PWS_Dental.docx

PERFORMANCE WORK STATEMENT (PWS)

FOR

MDANG Dental Examination Services

1. General:

1.1 Scope: The purpose of this requirement is to provide dental examination services in support of individual Airman dental readiness as prescribed by AFI10-250. This requirement is designed to be flexible, responsive, and meets the ever-evolving needs of the government. DoDI 6025.19 establishes aggressive quarterly and annual metric goals for the separate IMR elements and for the overall IMR category of Fully Medically Ready (FMR) Airmen. The ultimate goal is to maintain and improve dental readiness with an ideal goal of 100%. The Maryland Air National Guard (MDANG) Surgeon’s Office requires a highly responsive process whereby the government can quickly obtain needed support and services. The position will be filled with a licensed dentist authorized to perform dental services in the state of Maryland. The Contractor shall furnish all labor and services required to provide a comprehensive dental examination. A dental suite consisting of a dental chair, panograph machine, computer and desk, and all disposable examination equipment will be supplied at no cost to the contractor.

1.2 Background: All uniformed services are required to monitor and report Individual Medical Readiness (IMR) IAW Department of Defense Instruction (DoDI 6025.19). The minimum goal is for 85% of Service Members in the ANG to meet all of the IMR requirements with an ideal goal being 100%. DoD established a uniform dental classification in HA Policy 02-11, Policy on Standardization of Oral Health and Readiness Classification. DoD policy requires dental screening examination and remediation to be accomplished and documented on at least 90% of Airman. Members will receive an annual screening exam that will be entered in DENCLASS for documentation and tracking purposes.

1.3. Period of Performance (PoP): The period of performance shall be one year from the award date plus four option years.

1.4. General Information:

1.4.1. Quality Control (QC): The Contractor shall provide a preliminary Quality Control Plan (QCP) with their proposal The QCP shall include a detailed discussion of the steps proposed to ensure quality, adherence to schedule, proactive communication and adherence to budget. The QCP shall include a description of corrective action steps to take should the Contractor performance be substandard. An organizational depiction of the project team and chain(s)-of-command shall also be included in the QCP. The QCP shall be submitted as part of the proposal.

1.4.2. Quality Assurance (QA): The Government shall develop and utilize a quality assurance plan. This plan shall be primarily focused on what the Government must do to ensure the contractor has performed in accordance with the performance standards. It defines how the performance standards will be applied, the frequency of surveillance, and acceptable quality level(s) (defect rate(s)).

1.4.3. Recognized Holidays: The following are recognized US holidays. The contractor is NOT required to perform services on these days:

1.4.3.1 New Year’s Day: January 1st

1.4.3.2 Martin Luther King, Jr.’s Birthday

1.4.3.3 President’s Day

1.4.3.4 Memorial Day

1.4.3.5 Independence Day: July 4th

1.4.3.6 Labor Day

1.4.3.7 Columbus Day

1.4.3.8 Veteran’s Day: November 11th

1.4.3.9 Thanksgiving Day

1.4.3.10 Christmas Day

1.4.4. Place and Performance of Services: The primary location of onsite work is Warfield ANGB. Contract services will be provided on one weekday per month and on Saturday of regularly scheduled drills each month as determined by the installation commander. The month of July does not commonly hold regularly scheduled drills and will require two weekday PHA events. Contract services will be performed during core office hours which are 0730 hrs. to 1600 hrs. Contractor shall not work any alternate work schedule without the explicit and prior approval of both the COR and the Contracting Officer. Telecommuting is not authorized for this Performance Work Statement. Overtime is not authorized for this Performance Work Statement. Performance of services should be on a regular weekly schedule to allow for quality monitoring and not be varied unless there is prior request and approval from the COR and Contracting Officer. Contractor shall not perform services on recognized US holidays or when Government facility/installation is closed due to local or national emergencies, administrative closings, or similar Government directed facility/installation closing. Performance shall be on-site. The contractor shall at all times maintain an adequate work force for the uninterrupted performance of all tasks defined within this PWS when the Government facility/installation is not closed for the above reasons. When hiring personnel, the contractor shall keep in mind that the stability and continuity of the work force are essential.

