Past Performance Questionnaire.pdf

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!