control to ensure fully acceptable services are provided.

6. GOVERNMENT SURVEILLANCE

6.1. Methods of QA Surveillance. The method of surveillance is based on the performance criteria of the contract terms and specifications. Each requirement will describe the tasks to be performed and the standard for successful performance. The specific surveillance method for each performance standard and acceptable quality level is listed in the “Surveillance Method” column of the Performance Requirement Summary (PRS). The Government intends to monitor and evaluate the Contractor's performance based on any or all of the following five (5) surveillance methods:

6.1.1. 100 Percent Inspection. Performance will be inspected/evaluated at each occurrence as noted on the surveillance schedule. Primarily utilized for measurable related to health, safety and other critical considerations.

6.1.2. Periodic Inspection. This method consists of selected surveillance tasks by the Government, generally on a planned schedule that does not require 100% inspection, or are performed on a random/infrequent basis. The COR will evaluate the Contractors reports, surveys, etc. on a weekly, biweekly, monthly or quarterly basis.

6.1.3. Random Inspections. This method is designed to evaluate the outputs of the award requirement by observation on an unscheduled basis.

6.1.4. Periodic/Random Sampling. Review Contractor procedures for proper application weekly, biweekly, monthly or quarterly basis. A randomization tool such as the one recommended by DAU at http://www.randomizer.org/ shall be used in creating and selecting true random sets.

6.1.5. Customer Feedback. Customer feedback may be obtained either from the results of formal customer satisfaction surveys or from random customer complaints. Customer complaints, to be considered valid, must set forth clearly and in writing the detailed nature of the complaint, must be signed or emailed and forwarded to the PM or COR who will assess the validity of the complaint and retain it in a documentation file. The PM shall also keep the tabulated results of all customer satisfaction surveys on file. The results of all monitoring activity shall be documented on the Surveillance Checklist or Activity Summary Form. This form will be developed by the requiring activity and provided to the Contracting Officer on a monthly basis. For customer feedback or complaints it is recommended that the Customer Complaint Record DA Form 5477 http://armypubs.army.mil/eforms/pdf/A5477.PDF be used. However customer feedback can be in any form, verbal or written but no matter the format the COR will maintain a record of the feedback positive or negative.

a. If immediate response to a complaint is required, the COR will provide the response to the requester as soon as practical.

b. The COR will conduct an investigation to determine the validity of any negative comments received.

c. If the negative comment is determined not to be valid, if possible, the COR will inform customer of the reason(s) as soon as practical.

d. For validated negative comments that are true contractual non-conformances see paragraph 6. If this non-conformance is a more serious (systemic in nature) deficiency or recurring deficiency that could indicate a trend the COR should see paragraph 6.2.

e. The COR will follow up with the customer of the corrective action taken by the Contractor, if applicable.

6.2. Monthly Surveillance Schedule. The COR will develop a monthly schedule of surveillance activities based on the Performance Standards as outlined in the Performance Requirements Summary (PRS) as well as any other critical contractual requirements determined to be higher risk requiring oversight. The surveillance outlined in the monthly schedule will be as detailed and in-depth as necessary to provide the Government with the objective quality evidence required to support acceptance of the services provided by the Contractor. The schedule will provide planned periodic surveillance during all required hours of the Contractor’s operation. The schedule is “FOR OFFICIAL USE ONLY” and is not releasable to anyone other than authorized Government personnel. The schedule will identify the method of surveillance, the date of inspection, place of inspection, activity to be monitored, and who will conduct the surveillance (dates and times can be altered without a formal change to the schedule as long as all inspections are performed). The DA Form 5475-R (COR/QAE Surveillance Schedule) http://armypubs.army.mil/eforms/pdf/A5475.PDF may be tailored to be used for this purpose. The monthly schedule will be completed no later than seven (7) calendar days prior to the beginning of the period it covers and a copy loaded within the VCE-COR module for the KO to review.

6.3. Inspection Instructions/Checklists. The COR will develop inspection instructions/checklists for all planned inspections which may require special instructions on how to perform the inspection, what observations should be made with specific details of what to look for acceptable performance. The Surveillance Activity Checklists, DA Form 5476 http://armypubs.army.mil/eforms/pdf/A5476.PDF may be tailored to be used for this purpose or the form attached, Surveillance Checklist.

