36C25025Q0752.docx

Combined Synopsis/Solicitation Notice Combined Synopsis/Solicitation Notice

GENERAL INFORMATION

SET-ASIDE

Columbus Chalmers P. Wylie Ambulatory Care Center 420 North James Road Columbus OH 43219-1834

POINT OF CONTACT*

Contracting Officer Gina P. Crank gina.crank@va.gov 614 625 1236

NA

NA

PLACE OF PERFORMANCE

4100 W. Third Street

Dayton Ohio

ADDITIONAL INFORMATION

DESCRIPTION

This is a combined synopsis/solicitation for commercial items prepared in accordance with (IAW) the format in Subpart 12.6, as supplemented with additional information included in this notice. This announcement constitutes the only solicitation; quotes are being requested, and a written solicitation will not be issued. The Government reserves the right to make no award from this solicitation.

This is a request for quote (RFQ), and the solicitation number is 36C25025Q0752. The Government anticipates awarding a firm-fixed price Purchase Order resulting from this solicitation. The solicitation document and incorporated provisions and clauses are those in effect through FAR Deviations JUN 2025 (eff. 06/11/2025) VAAR DEVIATION APR 2025 (eff. 04/01/2025). The associated NAICS Code is 334510, Electromedical and Electrotherapeutic Apparatus Manufacturing.

The Department of Veterans Affairs, Network Contracting Office 10, is soliciting quotes from all sources to supply the Dayton VA Medical Center Ceiling Lift Systems. Respondents to this solicitation must fully demonstrate their capability by supplying detailed quote information, along with any other documents necessary to support the requirements below. This is a Brand Name only requirement for GULDMANN GH3+ Ceiling Lift Systems.

Quotes are to be provided to Gina P. Crank, Contracting Officer, via email at gina.crank@va.gov, no later than July 22, 2025, by 5:00 PM EST. No telephone calls will be accepted. No submission received after the above-mentioned date and time will be accepted.

A.1 PRICE/COST SCHEDULE

ITEM INFORMATION

4x4 Room Covering System GH3+ 825lbs SWL Hoist w/Scale & Hanger Bar. Includes Certified Install (up to 1 mobilization)

Appropriation: 552-3650160-196-824100 Nursing Service-3131 Medical, Dental and Scien-SPP0D04A1

Includes Certified Install (up to 1 mobilization) and uninstallation of previous system. GULDMANN CERTIFIED INSTALLATION. Non-Union Labor and hardware to install lifts in 1 room. [1] room per day, [2] mobilization(s) of the installation team. Electrical work, existing structure demo, modification, or reinstallation including but not limited to ceilings, walls, tile, patching, painting, acoustic caulking, asbestos abatement, smoke/firewall repair, fireproofing reapplication, sprinkler relocation and door header modification is outside the scope of work for Guldmann installers and Guldmann is not licensed for performing such work, nor is Guldmann responsible for hiring specific contractors/trades to perform such work. ICRA up to level II provided; additional is responsibility of facility. Guldmann will perform light cleaning of the area but returning room to original condition is outside of scope of work for Guldmann installers. If an Above Ceiling Work Permit is required, the facility must provide.

Stamped Engineered Drawings

Statement of Work: Added ceiling lift motor on existing track

A. General Information

1. Title of Project: Ceiling lift addition at Dayton VA MHC

2. Scope of Work: The contractor shall provide all labor, supervision and all other resources required to deliver the requirements stated herein, except as may otherwise be specified in this statement of work. A 825-pound Guldmann GH3 ceiling lift is to be delivered, traverse rails installed, and tested in building 330 rooms: 2C143, 2C146, and 1B149. Details are provided in sections C and D below, Specific Mandatory Tasks and Associated Deliverables.

3. Background: These additional lifts are required to provide dignified treatment to persons entering the SCI clinic and Interventional Radiology. These areas require overhead ceiling lifts to provide access to care and protect staff and Veterans from injury.

4. Performance Period/Schedule: The contractor shall start the work required under this SOW by about July 2025 as coordinated with COR and treatment areas. If the contractor proposes an earlier completion date, and the Government accepts the contractor’s proposal, the contractor’s proposed completion date shall prevail. Installation dates and designs must be coordinated with Contracting Officer Representative (COR), and ICRA must be completed before beginning.