1.4.5. Security Requirements: The contractor shall comply with the security requirements as stated in this contract and as provided for in AFI 31-601, Industrial Security Program Management. The provisions for DoD 5220.22-M, National Industrial Security Program (NISPOM), shall apply to this contract. The contractor shall ensure that employees adhere to all MAJCOM, NGB and local security regulations and directives.

1.4.5.1 Applicable to Air Force and ANG installations unless specified otherwise in the Task Order: Air Force and ANG installations are closed installations, pursuant to Sec 21, Internal Security Act of 1950, 50 U.S.C. 797 and, as such, only those persons granted permission may enter. It is therefore required that control be exercised over contractor employees while working on Federal property.

1.4.5.2 Access and General Protection/Security Policy and Procedures. This standard language is for contractor employees with an area of performance within Government controlled installation, facility, or area. The contractor shall comply with all applicable installation/facility access and local security policies and procedures, which may be obtained from the Contracting Officer’s Representative (COR). The contractor shall also provide all information required for background checks to meet installation access requirements to be accomplished by the local installation’s Security Forces, Director of Emergency Services or local Security Office. The contractor shall ensure compliance with all personal identity verification requirements as directed by DoD, HAF and/or local policy. Should the Force Protection Condition (FPCON) change, the Government may require changes in contractor security matters or processes.

1.4.5.3 For Contractors Requiring Common Access Card (CAC). Before CAC issuance, the contractor employee requires, at a minimum, a favorably adjudicated National Agency Check with Inquiries (NACI) or an equivalent or higher investigation in accordance with Air Force Directive 31-101. The contractor employee will be issued a CAC only if duties involve one of the following: (1) Both physical access to a DoD facility and access, via logon, to DoD networks on-site or remotely; (2) Remote access, via logon, to a DoD network using DoD-approved remote access procedures; or (3) Physical access to multiple DoD facilities or multiple non-DoD federally controlled facilities on behalf of the DoD on a recurring basis for a period of 6 months or more. At the discretion of the sponsoring activity, an initial CAC may be issued based on a favorable review of the FBI fingerprint check and a successfully scheduled NACI at the Office of Personnel Management.

1.4.5.4 Security Clearances: Contract employees who have access to classified information, Local Area Network (LAN) or controlled/restricted areas require a National Agency Check (NAC); some will subsequently require a Secret security clearance. Standard Form 86 shall be accomplished within 5 calendar days of Task Order award or hiring of new employees. A National Agency Check with Inquiries (NACI) is required and a favorable completion of FBI fingerprint History Check must be completed.

1.4.5.4.1. A National Agency Check with Inquiries (NACI) is required and a favorable completion of FBI fingerprint History Check must be completed OR the Contractor must have or be able to obtain and maintain a SECRET clearance.

1.4.5.4.2. Contractor shall work with the Contracting Officer for processing into the Trusted Associate Sponsorship System (TASS) formerly known as Contractor Verification System (CVS).

1.4.5.5 Homeland Security Presidential Directive (HSPD) 12. The “smart” card or Common Access Card (CAC) identification system is necessary for access to physical assets and IT systems. The more stringent identity proofing requirements are mandatory. Extensive employee background checks may take extended periods of time and can potentially hamper contract performance.

1.4.5.6 Requirements vary from state to state but both Army and Air National Guard require contractor application for a Common Access Card (CAC) to be processed through Trusted Associate Sponsorship System (TASS). Within 10 working days of an awarded Task Order, the contractor shall submit a list of employees to the Contracting Officer who will be supporting the effort for input into the TASS. The Contracting Officer shall ensure that the Trusted Agent Security Manager (TASM) receives this information and the TASM will provide it to the appropriate Trusted Agent (TA). The list shall be on company letterhead and shall include the employee’s full name, address, date of birth, social security number, valid/current email address, security clearance, Task Order/contract number and end date of Task Order. Additional information may be necessary as requirements vary with each Federal facility. The Contractor shall comply with the Federal facility requirements for obtaining a CAC as defined in the PWS. Once the Trusted Agent (TA) inputs the contractor employees’ data into the TASS, they will receive a system generated email to visit the TASS website to verify and update/add their information. Within a few days after they complete the application (unless there are issues with their registration/NAC, etc.), they will be approved and will receive a second system generated email stating that their registration is complete. At that point they should go to the nearest CAC/DEERS office for issuance of a CAC card. Failure to respond to the first system generated email within five working days will remove them from the system. They will need to resubmit their contact details; hard copy or electronic documentation will be shredded or deleted once they are input into the TASS system. Subsequent listings of additions/deletions shall be submitted to the Contracting Officer as employees are hired or released.

