QASP Rev.docx

Quality Assurance Surveillance Plan

For

MEDCOM HQ Capability Support: Programmatic and Financial Support Services

June 2022

Subject Page Number

1. Overview

2. Description of Services

3. Roles and Responsibilities

4. Contract Quality Requirements

5. Government Surveillance

6. Non-Conforming Performance

7. Deduct Plan

8. Data Analysis

9. Acceptance of Services

10. COR Status Report

11. Contractor Manpower Reporting Application (CMRA)

12. Contractor Performance Assessment Reporting System (CPARS)

13. Combating Trafficking In Persons

14. COR/Quality Assurance Surveillance Files

15. QASP Changes

1. Overview.

1.1. Purpose. The purpose of this Quality Assurance Surveillance Plan (QASP) is to identify the methods and procedures the Government will use to ensure it receives the services under this contract as identified in the Performance Work Statement (PWS).

1.2. Intent. The intent of this QASP is to: 1) ensure Contractor performance meets or exceeds contract terms, conditions, and specifications; 2) hold the Contractor accountable for quality control; and 3) encourage the Contractor to take appropriate steps to control and improve quality. Accordingly, the Government will perform surveillance on the contract in accordance with this QASP, but reserves the right to monitor the contract in any manner necessary, at any time necessary, and at all places necessary to ensure that the rendered services conform to contract requirements. The Government also reserves the right to perform quality assurance at the Subcontractor level and perform quality assurance at the contractor's place of business, if applicable. Resolution of non-conforming services discovered at the Subcontractor level will be addressed with the prime Contractor.

2. Description of Services.

2.1. Scope of Work. The contractor shall provide MEDCOM HQ Capability Support programmatic and financial management support to MEDCOM, to include the Regional Health Commands (RHC), by providing a financial management capability to address the management of the medical readiness resources. The contractor shall support audit response and remediation under the direction of the RHC accounting office. The contractor shall assist the RHC resource management divisions in addressing financial management policy, facilitate the POM process, monitor fiscal execution, and provide accounting support. Additionally, the contractor shall provide a full complement of integrated program management capabilities in support of MEDCOM/RHC operations. These capabilities include; executive officer support facilitating internal and external staff coordination, data analytics, studies, functional analysis, strategic planning, strategic outreach, training, process improvement and information technology.

2.1.1. Region Audit Response and Remediation

· Audit Response - Under the direction and approval of the RHC Accounting Office, contractor shall develop and implement, upon approval of F&A, an audit response communication plan that accounts for internal MEDCOM stakeholders such as Regional Health Commands and MTFs as well as external stakeholders such as the Department of the Army (DA), DHA, Defense Financial Accounting Service (DFAS), and Office of the Under Secretary of Defense (Comptroller) (OUSD[C]). The contractor shall facilitate MEDCOM audit response by tracking and providing quality control on Provide by Client (PBC) submissions. The contractor shall provide stakeholder coordination and logistical support for process walkthroughs and sites visits along with DA and DHA audit meetings.

· Audit Remediation – The contractor shall perform audit remediation on MEDCOM, OTSG, and MTF relevant Notices of Findings and Recommendations (NFRs) by developing and recommending CAPs to F&A. Once approved, contractor shall implement the CAPs. The contractor shall facilitate MEDCOM’s Federal Information System Controls Audit Manual (FISCAM) response, under the direction of F&A, in order to adjudicate findings on MEDCOM related information technology (IT).

· Manager’s Internal Control – The contract shall facilitate MEDCOM Manager’s Internal Control Program (MICP) and implement an Enterprise Risk Management (ERM) capability based on F&A direction. The contractor shall assist with the development of the MEDCOM Certification Statement and the Internal Control Evaluation (ICE) Summary. The contractor shall perform assessments on Internal Control over Operations (ICO) assessable units (AU) and report findings to F&A. The contractor shall design and implement testing plans for Internal Control over Financial Reports (ICOFR). The contractor shall develop and implement an ERM strategy to identify risks and applicable mitigation controls.

