TE_16_QASP_Checksheets_102016.doc
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QASP CHECK SHEETS
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INSPECTION CHECKSHEET #1
CLIN REQUIREMENT: Facility Operations REFERENCE: PWS Section 3 Basic Services PERFORMANCE RATINGS: Each Element Rating is Pass, Fail, or N/A. Pass = P (total weight earned), Fail = F (weight earned is 0%) N/A = N/A (weight evenly redistributed to other elements for that month).
CHECKSHEET AQL 95%
Month/Year:
| TASK |
| AQL Performance Criteria |
| Weight |
| Rating P/F/NA |
| Weight Earned |
| Rating Comments |
| 1. BOP (3.1.1) |
| The BOP was followed with less than 3 minor instances or 1 major instance (outage, a/c loss, wasted energy) of nonconformance documented during the month. |
25%
| 2. Equipment Checks (3.1.4) |
| The AQL is achieved if 100% of all the required equipment checks were performed IAW all the contract requirements. All required documentation (chiller logs, boiler logs, etc.) was recorded and available for IRS review. |
15%
| 3. Maintain Equipment Rooms (3.1.7) |
| The AQL is achieved if there is zero instances where the contractor has not kept these areas cleaned IAW the PWS. |
10%
| 4. Equipment Condition Report (3.1.10) |
| The AQL is achieved if 100% of the reports are provided to the COR by 9 am with all the required information. |
10%
| 5. Waste Management (3.7.22); Hazardous Materials (3.7.22 through 3.7.22.1); . Environmental & Safety Compliance Program (3.7 all) |
| The AQL is achieved if there is no documented instance of the contractor not following the PWS requirements surrounding waste; |
improper storage of hazardous material; the contractor not following their written program and the site’s EMS and all applicable environmental laws & regulations.
10%
| 6. Refrigerants (3.7.23 through 3.7.23.3) |
| The AQL is achieved if there is no documented instance of the contractor: (1) not following the RMP (2) failure to record applicable actions in RCM (3) failure to properly reclaim refrigerant and (4) not accounting for proper refrigerant inventories. |
10%
| 7 Landscaping Services (3.1.5) |
| The AQL is achieved if 100% of all scheduled tasks were completed on time with quality workmanship and met all the scope requirements. Rework is allowed provide it was completed and re-inspection occurred (and it passed) before the scheduled completion date. Otherwise it is recorded as a failure. |
| 15% |
| 8. Asbestos Containing Materials (ACM) (3.7.25.1) |
| The AQL is achieved if 100% of all ACM removal, disposal, and documentation were completed according to the requirements in the PWS. |
| 5% |
OVERALL RATING
100%
Summary Documentation/Rating Comments:
IRS COR Signature: _______________________________________________________________Date: _________________________________ Site Manager Receipt/Signature:_____________________________________________________Date:_________________________________
INSPECTION CHECKSHEET #2
CLIN REQUIREMENT: Water Treatment
REFERENCE: PWS Section 3.2
PERFORMANCE RATINGS: Each Element Rating is Pass, Fail, or N/A. Pass = P (total weight earned), Fail = F (weight earned is 0%) N/A = N/A (weight evenly redistributed to other elements for that month).
CHECKSHEET AQL 95%
Month/Year:
| TASK |
| Pass/Fail/N/A AQL Performance Criteria |
| Weight |
| Rating P/F/NA |
| Weight Earned |
| Rating Comments |
| 1. Independent Monthly Testing (3.2.2) |
| The AQL is achieved if the water test was performed for the month and results were provided to the COR within 5 calendar days. |
| 25% |
| 2. Weekly Water Treatment Test (3.2.3) |
| The AQL is achieved if the water test was performed for all weeks in the month, any necessary adjustments were made to the system, and all results and actions were provided in a written report to the COR within 2 calendar days. |
| 40% |
| 3. Chemicals (3.2.4) |
| The AQL is achieved if all chemicals used during the month were IAW the PWS and there were no instances of algae, slim, bacteria, scale, or corrosion noticed in any system where the contractor did not take immediate corrective action that resulted in the elimination of the problem. |
| 20% |
| 4. Other Water Inspections (3.2.5) |
| The AQL is achieved if the annual water testing for the presence of Legionella was performed IAW the PWS requirements and the results given to the COR within 15 calendar days of the sample being taken. |
| 15% |
OVERALL RATING
100%
IRS COR Signature: _______________________________________________________________Date: _________________________________ Site Manager Receipt/Signature:_____________________________________________________Date:_________________________________
INSPECTION CHECKSHEET #3
CLIN REQUIREMENT: Service Calls REFERENCE: PWS Section 3.3
PERFORMANCE RATINGS: Overall Each Element Rating is Pass, Fail, or N/A. Pass = P (total weight earned), Fail = F (weight earned is 0%) N/A = N/A (weight evenly redistributed to other elements for that month).