1.4.5.5 Retrieving Identification Media. The contractor shall retrieve all identification media (including vehicle passes) from their employees who depart for any reason. All identification media shall be returned to the KO within 14 days of employee departure.

1.4.5.6 COMSEC. All communications with DOD organizations are subject to communications security (COMSEC) review. Contractor employees shall be aware telephone communications networks are continually subject to intercept by unfriendly intelligence organizations. DOD has authorized the military departments to conduct COMSEC monitoring and recording of telephone calls originating from, or terminating at, DOD organizations. Therefore, the contractor is advised that any time they place/receive a call they are subject to COMSEC procedures. The contractor shall assume the responsibility for ensuring wide and frequent dissemination of the above information to all employees dealing with DOD information. The contractor shall be aware of and abide by all Government regulations concerning the authorized use of the Government's computer network; including the restriction against using the network to recruit Government personnel or advertise job openings.

1.4.5.7 During the performance of this Order, contractor employees may have access to or may generate unclassified information of a sensitive nature that is inappropriate for release to the public. Contractor shall implement information control procedures that require Government approval prior to the release of any information derived from the performance on any Order by the contractor or its employees, regardless of forum.

1.4.5.8 Contractor and all associated employees shall comply with applicable installation, facility, and area commander installation/facility access and local security policies and procedures (provided by government representative). The contractor shall also provide all information required for background checks to meet installation access requirements to be accomplished by installation Provost Marshal Office, Director of Emergency Services or Security Office. Contractor workforce shall comply with all personal identity verification requirements as directed by DOD HQDA and or local policy. Should the Force Protection Condition (FPCON) change, the Government may require changes in contractor security matters or processes.

1.4.6 Physical Security: The contractor shall safeguard all Government property provided for contractor use. At the close of each work period, Government facilities, equipment and materials shall be secured.

1.4.7 AT Level 1 Awareness Training: All contractor employees, to include subcontractor employees, requiring access to Army Installations, facilities, and controlled access areas shall complete AT Level 1 Awareness Training within 30 calendar days after the contract start date and within 30 calendar days of new employees commencing performance. The contractor shall submit certificates of completion for each affected contractor employee and subcontractor employee to the COR or to the contracting officer, if a COR is not assigned, within 15 calendar days after completion of training. AT Level 1 awareness training is available at the following website: https://atlevel1.dtic.mil/at

1.4.8 Information Awareness: All contractor employees and associated sub-contractor employees shall complete the DoD Information Assurance Awareness CyberAwareness Challenge before issuance of network access and annually thereafter. All contractor employees performing services involving IA/IT functions shall comply with DoD and Air Force training requirements in DoD 8570.01, DoD 8570.01-M and AFPD 33-2 within 15 days of the start of contract performance.

1.4.9 For Information Assurance (IA) / Information Technology (IT) Certification. In accordance with DoD 8570.01-M , DFARS 252.239.7001 and AFM 33-282, contractor employees performing services supporting IA/IT functions shall be appropriately certified upon contract award. The baseline certification as stipulated in DoD 8570.01-M shall be completed upon contract award.

1.4.10 Advanced Distributed Learning Service (ADLS). All contractor employees and associated sub-contractor employees assigned to work on a government site and/or requiring access to a DoD network will be required to register with ADLS at commencement of services in order to complete the necessary training required of them initially and annually for the duration of the contract (i.e., DoD Information Assurance, OPSEC, Protecting Sensitive Information). ADLS website: https://golearn.csd.disa.mil/kc/rso/login/ADLS_login.asp

1.4.10 Classified Information: Not Applicable

1.4.11 Conservation of Utilities: The contractor shall instruct employees in utilities conservation practices. The contractor shall operate under conditions to preclude the waste of utilities, which include turning off the water faucets or valves after using the required amount.