· Audit Analytics – The contractor shall provide metrics and process improvement recommendations on MEDCOM’s audit response and remediation processes and implement MEDCOM approved recommendations.

Deliverables

· Audit Project Plan that cascades from DA and DHA timelines

· Weekly Metrics Report on PBC, audit remediation, and mailbox correspondence

· Quarterly recommendations to improve audit response and remediation

· Annual MICP Risk Assessment Plan and MEDCOM Certification Statement

· ICO and ICOFR annual reports

· ERM Process Design

2.1.2. Region Financial Management

· Programming & Budget - Refine annual Programming and Budget guidance based on the organization’s strategic plan given the fiscal constraints. Provide analysis on resource allocation and cost estimation on organization programs to deliver effective and efficient medical readiness capabilities. This includes evaluating emerging requirement cost estimates for POM submission along with creating measures and analytical tools to analyze program performance.

· Financial Reporting - Provide monthly Status of Fund reports to subordinate organizations showing obligation rates and remaining balances. Determinate corrective actions to adjudicate variance between actual execution and spend plan. Resource Allocation Decisions. Conduct reconciliation on Open Commitments in order to cancel the transaction or Obligate the funds.

· Accounting - Provide subject matter expertise and over-the-shoulder support in GFEBS Financial and Funds Management modules to support MEDCOM’s analysis of GFEBS transactions and accounting procedures. Facilitate the Triannual Review, based on F&A direction, with MEDCOM subordinate organizations to determine the accuracy and status of all recorded commitments, obligations, expenses, and disbursements. Recommend solutions for processing deobligations in GFEBS for aged ULOs that are no longer valid.

· Accounting Tools - Develop a tool to isolate and investigate potential causes of financial imbalances for the GFEBS Solution by leveraging federal financial management and SAP expertise with enterprise-level analytics and data visualization expertise.

· Data Analytics (HQ). Provide data analytics support, to include economic analysis, using MHS and MEDCOM medical and financial data to senior leaders in a timeframe determined by the client. Provide data analysis to senior leaders to include OTSG/MEDCOM Senior Leadership, One Staff Deputy Chiefs of Staff and RHC commanders and relevant stakeholders within a minimum of 24 hours or next business day or longer for complex issues, for issues that require immediate response. Develop, implement, and maintain within a timeframe determined by the client, Tableau dashboards to display metrics, trends, and issues relevant to MEDCOM senior leaders to focus work efforts on priority tasks needing timely resolution.

Deliverables

· Financial Management Program Project Plan that outlines lines of effort supported throughout the fiscal year

· Annual Programming and Budget Guidance

· Monthly Program Status of Fund Report that shows program’s execution and variance

· Accounting Transaction Reconciliation Plan for Triannual Review and ULOs

· Monthly Metrics Report on adjudication of ULOs

· Quarterly recommendations to improve aged ULOs

2.1.3. HQ Program Management

· Program Management – Contractor shall provide program management and executive officer support, under the direction of the government lead, for daily internal operations in order to maximize the effectiveness of senior staff in executing their program and related administrative responsibilities. Facilitate executive level activities to including meeting support and assessment to include EXSUMs, talking points, coordination of action items. Develop and present decision briefs using the Military Decision-Making Process (MDMP). Facilitate knowledge management by establishing and maintaining an electronic repository site along with conducting After Action Reviews (AARs) on major projects. Review, brief, approve program/ project reports, vouchers and deliverables. Perform portfolio management for medical readiness programs. Manage project schedules and conduct program/ project oversight. Execute supporting staff preparations. Attend relevant MHS Governance sub-working groups and Army Medicine Governance work groups. Conduct planning and operation synchronization efforts and work groups.

· Administrative Support Services - The requirement is to provide administrative support services to MEDCOM leadership and staff. The administrative support services shall include but are not limited to;

· Telephone and receptionist services. Receive all visitors and incoming telephone calls. Determine nature of call or business of visitors and take appropriate action. Refer business matters and visitors to appropriate Government office personnel.

· Identifying need for office supplies, repairs on office equipment, and printing services.

