AUSTIN TE-12.pdf

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Attached to
Operations and Maintenance Services
Solicitation number
TIRMS10R00005
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Technical Exhibit 12

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Text version

NON-CONFORMANCE

NOTIFICATION FOR REWORK

IRS SITE:

CMMS WORK ORDER #

1. Date Government Received Completed Work Order:

2. Date of Initial Inspection:

3. NOTICE OF REWORK (circle) 1st 2nd 3rd 4th 5th

GOVERNMENT ACTION

4. TO (Site Manager Name):

5. FROM (Name of Government Representatives):

6. DESCRIPTION OF NON-CONFORMANCE (Describe in detail all discrepancies found during the inspection.

Attach a copy of the S/C, P/M, or IDIQ ticket if necessary).

7. DATE TIME STAMP GIVEN TO CONTRACTOR

CONTRACTOR ACTION

8. MECHANIC (printed name) :

9. DATE RECEIVED FOR REWORK:

10. ACTIONS TAKEN TO CORRECT NON-CONFORMANCE (address each discrepancy described in section 6 above with action taken to correct the deficiency).

11. MECHANIC SIGNATURE:

12. DATE OF

COMPLETION:

GOVERNMENT CLOSE OUT

13. DATE TIME STAMP RETURNED TO GOVERNMENT

14. INSPECTOR (printed name):

15. DATE OF REWORK INSPECTION:

16. REWORK INSPECTION OUTCOME (circle one)

PASS FAIL

IF FAIL, INITIATE A NEW

REWORK FORM AND

ATTACH A COPY OF THIS

FORM.

17. SIGNATURE OF MECHANICAL WORK INSPECTOR:

18. DATE:

19. SIGNATURE OF SUB-COTR:

20. DATE:

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