CHECKSHEET AQL 95%
Month/Year:
| TASK |
| AQL Performance Criteria AQL |
| Weight |
| Rating P/F/NA |
| Weight Earned |
| Rating Comments |
1. Service Call Response/Completion Requirements (3.3.3 through 3.3.3.5)
| The AQL is achieved if a minimum of 99% of the completed SC’s for the month were completed within contract required timeframes. |
| 20% |
2. Service Call Workmanship (3.3 through 3.3.3.5)
| The AQL is achieved if a minimum of 99% of the inspected SC’s were completed with quality workmanship IAW acceptable trade practices and IAW contract requirements. |
| 20% |
| 3. Service Call Deferrals (3.3.3.6) |
| The AQL is achieved if the contractor has requested a deferral 100% of the time it was required. |
| 10% |
| 4. Materials Equipment and Critical Spares (3.3.5) |
| The AQL is achieved if the required number and type of supplies and critical spare parts (as indicated on the contractor developed inventory that was supplied during the phase in) has been maintained onsite. |
| 10% |
| 5. Service Call Database – Timely Input (3.3.10) |
| The AQL is achieved if a minimum of 99% of all inspected SC’s are closed out in the CMMS within 2 days of the date/time stamp of the mechanic completing the ticket. |
| 15% |
| 6. Service Call Database – Documentation (3.3.10) |
| The AQL is achieved if a minimum of 99% of all inspected service calls have all the required documentation on the hard copy and in the CMMS database. |
| 15% |
| 7. QCP Service Call Inspections (3.11.1 – 3.11.4) |
| The AQL is achieved if the contractor performed the minimum required service call inspections by the properly identified personnel and a copy of each inspection was received by the COR within 1 calendar day of the inspection and all hard copies are maintained in an orderly filing system and available for review by the COR. |
| 10% |
OVERALL RATING
100%
IRS COR Signature: _______________________________________________________________Date: _________________________________ Site Manager Receipt/Signature:_____________________________________________________Date:_________________________________
INSPECTION CHECKSHEET #4
CLIN REQUIREMENT: Preventive Maintenance REFERENCE: QASP Inspection Guide
PERFORMANCE RATINGS: Overall Each Element Rating is Pass, Fail, or N/A. Pass = P (total weight earned), Fail = F (weight earned is 0%) N/A = N/A (weight evenly redistributed to other elements for that month).