· Reserving NSWC PCD rooms for meetings.

· Managing office electronic calendars (meeting/event calendars, conference room calendars etc.)

· Maintains records, files, statistical data, and suspense system.

· Populate and track official documents adhering to Government format.

· Using Microsoft Outlook to send and retrieve messages, clearly identifying themselves as contractors in the signature block.

· Collating and preparing office monthly reports.

· Attending office meetings to become cognizant of office requirements, functions, and events.

· Organizing government travel and the completion of Defense Travel System (DTS) documentation to include training, operation, and administration. Prepare travel orders, visit request forms, and enter required data into required systems. Provide account or appropriation information to support the development of travel status reporting. Forward security clearance and visit request documentation to the necessary offices.

· Designing and organizing filing systems. Filing documentation and maintaining office-filing systems.

· Receiving and distributing incoming correspondence.

· Edit outgoing correspondence and reports for format, grammar, and punctuation. Utilize Microsoft Office in preparing a variety of correspondence, memorandums, briefings and other reports required for day-today office operation.

· Data Analytics – Provide data analytics support, to include economic analysis, using MHS and MEDCOM medical and financial data in order to assist senior leaders in making data driven decisions. Provide timely data analysis to senior leaders and relevant stakeholders for issues that require immediate response. Develop and implement Tableau dashboards to display metrics, trends, and issues relevant to MEDCOM senior leaders to focus work efforts on priority tasks needing timely resolution.

· Studies and Analysis – Conduct studies and analysis, based on government lead priorities, to inform senior leadership decisions necessary to achieve MEDCOM strategic priorities. Assist in the development of the study’s purpose and coordination with key stakeholders. Use an appropriate analytical approach and present the findings along with recommendations.

· Functional Analysis – Provide functional analysis support by conducting Requirement Definition, Analysis, Integration and Planning. Apply analytical skills in development and implementation of functional areas process improvement activities, studies, policies and procedures in the functional areas of Human Resources, Medical, Reserve Finance, Procurement, Materiel Management, or C3I. Create and maintain comprehensive resource assessment tools that influence Army Medicine Manpower and Resource Models. Collaborate with Army Medicine proponents to ensure models address staffing levels, infrastructure and commodity utilization. Perform Cost Benefit Analyses and/or Business Case Analyses to identify solutions that provide the greatest value for a given level of investment. Monitor Resource Utilization by reviewing spending patterns within focus areas down to the MTF. Provide assessment on variance analysis of the financial spending versus the projected spending plan. Determine the program impacts due to financial constraints. Review the targeted outcome against actual and provide analysis on the effectiveness of generating value. Determine if resources are achieving the desired performance level for the initial cost estimate.

· Strategic Planning – Provide strategic planning support services to achieve clearly defined processes, procedures, roles and responsibilities within Army and DoD that are documented and deployed. Develop and recommend strategies, metrics, and feedback mechanics for plan implementation. Establish principles and/or protocols to guide decisions and achieve desirable clinical and administrative outcomes. The Contractor shall conduct Performance Plan assessments of the MTF Readiness Performance Plans (RPP) and programs at HQs region and MTFs to determine feasibility and identify performance shortfalls.

· Strategic Outreach – Plan, synchronize and execute engagements in order to facilitate strategic messaging and gain feedback from MTF functional leaders. Conduct site visits in support of unit training, organizational assessments, strategic plans and synchronization. Conduct research for reports, technical papers and policy recommendations for strategic and outreach operations to include preparation of reports and response for Congressional, DHA and Army Medicine inquiries. Develop and implement strategic messaging with DoD and inter-agency leaders. Conduct marketing, education and awareness campaigns ISO Service Line target audiences.

· Training – Identify end-user training requirements and develop training plans, materials and venues to address requirements and provide support in the development and review of organizational change management plans and end-user training plans. Conduct over the shoulder support across different MEDCOM domains.

