A.01.30_Attachment__1_-_Contract_Discrepancy_Report1.pdf

ATTACHMENT 1

DATE

CONTRACT DISCREPANCY REPORT

Instructions: QAP fills in blocks 1, 3, 4, 5 (prepared), and 6. Contractor fills in blocks 9 and 10.

1. CONTRACT NUMBER 2. REPORT NUMBER FOR THIS DISCREPANCY

3. TO: (Contractor and Managers Name) 4. FROM: (Name of QAE)

5. DATES

PREPARED RETURNED BY CONTRACTOR ACTION COMPLET E

6. DISCREPANCY OR PROBLEM: (Describe in detail: include applicable SOW/Contract references: attach continuation sheet if necessary.)

7. SIGNATURE OF CONTRACTING OFFICER

8. TO: (Contracting Officer) FROM: (Contractor)

9. CONTRACTOR RESPONSE AS TO CAUSE, CORRECTIVE ACTION AND ACTIONS TO PREVENT RECURRENCE: ATTACH CONTINUATION SHEET IF NECESSARY. (Cite applicable Q.C. program procedures or new Q.C. procedures.)

10. SIGNATURE OF CONTRACTOR REPRESENTATIVE

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

12. GOVERNMENT ACTIONS (Reduced payment, cure notice, show cause, other.)

CLOSE OUT

NAME-TITLE SIGNATURE DATE

CONTRACTOR

NOTIFIED

QAE

ACO