CHECKSHEET AQL 95%
Month/Year:
| TASK |
| AQL Performance Criteria AQL |
| Weight |
| Rating P/F/NA |
| Weight Earned |
| Rating Comments |
| 1. PM Performance – Quality Workmanship (3.4 through 3.4.2) |
| The AQL is achieved if a minimum of 99% of all inspected PM’s for the month were completed IAW the associated guide card checkpoints. Rework is allowed but it must be completed and re-inspected by the end of the month, otherwise it is recorded as a failure. |
| 20% |
| 2. PM Deferral (3.4.2 E) |
| The AQL is achieved if a deferral is requested 5 days before the due date with the required documentation in the CMMS in 100% of the instances when it is required. |
| 10% |
| 3. Changes in Equipment Inventory (3.4.3) |
| The AQL is achieved if 100% of the required equipment changes were made in the CMMS within the contract required time frame of 7 days. |
10%
| 4. PM Documentation - accuracy (3.4.4) |
| The AQL is achieved if a minimum of 99% of all the inspected PM’s have all the required data on the hard copy work order (including a completed date/time stamp) and in the CMMS according to the PWS requirements. |
| 15% |
| 5. PM Documentation – timely input (3.4.4) |
| The AQL is achieved if a minimum of 99% of all inspected PM’s are closed out in the CMMS within 2 days of the date/time stamp of the mechanic completing the ticket. |
| 15% |
| 6. Certification Testing (3.4.6 & 3.4.7) |
| The AQL is achieved if 100% of the scheduled certifications were completed IAW the PWS requirements for the month. Certifications that have been granted approved deferrals by the COR will not be counted in this analysis. |
| 10% |
| 7. Infrared Testing (3.4.8) |
| The AQL is achieved if 100% of the scheduled infrared scans were completed IAW the PWS requirements for the month and the written report was received timely with all the required information. Infrared scans that have been granted approved deferrals by the COR will not be counted in this analysis. |
| 10% |
| 8. QCP PM Inspections (3.11.1 – 3.11.4) |
| The AQL is achieved if the contractor performed the minimum required PM inspections by the properly identified personnel and a copy of each inspection was received by the COR within 1 calendar day of the inspection and all hard copies are maintained in an orderly filing system and available for review by the COR. |
| 10% |
OVERALL RATING
100%
IRS COR Signature: _______________________________________________________________Date: _________________________________ Site Manager Receipt/Signature:_____________________________________________________Date:________________________________
INSPECTION CHECKSHEET # 5
CLIN REQUIREMENT: Additional Services REFERENCE: PWS Section 4
PERFORMANCE RATINGS: Overall Each Element Rating is Pass, Fail, or N/A. Pass = P (total weight earned), Fail = F (weight earned is 0%) N/A = N/A (weight evenly redistributed to other elements for that month).
CHECKSHEET AQL 95%
| TASK |
| AQL Performance Criteria AQL |
| Weight |
| Rating P/F/NA |
| Weight Earned |
| Rating Comments |
| 1. IDIQ Timely Proposals (4.2) |
| The AQL is achieved if 100% of all IDIQ proposals were prepared and submitted in accordance with applicable IRS time constraints identified in the PWS. |
20%
| 2. Complete Proposals (4.2 through 4.3.4) |
| The AQL is achieved if the contractor has provided a complete proposal with all the requirements as outlined in Sections 4.2 through 4.3.4 for all the requested additional services task orders for the month. The contractor is allowed to rework proposals as long as they are re-submitted within the allowable timeframe. Otherwise it is recorded as a failure. |
20%
| 3. Task Order Schedule (4.2) |
| The AQL is achieved if the contractor has provided a complete schedule (within 3 calendar days of receipt of an approved task order) that identifies critical milestones and the completion date for each IDIQ order received during the month. |
10%
| 4. Task Order Timely Completion (Section 4) |
| The AQL is achieved if 100% of all IDIQ task orders with a scheduled completion date during the month were completed by the scheduled completion date in the Task Order. If the CO has granted an extension that is the new scheduled completion date and evaluation of this element shall be based on the new scheduled completion date. |
| 20% |
| 5. Task Order Quality (Section 4) |
| The AQL is achieved if 100% of all IDIQ task orders were completed with quality workmanship and met all the scope requirements. Rework is allowed provide it was completed and re-inspection occurred (and it passed) before the scheduled completion date. Otherwise it is recorded as a failure. |
| 20% |
| 6. Task Order Reports (4.3.7) |
| The AQL is achieved if the monthly IDIQ Task Order report was supplied within the contract timeframe and has all the required details as outlined in section 4.3.7 of the PWS (and the details are accurate). Rework is allowed (if the initial report is inaccurate) if the report is corrected and re-submitted within the required timeframe. Otherwise it is considered as failed. |
| 10% |
OVERALL RATING
100%
IRS COR Signature: _______________________________________________________________Date: _________________________________ Site Manager Receipt/Signature:_____________________________________________________Date:_________________________________
INSPECTION CHECKSHEET # 6
CLIN REQUIREMENT: Phase-In Deliverables/Submittals
REFERENCE: PWS
PERFORMANCE RATINGS: Overall Each Element Rating is Pass, Fail, or N/A. Pass = P (total weight earned), Fail = F (weight earned is 0%) N/A = N/A (weight evenly redistributed to other elements for that month).