· Process Improvement – Identify areas for improvement based on MEDCOM requirements. Review current system and propose how the system can be reengineered to meet future needs based on lessons learned gathered from MEDCOM feedback and contractor experience. Review existing procedures relevancy and effectiveness to accomplish functional areas. Coordinate necessary updates through interagency and interdisciplinary work groups. Develop new procedures to cover "gaps." Standardize processes that support medical readiness and administrative services. Align strategy to specific outcome measures. Evaluate existing measures against the desired strategic direction. Coordinate and implement new metrics with database managers to configure data platforms. Establish data collection procedures to include sources and frequency. Conduct Review and Analysis with HQ, regional and MTF personnel on specific focus areas. Identify performance gaps and establish remediation plans. Consolidate best practices and profligate through the enterprise. Initiate process improvement projects to address systemic issues. Support MEDCOM Lean Six Sigma projects and pilot projects. Assess existing capabilities and develop a gap analysis. Produce a strategy based on DOTMLPF-P that details how performance gaps will be mitigated.

· Information Technology – Provide information technology to support, assist and perform independent analyses and assessment of new technology. Support, assist, and conduct systems engineering and trade-off analysis to support technical and budgetary decisions concurrent with long range Government plans. Assist in planning, preparing, conducting, analyzing and reporting of tests, demonstrations and experiments using live systems and stakeholders, virtual systems, Modeling & Simulations via distributed interactive simulation, or any combination of these. Provide front end SharePoint development support, ongoing site maintenance, and end user support.

2.2. Type of Contract. Firm Fixed Price

3. Roles and Responsibilities.

3.1. Government.

3.1.1. Contracting Officer (KO). The KO is the only person with the authority to enter into, administer, and or terminate contracts, and make related determinations and findings on behalf of the Government. Note: The only individual who can legally bind the Government.

3.1.2. Contracting Officer’s Representative (COR). The (COR) will be identified by separate letter. The COR monitors all technical aspects of the contract and assists in contract administration. The COR is authorized to perform the following functions: assure that the Contractor performs the technical requirements of the contract: perform inspections necessary in connection with contract performance: maintain written and oral communications with the Contractor concerning technical aspects of the contract: issue written interpretations of technical requirements, including Government drawings, designs, specifications: monitor Contractor's performance and notifies both the Contracting Officer and Contractor of any deficiencies; coordinate availability of Government furnished property, and provide site entry of Contractor personnel. A letter of designation issued to the COR, a copy of which is sent to the Contractor, states the responsibilities and limitations of the COR, especially with regard to changes in cost or price, estimates or changes in delivery dates. The COR is not authorized to change any of the terms and conditions of the resulting order.

3.2. Contractor.

3.2.1. Contractor Program Manager. The contractor’s technical effort shall be under the direction of a contractor project manager, who shall provide the overall contractor management of the contract including personnel, planning, quality control, direction, coordination, and reviews necessary to ensure effective contract performance. The contractor project manager shall serve as the primary point of contact.

3.2.1.2. The contractor shall also submit a monthly progress, status, and management report to provide visibility into (1) progress towards achieving the technical and schedule requirements/objectives of the contract, identify accomplishments to date and compare the status achieved to planned goals, (2) overall status of contract performance, to include but not limited to, the identification of problem areas affecting technical/schedule/cost elements, recommendations for problem resolution and resolution results related to previously identified problem areas.

3.2.1.3. The contractor shall submit a final technical report to provide concise description of all findings and accomplishments achieved during the course of contractor performance.

4. Contract Quality Requirements.

4.1. Contractor’s Quality Control Program. The Contractor’s quality control program (IAW FAR Part 46 and applicable 52.246-(Clause(s))) is the means by which the Contractor assures that work complies with the requirement of the contract. The Contractor shall ensure services are performed in accordance with this PWS. The Contractor shall identify, prevent, and ensure non-recurrence of defective services.

4.2. Government Quality Assurance. The Government shall evaluate the Contractor’s performance under this contract in accordance with this QASP. This plan is primarily focused on what the Government must do to ensure that the Contractor has performed in accordance with the performance standards. It defines how the performance standards will be applied, the frequency of surveillance and minimum acceptable defect rate(s).