5. Type of Contract: Firm-Fixed-Price B. Contract Award Meeting

1. The contractor shall not commence performance on the tasks in this SOW until the CO has conducted a kick off meeting or has advised the contractor that a kick off meeting is waived.

C. General Requirements 1.

All installation must comply with requirements of Patient Safety Alert AL14-07, including the Checklist for Installation and Relocation. The installation checklist must be filled out for each checklist, in addition to any checklist required by the manufacturer, and supplied to the COR.

2. Contractor will provide evaluation of spaces where ceiling lifts are needed and submission of plans to Dayton VA MHC Engineering service, to ensure that workable versions are installed and comply with VA design requirements and relevant standards.

3. Contractor will coordinate with Engineering service to verify access to engineering mechanical, HVAC, and fire systems components within the mounting area of the lift units.

4. Contractor will coordinate with Contracting Officer Representative (COR) to schedule installations

5. Contractor will participate in ICRA/PCRA site assessment and comply with all ICRA/PCRA requirements.

6. Contractor will provide all qualified personnel, materials, equipment and services necessary to install ceiling lifts for the rooms described below under Location, including lifts, tracks, spreader bars, attachment hardware, and all other equipment necessary for safe operation. Detailed requirements are described in the Standards and Special Requirements sections. Lift systems may be configured in any way that covers the rooms best and meets the requirements.

7. Contractor will provide installation and testing of all equipment for ceiling lifts, according to VA checklist requirements, resulting in a turnkey system.

8. Contractor will provide as-built drawings and structural engineering drawings for lift units.

9. Contractor will provide evidence of testing of all lift systems provided and schedule testing when it can be overseen by COR.

10. Contractor will meet construction safety requirements, including construction orientation, safety training requirements, dust control requirements from the Infection Control Risk Assessment, TB testing, electrical safety requirements, and Above Ceiling Permit requirements including re-sealing any penetrations of fire barriers.

D. NARA Records Management Language Clause

1. Citations to pertinent laws, codes and regulations such as 44 U.S.C Chapter 21 , 29, 31 and 33; Freedom of Information Act (5 U.S.C. 552); Privacy Act (5 U.S.C. 552a); 36 CFR Part 1222 and Part 1228.

2. Contractor shall treat all deliverables under the contract as the property of the U.S. Government for which the Government Agency shall have unlimited rights to use, dispose of, or disclose such data contained therein as it determines to be in the public interest.

3. Contractor shall not create or maintain any records that are not specifically tied to or authorized by the contract using Government ‘IT’ equipment and/or Government records.

4. Contractor shall not retain, use, sell, or disseminate copies of any deliverable that contains information covered by the Privacy Act of 1974 or that which is generally protected by the Freedom of Information Act.

5. Contractor shall not create or maintain any records containing any Government Agency records that are not specifically tied to or authorized by the contract.

6. The Government Agency owns the rights to all data/records produced as part of this contract.

7. The Government Agency owns the rights to all electronic information (electronic data, electronic information systems, electronic databases, etc.) and all supporting documentation created as part of this contract. Contractor must deliver sufficient technical documentation with all data deliverables to permit the agency to use the data.

8. Contractor agrees to comply with Federal and Agency records management policies, including those policies associated with the safeguarding of records covered by the Privacy Act of 1974. These policies include the preservation of all records created or received regardless of format [paper, electronic, etc.] or mode of transmission [e-mail, fax, etc.] or state of completion [draft, final, etc.].

9. No disposition of documents will be allowed without the prior written consent of the Contracting Officer. The Agency and its contractors are responsible for preventing the alienation or unauthorized destruction of records, including all forms of mutilation. Willful and unlawful destruction, damage or alienation of Federal records is subject to the fines and penalties imposed by 18 U.S.C. 2701. Records may not be removed from the legal custody of the Agency or destroyed without regard to the provisions of the agency records schedules.

10. Contractor is required to obtain the Contracting Officer's approval prior to engaging in any contractual relationship (sub-contractor) in support of this contract requiring the disclosure of information, documentary material and/or records generated under or relating to this contract. The Contractor (and any sub-contractor) is required to abide by Government and Agency guidance for protecting sensitive and proprietary information.

E. Specific Mandatory Tasks and Associated Deliverables

1. Location of Ceiling Lift Installation: 2C143, 2C146, and 1B149

2. Description of Tasks and Associated Deliverables: The contractor shall provide the specific deliverables described below within the performance period stated in Section A.4 of this SOW.