1.4.12. Special Qualifications: The dentist must be licensed in the state of Maryland, and maintain an active and unrestricted license through the duration of the contract.

1.4.12.1. Responsible for completing HIPAA Training annually, and maintains patient confidentiality.

1.4.12.2. Responsible for compliance with all OSHA guidelines regarding the use of disposable examination instruments and medical waste.

1.4.12.3. Responsible for the proper implementation of Standard Universal precautions and infection control measures.

1.4.12.4. Attend PHA events as determined by the needs of the state and the individual units.

1.4.12.5. Perform comprehensive dental examinations and access current oral health in accordance with Air Force Standards outlined in AFI 10-250 and AFI 47-101.

1.4.12.6. Documents all clinical findings extemporaneously in the Airman’s Treatment Record and Corporate Dental System (CDS). Maintain Airman dental records in accordance with AFI 41-210 and AFI 47-101.

1.4.12.7. Follow the regulations and policies applicable to Individual Medical Readiness (IMR) and deployment with respect to dental readiness, to include the AFI 10-250, AFI 47-101, and other applicable guidance.

1.4.12.8. Reports significant or concerning findings to the Commander or his/her designated representative.

11.4.12.9. Dental treatment is not required or authorized.

1.5. Post Award Conference/Periodic Progress Meetings: The contractor agrees to attend any post award conference convened by the KO. The KO, Contracting Officer’s Representative (COR), and other Government personnel, as appropriate, may meet periodically with the contractor to review the contactor performance.

1.6. Identification of Contractor Employees: All contract personnel attending meetings, answering Government telephones and working in other situations where their contractor status is not obvious to third parties are required to identify themselves as such to avoid creating an impression in the minds of members of the public that they are Government officials. The contractor shall also ensure that all documents or reports produced by contractor personnel are suitably marked as contractor products or that contractor participation is appropriately disclosed.

1.7. Identification Badges: When contractor employees are working on Government facilities or participating in Government meetings, the contractor employees or associated subcontractor employees shall wear identification badges distinguishing themselves as such. The badges shall have the company name, employee name and the word “contractor” displayed. Contractor or Government issued badges are acceptable.

1.8. Contractor Travel: Travel is not authorized for this task order.

1.9. Organizational Conflicts of Interest (OCI): The contractor and subcontractor personnel performing work under this contract may receive, have access to or participate in the development of proprietary or source selection information (e.g., cost or pricing information, budget information or analyses, specifications or work statements, etc.) or perform evaluation services which may create a current or subsequent OCIs, as defined in FAR Subpart 9.5. The contractor shall notify the Contracting Officer immediately whenever it becomes aware that such access or participation may result in any actual or potential OCI and shall promptly submit a plan to the Contracting Officer to avoid or mitigate any such OCI. The contractor’s mitigation plan will be determined to be acceptable solely at the discretion of the Contracting Officer and in the event the Contracting Officer unilaterally determines that any such OCI cannot be satisfactorily avoided or mitigated, the Contracting Officer may affect other remedies as he or she deems necessary, including prohibiting the contractor from participation in subsequent contracted requirements which may be affected by the OCI.

2. Definitions and Acronyms

2.1. DEFINITIONS:

2.1.1. CONTRACTOR. A supplier or vendor awarded a contract to provide specific supplies or service to the government. The term used in this contract refers to the prime.

2.1.2. CONTRACTING OFFICER (KO). A person with 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.

2.1.3. CONTRACTING OFFICER'S REPRESENTATIVE (COR). An employee of the U.S. Government designated by the KO to monitor contractor performance. Such appointment shall be in writing and shall state the scope of authority and limitations. This individual has authority to provide technical direction to the Contractor as long as that direction is within the scope of the contract, does not constitute a change, and has no funding implications. This individual does NOT have authority to change the terms and conditions of the contract.

