Past Performance Questionnaire.docx
DOCX document 20 KB Posted
- Attached to
- R702--Study for Department of Veterans Affairs Health Outcomes of Military Exposures Epidemiology
- Solicitation number
- 36C24526Q0544
About this file
This is a Past Performance Questionnaire template used by the Department of Veterans Affairs to evaluate contractor performance on the Health Outcomes of Military Exposures (HOME) epidemiology study. The questionnaire is distributed to references provided by offerors and solicits assessments across three primary evaluation categories: quality of performance, cost control, and general comments. For quality of performance, evaluators rate overall performance and specific competencies including project management and progress reporting, data collection and reporting, simple and complex data analyses, and educational and informational materials development. Respondents select from four rating options—Exceptional, Satisfactory, Unsatisfactory, or Not Applicable—with mandatory narrative explanations required for Exceptional or Unsatisfactory ratings.
The questionnaire collects identifying information from the assessor including company name, title, email address, and date of assessment. Per Department of Veterans Affairs policy, all information provided is classified as Evaluation Information that is prohibited from disclosure and exempt from FOIA release, ensuring the confidentiality of both the assessor's identity and other reference sources. The form is designed to evaluate past performance on contracts similar to the current HOME study, which involves longitudinal health surveys of Post 9/11 deployed and era veterans, data collection via web and telephone platforms (up to 100,000 respondents), and both simple and complex data analysis services with a three-year period of performance.
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Other files
| File | Type | Posted |
|---|---|---|
| Q and R - 5.xlsx | XLSX spreadsheet | |
| Q and R -1.docx | DOCX document | |
| Q and R - 3.xlsx | XLSX spreadsheet | |
| Q and R - 6.docx | DOCX document | |
| Q and R - 8.docx | DOCX document | |
| Q and R - 7.docx | DOCX document | |
| Q and R - 4.xlsx | XLSX spreadsheet | |
| Q and R - 2.xlsx | XLSX spreadsheet | |
| Amendment - Solicitation No. 36C24526Q0544 0002.pdf | ||
| Amendment - Solicitation No. 36C24526Q0544 0001.pdf | ||
| Supplemental Instructions.pdf | ||
| Solicitation No. 36C24526Q0544.pdf | ||
| Past Performance Questionnaire.pdf | ||
| QASP for Post 911 survey.pdf | ||
| VHA 1605.05 BUSINESS ASSOCIATE AGREEMENT.docx | DOCX document | |
| VHA 1605.05 BUSINESS ASSOCIATE AGREEMENT.pdf |
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Text version
PAST PERFORMANCE QUESTIONNAIRE
The Department of Veterans Affairs is evaluating a quote [Offeror’s name here], hereafter referred to as “Offeror,” for Health Outcomes of Military Exposures. Offeror has provided your name so that we may ask you questions regarding Offeror’s past performance on a similar contract between your company and Offeror.
Any information you provide in this questionnaire is considered Evaluation Information and is prohibited from disclosure and exempt from release under the Freedom of Information Act; as such, the Department of Veterans affairs will not release your name or the names of other individuals providing reference information about Offeror’s past performance.
Instructions: Provide an assessment of the Offeror’s past performance by checking the box with one of the following rating options. You are encouraged to write comments as often as you’d like. If your assessment is “Exceptional” or “Unsatisfactory,” then please provide a brief narrative that explains your rationale for the rating.
THANK YOU FOR YOUR SUPPORT AND PARTICIPATION!
Rating Options:
Exceptional—Offeror’s performance exceeded most contractual requirements and performance was accomplished with no issues or concerns.
Satisfactory—Offeror’s performance meets (or met) all contractual requirements and performance was accomplished with minor issues or concerns, for which Offeror’s corrective actions were effective.
Unsatisfactory—Offeror’s performance does not meet (or did not meet) contractual requirements and performance was accomplished with significant problems, issues or concerns, for which Offeror’s corrective actions were ineffective.
Not Applicable—Unable to provide a meaningful assessment.
Performance Assessment
1. Quality of performance
a. What is your overall assessment of the quality of the Offeror’s performance?
| Exceptional |
| Satisfactory |
| Unsatisfactory |
| N/A |
Comments:
b. Assess Offeror’s quality of performance in these areas:
| Exceptional |
| Satisfactory |
| Unsatisfactory |
| N/A |
Project Management and Progress Reporting
Data Collection and Reporting
Simple and Complex Data Analyses
Educational and Informational Materials
2. Cost control
a. What is your overall assessment of the Offeror’s ability to forecast, manage and control costs?
| Exceptional |
| Satisfactory |
| Unsatisfactory |
| N/A |
3. General comments:
_____________________________ Date:_____________ Company Name:
Assessor’s Name:
Title:
Assessor’s Email: __________________________
THANK YOU FOR YOUR SUPPORT AND PARTICIPATION!
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