PWS and QASP_Forest Inventory-Timber Cruise).pdf

PERFORMANCE WORK STATEMENT (PWS)

FOR

Camp Shelby Forest Inventory (Timber Cruise) Services

6 August 2026

1.0 General:

1.1 Scope: The contractor shall provide all personnel, equipment, tools, materials, supervision, and quality control necessary, except as specified in Paragraph 3.0 as Government Furnished, to perform a forest inventory (timber cruise) across approximately 1,694 forested acres on 8 DoD-owned units at Camp Shelby, Mississippi, under the direction of the Mississippi Military Department (MMD), as defined in this PWS. The objective is to obtain current, stand-level data on forest composition, timber volume, stand condition, regeneration, and understory conditions. Deliverables will provide MMD with actionable information to make immediate forest management decisions and to support a long-term system of updating forest inventory. The Contractor must use Prism Cruising software (by Lim Geomatics) to collect, process, and upload all data, ensuring compatibility with MMD’s existing database and workflows.

1.2 Background: Camp Shelby Joint Forces Training Center includes both State and DOD lands. MMD is responsible for managing the forest resources within Camp Shelby to balance sustainable timber management, military training land use, and ecological conservation. An updated forest inventory is needed to guide management decisions, prioritize silvicultural treatments, and ensure efficient long-term ecosystem management.

Beyond forestry objectives, this effort directly supports military readiness by maintaining training lands in a sustainable condition.

1.3 Period of Performance (PoP): Fieldwork shall be completed within 90 calendar days from Notice to Proceed (NTP). The Draft Forest Inventory Report (FIR) is due 60 days after fieldwork completion. The Final FIR is due 30 days after MMD review comments.

Extensions may be granted for documented weather events, military training closures, or other unavoidable delays, at the discretion of the COR.

1.4 General Information:

1.4.1 Place and Performance of Services: The contractor shall provide services between the hours of 0730-1630 on Monday through Friday, except on recognized US holidays or when the Government facility/installation is closed due to local or national emergencies, administrative closings, or similar Government-directed facility/installation closings.

Performance shall be at Camp Shelby Joint Forces Training Center, Mississippi (8 DoD-owned units). The contractor shall at all times maintain an adequate work force for the ii uninterrupted performance of all tasks defined within this PWS when the Government facility/installation is not closed for the above reasons.

1.4.1.1 Telework: The Government does not permit the contractor to telework in support of this requirement.

1.4.1.2 Unscheduled gate closures by the Security Police may occur at any time causing all personnel entering or exiting a closed installation to experience a delay. This cannot be predicted or prevented. Contractors are not compensated for unexpected closures or delays. Vehicles operated by contractor personnel are subject to search pursuant to applicable regulations. Any moving violation of any applicable motor vehicle regulation may result in the termination of the contractor employee’s installation driving privileges.

1.4.1.3 The contractor’s employees shall become familiar with and obey the regulations of the installation; including fire, traffic, safety and security regulations while on the installation. The Government reserves the right to direct the removal of an employee from Government property or revoke access to Government systems for misconduct, security reasons, or any overt evidence of communicable disease. Removal of contractor employees for reasons stated above does not relieve the Contractor from responsibility for total performance of this contract.

1.4.2 Recognized Holidays: The following are recognized United States (US) holidays. The contractor shall not perform services on these days:

1.4.2.1 New Year’s Day: January 1st

1.4.2.2 Martin Luther King, Jr.’s Birthday

1.4.2.3 President’s Day

1.4.2.4 Memorial Day

1.4.2.5 Juneteenth National Independence Day: June 19th

1.4.2.6 Independence Day: July 4th

1.4.2.7 Labor Day

1.4.2.8 Columbus Day

1.4.2.9 Veteran’s Day: November 11th

1.4.2.10 Thanksgiving Day

1.4.2.11 Christmas Day: December 25th

1.4.3 Quality Control (QC): The contractor shall develop and maintain an effective QC Plan (QCP) to ensure services are performed in accordance with this PWS. The contractor’s QCP is the means by which it assures itself that its work complies with the requirements of the contract. As a minimum, the contractor shall develop QC procedures that address the areas identified in Technical Exhibit 1, Performance Requirements Summary (PRS). A final QCP shall be submitted to the Contracting Officer Representative (COR) NLT 10 days after contract award.