3. Standards:

a. Ceiling Lift Performance Requirements:

i. Ceiling Lifts shall meet all Underwriters Laboratory requirements, life safety codes, national electric codes, fire safety codes, and all other applicable federal, state and local codes. Appropriate documentation should be provided.

ii. Ceiling Lifts shall comply with ISO 10535 (Hoists for the transfer of disabled persons – Requirements and test methods).

iii. Ceiling lift manufacturer must allow and warrant the use of their lifts with the full range of Guldmann, Alpha Modalities and Barton/Humancare loop slings.

iv. The lifts shall be mounted on newly installed traverse rail systems and tested according to the AL14-07 checklist.

v. Lifts must be capable of picking patients up off the floor.

vi. Lifts must not beep or flash during normal operation.

vii. Contractor must install lifts without relocating or interfering with operations of existing sprinkler heads, lights, HVAC grills, curtain tracks, IV tracks, televisions, permanent furniture, or other permanent structure. Contractor must describe any such fixtures that must be moved during contract bid and pre-construction meetings. Installation may be delayed, canceled, or moved to a mutually acceptable location if building changes cannot be made in ways that allow lift installation.

viii. Contractor shall not breach any firewalls during installation of these lifts. Any fire barrier that must be penetrated must be discussed with VA safety personnel and must immediately have fire barrier repaired. An Above Ceiling Permit must be filled out before ceiling work, and the COR will check the ceiling after ceiling work, to make sure any fire barrier penetration was repaired.

ix. Each room where lifts are installed shall be returned to original condition, excluding the newly installed ceiling lift.

x. Ceilings must not be slotted exposing space above ceiling to the room below.

xi. Ceiling lift motors shall be capable of lifting at least 550 pounds or 825 pounds, as specified on the Location list.

xii. A specific opportunity for Service Agreements, Preventive Maintenance Agreements, and Extended Warranty Agreements should be presented.

xiii. Maintenance and inspection shall be provided for two years from date of final acceptance.

xiv. Warranty shall include all travel or shipping associated with any warranty repair.

xv. New lifts shall accept generic type replacement batteries without voiding any warranties.

xvi. Motors shall be GFCI protected.

xvii. Ceiling lifts must be motorized.

xviii. Ceiling lifts must include a 2-point hanger bar suitable and allowable for use with the full range of Guldmann slings, Humancare/Barton slings, and Alpha Modalities repositioning slings, without easily breakable parts such as rubber flaps.

xix. Ceiling lifts must recharge automatically, by recharging at any location on the rail. Lifts that recharge without employee action will be preferred.

xx. Ceiling lifts must include safeguards to prevent patients from being trapped or hurt, such as emergency stop buttons or emergency lowering devices in case of power failure. Use of emergency lowering devices must not require tools or ladders.

4. Contractor shall provide the following with the bid:

a. Provide proof of multiple ceiling lift installations of the room covering style with continuous charge, direct connections between two traverse systems in different rooms, and minimum 20’x20’ coverage in this or other Veterans Administration Hospitals.

b. Provide proof of ongoing service quality and consistent management, including failure reports and any other applicable documentation.

5. Manuals: Contractor shall provide electronic copies of the user manuals and repair manuals for each different model of lift installed under this order or contract at no additional cost to the government.

6. Inspection: Each room’s lift system shall be weight and function tested after installation in compliance with the VHA checklist required by Patient Safety Alert AL14-07. Each checklist shall be provided to the Contracting Officer Representative along with any checklist required by the manufacturer. Any changes in inspection requirements during the period of installation will be communicated to the Contractor immediately.

7. Contractor conduct requirements:

a. Equipment and supplies must not be shipped before designs are approved and contractor has approval to install. Dayton VA MHC cannot store uninstalled equipment for a significant length of time.

b. All employees and subcontractors must wear a visible name and company identification when onsite. When more than one person is onsite performing work under this contract, one must be designated as a supervisor and must be fully responsible for the work to be performed.

c. The Contractor shall provide all supplies, materials, equipment, qualified personnel, supervision, management, and transportation to perform all tasks as identified herein. All work is to be performed in accordance with the guidelines established by Federal, State, and local ordinances and The Joint Commission. The Contractor’s procedures and quality control procedures shall conform to these guidelines.