6.4. Documentation of Inspections. All inspections/observations will be documented and will include as a minimum date and time, who performed the inspection, what was inspected, to what standard and the results. Successful or exceptional performance will be documented as well as deficiencies in Contractor performance. Documentation will be maintained for future reference, audit, proof of inspection, and past performance documentation. The Tally Checklist DA Form 5481 http://armypubs.army.mil/eforms/pdf/A5481.PDF may be tailored to be used for this purpose.

6.5. Combat Trafficking in Persons. DoD has a particular duty to act, because human trafficking is a direct threat to our national security. FAR 52.222-50 – Combating Trafficking in Persons is a mandatory clause on all contracts. CORs must be aware of how Contractors treat their employees. CORs are the first line of defense in the battle against human trafficking. CORs must complete Combating Trafficking in Persons training annually. CORs must be diligent in ensuring that Contractors and Contractor personnel are not trafficking in persons. The COR must inform the Contracting Officer if the Contractor, Contractor personnel, subcontractor, or subcontractor personnel have failed to comply with the requirements of the clause at FAR 52.222-50.

6.5.1. DoD has a zero tolerance policy for human trafficking. As the COR monitors the Contractor and its employees, Combating Trafficking in Persons should rank among the COR’s chief priorities.

6.5.2. CORs should not personally investigate suspected incidents of Trafficking in Persons but should forward all reported or suspected violations to the Contracting Officer immediately.

7. CONFORMANCE STANDARDS

7.1. Rating Criteria.

Performance Rating
Criteria
Excellent / Outstanding
Performance meets contractual requirements and exceeds many to the government’s benefits. The contractual performance of the element or sub-element being assessed was accomplished with no problems and Contractor actions were highly effective.
Very Good
Performance meets contractual requirements and exceeds some to the government benefits. The contractual performance was accomplished with few minor problems for which corrective actions taken by the Contractor were effective
Good
Performance does not meet some contractual requirements. The contractual performance contains some minor problems for which corrective actions taken by the Contractor were satisfactory.
Marginal
Performance does not meet some contractual requirements. The contractual performance reflects a serious problem for which the Contractor has not yet identified corrective actions. The Contractors proposed actions appear 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 serious problem(s) for which the Contractor’s corrective actions appear or were ineffective.

7.2. Non-Conforming Performance. All Contractor non-conformances with contract requirements will be documented. Maintaining documentation of all contractor non-conformances is part of contractor past performance data and can be used to identify negative performance trends.

7.2.1. All non-conformances shall be documented at the time discovered. The COR documentation will include the contract number and order number, reference to the specific contract requirement, the specific deficiency to the requirement, where it was discovered, the date and time it was discovered, focal point for the Contractor who was notified, and suspense date for the Contractor response.

7.2.2. Non-conformances shall be classified in one of three categories: Level I (Minor), Level II (Major) or Level III (Critical).

a. Level I (Minor). Is defined as a non-conformance that is not likely to materially reduce the usability of the supplies or services for their intended purpose, or is a departure from established standards having little bearing on the effective use or operation of the supplies or services. Minor non-conformances usually can be corrected on the spot, where no further corrective action (CA) response is necessary, and can be issued to the contractor either through a verbal or written Contract Discrepancy Report (CDR). However, even verbal CDR(s) are still required to be documented by the government. Verbal Level I CDRs may be issued directly to the appropriate level of Contractor management by the COR. The COR will notify the KO when CDRs are issued and document them on a tally checklist, DA Form 5481 http://armypubs.army.mil/eforms/pdf/A5481.PDF, and include them in their monthly reports. Written CDRs will be signed and issued by the KO.

b. Level II (Major). Is defined as a non-conformance, other than critical, that is likely to result in failure of the supplies or services and/or to materially reduce the usability of the supplies or services for their intended purpose. Deficiencies that are recurring (a number of Level I non-conformance documented by the government) or for a non-responsive Contractor indicating a trend or failure of the Contractor’s quality control can also be classified as a Level II CDR. The KO will issue all Level II CDRs in writing with the information provided by the COR.

c. Level III (Critical). Is defined as a non-conformance that is likely to result in hazardous or unsafe conditions for individuals using, maintaining, or depending upon the supplies or services; is likely to prevent performance of a vital agency mission; is for a repeated or uncorrected Level II CDR; or is for a non-responsive Contractor to a Level II CDR. The KO will issue all Level II CDRs in writing with the information provided by the COR.

