95379-ORCF HUD Representative’s Trip Report

HUD Representative’s Trip Report

U.S. Department of Housing and Urban Development Office of Residential Care Facilities

OMB Approval No. 2502-0605 (exp. 11/30/2022)

Public reporting burden for this collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. The information is being collected to obtain the supportive documentation that must be submitted to HUD for approval, and is necessary to ensure that viable projects are developed and maintained. The Department will use this information to determine if properties meet HUD requirements with respect to development, operation and/or asset management, as well as ensuring the continued marketability of the properties. Response to this request for information is required in order to receive the benefits to be derived from the National Housing Act Section 232 Healthcare Facility Insurance Program. This agency may not collect this information, and you are not required to complete this form unless it displays a currently valid OMB control number. While no assurance of confidentiality is pledged to respondents, HUD generally discloses this data only in response to a Freedom of Information Act request.

Warning: Anyone who knowingly submits a false claim or makes a false statement is subject to criminal and/or civil penalties, including confinement for up to 5 years, fines, and civil and administrative penalties. (18 U.S.C. §§ 287, 1001, 1010, 1012; 31 U.S.C. §3729, 3802).

Project Name:      		FHA Project No:      		Schedule Progress:      		Actual Progress:      		Date of Visit:      
No. of Buildings:      	No. Dwelling Units:      		Locality:      				Contractor:      
A. Evaluation: Details - Concerning: 1. Contractor’s organization, operations and supervision, disputes, etc. 2. Architect’s supervision and services 3. Special circumstances, occupancy, delays, claims					4. Non-compliance in the work 5. Payments to the contract; Labor and EEO Provisions.
     

B. All items must be covered in this report and all adverse findings shall be discussed with Project Architect.

C. Trip Included Examination of      				Dwelling Units in Bldgs. Nos:      
D. Arrived: (date)      		(hour)      	Departed: (date)      			(hour)      
Report No:       Date:      	Name & Signature of HUD Representative: X      				Name & Signature of Construction Manager X     

Instructions - FORM HUD-95379-ORCF – HUD REPRESENTATIVE’S TRIP REPORT

(HEALTHCARE)

(INSPECTION REPORT)

PURPOSE: Form HUD-95379-ORCF is used for documenting job site visits and evaluation of healthcare project construction.

PREPARED BY: Designated member of the Architecture and Engineering Staff, e.g., Inspector, HUD Representative, Construction Manager (CM), or others including supervisory personnel.

NUMBER: Original and additional copies as necessary to meet distribution needs.

DISTRIBUTION: The original shall be forwarded to the Construction Manager. One copy shall be retained by the designated person who prepares the report. Additional copies shall be distributed as deemed necessary to the architect, owner, or builder, etc. When inspections are conducted by an inspection contractor, copies shall be provided to the Government Technical Monitor (GTM) and Government Technical Representative (GTR) based on contract requirements.

GENERAL INSTRUCTIONS: In narrative form give full and detailed information concerning each applicable item shown on the report with reference being made to the heading and item number. Positive as well as adverse information should be included. It is essential that the analysis of contract administration by the supervisory architect, builder’s supervision of construction, and status of physical work be accurate, thorough, well considered and comprehensive. Additionally, photographs should be used to supplement comments to the maximum extent possible, especially when photographs will add to the understanding of adverse conditions.

PREPARATION: The HUD Representative, or any other person visiting the site in an official capacity, shall prepare a complete report on Form HUD-95379-ORCF for each visit to each project. Results of special assignments may also be reported on this form unless otherwise directed by the Construction Manager.

SPECIAL INSTRUCTIONS:

1. Heading. Applicable information and dates shall be entered in the spaces provided. Scheduled progress shall be from the Builder’s Progress Schedule and actual progress shall be as estimated by the HUD Representative.

2. Part A. Evaluation – Details. All five items under Part A must be answered. If more than one page is needed, each page shall be numbered, identified with the project name, and show the date of the visit. The HUD Representative’s observations for each item shall be reported by entering the item number followed by a clear, concise statement as to:

Item 1: Facts should be entered under this item that pertains to the Builder’s organization, operations and supervision. Observations in regard to the progress of the work, status of the work, trades and equipment working, storage of material, protection of material stored or installed, temporary job facilities and utilities, site housekeeping, job safety and security, and the quality of project supervision as to planning, direction, control, and coordination should be included. Any adverse observation(s) shall also be recorded.

Item 2: An evaluation of the Architect’s performance should be provided here. Under the terms of the Owner-Architect Agreement, the Architect is to provide construction contract administration for the Owner including on-site observation and other specific services. Comments on the Architect’s compliance or non-compliance with the Agreement should be entered. The date of the Architect’s latest site visit and any instructions to the Builder contained in the Architect’s log/field reports shall be recorded.

Item 3: All details concerning special circumstances, occupancy, delays, claims, disputes, etc., should be entered here. Include information that pertains to inspection of the work or job site visits by others; premature occupancy, permission to occupy or occupancy permits; potential and actual delays and their causes, such as strikes or unusual weather; potential change orders; potential or actual disputes between builders, subcontractors, workmen, architect, owner or others; etc. Minimum entry should provide details of observations made to determine that no adverse conditions appear to be present; e.g., Discussions with ...; details of good progress and good working relationships observed; etc.

Item 4: Observed non-compliances in the physical work with the drawings and specifications, or other failures of the Builder to perform in accordance with the provisions of the construction contract shall be detailed under this item. All such observations noted must be accurately documented and followed-up during subsequent visits. Non-compliances must continue to be entered on subsequent reports until corrected and the method of correction recorded. Minimum entry should detail what was observed and/or who was contacted to determine that no non-compliance issues appeared to be present.

Item 5: All facts in regard to payments to the Builder, labor and EEO provisions should be entered here. Actions such as the acceptance or modification of a request for payment, inventory of stored materials, wage interviews, or observations concerning display or failure to display wage decisions and EEO posters should be included. Any violations of the labor or EEO provisions of the contract that is observed shall be recorded.

3. Parts B, C, D – The Parts are self-explanatory. Entries shall always be made in Parts C and D.

4. The HUD Representative, or other official, visiting the site must date, print name and sign the report.

5. Reports shall be numbered consecutively in the space provided at the bottom of the Form. If the report is other than a regular site visit, it shall be identified in this space as: Special, Final, Guarantee, etc.

REPORT EVALUATION:

1. The Contract Manager (CM) shall be responsible for the review and evaluation of each report, and if the contents so indicate, initiate the appropriate actions necessary to accomplish any required corrections.

2. The CM shall take appropriate steps to ensure that each report is properly prepared, containing thorough, accurate, and well-considered information.

3. The CM or designated Deputy shall date, print name and sign the report after review and evaluation.

Previous versions obsolete Page 4 of 4 form HUD-95379-ORCF (06/2019)