d. Contractor personnel must conduct their work so as not to interfere with the normal functioning of the facility and will stop work if asked by Dayton VA MHC personnel. Hours of work may need to be limited to daytime on units where patients sleep and night time in areas where patients would be exposed by daytime work.

e. The Contractor shall take all precautions necessary to protect the lives and health of occupants of the building.

f. The Contractor must follow procedures required by Dayton VA MHS Infection Control personnel and the construction safety committee, to include any required dust control specified in the Infection Control Risk Assessment.

g. The Contractor must state what efforts will be made to minimize noise during installation of equipment.

h. The Contractor shall immediately correct any fire and safety deficiencies caused by his personnel. If the contractor fails or refuses to correct deficiencies promptly, the Contracting Officer may issue an order stopping all or any part of the work and may hold the contractor in default of the contract.

i. The Contractor shall comply with applicable Federal, State, and local safety and fire regulations and codes which are in effect at the beginning of the contract period. The contractor shall keep abreast of any changes in these regulations and codes applicable to the contract.

j. All material and equipment will be removed from the facility or stored properly at the end of each workday and secured during the workday in the areas specified by the Contracting Officer’s Technical Representative.

k. The Contractor is responsible for supplying, completing, and submitting all reports required or requested by Federal, State, or local ordinances which pertain to any duties contained in the contract.

l. The Contractor will be required to furnish the Dayton VA MHC with material safety data sheets for all chemicals used during installation. This information is required by the VA for emergency treatment in the event of ingestion of and/or contact with the material by humans and is required by OSHA regulations.

m. The Contractor’s onsite lead installer must attend a VANTHCS construction safety orientation and supply job hazard analyses as required by Construction Safety Officer to show how hazards to Contractor and VANTHCS personnel are being minimized.

n. All Contractor personnel must have OSHA 10-hour construction safety training cards.

o. The Contractor’s personnel shall follow applicable policies of the Dayton VA MHC, to include policies concerning fire and disaster preparedness programs.

p. The contractor shall furnish at his own expense all labor, materials, machinery, and appliances which may be necessary or appropriate in the performance of this contract.

q. All accumulated rubbish is to be collected and placed in the dumpster provided by the Government.

8. Special Requirements:

a. The contractor must have visited the sites and assessed the structure of each ceiling lift location to ensure safe installation of the equipment and shall supply the installation plans to the COR, Dayton VA MHC Engineering Service and Construction Safety Group, who must accept them before installation.

b. Ceiling lift installations shall comply with NFPA 13 for fire sprinklers and with NFPA 99 and NFPA 70 for proper grounding and bonding and access to electrical and safety systems.

c. The contractor should not require movement of any lights, sprinklers, televisions, or other fixtures in order to install ceiling lifts. If movement of preexisting fixtures is unavoidable, the contractor must include such notice when the bid is submitted.

d. Wall mounted lifts are acceptable in the place of ceiling mounts where they are more effective or cause less risk to install.

e. Ceiling lifts must not add obstacles or impair any normal operations in patient care rooms.

f. All installation that affects existing areas and electrical work shall be coordinated with the Dayton VA MHC Engineering service.

g. The contractor will install all necessary mounts, braces, and any other components needed for full lift function and safety.

h. Any electrical subcontractor must have health care experience, must have positive references, and must be directly overseen by the Contractor.

9. Schedule for Deliverables: If for any reason any deliverable cannot be delivered within the scheduled time frame, the contractor is required to explain why in writing to the CO, including a firm commitment of when the work shall be completed.

This notice to the CO shall cite the reasons for the delay, and the impact on the overall project. The CO will then review the facts and issue a response, in accordance with applicable regulations.

10. Changes to Statement of Work: Any changes to this SOW shall be authorized and approved only through written correspondence from the CO. A copy of each change will be kept in a project folder along with all other products of the project. Costs incurred by the contractor through the actions of parties other than the CO shall be borne by the contractor.

11. Reporting Requirements: The VHA checklist and any manufacturer’s checklist are the sole report and must be provided to the COR by 2 weeks after installation. Lift installation is not considered complete and cannot be paid for until the checklist is complete and provided to the COR.