5. Government Surveillance.

5.1. Methods of Surveillance. The following Methods of Surveillance will be utilized in monitoring the Contractors’ performance:

5.1.1. 90% Inspection

5.1.2. Random Sampling

5.1.3. Periodic Inspection

5.1.4. Customer Feedback. The DA Form 5477, Customer Complaint Record, QASP Attachment 2, will be used to document/record all complaints. The following procedures will be followed when a complaint is received.

· The COR will investigate and determine the validity of the complaint.

· If the complaint is determined to be invalid, the COR will inform the person who submitted the complaint of the reason(s) as soon as practical.

· For validated complaints that are true contractual non-conformances, the procedures in paragraph 6 below will be followed.

5.2. Surveillance Schedule. A Surveillance Schedule will be created for each month of Contractor performance utilizing the DA 5475, COR Surveillance Schedule,QASP Attachment 3. The schedule is “FOR OFFICIAL USE ONLY” and is not releasable to anyone other than authorized Government personnel. A copy of the Surveillance Schedule will be filed in the Wide Area WorkFlow e-Business Suite, Procurement Integrated Enterprise Environment (PIEE), https://piee.eb.mil (Either as an Attachment to the Monthly COR Status Reports or uploaded separately in the Miscellaneous Documents Section of the CORs’ Online File.).

5.3. Surveillance Instructions/Checklists. Surveillance Checklists, QASP Attachment 4, will be utilized and completed when surveillances are conducted

5.4. Surveillance Documentation. No later than the 15th of each month surveillance documentation for the preceding month will be uploaded in the Wide Area WorkFlow e-Business Suite, PIEE, https://piee.eb.mil. Monthly surveillance documentation includes the Monthly Status Report, the Surveillance Schedule and all completed Surveillance Checklist(s) for the preceding month. Surveillance Schedules and completed Surveillance Checklists may be uploaded in PIEE either as Attachments to Monthly Status Reports or uploaded separately in the Miscellaneous Documents Section of the CORs’ Online File.).

6. Non-Conforming Performance. Non-conformance occurs when a Contractor fails to meet Contract or Task Order terms, conditions and/or specifications. All instances of non-conformance will be documented and the Contractor will be notified. Resolution of non-conformance discovered at the Subcontractor level will be addressed with the prime Contractor. Non-conformance is classified as either: Level I (Minor); Level II (Major); or Level III (Critical).

6.1. Level I (Minor). Level I non-conformance is not likely to materially reduce the usability of services for their intended purpose or is a departure from established standards having little bearing on completing the contract requirement. Minor non-conformances can usually be corrected on the spot and can be issued to the Contractor through either a verbal or written Contract Discrepancy Report (CDR). However, the Government is still required to document verbal Level I CDRs. The COR may issue verbal Level I CDRs directly to the appropriate level of Contractor management. The COR will notify the KO as soon as practical when a verbal Level I CDR is issued and document them in their Monthly Reports. If the non-conformance cannot be corrected on the spot, the Contractor shall be given a suspense date to correct the deficiency. The KO will issue and sign written Level I CDRs, QASP Attachment 5.

6.2. Level II (Major). Level II non-conformance is likely to result in failure of the services to meet contract requirements. Also, repeated discrepancies, a large number of documented Level I CDRs and trends indicating failure of the Contractor’s quality control program can be classified as Level II CDRs. The KC issues all Level II CDRs in writing, QASP Attachment 5. The COR will notify the KO as soon as practical when a major non-conformance is identified.

6.3. Level III (Critical). Level III non-conformances result in hazardous or unsafe conditions due to the manner in which the services are performed; prevent or impact a vital agency mission as a result of performance; or are for repeated or uncorrected Level II CDRs. The Contracting Office Director or Deputy Director issues written Level III CDRs. The COR is responsible for notifying the KO immediately upon discovery of a critical non-conformance.

6.4. Documenting CDRs. Documentation, as a minimum, will include: the Contract or Task Order number; reference to the specific contract requirement; the specific discrepancy to the requirement; where it was discovered; the date and time it was discovered; Contractor representative who was notified; and the suspense date for Contractor response/corrective action.