2.1.4. DEFECTIVE SERVICE. A service output that does not meet the standard of performance associated with the Performance Work Statement.

2.1.5. DELIVERABLE. Anything that can be physically delivered and includes non-manufactured things such as meeting minutes or reports.

2.1.6. KEY PERSONNEL. Contractor personnel that are evaluated in a source selection process and that may be required to be used in the performance of a contract by the Key Personnel listed in the PWS. When key personnel are used as an evaluation factor in best value procurement, an offer can be rejected if it does not have a firm commitment from the persons that are listed in the proposal.

2.1.7. PHYSICAL SECURITY. Actions that prevent the loss or damage of Government property.

2.1.8. QUALITY ASSURANCE. The government procedures to verify that services being performed by the Contractor are performed according to acceptable standards.

2.1.9. QUALITY ASSURANCE SURVEILLANCE PLAN (QASP). An organized written document specifying the surveillance methodology to be used for surveillance of contractor performance.

2.1.10. QUALITY CONTROL. All necessary measures taken by the Contractor to assure that the quality of an end product or service shall meet contract requirements.

2.1.11. SUBCONTRACTOR. One that enters into a contract with a prime contractor. The Government is not privy to the contract with the subcontractor.

2.1.12. WORK DAY. The number of hours per day the Contractor provides services in accordance with the contract.

2.2. ACRONYMS:

AFARS Army Federal Acquisition Regulation Supplement AFI Air Force Instruction AR Army Regulation CFR Code of Federal Regulations CONUS Continental United States (excludes Alaska and Hawaii) COR Contracting Officer Representative DA Department of the Army DD250 Department of Defense Form 250 (Receiving Report) DD254 Department of Defense Contract Security Requirement List DFARS Defense Federal Acquisition Regulation Supplement DOD Department of Defense FAR Federal Acquisition Regulation KO Contracting Officer OCI Organizational Conflict of Interest OCONUS Outside the Continental United States (includes Alaska and Hawaii and all off shore U.S. territories and possessions) ODC Other Direct Costs POC Point of Contact PRS Performance Requirements Summary PWS Performance Work Statement QA Quality Assurance QAP Quality Assurance Program QASP Quality Assurance Surveillance Plan QC Quality Control QCP Quality Control Program TE Technical Exhibit

3. Government Furnished Property, Materials, and Equipment (GFP/M/E):

3.1 Property: Government Computer and work station.

3.2 Materials: All dental instruments, supplies and Personal Protective Equipment.

3.3 Equipment: The government will provide a fully equipped dental suite, computers, scanners, telephones and materials necessary to comply with contract requirements at the job site.

3.4 Services: The government will provide parking on the facility.

3.5 Utilities: None.

4. Contractor Furnished Property, Materials, and Equipment (CFP/M/E): Name Tag.

4.1 General: Except for those items specifically stated to be Government-Furnished in Paragraph 3, the contractor shall furnish everything required to perform these services as indicated in this contract.

4.2 Secret Facility Clearance: Not required.

5. Requirements: The intent of this requirement is to provide dental examination services for the MD ANG in support of surge and contingency requirements as well as its steady-state mission. Any changes to the initial staffing will be completed through a bilateral supplemental agreement.

5.1. Contractor shall provide a licensed dentist to provide dental readiness support to the MD ANG. Personnel assigned to this requirement shall possess the required technical skills and expertise to perform the functions with minimum guidance.

