36C24918R0350-019.docx
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- Neuromonitoring Services - 596
- Solicitation number
- 36C24918R0350
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36C24918R0350 Attachment 4-Past Performance Survey.docx
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| 36C24918R0350-020.docx | DOCX document | |
| 36C24918R0350-016.docx | DOCX document | |
| 36C24918R0350-018.doc | DOC document | |
| 36C24918R0350-017.pdf | ||
| 36C24918R0350-015.docx | DOCX document |
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ATTACHMENT 5 PAST PERFORMANCE SURVEY
INTRA-OPERATIVE NEUROPHYSIOLOGIC MONITORING (IONM) AKA: NEURO-MONITORING SERVICES
REFERENCE INSTRUCTIONS: The Department of Veterans Affairs is seeking offerors for award of a VA contract for Intra Operative Neurophysiologic Monitoring (IONM) Services for a five (5) year ordering period. You have been identified as a reference and your comments would be appreciated. Your comments are considered Source Selection Sensitive; therefore, you are advised that the release of the names of individuals providing reference information about Offeror’s past performance is prohibited. Survey should be completed by evaluator and submitted no later than Wednesday, March 30, 2018 @ 4:30 p.m. CT via email directly to dewana.raynor@va.gov.
NOTE: Incomplete or unsigned surveys will not be considered.
Company being evaluated:_______________________________________________ Period of Performance:__ What was the average monthly volume of the services provided? (Number of cases per month? Average number of hours per case?) __ ____________________________________ Name and title/position of evaluator:
Contact telephone number:
Contact e-mail address:
Please evaluate the past performance using only the following ratings without variation. If the rating is other than Fully Acceptable, please provide additional information in the appropriate block or in the remarks section of this form.
S = Superior Performance
V = Very Good with very few issues
F = Fully Acceptable/Good
M = Marginally Acceptable
U = Unacceptable Performance
| Please rate and provide information/comments for the following: |
| Circle/indicate selection |
| Q1. Rate how well the contractor complies with requirements and/or expectations? |
| S V F M U |
| Q2. Rate contractor’s knowledge and expertise in providing on-site IONM services. |
| S V F M U |
| Q3. Rate this contractor’s knowledge and expertise in providing demonstration of IONM set-up and preparation tasks to customer personnel. |
| S V F M U |
| Q4. Rate the level of access to the contractor’s customer service personnel. (e.g., How easy was it to speak with Customer Service? Were you put on hold for an extended period of time? Were there multiple menus to wade through before speaking with someone? What kind of holiday/weekend service or support was provided? etc.) |
| S V F M U |
| Q5. Rate the customer support provided by the contractor. (Was local service/account representative prompt and responsive? Were qualified technicians and neurologists available for scheduling? Were qualified on-site technicians and off-site neurologists available for short notice/emergency surgeries?) |
| S V F M U |
| Q6. Rate the adaptability of this contractor during surgery to changes in patient needs or equipment issues. |
| S V F M U |
| Q7. Rate overall ease of contractor’s scheduling process. |
| S V F M U |
| Q8. Rate how well contractor protects the privacy of patients. |
| S V F M U |
| Q9. Rate quality of off-site neurologist support. |
| S V F M U |
Q10. Would you award another contract to the firm being evaluated? If no, please explain:
Yes No
Additional Remarks: Please use this space to indicate anything else you would like to say about the contractor being referenced or to list anything you especially liked or disliked about this contractor:
| Signature of Evaluator |
| Date |
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