DEP Form 02 "Site Owner/Responsible Party Contractor Performance Survey Form - Petroleum Restoration Program" - Florida

DEP Form 02 is a Florida Department of Environmental Protection form also known as the "Site Owner/responsible Party Contractor Performance Survey Form - Petroleum Restoration Program". The latest edition of the form was released in April 1, 2016 and is available for digital filing.

Download a PDF version of the DEP Form 02 down below or find it on Florida Department of Environmental Protection Forms website.

ADVERTISEMENT

Download DEP Form 02 "Site Owner/Responsible Party Contractor Performance Survey Form - Petroleum Restoration Program" - Florida

728 times
Rate
4.8(4.8 / 5) 51 votes
Florida DEP - Division of Waste Management - Petroleum Restoration Program
SITE OWNER/RESPONSIBLE PARTY
CONTRACTOR PERFORMANCE SURVEY FORM
FDEP Facility No. __________________
Facility Name: ___________________________________________
FDEP Contract No.: _________________
FDEP Task Assignment/Purchase Order (PO) No.: ______________
Facility Address: _____________________________________________________________________________
FDEP Contractor Name: _________________________________________
FDEP Contractor ID No: _______
Name and Title of Owner/RP Representative Completing Survey: ______________________________________
Check All Applicable: ____ Property Owner ____ Facility Owner
and/or
____ Responsible Party
Representative Signature: _______________________________
Survey Completion Date: _______________
Contractor Performance Evaluation Survey
1. The contractor did a good job communicating general project details, schedules, status and
NA
reports.
(Consistently good = 2, Some concerns = 1, No communications = 0, Not
applicable = NA)
2. The contractor provided sufficient notice of on-site activities related to assessment or cleanup.
NA
(Timely notices = 2, Some untimely notices = 1, No notices for on-site activities = 0, Not applicable =
NA)
3. The contractor effectively oversaw and coordinated on-site work to maintain reasonable ingress and
NA
egress and minimize disruption to facility operation and use.
(Good oversight/coordination = 2, Some limited disruptions = 1, Operation/use impacted = 0, Not
applicable = NA)
4. The contractor and subcontractors appeared to follow reasonable safety protocols for their staff and
NA
equipment, facility occupants, vehicle traffic and the general public.
(Protocols consistently followed = 2, Protocols inconsistently followed = 1, Failed to follow safety
protocols = 0, Not applicable = NA)
5. The contractor took reasonable precautions to prevent or avoid damage to structures or other facility
NA
assets while performing on-site work.
(No damage = 2, Minor damage = 1, Damage from inadequate precautions = 0, Not applicable = NA)
6. The contractor satisfactorily restored/repaired any damage to structures or other facility assets that may
NA
have occurred while performing on-site work.
(Satisfactory = 2, Minor unresolved damage = 1, Ongoing impacts damage = 0, Not applicable = NA)
7. If applicable, the contractor reasonably complied with special requirements that applied
to this facility (i.e., security checks or special schedule requirements for schools,
NA
airports, seaports, etc.).
(Reasonable compliance = 2, Limited Noncompliance = 1, Operations/use impacted
by noncompliance = 0, Not applicable = NA)
NA
Section Total =
_______
Section Score (Section Total / No. of Relevant Items) = _______
NA
Documentation is required for any significant non-performance issues affecting this rating (items scored 1 or less). If you have any
questions, the Department Site Manager for this project is:
Site Manager: __________________________________________
Phone: ______________________________
E-mail: ______________________________________________________
Site Owner/Responsible Party Contractor Performance Survey Form No. 02
(April 2016)
Page 5 of 5
Incorporated in 62-772.300(6)
Florida DEP - Division of Waste Management - Petroleum Restoration Program
SITE OWNER/RESPONSIBLE PARTY
CONTRACTOR PERFORMANCE SURVEY FORM
FDEP Facility No. __________________
Facility Name: ___________________________________________
FDEP Contract No.: _________________
FDEP Task Assignment/Purchase Order (PO) No.: ______________
Facility Address: _____________________________________________________________________________
FDEP Contractor Name: _________________________________________
FDEP Contractor ID No: _______
Name and Title of Owner/RP Representative Completing Survey: ______________________________________
Check All Applicable: ____ Property Owner ____ Facility Owner
and/or
____ Responsible Party
Representative Signature: _______________________________
Survey Completion Date: _______________
Contractor Performance Evaluation Survey
1. The contractor did a good job communicating general project details, schedules, status and
NA
reports.
(Consistently good = 2, Some concerns = 1, No communications = 0, Not
applicable = NA)
2. The contractor provided sufficient notice of on-site activities related to assessment or cleanup.
NA
(Timely notices = 2, Some untimely notices = 1, No notices for on-site activities = 0, Not applicable =
NA)
3. The contractor effectively oversaw and coordinated on-site work to maintain reasonable ingress and
NA
egress and minimize disruption to facility operation and use.
(Good oversight/coordination = 2, Some limited disruptions = 1, Operation/use impacted = 0, Not
applicable = NA)
4. The contractor and subcontractors appeared to follow reasonable safety protocols for their staff and
NA
equipment, facility occupants, vehicle traffic and the general public.
(Protocols consistently followed = 2, Protocols inconsistently followed = 1, Failed to follow safety
protocols = 0, Not applicable = NA)
5. The contractor took reasonable precautions to prevent or avoid damage to structures or other facility
NA
assets while performing on-site work.
(No damage = 2, Minor damage = 1, Damage from inadequate precautions = 0, Not applicable = NA)
6. The contractor satisfactorily restored/repaired any damage to structures or other facility assets that may
NA
have occurred while performing on-site work.
(Satisfactory = 2, Minor unresolved damage = 1, Ongoing impacts damage = 0, Not applicable = NA)
7. If applicable, the contractor reasonably complied with special requirements that applied
to this facility (i.e., security checks or special schedule requirements for schools,
NA
airports, seaports, etc.).
(Reasonable compliance = 2, Limited Noncompliance = 1, Operations/use impacted
by noncompliance = 0, Not applicable = NA)
NA
Section Total =
_______
Section Score (Section Total / No. of Relevant Items) = _______
NA
Documentation is required for any significant non-performance issues affecting this rating (items scored 1 or less). If you have any
questions, the Department Site Manager for this project is:
Site Manager: __________________________________________
Phone: ______________________________
E-mail: ______________________________________________________
Site Owner/Responsible Party Contractor Performance Survey Form No. 02
(April 2016)
Page 5 of 5
Incorporated in 62-772.300(6)
ADVERTISEMENT
Fill PDF online