7.3. Contract Deficiency Reports. All CDRs will be accomplished using the DA Form 5479-R http://armypubs.army.mil/eforms/pdf/A5479.PDF. This is a standard Department of Army form which is not specific to ACC or MICC so areas of the form designated for use by the QAE should be completed by the COR instead. For COR issued Level I CDRs the CDR number and level will be documented in block four of the form. The unique CDR number will consist of the Requiring Activity (RA) Department of Defense Activity Address Code (DoDAAC), a dash, last two digits of the year, a dash, then a four digit sequential number starting with 0001, i.e. W911SG-13-0001.

7.3.1. The COR will forward copies of CDR to the KO within one working day and load all verbal Level I CDRs and tally checklist within the VCE-COR module.

7.3.2. The KO will notify the Contractor and request corrective action to the specific non-conformance(s), identification of the root cause and corrective action for the root cause with a required suspense date. The KO may require the Contractor to re-perform any services that do not meet contract requirements at no additional cost to the Government.

7.3.3. The KO and COR will not consider the CDR closed until all deficiencies have been corrected and all agreed upon actions of the Corrective Action Plan (CAP) have been completed. Contractor’s failure to follow through and complete corrective actions will be reported immediately to the KO for further action. (Note: if the COR has to repeatedly perform re-inspection there could be a Government re-inspection cost which could be recovered from the Contractor). The COR will also follow-up after the Contractor has completed the corrective action to ensure that the Contractor’s corrective action was sufficient to preclude recurrence.

8. Data Analysis. COR shall perform and document analysis of available data monthly and make adjustments to surveillance schedule as required based on results of analysis. Analysis shall be used to look for and document trends in performance which may indicate shifts in performance risk that could result in increased or reduced surveillance. Data can be based on Government observations or Contractor observations. Negative trends noted using Government observations could result in issuing Contractor a Contract Deficiency Report (CDR). Trends noted using Contractor data should never result in a CDR unless the Contractor is not addressing the negative trend. Documentation of data analysis will be in the Monthly COR Activity Report.

9. Acceptance of Services. When all services have been deemed acceptable and there is documented objective quality evidence to support acceptable performance the COR will accept the services provided and authorize payment upon satisfactory completion of the work. This is done by approving the Contractor’s invoice in Wide Area Workflow (WAWF) https://wawf.eb.mil/. All CORs who are approving officials shall complete the WAWF on-line training, it is recommended all CORs complete the training.

10. Monthly COR Activity Report. The COR will submit a brief monthly activity report to the KO which will include the next months surveillance schedule, summary of inspections performed with results, summary of customer complaints with analysis, summary of contract discrepancies, results of data analysis, recommended adjustments to surveillance, invoices accepted and any other pertinent contract activities. This report will be loaded into the VCE-Tool by the 15th of each month.

11. Contractor Manpower Reporting (CMR).

11.1. The Contractor shall report ALL Contractor labor hours (including Subcontractor labor hours) required for performance of services provided under this contract for the Army via a secure data collection site. The Contractor is required to completely fill in all required data fields using the following web address: http://www.ecmra.mil/, and then click on “Department of the Army CMRA” or the icon of the DoD organization that is receiving or benefitting from the contracted services.

11.2. Reporting inputs will be for the labor executed during the period of performance during each Government fiscal year (FY), which runs October 1 through September 30. While inputs may be reported any time during the FY, all data shall be reported no later than October 31 of each calendar year, beginning with 2019. Contractors may direct questions to the help desk at help desk at: http://www.ecmra.mil/. Contractors may direct questions to the help desk by clicking on “Send an email” which is located under the Help Resources ribbon on the right side of the login page of the applicable Service/Component’s CMR website”.