6.5. Tracking and Resolving CDRs. All CDRs, verbal and written, regardless of issuer will be included in the COR’s Monthly Report. The COR and KO shall track CDRs to ensure the Contractor identifies and takes appropriate corrective action to the root cause and the specific non-conformance is corrected within the required timeline. The KO will make a final written determination of the Government’s remedies if the non-conformance is not corrected by the Contractor after receiving notice and a reasonable opportunity to correct the work

7. Deduct Plan. This acquisition does not include a Deduct Plan.

8. Data Analysis. Data Analysis will be performed to identify trends in cost, schedule and/or performance risks. The results of Data Analysis will be documented in COR Status Reports and may be used to make adjustments to surveillance schedules, increase or decrease surveillance, if deemed appropriate. Negative trends noted using Government data/observations could result in issuing the Contractor a Contract Discrepancy Report. Trends noted using Contractor data will not result in a CDR unless the Contractor is not addressing the negative trend.

9. Acceptance of Services. When all services have been deemed acceptable and there is documented objective quality evidence to support acceptable performance the COR will accept the services provided and authorize payment of the Contractor. This is accomplished by approving the Contractor’s Receiving Reports in Wide Area WorkFlow, e-Business Suite, https://piee.eb.mil

10. COR Status Report. COR Status Reports will be submitted on a Monthly basis, no later than the 15th of each month for the preceding month, to the Contracting Officer via the Wide Area WorkFlow e-Business Suite, PIEE. COR Status Reports will provide a synopsis of the Contractors performance for the inclusive dates of the report. The synopsis will contain a summary of: surveillances performed; Customer Feedback, if any; CDRs, if any; an analysis of the Contractors performance; recommended adjustments to surveillance schedules; and any other pertinent contract information. Completed Surveillance Checklists and CDRs, if any, will be included as attachments to COR Status Reports or uploaded separately in the Miscellaneous Documents Section of the CORs’ Online file

11. Contractor Manpower Reporting Application (CMRA). In accordance with Office of the Secretary of Defense Memorandum, Enterprise-wide Contractor Manpower Reporting Application, dated 28 Nov 2012, the Contractor must report contractor manpower to the Contractor Manpower Reporting website at https://cmra.army.mil. While inputs may be reported any time during the FY, all data shall be reported no later than October 31 of each calendar year. The COR shall verify that the Contactor has complied with the required contractor manpower reporting annually and document the results in the Wide Area WorkFlow, e-Business Suite, PIEE, Miscellaneous Documents Section

12. Contractor Performance Assessment Reporting System (CPARS). Documented surveillance data (COR Status Reports, Completed Surveillance Checklists, Customer Feedback and CDRs, if any) will be used to support CPARS ratings. CPARS will be completed in accordance with AFARS, Subpart 5142.15 – Contractor Performance Information. The COR shall document that CPARS, if required, was completed in the Wide Area WorkFlow, e-Business Suite, PIEE, Miscellaneous Documents Section https://piee.eb.mil.

13. Combating Trafficking In Persons (CTIP). In accordance with PGI 222.17 and FAR 52.222-50, the KO will be notified immediately of any information from any source that alleges a Contractor employee, subcontractor and/or subcontractor employee has engaged in conduct that violates the United States Government “zero” tolerance policy regarding trafficking in persons.

14. COR/Quality Assurance Surveillance Files. The official COR/Quality Assurance Surveillance File will be maintained in the Wide Area WorkFlow, e-Business Suite, PIEE, https://piee.eb.mil/, IAW DoDI 5000.72, DoD Standard for COR Certification.