5.1.1. The Government will provide training for DENCLASS to the contractor.

5.2. Contractor Manpower Reporting (CMRA):

5.2.1 The Office of the Assistant Secretary of the Army (Manpower & Reserve Affairs) operates and maintains a secure Army data collection site where the Contractor shall report ALL Contractor manpower (including subcontractor manpower) required for performance of this contract. The contractor shall completely fill in all the information in the format using the following web address https://Contractormanpower.army.pentagon.mil. The required information includes: (1) Contracting Office, KO, Contracting Officer’s Technical Representative (COTR) or also known as the Contracting Officer’s Representative (COR); (2) Contract number, including task and delivery order number; (3) Beginning and ending dates covered by reporting period; (4) Contractor's name, address, phone number, e-mail address, identity of Contractor employee entering data; (5) Estimated direct labor hours (including sub-Contractors); (6) Estimated direct labor dollars paid this reporting period (including sub-Contractors); (7) Total payments (including sub-Contractors); (8) Predominant Federal Service Code (FSC) reflecting services provided by Contractor (and separate predominant FSC for each sub-Contractor if different); (9) Estimated data collection cost; (10) Organizational title associated with the Unit Identification Code (UIC) for the Army Requiring Activity (the Army Requiring Activity is responsible for providing the Contractor with its UIC for the purposes of reporting this information); (11) Locations where Contractor and sub-Contractors perform the work (specified by zip code in the United States and nearest city, country, when in an overseas location, using standardized nomenclature provided on website); (12) Presence of deployment or contingency contract language; and (13) Number of Contractor and sub- Contractor employees deployed in theater this reporting period (by country). As part of its submission, the Contractor shall provide the estimated total cost (if any) incurred to comply with this reporting requirement. Reporting period shall be the period of performance not to exceed 12 months ending September 30 of each government fiscal year and must be reported by 31 October of each calendar year. Contractors may use a direct XML data transfer to the database server or fill in the fields on the website. The XML direct transfer is a format for transferring files from a Contractor’s system to the secure website without the need for separate data entries for each required data element at the website. The specific formats for the XML direct transfer may be downloaded from the website.

6.0 Applicable Publications: Publications applicable to this PWS are listed below:

Air Force Instruction 10-250 Air Force Instruction 41-210 Air Force Instruction 47-101 Air Force Instruction 48-123 16 Apr 2014 06 Jun 2012 20 Feb 2014 05 Nov 2013

Technical Exhibit 1

Performance Requirements Summary

This Performance Requirements Summary includes performance standards. The Government will use these standards to determine contractor performance and shall compare contractor performance to the Acceptable Quality Level (AQL).

PWS

Paragraph

Task

Performance Standard

Acceptable Quality Level (AQL) Surveillance Method/ By Whom

1.4.12.2.

1.4.12.3.

OSHA Adherence/Infection Control: Compliant Disposal of Medical Waste and use of Personal Protective Equipment.

1.4.12.5.

1.4.12.7.

1.4.12.6.

1.4.12.7.

Technical Exibit 2

Deliverables Schedule

JKO/ Certificate

MSME via e-mail

1.4.12.2., 1.4.12.3. OSHA Adherence/Infection Control: Compliant Disposal of Medical Waste and use of Personal Protective Equipment.

1.4.12.6., 1.4.12.7.

Documents all clinical findings extemporaneously in the Airman’s Treatment Record and Corporate Dental System (CDS).

QASP

Quality Assurance Surveillance Plan (QASP)

1.0 Background: All uniformed services are required to monitor and report Individual Medical Readiness (IMR) IAW Department of Defense Instruction (DoDI 6025.19). The minimum goal is for 85% of Service Members in the ANG to meet all of the IMR requirements with an ideal goal being 100%.

DoD established a uniform dental classification in HA Policy 02-11, Policy on Standardization of Oral Health and Readiness Classification. DoD policy requires dental screening examination and remediation to be accomplished and documented on at least 90% of Soldiers. Members will receive an annual screening exam that will be entered in DENCLASS for documentation and tracking purposes.

1.1 The MHS has two primary goals for Case Management:

1.1.1 Improve the dental readiness of Soldiers.

1.1.2. Educate and improve the oral health of Soldiers.

1.2 Vision: Develop and maintain the dental and oral health of soldiers to ensure a healthy, ready and deployable force for federal, state missions.

1.3 Mission: To Provide a dentally ready force.

1.4 Support deployment of a healthy force – Soldiers

1.5 Support deployment of the medical force – Units

2. Purpose: This Quality Assurance Surveillance Plan is a government-developed document used to determine if the contractor’s performance meets the performance standards contained in the contract. The QASP establishes procedures on how this assessment/inspection process will be conducted. It provides the detailed process for a continuous oversight process:

- What will be monitored

- How monitoring will take place

- Who will conduct the monitoring

- How monitoring efforts and results will be documented

2.1 The contractor is responsible for implementing and delivering performance that meets contract standards using its Quality Control Plan. The QASP provides the structure for the government’s surveillance of the contractor’s performance to assure that it meets contract standards. It is the government’s responsibility to be objective, fair and consistent in evaluating contractor performance.