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1.4.4 Quality Assurance (QA): The Government will evaluate the contractor’s performance under this contract in accordance with the Quality Assurance Surveillance Plan (QASP). This plan is primarily focused on what the Government will do to ensure that the contractor has performed in accordance with the performance standards.

1.4.5 Installation Access and Security Requirements: The contractor shall comply with all applicable installation/facility access and local security policies and procedures, which may be obtained from the COR. The contractor and all associated subcontractor employees shall provide all information required for background checks to meet installation access requirements.

1.4.5.1 For contractors that do not require a CAC, but require access to a DoD facility or installation: Contractor and all associated sub-contractors employees shall comply with adjudication standards and procedures using the National Crime Information Center Interstate Identification (NCIC-III) and Terrorist Screening Database (TSDB) (Army Directive 2014-05), and applicable installation, facility and area commander installation/facility access, and local security policies and procedures.

1.4.5.2 Awareness Training (AT) Level 1: All contractor employees, including subcontractor employees, requiring access to Army installations, facilities, and controlled access areas shall complete AT Level 1 training within 30 calendar days after contract start date and within 30 calendar days of new employees commencing performance.

1.4.5.3 iWATCH Training: The contractor and all associated subcontractors with an area of performance within an Army-controlled installation, facilities or area shall brief all employees on the local iWATCH program. This training shall be completed within 30 calendar days of contract award and within 30 calendar days of new employees commencing performance.

1.4.6 Physical Security: The contractor shall safeguard all Government property provided for contractor use. At the close of each work period, Government facilities, equipment and materials shall be secured.

1.4.7 Special Qualifications: The contractor shall perform all services in accordance with accepted forestry standards for the southeastern United States. All activities shall comply with applicable Federal, State, and local regulations, including Mississippi Best Management Practices (BMPs).

• Lead forester shall hold a B.S. in Forestry (SAF-accredited), be a Mississippi Registered Forester, and have at least four (4) years of practical forestry experience in the southeastern U.S.

• Field crews must be trained and proficient in Prism Cruising software. Contractor must demonstrate Prism proficiency prior to commencing fieldwork.

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1.4.8 Post Award Conference/Periodic Progress Meetings: The contractor agrees to attend any post award conference convened by the KO in accordance with FAR 42.5. The KO, COR and other Government personnel, as appropriate, may meet periodically with the contractor to review the contactor’s performance.

1.4.9 Contract Manager (CM): The contactor shall designate a CM who shall ensure performance under this contract. The name of this person, and an alternate who shall act for the contractor when the CM is absent, shall be designated in writing to the KO.

1.4.10 Identification of Contractor Employees: All contractor personnel attending meetings, answering Government telephones and working in other situations where their contractor status is not obvious to third parties are required to identify themselves as such to avoid creating an impression that they are Government employees.

1.4.11 Combating Trafficking in Persons: The United States Government has adopted a zero tolerance policy regarding trafficking in persons. Contractors and contractor employees shall not engage in severe forms of trafficking in persons during the period of performance of the contract.

1.4.12 Organizational Conflicts of Interest (OCI): The contractor and subcontractor personnel performing services under this contract may receive, have access to or participate in the development of proprietary or source selection information which may create a current or subsequent OCIs, as defined in FAR Subpart 9.5.

2.0 Definitions and Acronyms:

2.1 Definitions:

• Contractor: A supplier or vendor awarded a contract to provide specific supplies or service to the Government. The term used in this contract refers to the prime.

• Defective Service: A service output that does not meet the standard of performance associated with the PWS.

• Deliverable: Anything that can be physically delivered and includes non-manufactured things such as meeting minutes or reports.

• Quality Assurance: The Government procedures to verify that services being performed by the Contractor are performed according to acceptable standards.

• Quality Control: All necessary measures taken by the Contractor to ensure that the quality of an end product or service shall meet contract requirements.

