Attachment_3_-_Samples_of_Records,_Reports,_and_Forms.docx
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- W911RX-17-B-0007
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ATTACHMENT 3
SAMPLES OF RECORDS, REPORTS, AND FORMS
The Contractor shall develop, prepare, maintain, and submit the records, reports, and forms below.
Daily Quality Control Report
Vehicle and Equipment List
Weekly Refuse Collection Record
Weekly Material and Waste Disposal Record
Weekly Construction and Demolition Disposal Record
Monthly Asbestos Disposal Record
DAILY QUALITY CONTROL REPORT
(Contractor’s Name and Address)
Contract No: W911RX- Date: Report No:
Description and Location of Work:
Weather: ; Temperature: Min Max ; Precip: Inches Type
Contractor/Subcontractors: (Areas of responsibility and labor count for each.)
a.
b.
c.
d.
e.
f.
Equipment Data: (Indicate Items of construction equipment, other than hand tools, at the job site, and whether or not used.)
Work Performed Today: Estimated % Complete
Results of Surveillance: (Include satisfactory work inspected, deficiencies found, corrective actions taken, and when corrective actions are completed and reinspected.)
Material Inspected: (Include any material arrived on site, also material incorporated in the construction.)
DAILY QUALITY CONTROL REPORT - Page 2 (Contractor’s Name and Address)
Tests Required, Performed and Results:
Instructions Received or Given: (Include any instructions received from, or given to, Government representatives or other Government contractors.)
Remarks: (Include any item not addressed in other sections, problems with plans or specifications, any disputes.)
Safety: (Note all unsafe conditions, equipment, personnel, surroundings and corrective actions, also safety meetings.)
Correspondence:
| Documents on Work Site yes no |
| Submittal |
| Date |
| Date |
| Approved |
Plans
| Number |
| Sent |
| Received |
| yes no |
Specifications
Manufacturer’s Installation Instructions
Shop Drawings
Permits
Other:
Signature of Quality Control Inspector _____________________________________________________
Signature of Quality Control Manager _____________________________________________________
VEHICLE AND EQUIPMENT LIST
EQUIPMENT LIST: Bidders shall submit with its bid a list stating major pieces of equipment to be used in performance of this contract by vehicle make, model and year; type of equipment; number of pieces of equipment; and whether the equipment is owned, leased or rented. The list shall include other support and maintenance items such as small tools, cleaning and painting equipment and any other such items required to demonstrate that the bidder is adequately prepared to perform under this contract.
VEHICLES:
HEAVY EQUIPMENT:
CLEANING AND PAINTING TOOLS AND EQUIPMENT:
REPAIR AND MAINTENANCE TOOLS AND EQUIPMENT:
MISCELLANEOUS TOOLS AND EQUIPMENT:
WEEKLY REFUSE COLLECTION RECORD
DATE:__________________________DRIVER:_____________________________VEHICLE NO:______________________
AREA SERVICED:____________________START TIME:__________________COMPLETION TIME:___________________
| BLDG NO. |
| DUMPSTER/CART NO. |
| REMARKS |
WEEKLY MATERIAL AND WASTE DISPOSAL RECORD
WEEK OF:____________________
| DATE |
| TIME |
| VEH NO. |
| TYPE MATERIAL/DISPOSAL LOCATION |
| VOLUME, CY |
| NET WT. LBS |
WEEKLY CONSTRUCTION AND DEMOLITION DISPOSAL RECORD
WEEK OF:______________________
| DATE |
| TIME |
| VEH NUMBER LIC PLATE NO. |
| UNIT DESIGNATION CONTRACT NAME/NO. |
| EST WT |
| DESCRIPTION/REMARKS |
MONTHLY ASBESTOS DISPOSAL RECORD
MONTH:__________________________
DATE/
TIME
VEHICLE NO. or
LICENSE NO.
| SOURCE (FAC NO.) |
| PRINTED NAME |
| PHONE NUMBER |
| EST. VOL. (CY) |
| DISPOSAL LOCATION |
REMARKS
| AGENCY (KTR/DPW) |
| SIGNATURE |
EST. WT. (LB)
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