12. Government Responsibilities: Dayton VA MHC will provide:

a. Guidance for contractor site visits and information on which rooms need lifts. (Safety service/COR in association with affected services.)

b. Coordination to allow for lift installation as rooms are available. (Safety service/COR in association with affected services.)

c. Technical information on the building and requirements for construction. (Engineering service.)

d. Coordination and scheduling for training efforts. (Safety service/COR in association with affected services.)

e. Oversight of installation testing. (Safety service.)

f. Answers to Contractor questions during the purchasing and installation process. (CO and COR.)

g. Prioritization and final specification of lift locations in case proposed cost exceeds budget. (COR in association with affected services.)

ADDENDUM TO STANDARD FORM 1449 – SUPPLIES OR SERVICES AND PRICE/COST

REQUIRED EQUIPMENT, INSTALLATION, SUPPLIES AND TRAINING:

Lift systems to be installed in 4D-118, Hematology/Oncology.

The following solicitation provisions apply to this acquisition:

FAR 52.212-1, “INSTRUCTIONS TO OFFERORS–COMMERCIAL ITEMS” (SEP 2023)

FAR 52.212-3, “OFFERORS REPRESENTATIONS AND CERTIFICATIONS–COMMERCIAL ITEMS” (NOV 2023) Offerors must complete annual representations and certifications electronically via the System for Award Management (SAM) website located at https://www.sam.gov/portal in accordance with FAR 52.212-3, “Offerors Representations and Certifications–Commercial Items.” If paragraph (j) of the provision is applicable, a written submission is required.

The following contract clauses apply to this acquisition:

FAR 52.212-4, “CONTRACT TERMS AND CONDITIONS–COMMERCIAL ITEMS” (NOV 2023)

ADDENDUM to FAR 52.212-4 CONTRACT TERMS AND CONDITIONS—COMMERCIAL ITEMS Clauses that are incorporated by reference (by Citation Number, Title, and Date), have the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available.

The following clauses are incorporated into 52.212-4 as an addendum to this contract:

VAAR 852.212-70 PROVISIONS AND CLAUSES APPLICABLE TO VA ACQUISITION OF COMMERCIAL ITEMS (APR 2020) – 852.203-70, 852.232-72, 852,233-70, 852.233-71 852.246-71, 852.247-71, 852.270-1

VAAR 852.212-71 GRAY MARKET LANGUAGE (FEB 2023)

FAR 52.212-5, “Contract Terms and Conditions Required to Implement Statutes or Executive Orders” (DEC 2023) The following subparagraphs of FAR 52.212-5 are applicable:

[52.203-6, 52.204-10, 52.209-6, 52.219-6, 52.222-3, 52.222-19, 52.222-21, 52.222-26, 52.222-35, 52.222-36, 52.222-37, 52.222-40, 52.222-50, 52.223-18, 52.225-1, 52.225-13, 52.232-18, 52.232-19, and 52.232-33.] All quoters shall submit the following: A completed schedule with pricing, adequate documentation detailing the capabilities of the product.

All quotes shall be sent to the electronically via email to Gina P. Crank @ gina.crank@va.gov.

Award will be based upon a comparative evaluation of quotes in accordance with the Simplified Acquisition Procedures of FAR 13. Comparative evaluation is the side by side pairwise comparison of quotes based on factors resulting in a Contracting Officer decision for the quote most favorable to the Government.

The award will be made to the response most advantageous to the Government.

Responses should contain your best terms and conditions.

To facilitate the award process, all quotes must include a statement regarding the terms and conditions herein as follows:

"The terms and conditions in the solicitation are acceptable to be included in the award document without modification, deletion, or addition."

OR

"The terms and conditions in the solicitation are acceptable to be included in the award document with the exception, deletion, or addition of the following:"

Quoters shall list exception(s) and rationale for the exception(s), if any.

Submission of your response shall be received not later than July 22, 2025 by 5:00 PM EST to gina.crank@va.gov Late submissions shall be treated in accordance with the solicitation provision at FAR 52.212-1(f).

Any questions or concerns regarding this solicitation should be forwarded in writing via e-mail to the Point of Contact listed below.

Point of Contact Gina P. Crank Contracting Officer Network Contract Office (NCO) 10 Office: 614-625-1236 Email: gina.crank@va.gov

DEPARTMENT OF VETERANS AFFAIRS

Justification for Single Source Awards IAW FAR 13.106-1 For Over Micro-Purchase Threshold but Not Exceeding the SAT ($250K)

Acquisition Plan Action ID: 36C250-25-AP-4499

1. Contracting Activity: Department of Veterans Affairs, VISN 10, for 552 Dayton VA Medical Center. The replacement of two Liko Lifts was installed in 2002 and install a ceiling lift in Interventional Radiology. 2237# 552-25-4-196-0030.

