ATTACHMENT 3 - VISN4 DME CONTRACTOR TRAINING REPORT.docx
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- 36C24427Q0004
About this file
This is a contractor training report template for the VISN 4 Durable Medical Equipment (DME) contract, designed to document mandatory employee training completion and compliance. The form serves as a tracking mechanism for contractor personnel assigned to provide DME storage, delivery, installation, and repair services across VISN 4 West medical centers.
The template requires documentation of seven mandatory training courses and certifications for all contractor employees, including VA Privacy and Information Security Awareness (VA 10176), Privacy and HIPAA Training (VA 10203) for personnel with access to Protected Health Information, Integrity and Compliance Awareness Training (VA 43790), Emergency Preparedness/Disaster Policy and Procedures with location-specific components, area or program-specific orientation, employee competency assessments, and Health Care Personnel Influenza Vaccination certification per VHA Directive 1192.01. The form includes columns for contractor employee initials, certificate attachment verification, completion dates, and Contracting Officer's Representative (COR) initials, with provisions to mark training as "N/A" when not applicable to specific contract roles. The report also contains fields for documenting new provider information, background check status, and provider separation dates, establishing a complete personnel compliance record for DME contractor oversight.
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ATTACHMENT 3
VISN4 DME CONTRACTOR TRAINING REPORT
TO BE COMPLETED FOR EACH CONTRACTOR EMPLOYEE
Note: If any of the below training is not applicable to subject Contract, the COR will notate N/A, add initials and date each line.
Course / Training Requirement Contractor Employee Initials & Certificate Attached as Applicable
Date Completed
COR Initials
VA Privacy and Information Security Awareness and Rules of Behavior (VA 10176) Target audience: This course is for all VA staff, contractors and volunteers who use a computer to perform their job.
Privacy and HIPAA Training
(VA 10203)
Target audience: Any VA employee or non-VA employee with access to Protected Health Information (PHI)
Integrity and Compliance Awareness Training for all Staff
(VA 43790)
Target audience: All VHA staff, contractors, trainees, and volunteers who do not work in revenue and is mandated per VHA Directive 1030
Emergency Preparedness/Disaster Policy and Procedures (location specific)
Initial competence assessment/employee competencies/product-specific training
Area/Program/Unit Specific Orientation
Health Care Personnel Influenza Vaccination Form Appendix B Target audience: All HCP including VHA staff, contractors that work in VHA locations or who come into contact with VA patients or other HCP as part of their duties and is mandated per VHA Directive 1192.01
NEW PROVIDER
| NAME |
| DATE STARTED |
| BACKGROUND CHECK |
PROVIDER NO LONGER PROVIDING SERVICES
| NAME |
| LAST DAY OF WORK |
CRG Chapter 7 Appendix F COR Roles and Responsibilities Page 1 of 4 Revision 03 Effective Date: 09/01/2024
File details come from the government source that posted it. Updated .