Atch 8 - Contractor EMR Certification Form.docx
DOCX document 18 KB Posted
- Attached to
- Z2DZ--Improve Security and Safety 539-25-507
- Solicitation number
- 36C25026Q0505
About this file
This is a Contractor Electronic Medical Records (EMR) Certification Form required for the Department of Veterans Affairs Veterans Health Administration (VHA) Veterans Integrated Service Network 10 (VISN 10) security and safety improvement project (539-25-507). The form serves as a template and compliance document for contractors to certify their EMR systems and capabilities in support of VA healthcare operations. As a certification form appendix, it does not specify detailed products or services required, but rather establishes the documentation and attestation framework contractors must complete to demonstrate their EMR systems meet VA standards, security protocols, and interoperability requirements necessary for integration with the VA's healthcare delivery infrastructure.
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Other files
| File | Type | Posted |
|---|---|---|
| Attachment Drawing REF1 -V2.pdf | ||
| 36C25026Q0505 0001.docx | DOCX document | |
| Atch 1 -WD.pdf | ||
| Atch 6 - REF1 Drawing.pdf | ||
| Atch 9 - Request for Information.docx | DOCX document | |
| Atch 12 - Single Source JCI PACS Redacted.pdf | ||
| Atch 13 - Single Source RF Technologies Redacted.pdf | ||
| 36C25026Q0505_1.docx | DOCX document | |
| Atch 3 - A Drawing.jpg | JPG image | |
| Atch 4 - B Drawing.jpg | JPG image | |
| Atch 5 - C Drawing.jpg | JPG image | |
| Atch 2 - CombinedSpecs 539-25-507.pdf | ||
| Atch 11 - VHA PCRA 2024_Final539-25-507.pdf | ||
| Atch 7 - VHA Directive 1192.01, Seasonal Influen..pdf | ||
| Atch 10 - Instructions for VAAR 852.219-75.docx | DOCX document |
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Text version
Pre-Award Contractor Safety and Environmental Record Evaluation Form
Information provided below is current and applicable to Project 539-26-507:
Company Name: Address: Telephone: Fax: Email: Contact:
1. Utilizing your OSHA 300 Forms, please complete the following information:
| Category |
| 2022 |
| 2023 |
| 2024 |
| 2025 |
Number of man hours (jobsite and office).
Number of cases involving days away from work, restricted activity, or both (Column H and I of OSHA 300).
Days away, restricted, or transferred rate (# of days away, restricted, or transferred cases x 200,000/# of man hours) (DART Rate).
Number of serious, willful, or repeat violations from OSHA within the last 3 years. Please attach explanation for any violations.
Please attach copies of the following documents: OSHA 300 and 300a Forms. These forms can be accessed through the OSHA publications search page: http://www.osha.gov/pls/publications/publication.html.
2. Provide six-digit North American Industrial Classification System (NAICS) Code for this acquisition: 236220
3. Who administers your company’s Safety and Health Program?
4. Company’s Insurance Experience Modification Rate (EMR):
File details come from the government source that posted it. Updated .