2. Brief Description of Supplies/ Services required and the intended use/Estimated Amount: The patient ceiling lifts must have a 825 lb weight capacity with the integrated scale option. Ceiling lifts are used to transfer and reposition patients from one surface to another. The ceiling lifts must meet VHA Directive 2010-032. The ceiling lifts must be compatible with the current ceiling motors and slings at the facility, which are 100% Guldmann. The rails must be compatible with Guldmann GH3 motor for the replacement rails requested for existing GH3 motors. The rails must offer the continuous charge compatible with the GH3 motors.

3. Unique characteristics that limit availability to only one source, with the reason no other supplies or services can be used: Per Manufactures Instructions for the GH3 motor, “Guldmann shall not be liable for faults or accidents that may occur as a result of using lifting slings made by other manufactures.” Ceiling lifts have been installed in many places throughout Dayton VA. These requested systems integrate into an existing system of 100% Guldmann lifts that are used to lift, transfer, and reposition inpatients and outpatients. Patients may arrive at any of these locations on a sling or be sent on to another location on a sling applied at these locations. Placing a second brand of lift within the facility could contribute to potential safety risks to veterans and staff.

The patient ceiling lifts are 825lbs weight capacity or higher, battery size sufficient for maximum recharge time of 4 hours; battery protection; 115/230V supply voltage; capable of 40 lifts in-series with maximum weight capacity; with option of integrated digital scale with integrated LCD hand control; continuous in track charging capability and nickel-metal hydride battery technology. Costs will increase with multiple companies being used in one facility.

4. Description of market research conducted and results or statement why it was not conducted: Arjo Huntleigh and Guldmann Inc. were contacted. In addition, Market Research was conducted by searching SBA and SCMC. SBA resulted in 6 vendors with NAICS 334510, when adding keywords the results went to 0. Searched SCMC, keyword also resulted in 6 vendors, none of which were the item #s needed.

5. Contracting Officer's Certification: Purchase is approved in accordance with FAR13.106-1(b). I certify that the foregoing justification is accurate and complete to the best of my knowledge and belief.

Contracting Officer

Combined Synopsis/Solicitation Notice image1.emf

AL14-07PSAChecklistforInstallationandRelocation-Fillable.pdf

Revision 2.1 1 of 4 Serial #: ____________________

Verify NFPA 99 and NFPA 70 compliance for access to electrical and safety systems.

Verify required access to mechanical, HVAC, and fire systems components within the lift installation area.

Verifiy minimum clearances for operation are compliant with manufacturer recommendations. (Ensure room clearance and that the ceiling height is adequate for lift usage.)

Facility: Manufacturer:

Model:

COMPLETE

Mfgr Contact:VAMC Contact's Phone Number:

Installer:

Serial Number: EE Number:

Work Order:

Installation or Relocation Checklist for Ceiling Mounted Patient Lifts The commissioning for a patient ceiling lift system(s) shall include, but not be limited to, the following points as components of the commissioning procedures.

NOTE: Ceiling mounted patient lifts are not to be installed in treatment units with actively suicidal patients.

Lift Location:

VAMC Contact:

Pre-Installation COMPLETE

Obtain structural and related engineering design drawings and calculations for the new lift installation.

Design drawings shall be developed for specific lift installation under specific pre-existing conditions of the facility.

Mfgr Contact's Phone Number:

Date:Installer's Phone Number:

Verify NFPA 99 and NFPA 70 compliance for proper grounding and bonding.

Verify that the lift is listed by the manufacturer to be installed and operated in the environment that the lift is operating under. (For example, water tight lifts shall be installed and operated in wet, damp or humid locations such as pools or bathrooms.)

Verify NFPA 13 compliance for fire sprinkler system (including but not limited to fire sprinkler heads and piping).

If the facility is located in a seismic area, as identified in VA Handbook H-18-8 Seismic Design Requirements, verify that the ceiling mounted patient lift system installation is in compliance with the requirements of VA Directive 7512 Seismic Safety of VA Buildings and VA Master Design Specification

13.05.041 Seismic Restraint Requirements for Non-Structural Components.

Perform site survey of the pre-existing conditions and as-built drawings above and below finish ceiling at the installation location to confirm existing structural and ceiling conditions.

