Contract Data Requirements List A001 Contractor Service Report Technician Qualification Template

CDRL A001

Contractor Service Report / Technician Qualification or Certification Confirmation HAAS HS-4R Milling Machine Repair - Serial Number 2052422 Contract/Order No.

Contractor
Phillips Corporation, Federal Division / Phillips Federal Service Date(s)

Location
MDMC PPB, Bldg. 638, Yermo Annex
Machine
Haas HS-4R
Serial Number
2052422
Work Order/Service No.

Government TPOC
Luke Wirick

1. Technician Information and Qualification

Field
Contractor Entry
Technician Name

Employer / Organization

Job Title / Service Role

Qualification Basis
Certification / Training / Authorization No. (if applicable)

Qualification Evidence Attached or Available Upon Request

2. Service Report

Required Information
Contractor Entry
Date(s) and Hours of On-Site Service

Parts / Components Installed
Work Performed

Core Items Removed / Prepared for Return

Machine Configuration / Parameter Actions Performed (if applicable)

Safety / ESD / Electrical Precautions Used

Remaining Deficiencies or Recommendations

3. Contractor Certification

I certify that the information above accurately describes the technician qualifications and services performed for the Haas HS-4R repair requirement. Authorized Contractor Representative
Signature
Date

Submission: At completion of service or upon Government request, in accordance with the contract/order and CDRL A001.