PWS_TE 5 - Forms 2021-10-29.docx

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Fort Riley Refuse and C/D Landfill Operations Sole Sorce Extension
Solicitation number
W911RX-18-D-0003
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Technical Exhibit 2

Samples of Records, Reports, and Forms

The Contractor shall develop, prepare, maintain, and submit the records, reports, and forms below.

Daily Quality Control Report

Weekly Skip Report

Weekly Construction and Demolition Disposal Record

Monthly Asbestos Disposal Record

DAILY QUALITY CONTROL REPORT

(Contractor’s Name and Address)

Contract No: W911RX- Date: Report No:

Description and Location of Work:

Weather: ; Temperature: Min Max ; Precip: Inches Type

Contractor/Subcontractors: (Areas of responsibility and labor count for each.)

a.

b.

c.

d.

e.

f.

Equipment Data: (Indicate Items of construction equipment, other than hand tools, at the job site, and whether or not used.)

Work Performed Today: Estimated % Complete

Results of Surveillance: (Include satisfactory work inspected, deficiencies found, corrective actions taken, and when corrective actions are completed and reinspected.)

Material Inspected: (Include any material arrived on site, also material incorporated in the construction.)

DAILY QUALITY CONTROL REPORT - Page 2 (Contractor’s Name and Address)

Tests Required, Performed and Results:

Instructions Received or Given: (Include any instructions received from, or given to, Government representatives or other Government contractors.)

Remarks: (Include any item not addressed in other sections, problems with plans or specifications, any disputes.)

Safety: (Note all unsafe conditions, equipment, personnel, surroundings and corrective actions, also safety meetings.)

Correspondence:

Documents on Work Site yes no
Submittal
Date
Date
Approved

Plans

Number
Sent
Received
yes no

Specifications

Manufacturer’s Installation Instructions

Shop Drawings

Permits

Other:

Signature of Quality Control Inspector _____________________________________________________

Signature of Quality Control Manager _____________________________________________________

WEEKLY SKIP REPORT

DATE:__________________________DRIVER:_____________________________VEHICLE NO:______________________

AREA SERVICED:____________________START TIME:__________________COMPLETION TIME:___________________

BLDG NO.
DUMPSTER/CART NO.
COMMENTS (i.e. description and license number of blocking vehicle)

WEEKLY CONSTRUCTION AND DEMOLITION DISPOSAL RECORD

WEEK OF:______________________

DATE
TIME
VEH NUMBER LIC PLATE NO.
UNIT DESIGNATION CONTRACT NAME/NO.
EST WT
DESCRIPTION/REMARKS

MONTHLY ASBESTOS DISPOSAL RECORD

MONTH:__________________________

DATE/

TIME

VEHICLE NO. or

LICENSE NO.

SOURCE (FAC NO.)
PRINTED NAME
PHONE NUMBER
EST. VOL. (CY)
DISPOSAL LOCATION

REMARKS

AGENCY (KTR/DPW)
SIGNATURE

EST. WT. (LB)

File details come from the government source that posted it. Updated .