Attachment 1.A.pdf
PDF 117 KB Posted
- Solicitation number
- 36C25025R0013
About this file
This is a surveillance checklist for non-emergent wheelchair and ambulatory patient transportation services at the Saginaw VA Medical Center in Michigan. The checklist outlines five key performance objectives with associated standards and surveillance methods.
The performance requirements include: (1) on-time transportation service with 97% of passengers arriving 15 minutes before appointments, monitored through customer feedback; (2) incident reporting within 24 hours with a 97% compliance threshold, monitored through random checks; (3) monthly invoice reporting with required documentation at 95% compliance, verified through 100% inspection; (4) vehicle fleet maintenance requirements at 95% compliance, checked through periodic inspections; and (5) driver requirements and training standards at 95% compliance, also verified through periodic inspections. Each metric has specific PWS paragraph references and includes columns to mark whether standards are met or not met during inspections.
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Other files
| File | Type | Posted |
|---|---|---|
| 36C25025R0013 0001.docx | DOCX document | |
| Attachment 3 REVISED.pdf | ||
| Solicitation Questions with Responses.pdf | ||
| Attachment 2.xlsx | XLSX spreadsheet | |
| Attachment 2.xlsx | XLSX spreadsheet | |
| 36C25025R0013.pdf | ||
| Attachment 3.pdf | ||
| Attachment 1.pdf | ||
| Attachment 2.xlsx | XLSX spreadsheet | |
| Attachment 4.pdf | ||
| Appendix D.pdf | ||
| Attachment 4 - Service Contract Act WD 2015-4865 REF 25 Eff 7.22.2024.pdf | ||
| Attachment 2 - Price-Cost Schedule.xlsx | XLSX spreadsheet | |
| Appendix D- Rules of Behavior.pdf | ||
| Attachment 3 - Past Performance Questionnaire.pdf | ||
| 36C25025R0013.docx | DOCX document | |
| Attachment 1.A Surveillance Checklist - Saginaw Non Emergent Transportation.pdf | ||
| Attachment 1 - Quality Assurance Surveillance Plan.pdf |
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Text version
Surveillance Checklist
Saginaw VAMC - Non-Emergent Wheelchair and Ambulatory Patient Transportation Services
Contract: Non-Emergent Wheelchair and Ambulatory Patient Transportation
Services
Date/Time of Inspection:
Government POC Primary:
Government POC Alternate:
Organization: Saginaw VAMC Location: 1500 Weiss Street Saginaw, MI 48602
SS
Performance Objective -
Task PWS Para
Standard Performance
Threshold
Method of
Surveillance Met Not Met
Remarks
SS 1
Provide on- time transportation service to appointments
Section XII.f
Shall ensure all passengers arrive at their designated appointment location at least
15 minutes prior to the appointment time.
97% Customer
Feedback
Task PWS Para
Standard Performance
Threshold
Method of
Surveillance Met Not Met
Remarks
SS 2 Incident Reporting Section XIV.c
The Contractor shall submit all injury reports within 24 hours of incident to the VTS/COR and AOD for inclusion into the passenger’s administrative chart.
97% Random monitoring of incident reports
SS 3 Invoice Reports Section XIX
Provide a monthly invoice including secondary documentation in accordance with Section XIX of the PWS
95%
100% inspection of monthly invoices/reports
SS4 Vehicle Requirements Section VII
Contractor to maintain fleet of vehicles in accordance with paragraph VII of the PWS to include
95% Periodic
Inspection
Task PWS Para
Standard Performance
Threshold
Method of
Surveillance Met Not Met
Remarks providing reports upon request of the
COR or CO.
SS5
Driver Requirements and Training
Section V and VI
Contractor to ensure drivers meet diver requirements of section V and training standards in section VI
95% Periodic
Inspection
File details come from the government source that posted it. Updated .