36C26318Q0124-003.doc

Quality Assurance Surveillance Plan

For: Fargo VA Health Care System Contract Number: TBD Contract Description: The Department of Veterans Affairs (VA), Fargo and all Community Based Outpatient Clinics (CBOC), has a requirement for courier services that will require the contractor to pick up mail and lab samples from supported CBOC’s and deliver to the Fargo VA Health Care System .

Contractor’s name: TBD

1. PURPOSE

This Quality Assurance Surveillance Plan (QASP) provides a systematic method to evaluate performance for the stated contract. This QASP explains the following:

· What will be monitored.

· How monitoring will take place.

· Who will conduct the monitoring.

· How monitoring efforts and results will be documented.

This QASP does not detail how the contractor accomplishes the work. Rather, the QASP is created with the premise that the contractor is responsible for management and quality control actions to meet the terms of the contract. It is the Government’s responsibility to be objective, fair, and consistent in evaluating performance.

This QASP is a “living document” and the Government may review and revise it on a regular basis. However, the Government shall coordinate changes with the contractor. Copies of the original QASP and revisions shall be provided to the contractor and Government officials implementing surveillance activities.

2. Government Roles and Responsibilities

The following personnel shall oversee and coordinate surveillance activities.

a. Contracting Officer (CO) - The CO shall ensure performance of all necessary actions for effective contracting, ensure compliance with the contract terms, and shall safeguard the interests of the United States in the contractual relationship. The CO shall also assure that the contractor receives impartial, fair, and equitable treatment under this contract. The CO is ultimately responsible for the final determination of the adequacy of the contractor’s performance.

Assigned CO:

Organization or Agency:

Network Contracting Office 23

b. Contracting Officer’s Representative (COR) - The COR is responsible for technical administration of the contract and shall assure proper Government surveillance of the contractor’s performance. The COR shall keep a quality assurance file. The COR is not empowered to make any contractual commitments or to authorize any contractual changes on the Government’s behalf.

Assigned COTR:

Kim Ehrmantraut Department Of Veterans Affairs 2700 State Street

Bismarck ND 58501

c. Other Key Government Personnel: None

3. Contractor Representatives The following employees of the contractor serve as the contractor’s program manager for this contract.

a. Program Manager: TBD

b. Other Contractor Personnel: TBD Title:

4. Performance Standards Performance standards define desired services. The Government performs surveillance to determine if the contractor exceeds, meets or does not meet these standards.

Vendor will pick up crutches, canes, laboratory supplies and paper supplies. Totes may contain office and medical supplies, laboratory supplies, Point of Care reagents and controls, interoffice mail, medical records- X-rays, medications/prescriptions, ect. (medical supplies may consist of syringes, gauze, FOBT cards, gloves, gowns and drapes, and needles and/or specimen Q-tips).

a. Contractor shall provider and maintain training for its employees in appropriate safety and packaging procedures suitable to specimen type and distances transported. This should include issues such as adherence to regulation for transport of biohazards, use of rigid containers where appropriate, temperature control, notification procedures in case of accident or spills, etc. Upon request by the Contracting Officer Technical Representative (COTR), the contractor shall provide documentation certifying that the training has been provided to contractor employees, agents and/or sub-contractors. Reference 49 CFR 173.199 Diagnostic Specimens and used Health Care Products and 172.700, subpart H, Training and International Air Transportation Association (IATA) section 1.5.02.

Each vehicle used in the performance of this contract shall be adequately stocked with at least one current/up-to-date complete “Spill Kit” for a bio-hazard clean-up in case of leakage or accidental discharge from container.

5. Incentives Incentives shall be based on exceeding, meeting, or not meeting performance standards.

6. Methods of QA Surveillance Various methods exist to monitor performance. The COR shall use the surveillance methods listed below in the administration of this QASP.

PERIODIC INSPECTION: Inspections may be scheduled quarterly.

Performance Standard ID – 3 VALIDATED USER/CUSTOMER COMPLAINTS. (Relies on the patient to identify deficiencies. Complaints are then investigated and validated.)

Performance Standard ID – 1,2,4,5, 6

7. Ratings Metrics and methods are designed to determine if performance exceeds, meets, or does not meet a given standard and acceptable quality level. A rating scale shall be used to determine a positive, neutral, or negative outcome. The following ratings shall be used:

Excellent = Exceeds Standards Satisfactory = Meets Standards

Unsatisfactory = Fails to Meet Standards

8. DOCUMENTING PERFORMANCE

a. Acceptable Performance The Government shall document positive performance. Any report may become a part of the supporting documentation for any contractual action.

b. Unacceptable performance When unacceptable performance occurs, the COR shall inform the contractor. This will normally be in writing unless circumstances necessitate verbal communication. In any case the COTR shall document the discussion and place it in the COR file.

When the COR determines, formal written communication is required, the COR shall prepare a Contract Discrepancy Report (CDR), and present it to the contractor's program manager with a copy to the Contracting Officer.

The contractor shall acknowledge receipt of the CDR in writing. The CDR will specify if the contractor is required to prepare a corrective action plan to document how the contractor shall correct the unacceptable performance and avoid a recurrence. The CDR will also state how long after receipt the contractor must present this corrective action plan to the COR. The Government shall review the contractor's corrective action plan to determine acceptability.

Any CDRs may become a part of the supporting documentation for any contractual action deemed necessary by the CO.

9. Frequency of Measurement

a. Frequency of Measurement.

During contract performance, the COR will periodically analyze whether the negotiated frequency of surveillance is appropriate for the work being performed.

b. Frequency of Performance Assessment Meetings.

The COR shall meet with the contractor monthly to assess performance and shall provide a written assessment.

<After award, both the contractor’s Program Manager and the COR shall sign this document.>

Signature – Contractor Program Manager

Signature – Contracting Officer’s Technical Representative