2.2 Acronyms:

• BMP: Best Management Practices

• CM: Contract Manager

• COR: Contracting Officer Representative v

• DBH: Diameter at Breast Height

• DoD: Department of Defense

• FIR: Forest Inventory Report

• GIS: Geographic Information System

• KO: Contracting Officer

• MMD: Mississippi Military Department

• MSARNG: Mississippi Army National Guard

• PRS: Performance Requirements Summary

• PWS: Performance Work Statement

• QA: Quality Assurance

• QC: Quality Control

• SMZ: Special Management Zone

3.0 Government Furnished Property, Material, Equipment and Services

(GFP/M/E/S):

The Government will provide the property, material, equipment, and/or services listed below solely for the purpose of performance under this contract:

3.1 Property: NONE

3.2 Materials: NONE

3.3 Equipment: NONE

3.4 Services: NONE

3.5 Utilities: All utilities in the facility will be available for the contactor’s use in the performance of this contract. The contractor shall instruct employees in utilities conservation practices.

4.0 Contractor Furnished Property, Materials, and Equipment (CFP/M/E):

4.1 General: Except for those items specifically stated to be Government-Furnished in Paragraph 3.0, the contractor shall furnish all transportation, materials, equipment, tools, and supplies necessary to perform these services as indicated in Paragraph 1.1, including all necessary hardware and licenses for Prism Cruising software. These items will remain the property of the contractor after the contract ends.

5.0 Requirements:

The contractor shall:

5.1 Kickoff & Work Plan: Conduct a kickoff meeting with MMD representatives. Submit an Abbreviated Work Plan, Safety Plan, and Project Schedule.

5.2 Stand Boundaries: Utilize MMD-provided shapefiles and GIS boundaries for the 8 DoD-owned units for stand delineation, and integrate cruise data into the provided GIS layers.

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5.3 Timber Cruise (Field Data Collection): Collect the following data at sample plots at a 95% confidence interval using Prism Cruising software:

• Overstory Measurements: Species grouped (longleaf pine, loblolly pine, other pine, red oak group, white oak group, sweetgum, misc. hardwoods); DBH (2-inch classes);

Total and merchantable height (10-foot classes); Merchantable volumes by product class; Basal area per acre; Stand age (increment borings of 3–4 dominant/codominant trees per stand); Stand condition.

• Snags: Number of snags per acre (≥3” DBH, ≥6 ft tall); Average DBH of snags; Snag decay class (USFS 1-5 scale).

• Regeneration & Understory: Establish a 1/500th-acre subplot (5.3 ft radius) at each main plot center; Record seedlings/saplings (<5” DBH) by species group; Tally stems by size class; Report average regeneration density; Describe understory condition using cover class ranges (0–25%, 26–50%, 51–75%, 76–100%); Record dominant vegetation type.

• SMZ Data Collection: Include SMZs in the timber cruise at a reduced sampling intensity of 50%. Data collected should include species group composition, basal area per acre, snags per acre, and general understory condition. Label SMZ data clearly in tables and GIS outputs to distinguish from upland stands.

• Invasive Species Collection: Document Invasive Non-Native Species by species, location, and abundance.

5.4 Data Processing & GIS Integration: Upload all data into Prism and conduct QA/QC checks. Summarize results by stand, including overstory volumes, basal area, snags, regeneration, and understory. Integrate cruise results with MMD-provided shapefiles.

5.5 Reporting: Draft Forest Inventory Report (FIR) to include: Stand and stock tables;

Volumes by species group and product class; Basal area, stand age, and condition; Snags per acre; Regeneration/understory summary; Maps (1:20,000 scale or better) and GIS shapefiles/geodatabase (NAD83 Zone16N).

Incorporate MMD’s comments and resubmit the Final FIR in PDF, Excel, and Prism export formats. Deliverables shall not be released without written approval from MMD’s COR.

5.6 Wrap-Up Meeting: Conduct a final meeting with MMD representatives to present findings and deliverables.

5.7 Service Contract Reporting: The contractor shall report ALL contractor labor hours (including subcontractor labor hours) required for performance of services provided under this contract via the secure data collection site at SAM.gov.