CHECKSHEET AQL 95%
| Deliverable/Submittal/Personnel |
| AQL Performance Criteria AQL |
| Weight |
| Rating P/F/NA |
| Weight Earned |
| Rating Comments |
| 1. BOP (3.1.1) |
| The AQL is achieved if a complete BOP was submitted by the contractor addressing all the requirements of the PWS by the end of the Phase-In period. |
| 6% |
| 2. Water Treatment Program & Initial Analysis (3.2.1) |
| The AQL is achieved if the contractor has provided an initial water treatment analysis by an independent firm and developed a complete water treatment program based on the analysis for each identified system during the phase-in period. |
| 6% |
| 3. Critical Spares, Parts, & Supplies Inventory (3.3.5) |
| The AQL is achieved if the contractor has provided a complete written inventory 30 days before the end of the phase-in period and has all the listed spares, parts, and supplies listed on the inventory stocked on-site before the start of the contract. |
| 6% |
| 4. Existing Deficiency Report (3.10.3) |
| The AQL is achieved if the existing deficiency report is turned over to the COR within 2 weeks of the joint inspection with all the details as required in the PWS. |
| 6% |
| 5. Lock-Out/Tag-Out Program (3.714) |
| The AQL is achieved if the contractor developed a lock-out/tag-out program in accordance with 29 CFR 1910.147 and submitted it to the COR for approval during the first 30 days of the phase-in period. |
| 6% |
| 6. Confined Space Program (3.7.17) |
| The AQL is achieved if the contractor developed a confined space entry permit system for all permit-required confined spaces within 45 calendar days of the phase-in period. |
| 6% |
| 7. Environmental Compliance and Safety Program/Plan (3.7.2) |
| The AQL is achieved if the contractor developed an Environmental Compliance and Safety Program/Plan for this contract in accordance with the requirements of the PWS for the review and approval of the COR within the phase in period. |
6%
| 8. Refrigerant Management Plan (3.7.23.1) |
| The AQL is achieved if the contractor developed a Refrigerant Management Plan (RMP) in accordance with GSA and/or Federal regulations for the review and approval of the COR within the first 30 days of the phase in period. |
6%
| 9. Waste Management Plan (3.7.2) |
| The AQL is achieved if the contractor developed a Waste Management Plan (RMP) in accordance with the PWS requirements for the review and approval of the COR within the phase in period. |
6%
| 10. Labeling system for equipment identification numbers (3.4.5) |
| The AQL is achieved if the contractor presents the COR with an equipment identification labeling system for approval during the phase-in period. |
6%
| 11. Oil Analysis Program (3.4.10.1) |
| The AQL is achieved if the contractor develops an Oil Analysis Program that meets all the requirements of the PWS and submits it to the COR during the phase-in period for approval. |
6%
| 12. Fuel Oil Treatment (5.4.2.1) |
| The AQL is achieved if the contractor submits to the COR during the phase-in period, for approval, product information covering the fuel oil treatment the Contractor proposes to use. |
6%
| 13. Report Formats (throughout the PWS) |
| The AQL is achieved if the contractor submits formats for the following documents during the phase-in period for the COR’s approval: |
1. Existing Deficiency Report Format
2. Tour Checksheet Format
3. Tour Logbook Format
4. Equipment Operating Log Sheets Format
5. Monthly Utility Usage Report Format
6. Daily Equipment Condition Report Format
7. Contractor QC Inspection Sheet Format 14%
| 14. Required Phase-In personnel (3.10.1) |
| The AQL is achieved if the contractor has all the phase-in personnel on-site by the required timeframes as outline in the PWS. |
| 14% |
OVERALL RATING
100%
IRS COR Signature: _______________________________________________________________Date: _________________________________ Site Manager Receipt/Signature:_____________________________________________________Date:_________________________________
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