12. Quality Assurance Surveillance File. The official COR Quality Assurance Surveillance File will be maintained in the on-line COR Management Tool https://arc.army.mil/COR per ACC PAM 70-1. The Quality Assurance, or COR Surveillance file shall contain the following as applicable:

a. Copy of the COR designation letter from the KO, any changes to that letter, and any termination letters.

b. Training Certifications for COR and refresher training.

c. Copy of the contract and all contract modifications.

d. Copy of the applicable Quality Assurance Surveillance Plan (QASP).

e. Copy of the Contractor’s Quality Control Plan (QCP)

f. All correspondence initiated by authorized representatives (Contractor or Government) concerning performance of the contract.

g. Names, position titles and contact information of all key personnel assigned to this contract both Government and Contractor.

h. Monthly surveillance schedules.

i. Surveillance Checklists

j. Records of all inspections performed and the results.

k. Customer Feedback.

l. Memoranda for record of minutes of any meeting, telephone conversations and discussions with the Contractor or others pertaining to the contract or contract performance.

m. Documentation pertaining to acceptance of services, reports or data

13. Contractor Performance Assessment Reporting System (CPARS). Documented surveillance data IAW this QASP will be used as objective data to support CPARS ratings. The inclusion of detailed documented inspection results provides objectivity to CPARS reporting. CPARS will be accomplished annually or at the end of a Task Order whichever occurs first. http://www.cpars.csd.disa.mil/cparsmain.htm

14. Reference Material.

a. DoD COR Handbook, 22 March 2012

b. AR 70-13 – Management and Oversight of Service Acquisitions, 30 July 2010

c. AR 702-11 – Army Quality Program, 2 March 2007

d. ACC Pamphlet 70-1 – Interim Army Contracting Command – Contracting Officer’s Representative Policy Guide, 26 March 2010

Attachment 1 QASP Matrix

Performance Objective
Reference
Standard
Acceptable Quality Level (AQL)
Method of Surveillance
Incentives or Disincentives
1. Combating Trafficking in Persons
DFARS/ PGI 222.1703
QASPs that are developed IAW DFARS 237.172 should appropriately describe how the COR will monitor the contractor's performance regarding trafficking in persons such that non-compliance with FAR 52.222-50 is brought to the immediate attention of the contracting officer.
100% Compliance
Direct Observation on all interactions with Contractor
Termination of Contract and/or Debarment from Governmental Work
2. Washing machines shall be in good mechanical condition to provide clean clothing when wet washed at a common wash agitation and manufactures recommended temperature.
PWS 5.2
a. Equipment shall be free of mark, deep scratches, dents, and cracked or broken parts.
98% Compliance
Monthly Scheduled Inspection
Past Performance Report or Monetary Reimbursement by the Contractor and/or Reduction in Payment
b. Each machine shall have a minimum capacity of 4.50 cubic feet.
100% Compliance
100% Inspection upon delivery and replacement.
Past Performance Report or Monetary Reimbursement by the Contractor and/or Reduction in Payment
3. Contract Labels, Work tickets completed and pending.
PWS

Monthly each location

100% Compliance
100% Inspection upon delivery and replacement
Past Performance Report or Monetary Reimbursement by the Contractor and/or Reduction in Payment
4. Vandalisms
PWS

Weekly Each Location

100% Compliance
100% Inspection upon delivery and replacement
Past Performance Report or Monetary Reimbursement by the Contractor and/or Reduction in Payment
5. Maintenance
PWS

Weekly Each Location

100% Compliance
100% Inspection upon delivery and replacement
Past Performance Report or Monetary Reimbursement by the Contractor and/or Reduction in Payment

Surveillance Schedule Surveillance Schedule

“FOR OFFICIAL USE ONLY”

1) Contract #: W911-13-R-002A
2) Contractor:
3) Functional Area: East and West Bliss
4) Surveillance Period:

5) COR:

7) Planned Date for Surveillance 8.a) PWS# 5.14 8.b) PWS# 1.6.8 8.c) PWS # 1.6.9.1 8.d) PWS # 1.6.10 8.e) PWS # 1.6.18 8.f) PWS # 5.2 8.g) PWS # 5.3 8.h) PWS # 5.10 8.i) PWS # 1.6.1 8.j) PWS # 5.11 8.k) PWS # 5.20

Date

Date

Date

Date

Date

“FOR OFFICIAL USE ONLY”

Surveillance Checklist Sample/Form

COR Inspection Checklist & Data Report
Meeting Contract Requirements

Contractor:

Contract Number:

Service Provided:

COR Name:

Date:
YES
No

Task 1:

Comments:

Comments:

Comments:

Comments:

Comments:

Comments:

Comments:

Comments:

Comments:

Comments:

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