6.0 Applicable Publications:

Publications applicable to this PWS are listed below:

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Publication Date of Publication

Mandatory or Advisory

Website

Federal Acquisition Regulation

Current Mandatory https://www.acquisition.gov/?q=browsefar

Defense Federal Acquisition Regulation Supplement

Current Mandatory https://www.acquisition.gov/dfars

Mississippi Best Management Practices (BMPs)

Current Mandatory Mississippi Forestry Commission https://www.acquisition.gov/?q=browsefar https://www.acquisition.gov/dfars viii

QUALITY ASSURANCE SURVEILLANCE

PLAN (QASP)

DoD Timber Inventory/Timber Cruise Services

For

Camp Shelby Joint Forces Training Center

Issued 06 August 2026 ii

TABLE OF CONTENTS

1 INTRODUCTION 3

1.1 Purpose 3

1.2 Performance Management Approach 3

1.3 Performance Management Strategy 4

2 ROLES AND RESPONSIBILITIES 4

2.1 The Contracting Officer 4

2.2 The Contracting Officer’s Technical Representative 5

3 IDENTIFICATION OF REQUIRED PERFORMANCE STANDARDS/QUALITY LEVELS

4 METHODOLOGIES TO MONITOR PERFORMANCE 5

4.1 Surveillance Techniques 5

4.2 Customer Feedback 6

4.3 Acceptable Quality Levels 6

5 QUALITY ASSURANCE DOCUMENTATION 7

5.1 The Performance Management Feedback Loop 7

5.2 Monitoring Forms 7

6 ANALYSIS OF QUALITY ASSURANCE ASSESSMENT 7

6.1 Determining Performance 7

6.2 Reporting 7

6.3 Reviews and Resolution 8

ATTACHMENT1: PERFORMANCE REQUIREMENTS SUMMARY 9

ATTACHMENT 2: Deliverables Schedule 9

ATTACHMENT 3: QUALITY ASSURANCE MONITORING FORM

1 INTRODUCTION

This QASP is pursuant to the requirements listed in the performance work statement (PWS) entitled Timber Inventory/Timber Cruise Services. This plan sets forth the procedures and guidelines the Camp Shelby Joint Forces Training Center will use in ensuring the required performance standards or services levels are achieved by the contractor.

1.1 Purpose

1.1.1 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.

1.1.2 This QASP defines the roles and responsibilities of all members of the integrated project team (IPT), identifies the performance objectives, defines the methodologies used to monitor and evaluate the contractor’s performance, describes quality assurance documentation requirements, and describes the analysis of quality assurance monitoring results.

1.2 Performance Management Approach

1.2.1 The PWS structures the acquisition around “what” service or quality level is required, as opposed to “how” the contractor should perform the work (i.e., results, not compliance). This QASP will define the performance management approach taken by Camp Shelby Joint Forces Training Center to monitor and manage the contractor’s performance to ensure the expected outcomes or performance objectives communicated in the PWS are achieved. Performance management rests on developing a capability to review and analyze information generated through performance assessment. The ability to make decisions based on the analysis of performance data is the cornerstone of performance management; this analysis yields information that indicates whether expected outcomes for the project are being achieved by the contractor.

1.2.2 Performance management represents a significant shift from the more traditional quality assurance (QA) concepts in several ways. Performance management focuses on assessing whether outcomes are being achieved and to what extent. This approach migrates away from scrutiny of compliance with the processes and practices used to achieve the outcome. A performance-based approach enables the contractor to play a large role in how the work is performed, as long as the proposed processes are within the stated constraints.

The only exceptions to process reviews are those required by law (federal, state, and local) and compelling business situations, such as safety and health.

A “results” focus provides the contractor flexibility to continuously improve and innovate over the course of the contract as long as the critical outcomes expected are being achieved and/or the desired performance levels are being met.

1.3 Performance Management Strategy

1.3.1 The contractor is responsible for the quality of all work performed. The contractor measures that quality through the contractor’s own quality control (QC) program. QC is work output, not workers, and therefore includes all work performed under this contract regardless of whether the work is performed by contractor employees or by subcontractors. The contractor’s QCP will set forth the staffing and procedures for self-inspecting the quality, timeliness, responsiveness, customer satisfaction, and other performance requirements in the PWS. The contractor will develop and implement a performance management system with processes to assess and report its performance to the designated government representative. The contractor’s QCP will set forth the staffing and procedures for self-inspecting the quality, timeliness, responsiveness, customer satisfaction, and other performance requirements in the PWS. This QASP enables the government to take advantage of the contractor’s QC program.

1.3.2 The Contracting Officer Representative/Contracting Officer Technical

Representative (COR/COTR) will monitor performance and review performance reports furnished by the contractor to determine how the contractor is performing against communicated performance objectives. The contractor will be responsible for making required changes in processes and practices to ensure performance is managed effectively.