2.2 The QASP is not part of the contract nor is it intended to duplicate the contractor’s quality control plan. This QASP is a living document. Flexibility in the QASP is required to allow for an increase or decrease in the level of surveillance necessary based on contractor performance.

2.3 The government may provide a copy of the QASP to the contractor to facilitate open communication. In addition, the QASP should recognize that unforeseen or uncontrollable circumstances might occur that are outside the control of the contractor.

2.4 Bottom line, the QASP should ensure early identification and resolution of performance issues to minimize impact on mission performance.

2.4.1 Authority

Authority for issuance of this QASP is provided under Part 46 of the Federal Acquisition Regulation, Inspection of Services clauses, which provide for inspection, acceptance and documentation of the service called for in the contract or order. This acceptance is to be executed by the contracting officer or a duly authorized representative.

2.4.2 Roles and Responsibilities

The following personnel shall oversee and coordinate surveillance activities.

2.4.2.1 Program/Project Manager (PM) – The PM (if the individual’s supervisor) nominates (or request the individual’s supervisory nominate the COR using VCE-COR or as directed by the Contracting Officer based upon the dollar value of the action. The PM/Supervisor ensures the COR is meets all COR training requirement outlined by the Contracting Office for the action before taking action regarding the nomination of the COR. The contract shall not be awarded until a qualified COR is appointed in writing by the Contracting Officer. The PM/Supervisor is not authorized to perform any COR duties but provides support to help the COR properly provide the necessary federal government oversight needed. The PM/Supervisor is required to include the performance of the COR in the COR/s annual performance rating. While the PM may serve as a direct conduit to provide Government guidance and feedback to thru the COR to the Contractor on technical matters, they are not empowered to make any contractual commitments or any contract changes on the government’s behalf. It is highly recommended the PM/Supervisor also nominate an alternate COR.

2.4.2.2 Contracting Officer (KO) – The KO shall ensure performance of all necessary actions for effective contracting, ensure compliance with the contract terms, and shall safeguard the interests of the United States in the contractual relationship. The KO shall also ensure the contractor receives impartial, fair, and equitable treatment under this contract. Determine the final assessment of the contractor’s performance.

2.4.2.3 Contracting Officer’s Representative (COR) The COR is responsible for providing continuous technical oversight of the contractor’s performance. The COR uses the QASP to conduct the oversight/surveillance process. The COR shall keep a Quality Assurance file that accurately documents the contractor’s actual performance. If required to use VCE-COR by the Contracting Officer, the COR will always make sure these records are accurately and timely uploaded to the VCE-COR system. The purpose is to ensure the contractor meets the performance standards contained in the contract. The COR is responsible for reporting early identification of performance problems to the KO. The COR is required to provide an annual performance assessment (or more frequently as directed by the Contracting Officer) to the KO which will be used in documenting past performance. The QASP is the primary tool for documenting contractor performance. The COR is not empowered to make any contractual commitments or to authorize any contractual change on the Government’s behalf. The COR shall meet with the KO periodically as directed (usually monthly or quarterly at a minimum) to discuss the CORs performance. These meeting are in addition to the progress and similar type meeting involving at a minimum the contractor, COR and KO. The COR and alternate as applicable should communicate frequently to ensure both are aware of the current on-going oversight status and contract performance status.

3.0 Government Contract Surveillance

The goal of the QASP is to ensure contractor performance is effectively monitored and documented. The COR is responsible for maintaining quality assurance surveillance for the federal government. The COR will ensure monthly quality assurance inspections are accomplished accurately and timely. All records shall be uploaded to VCE-COR as applicable.

4.0. Surveillance Matrix

The Surveillance Matrix (attachment 1) is the list of performance objectives and standards that must be performed by the government. This matrix details the method of surveillance the COR will use to validate and inspect these performance elements. Inspection of each element will be documented in the COR file.