15. QASP Changes. This QASP is a living document and, as such, may be changed as needed based on Data Analysis (trends), contract modifications, etc. The COR will send any recommended changes to the CO for approval and the CO must approve all changes

QASP Attachments:

1. Performance Requirements Summary (PRS)

2. Customer Complaint Record, DA Form 5477

3. Surveillance Schedule, DA Form 5475

4. Surveillance Checklist(s)

5. Contract Discrepancy Report, DA Form 5479

QASP Attachment 1

Performance Requirements Summary (PRS)

QASP Attachment 2 Customer Complaint Record, DA Form 5477

QASP Attachment 3 Surveillance Schedule, DA Form 5475

QASP Attachment 4 Surveillance Checklist(s)

Contractor:

Contract Number:

Service Provided:

COR Name:

Comments:

Comments:

Comments:

Comments:

Comments:

Comments:

Comments:

Comments:

Comments:

Comments:

Comments:

Comments:

Comments summary, to include, positive trends, negative trends, concerns, customer comments, and any additional COR comments:

QASP Attachment 5 Contract Discrepancy Report, DA Form 5479

DATE OF COMPLAINT TIME OF COMPLAINT

NATURE OF COMPLAINT

CONTRACT REFERENCE

VALIDATION

DATE CONTRACTOR INFORMED COMPLAINT TIME CONTRACTOR INFORMED OF COMPLAINT

ACTION TAKEN BY CONTRACTOR (Responsible officer)

RECEIVED AND VALIDATED BY

ORGANIZATION

INDIVIDUAL

NOTE: ( ) Used for in-house operation.

CUSTOMER COMPLAINT RECORD

For use of this form, see DA PAM 5-20; the proponent agency is ACSIM.

SOURCE OF COMPLAINT

(Responsible officer) (Responsible officer)

DA FORM 5477, MAR 2008 PREVIOUS EDITIONS ARE OBSOLETE. APD PE v1.01ES initiator:ralph.gaines@us.army.mil;wfState:distributed;wfType:email;workflowId:b71742b09d8a4c49a6eb59ab36d6e236

DATE OF COMPLAINT:

TIME OF COMPLAINT:

ORGANIZATION INDIVIDUAL SOURCE OF COMPLAINT:

NATURE OF COMPLAINT:

CONTRACT REFERENCE:

VALIDATION:

DATE CONTRACTOR INFORMED COMPLAINT Responsible officer:

TIME CONTRACTOR INFORMED OF COMPLAINT Responsible officer:

ACTION TAKEN BY CONTRACTOR Responsible officer:

RECEIVED AND VALIDATED BY:

NOTE Used for inhouse operation:

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Text2:

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DATE

COR/QAE SURVEILLANCE SCHEDULE

When completed stamp "FOR OFFICIAL USE ONLY"

DA FORM 5475, MAR 2008 APD PE v1.00

DATE

SERVICE

PREVIOUS EDITIONS ARE OBSOLETE.

image3.emf

6.

2. 3.

PREPARED ORAL NOTIFICATION RETURNED BY CONTRACTOR ACTION COMPLETE

4. DISCREPANCY OR PROBLEM (Describe in Detail: Include reference in PWS / Directive: Attach continuation sheet if necessary.)

5. SIGNATURE OF CONTRACTING OFFICER

7.

8. CONTRACTOR RESPONSE AS TO CAUSE, CORRECTIVE ACTION AND ACTIONS TO PREVENT RECURRENCE. ATTACH

1. CONTRACT NUMBER

9. SIGNATURE OF CONTRACTOR REPRESENTATIVE 10. DATE

11. GOVERNMENT EVALUATION (Acceptance, partial acceptance, rejection: attach continuation sheet if necessary)

12. GOVERNMENT ACTIONS (Payment deduction, cure notice, show cause, other.)

CONTRACT DISCREPANCY REPORT

TO: (Contractor and Manager Name)

DATES

CLOSE OUT

CONTRACTOR

NOTIFIED

NAME AND TITLE SIGNATURE DATE

QAE

CONTRACTING

OFFICER

CONTINUATION SHEET IF NECESSARY. (Cite applicable Q.A. program procedures or new A.W. procedures.)

DA FORM 5479, MAR 2008 APD PE v1.01ES

FROM: (Name of QAE)

TO: (Contracting Officer) FROM: (Contractor)

PREVIOUS EDITIONS ARE OBSOLETE.

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