2 ROLES AND RESPONSIBILITIES

2.1 The Contracting Officer

The Contracting Officer (KO) is responsible for monitoring contract compliance, contract administration, cost control and for resolving any differences between the observations documented by the COR/COTR and the contractor. The KO will designate one full-time COR/COTR as the government authority for performance management. The number of additional representatives serving as technical inspectors depends on the complexity of the services measured, as well as the contractor’s performance, and must be identified and designated by the KO.

2.2 The COR/COTR

The COR/COTR is designated in writing by the KO to act as his or her authorized representative to assist in administering a contract. COR/COTR limitations are contained in the written appointment letter. The COR/COTR is responsible for technical administration of the project and ensures proper government surveillance of the contractor’s performance. The COR/COTR is not empowered to make any contractual commitments or to authorize any contractual changes on the government’s behalf. Any changes that the contractor deems may affect contract price, terms, or conditions shall be referred to the KO for action. The COR/COTR will have the responsibility for completing QA monitoring forms used to document the inspection and evaluation of the contractor’s work performance. Government surveillance may occur under the inspection of services clause for any service relating to the contract.

3 IDENTIFICATION OF REQUIRED

PERFORMANCE STANDARDS/QUALITY

LEVELS

The required performance standards and/or quality levels are included in the PWS and in Attachment 1, Performance Requirements Summary. If the contractor meets the required service or performance level, it will be paid the monthly amount agreed on in the contract. Failure to meet the required service or performance level will result in a deduction from the monthly amount.

4 METHODOLOGIES TO MONITOR

PERFORMANCE

4.1 Surveillance Techniques

In an effort to minimize the performance management burden, simplified surveillance methods shall be used by the government to evaluate contractor performance when appropriate. The primary methods of surveillance are:

Random monitoring, which shall be performed by the COR/COTR designated inspector.

Periodic Inspection – COR/COTR typically performs the periodic inspection on a monthly basis.

4.2 Customer Feedback

4.2.1 The contractor is expected to establish and maintain professional communication between its employees and customers. The primary objective of this communication is customer satisfaction. Customer satisfaction is the most significant external indicator of the success and effectiveness of all services provided and can be measured through customer complaints.

4.2.2 Performance management drives the contractor to be customer focused through initially and internally addressing customer complaints and investigating the issues and/or problems but the customer always has the option to communicate complaints to the COR/COTR as opposed to the contractor.

4.2.3 Customer complaints, to be considered valid, must set forth clearly and in writing. The detailed nature of the complaint must be stated, document signed and forwarded to the COR/COTR. Upon receipt of a complaint, the COR/COTR will investigate and document the findings on the monitoring form, Attachment 2 and in the COR file.

4.2.4 Customer feedback may also be obtained from the results of formal customer satisfaction surveys or random customer complaints.

4.3 Acceptable Quality Levels

The acceptable quality levels (AQLs) included in Attachment 1, Performance Requirements Summary Table, for contractor performance are structured to allow the contractor to manage how the work is performed while providing negative incentives for performance shortfalls. For certain critical activities such as those involving Timber Inventory/Timber Cruise, the desired performance level is established at 100 percent. Other levels of performance are keyed to the relative importance of the task to the overall mission performance.

5 QUALITY ASSURANCE DOCUMENTATION

5.1 The Performance Management Feedback Loop

The performance management feedback loop begins with the communication of expected outcomes. Performance standards are expressed in the PWS and are assessed using the performance monitoring techniques shown in Attachment 1, Performance Requirements Summary.

5.2 Monitoring Forms

The government’s QA surveillance, accomplished by the COR/COTR, will be reported using the monitoring form in Attachment 2. The form, when completed, will document the government’s assessment of the contractor’s performance under the contract to ensure that the required quality levels are being achieved.

5.2.1 The COR/COTR will retain a copy of all completed QA surveillance forms.

6 ANALYSIS OF QUALITY ASSURANCE

ASSESSMENT

6.1 Determining Performance

6.1.1 The Government shall use the monitoring methods cited to determine whether the performance standards/service levels/AQLs have been met. If the contractor has not met the minimum requirements, it may be asked to develop a corrective action plan to show how and by what date it intends to bring performance up to the required levels. Failure to meet the AQL may result in a deduction from the monthly payment.

