Custodial_Services_TE_-_E1_Customer_Complaint_Form_(1).pdf
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- W912D0-19-R-0002
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TE-E1 Customer Complaint Form
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CUSTOMER COMPLAINT RECORD
Complainant’s Information
Date of Complaint Time of Complaint
Organization Name Building #
Name Phone
Email Alt Phone
Description/Nature of Complaint
This section for Quality Assurance (QA) Officer
Contract Document Reference
Validation QA Signature
Date
This section for Contract Officer’s Representative (COR) Action taken by Contractor and/or COR & Follow-Up Notes to Complainant
Attachment(s)
Date Contractor Notified Time Phone
Email Issued resolved:
YES NO Explain:
Received & Validated by (COR Signature)
Date
Fort Wainwright Alaska Supplement to DA Form 5477
MAR 2018
Technical Exhibit E1- Customer Complaint Record
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