Task Order Closeout - Quality Certification.pdf

This template is designed specifically for VA Medical Center (VAMC) projects, ensuring all regulatory requirements—including NFPA compliance and Patient Safety (ILSM)—are documented before final payment.

Task Order Closeout & Quality Certification

Project Title: [Insert Project Name]

Contract Number: 3622452___________

Task Order Number: [Insert Task Order]

VA Medical Center: [Insert Facility Name/Location]

1. Task Completion Summary

• Work Description: [Briefly describe the electrical work performed].

• Date of Substantial Completion: [Date]

• As-Built Drawings Status: [ ] Submitted [ ] Pending

• O&M Manuals/Warranties: [ ] Submitted [ ] N/A

2. Quality Control & Regulatory Compliance

The Contractor certifies that a formal Quality Control (QC) inspection was performed on [Date]. All work has been verified to meet the following standards:

• National Fire Protection Association (NFPA): Work complies with NFPA 70 (NEC) and NFPA 99 (Health Care Facilities Code).

• VHA Standards: Work adheres to VHA Directive 1028 and specific VA Master Specifications.

• Deficiency Status: [ ] All "Punch List" items are 100% complete.

• Government QA Walkthrough:

o Scheduled Date: [Date/Time] o VA Representative: [Name of COR or Engineering Staff]

3. Safety & Environmental Reporting

This section documents the mitigation of hazards during the performance period.

Requirement Status Reference/Permit # Interim Life Safety Measures (ILSM) [ ] Closed [ ] N/A [Permit #] Infection Control (ICRA) [ ] Cleaned/Sign-off [Permit #] Energized Electrical Work Permit [ ] Completed [ ] N/A [Permit #] Lockout/Tagout (LOTO) [ ] Locks Removed N/A Hot Work Permit [ ] Closed [ ] N/A [Permit #]

4. Final Contractor Certification

I, the undersigned, certify that the task order is complete and that all electrical systems installed have been tested for ground integrity, circuit labeling, and functional performance in accordance with the contract.

Contractor Name: ___________________________

Authorized Signature: ________________________

Date: ________________

5. VA Government Acceptance (Internal Use)

• COR Signature: ___________________________

• Date of Acceptance: ______________________

Here is the Electrical Task Order Closeout Checklist specifically tailored for NFPA 99 (Health Care Facilities Code) and NFPA 70 (NEC) requirements within a VA Medical Center environment.

You can attach this as an "Exhibit A" to the Closeout Document provided above to prove rigorous Quality Control.

Exhibit A: NFPA & VHA Electrical Compliance Punch-List

Item Requirement Reference Status (Pass/Fail)

Grounding & Bonding

Resistance between the appliance grounding slot and the medical system ground is < 0.1 \Omega.

NFPA 99 [ ]

Receptacle Testing

Correct polarity, physical integrity, and "Hospital Grade" tension tests passed.

NFPA 99

6.3.3 [ ]

Labeling All panels, breakers, and receptacles labeled with Circuit/Panel ID (e.g., Critical, Life Safety, or Normal).

VHA

Standards [ ]

LOTO Removal All Lockout/Tagout devices removed and original power configurations restored. NFPA 70E [ ]

Panel Clearance

36-inch working clearance maintained in front of all electrical equipment.

NFPA 70

110.26 [ ]

GFCI Testing All GFCIs within 6 feet of sinks or in wet areas tested and operational. NEC 210.8 [ ]

Sealing Firestopping applied to all electrical penetrations through rated walls/floors.

NFPA

101/NEC [ ]

Instructions for the Quality Assurance (QA) Walkthrough

To ensure a smooth hand-off to the VA Engineering Department, the contractor should have the following ready for the Government inspector:

1. Verification of Energized Work: If an Energized Electrical Work Permit (EEWP) was used, ensure the "Reason for Energized Work" section is signed off as closed.

2. ILSM Sign-off: If smoke detectors were capped or egress paths altered, provide proof that the Interim Life Safety Measures have been decommissioned and the area is returned to standard "Code" operation.

3. Digital Submission: If required by the VAMC, ensure a PDF copy of these test results is uploaded to the project folder (e.g., eCMS or Procore).