6.2 Reporting

6.2.1 At the end of each month, the COR will prepare a written report for the KO summarizing the overall results of the quality assurance surveillance of the contractor’s performance. This written report, which includes the completed quality assurance monitoring form (Attachment 2), will become part of the QA documentation and COR/COTR file. It will enable the government to demonstrate whether the contractor is meeting the stated objectives and/or performance standards, including cost/technical/scheduling objectives.

6.3 Reviews and Resolution

6.3.1 The COR/COTR may require the contractor’s project manager, or a designated alternate, to meet with the KO, COR/COTR and other government IPT personnel as deemed necessary to discuss performance evaluation. The COR/COTR will define a frequency of in-depth reviews with the contractor, including appropriate self-assessments by the contractor; however, if the need arises, the contractor will meet with the COR/COTR as often as required or per the contractor’s request. The agenda of the reviews may include:

Monthly performance assessment data and trend analysis

Issues and concerns of both parties

Projected outlook for upcoming months and progress against expected trends, including a corrective action plan analysis

Recommendations for improved efficiency and/or effectiveness

Issues arising from the performance monitoring processes

6.3.2 The COR/COTR must coordinate and communicate with the contractor to resolve issues and concerns regarding marginal or unacceptable performance.

6.3.3 The COR/COTR and contractor should jointly formulate tactical and long-term courses of action. Decisions regarding changes to metrics, thresholds, or service levels should be clearly documented. Changes to service levels, procedures, and metrics will be incorporated as a contract modification at the convenience of the KO.

ATTACHMENT 1: PERFORMANCE REQUIREMENTS SUMMARY (PRS)

TECHNICAL EXHIBIT 1

Performance Requirements Summary (PRS)

Performance Objective

Performance Standard

Acceptable Quality Levels

(AQL)

Surveillance Method / By Whom

5.3 Timber

Cruise / Field Collection Accuracy

The contractor shall conduct a field inventory in accordance with acceptable forestry standards.

DBH within ±1 inch; Total height within ±10 feet;

Basal area within ±10 ft²/acre; No errors in species group assignment or snag counts.

Field Plot Re-check (5-10% of plots) / COR

5.4 Data

Processing & GIS Integration

Upload all data into Prism and conduct QA/QC checks. Summarize results by stand.

Fall within PWS parameters with less than 2% deficiency.

Periodic Inspection / COR

5.5 Reporting The contractor

shall provide Draft and Final FIR for area, integrating all tabular and geospatial data.

Parameters according to PWS with less than 2% deficiency.

Periodic Inspection / COR

ATTACHMENT 2: Deliverables Schedule

PWS

Reference / Deliverable Title

Frequency Number of Copies

Medium/Format Submit To

1.4.3 Quality

Control Plan

(QCP)

NLT 10 days after contract award

1 Electronic Submission

COR

1.4.5.2 AT

Level 1 Awareness Training Certificates

Within 30 days after contract start or new employee start

1 Electronic Submission

COR

1.4.5.3 iWATCH Training Certificates

Within 30 days after contract start or new employee start

1 Electronic Submission

COR

5.1 Abbreviated Work Plan, Safety Plan, & Schedule

Following Kickoff Meeting

1 Electronic Submission

COR

5.4 & 8.0 Field Work Completed

Within 90 calendar days after notice to proceed

1 Electronic Submission / Prism

COR

5.5 & 8.1 Draft Forest Inventory Report (FIR)

Within 60 calendar days after field work completion

1 Electronic Submission (PDF, GIS, Excel)

COR

5.5 & 8.2 Final Forest Inventory Report (FIR)

Within 30 days after MMD review

1 Electronic Submission (PDF, GIS, Excel, Prism)

COR

5.6 Final

Wrap-Up Presentation Materials

At conclusion of project

1 PDF /

PowerPoint

COR

ATTACHMENT 3: QUALITY ASSURANCE MONITORING FORM

PERFORMANCE OBJECTIVE or STANDARD:

SURVEY PERIOD:

SURVEILLANCE METHOD (Check):

Random Sampling 100% Inspection Periodic Inspection Customer Complaint

LEVEL OF SURVEILLANCE (Check):

Monthly Quarterly As 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: __________________________________