D.6 - Past Performance Survey - Orthopedic Surgery Services.docx
DOCX document 27 KB Posted
- Solicitation number
- 36C24925R0004
About this file
This document is a Past Performance Survey for Orthopedic Surgery Services at the Memphis VA Medical Center. The survey is designed to collect reference information about a contractor's performance for a VA contract covering orthopedic surgery services, with a base year and four option years. The survey allows evaluators to rate the contractor on six key performance dimensions using a scale from Superior (S) to Unacceptable (U), including compliance with requirements, knowledge and expertise, personnel access, scheduling process, and patient privacy protection. The survey also includes a recommendation section asking whether the evaluator would award another contract to the firm being assessed, with space for additional remarks and detailed contact information.
The related federal contract opportunity (Solicitation Number: 36C24925R0004) seeks 1.5 Full-Time Equivalent (FTE) Board Certified/Board Eligible Orthopedic Physician Surgical Services for the Lt. Col. Luke Weathers, Jr. Veterans Affairs Medical Center in Memphis, Tennessee. The services will be provided on-site to VA beneficiaries, with the contract authorized under Title 38 USC 8153 Health Care Resources sharing Authority and utilizing FAR Parts 12 and 15. The opportunity is currently in the pre-solicitation stage and is being managed by the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 9.
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ATTACHMENT 6 –PAST PERFORMANCE SURVEY
PAST PERFORMANCE SURVEY
ORTHOPEDIC SURGERY SERVICES FOR THE MEMPHIS VA MEDICAL CENTER
REFERENCE INSTRUCTIONS: The Department of Veterans Affairs is seeking offerors for award of a VA contract for orthopedic surgery services for a base year plus four option years. 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 prior to the close of the solicitation and submitted via email directly to robert.pritchard2@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-call neurosurgery services. |
| S V F M U |
| Q3. Rate this contractor’s neurosurgeons. |
| S V F M U |
| Q4. Rate the level of access to the contractor’s personnel. (i.e. Did they respond in a timely manner? Did they meet the requirements of being available and responding as according to the contract?) |
| S V F M U |
| Q5. Rate overall ease of contractor’s scheduling process. |
| S V F M U |
| Q6. Rate how well contractor protects the privacy of patients. |
| S V F M U |
Q9. 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 |
File details come from the government source that posted it. Updated .