Perform pre-installation walkthrough to confirm full understanding and consensus of design drawing(s) and installation conditions.

Verify proper connections of the lift's structural system to the building’s structure (including seismic bracing if applicable).

Verify proper interface at the ceiling (hard deck or soft tile) and proper installation of all protective features around the support rods and rails/tracks.

NOTES:

Installation

Revision 2.1 2 of 4 Serial #: ____________________

PASS FAIL

Rails/Tracks and End Stops

Lift Unit and Straps

Inspection of lift unit casing for cracks and alignment.

Inspection and activation of hand control for full operation (e.g., up, down, left, right) and “return to charge” function if applicable.

Confirm any and all lift unit indicator lights are functioning. (e.g., red service warning light, charging state light) Inspection and verification of all emergency functions of the lift unit.

Verification that all fasteners and set screws are properly tightened on the trollies and rails/tracks.

Ensure that the rail/track is free of gaps (unless required by design). If included in installation, verify rail turntable function, exchanger function, gate alignment, and safety block installation.

Confirm track is clean and clear of all debris. (Use manufacturer’s recommended cleaning materials to avoid damage to the motor case and other components.)

Verify proper installation of electric motor per manufacturer's instructions to ensure operational rigidity of motor mounting.

Verify proper electrical connections per design drawings and manufacturer's instructions.

Verification that the lift unit charges properly.

Perform operational test to verify lift functionality.

Perform walkthrough to ensure compliance of the installation per the design drawing(s) and manufacturer's instructions.

Post-Installation

Verify structural component sizing and physical installation to ensure that the correct structural system is in place and properly installed to support the lift.

Verification that all manufacturer specified end stops or docking gates are properly installed.

Revision 2.1 3 of 4 Serial #: ____________________

2 Verify that training and competency are documented prior to release for use with patients.

Verify that manufacturer or manufacturer’s representative has provided training on the use of patient handling equipment to clinicians and other staff who move and handle patients.

Full extension and inspection of lift strap for loose threads or frays.

Verification of any “soft start” or “soft stop” features and that lifting speed does not exceed 2.5 inches per second with “zero” load.

Verification of load testing and deflection testing at the manufacturer's specified maximum rated lift capacity.

Verification of any “soft start” and “soft stop” features and that lifting speed does not exceed 1.5 inches per second under maximum rated lift capacity.

Verification of function of emergency stop at maximum rated lift capacity.

Verification of emergency lowering feature at maximum rated lift capacity.

Training

Inspection of spreader bar and clips for cracks and for loose or missing rings or cotter pins.

Confirm that the manufacturer's operating and maintenance manuals for this lift have been received.

Load Testing

Manuals

Revision 2.1 4 of 4 Serial #: ____________________

DATE:

SIGNATURE:

Installing Contractor

ADDITIONAL NOTES:

Manager of the Service Using the Ceiling Mounted Lifts COMPLETE After the activities listed in the above checklist and in the manufacturer's installation/operations/owner’s manual(s) have been completed, the manager of the service using the ceiling mounted lifts confirms that the current staff have received initial training on ceiling mounted lifts and that there is a process in place to provide ongoing training on the proper use of ceiling mounted lifts.

After the activities listed in the above checklist and in the manufacturer's installation/operations/owner’s manual(s) have been completed, the installing contractor shall release the ceiling mounted lift installation to VA representative.

TITLE:

VA Representative After the activities listed in the above checklist and in the manufacturer's installation/operations/owner’s manual(s) have been completed, the VA representative shall review those items with the installing contractor prior to releasing the ceiling mounted lift into service to ensure completion of all requirements.

Install and Relocation

Facility:

Work Order:

Manufacturer:

Lift Location:

Model:

VAMC Contact:

Serial Number:

EE Number:

VAMC Contacts Phone Number:

Mfgr Contact:

Installer:

Mfgr Contacts Phone Number:

Installers Phone Number:

Date:

NOTES:

Serial:

NOTES_2:

NOTES_3:

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Serial_2:

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NOTES_6:

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NOTES_8:

Serial_3:

DATE:

TITLE:

DATE_2:

TITLE_2:

DATE_3:

TITLE_3:

ADDITIONAL NOTES:

Serial_4:

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