4.1 Performance Rating Definitions

In evaluating the quality of contractor’s performance, the following performance ratings may be used.

Performance Rating Criteria

Performance objectives define the desired outcomes. Performance Standards define the level of service required under the contract to successfully meet the performance objective. The inspection methodology defines how, when, and what will be assessed in measuring performance. The Government performs surveillance, using this QASP, to determine the quality of the contractor’s performance as it relates to the performance element standards.

4.2 Corrective Action Report (CAR) (See attachment 2)

Used identify, document and resolve issues or performance concerns/failures.

4.3 Customer Complaint Form (See attachment 3)

Provides a format for customers who are support by the contractor to report on the contractor performance (For Agency use – Remember customers do not know what the contract requirements are). CORs should use this as method to become aware of issues but these forms are not to be used to evaluate the contractor unless complaint is valid and applicable to the contract (consult with Contracting Office if there are any questions).

4.4 Performance Assessment Report

Yellow Yes, performance and technical specifications are currently being met at the minimum AQL, but the following service / deliverable needs contractor attention. The Customer must identify what component of the deliverable and/or service requires attention.

Red No, performance and technical specifications are not met at AQL and the following service / deliverable needs immediate contractor resolution. The Customer must identify what component of the deliverable and/or service is below the minimum AQL.

CFMR

PERFORMANCE EVALUATION REVIEW WORKSHEET

Performance Rating

Deliverable/Service

Date

OSHA Adherence: Compliant Disposal of Medical Waste and use of Personal Protective Equipment

Yellow

Red

Documentation (Paper and electronic) of Dental defects IAW Army Dental Regulations

Yellow

Red

Appropriate Dental Classification Assignment and creation of Dental Treatment Plan when required

Yellow

Red

Comprehensive Dental Examination and Assessment of Current Oral Health

Yellow

Red

Follow all HIPAA Guidance and maintain patient confidentiality.

Yellow

Red

Attend PHA events as determined by the needs of the Wing.

Yellow

Red

Period of Performance: From ___________________to_________________

Number of Hours Actually Worked: _______ (Include only actual hours worked. Do not include non worked holidays, leave, etc. these are included in the rate the Government pays and are not paid as hours worked. ) Reimbursable Expenses: (include receipts) _______ Travel_______ (include approval sheet)

Attachment 1: Surveillance Matrix

provider

Attachment 2: Corrective Action Report (CAR)

CORRECTIVE ACTION REPORT (CAR)

(If more space is needed, use reverse and identify by number)

1. CONTRACTOR

2. CONTRACT NUMBER

3. TYPE OF SERVICES

4. FUNCTIONAL AREA

5. SUSPENSE DATE

6. CONTROL NUMBER

7. DEFICIENCY |_| MAJOR |_| MINOR

FINDING:

FINDING IMPACT:

Please respond with a written corrective action plan that details the corrective action of the cited deficiency, the cause of the deficiency, and actions taken to prevent recurrence by Suspense Date in Block 5. If date was not entered in Block 5, the contractor is not required to provide a response.

8. QUALITY ASSURANCE PERSONNEL (COR)

TYPED NAME AND GRADE

SIGNATURE AND DATE

9. ISSUING AUTHORITY

TYPED NAME AND GRADE

SIGNATURE AND DATE

10. COR RESPONSE TO CONTRACTOR CORRECTIVE ACTION AND ACTION TAKEN TO PREVENT RECURRENCE

11. COR DETERMINATION

|_| ACCEPTED |_| REJECTED

12. CLOSE DATE

Attachment 3: Customer Complaint Record

CUSTOMER COMPLAINT RECORD

DATE/TIME OF COMPLAINT

SOURCE OF COMPLAINT

ORGANIZATION

BUILDING NUMBER

INDIVIDUAL

PHONE NUMBER

NATURE OF COMPLAINT

CONTRACT REFERENCE

VALIDATION

DATE/TIME CONTRACTOR INFORMED OF COMPLAINT

ACTION TAKEN BY CONTRACTOR