R4 - Past Performance Questionnaire.pdf
PDF 307 KB Posted
- Attached to
- FDA Occupational Safety, Industrial Hygiene, Information Systems, and Training (OSIST) IDIQ
- Solicitation number
- OC-2026-132216
About this file
This is a Past Performance Questionnaire template used to evaluate contractor performance on federal contracts. The form is completed by a reference (typically a government official or contracting officer who directly supervised or oversaw the contractor's work) to assess an offeror's qualifications based on previous contractual experience.
The questionnaire captures essential contract information including the contract number, total contract value, period of performance, and whether the offeror served as prime or subcontractor. References provide ratings across seven assessment elements using a five-point scale: Very Good (VG), Satisfactory (S), Marginal (M), Unacceptable (U), and Not Applicable (NA). The assessment elements evaluate Cost/Price Control, Schedule Adherence, Performance, Quality, Business Relations, and Personnel Qualifications. Each rating includes specific performance level definitions; for example, "Very Good" indicates performance exceeds several requirements with few minor problems and highly effective corrective actions, while "Marginal" indicates failure to meet some requirements with serious problems for which corrective actions are not yet identified or ineffective. The form requires supporting narratives for each element and concludes with sections requesting identification of contractor strengths and weaknesses, whether the reference would award to the contractor again, and a certification statement attesting to the accuracy of the responses.
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Text version
ATTACHMENT R4
PAST PERFORMANCE QUESTIONNAIRE
Solicitation #:
Offeror Name:
Name of Reference:
Title/Role:
Email: Phone:
Agency/Company:
CONTRACT INFORMATION:
Contract #:
Total Contract Value ($):
Period of Performance:
Was the Offeror Prime or Sub?
Description of product/service provided:
RATING CATEGORIES:
RATING CODE PERFORMANCE LEVEL
Very Good VG Performance meets contractual requirements and exceeds several requirements. The contractual performance of the element being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.
Satisfactory S Performance meets contractual requirements. The contractual performance of the element being assessed contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.
Marginal M Performance does not meet some contractual requirements. The contractual performance of the element being assessed reflects a serious problem for which the contractor has not yet identified corrective actions or the contractor's proposed actions appear only marginally effective or were not fully implemented.
Unacceptable U Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance of the element being assessed contains serious problem(s) for which the contractor's corrective actions appear or were ineffective.
Not Applicable NA Unable to provide a score. Performance in this area not applicable to effort assessed.
ASSESSMENT ELEMENTS:
Using the rating categories on page 1, check the appropriate box for each assessment element and provide supporting narrative.
(1) Cost/Price Control – Rate the contractor's ability to control cost and deliver at the agreed-to price. Describe the reasons for changes to contract value (e.g., scope changes, overrun/underrun, Government-imposed schedule changes, etc.).
VG S M U NA
Supporting Narrative:
(2) Schedule Adherence – How well did the contractor adhere to the agreed-to schedule? What were the causes of any schedule variances? Were data deliverables and reports submitted on time?
(3) Performance – Rate the contractor's ability to successfully comply with the contract requirements, statement of work, subcontracting plan, etc.
(4) Quality – How well did the contractor adhere to the requirements of a Quality Assurance Plan or
Performance Based Contracting requirements? Did the services provided meet the required level of quality or results?
(5) Business Relations – Did the contractor exhibit reasonable/cooperative behavior in dealing with problems? Was turnover of personnel frequent? Rate the contractor's responsiveness to managing changes in providing replacement personnel.
(6) Personnel Qualifications – Rate the contractor’s ability to staff and retain a highly-qualified team with the knowledge and experience required to successfully complete the project.
(7) What is your overall rating of the contractor’s performance?
(8) Please identify the contractor’s strengths.
(9) Please identify the contractor’s weaknesses.
(10) Given the choice, would you award to this contractor again? Why?
CERTIFICATION:
I certify that the ratings and comments reflected in this questionnaire were made by the undersigned and are accurate to the best of my knowledge.
Signature______________________________________ Date ________________
File details come from the government source that posted it. Updated .