ATCH_13 _QACR_format.docx

ALiSS – QACR SAQMMA14R0042

Task Order Number: [insert TO number] Submitted by: [insert name] Date: [insert date]

The following noncompliant actions/events occurred in the month of [insert month and year]:

Noncompliance #1

Date of Occurrence:

Location of Occurrence:

Description of the noncompliance event (include name & badge number of involved personnel as applicable to event):

Action that will be taken during the next month to preclude the same and/or similar noncompliance actions:

Noncompliance #2

Date of Occurrence:

Location of Occurrence:

Description of the noncompliance event (include name & badge number of involved personnel as applicable to event):

Action that will be taken during the next month to preclude the same and/or similar noncompliance actions:

Noncompliance #3

Date of Occurrence:

Location of Occurrence:

Description of the noncompliance event (include name & badge number of involved personnel as applicable to event):

Action that will be taken during the next month to preclude the same and/or similar noncompliance actions:

Noncompliance #4

Date of Occurrence:

Location of Occurrence:

Description of the noncompliance event (include name & badge number of involved personnel as applicable to event):

Action that will be taken during the next month to preclude the same and/or similar noncompliance actions:

*Contractor should copy and paste additional Noncompliance boxes (the above) as needed.

Additional Information:

Address why their Quality Control Plan (QCP) failed to prevent and/or mitigate the noncompliance acts and what action has been taken or will be taken to modify the QCP accordingly.

State whether any part of its TOMP have been revised as part of its efforts to preclude the same and/or similar noncompliance actions in the future.

Attachment 13 Page 2 of 2