Attachment 6- Pre-Award Inspection Checklist.pdf
PDF 28 KB Posted
- Attached to
- BPA Mortuary Affairs (F. E. Warren AFB)
- Solicitation number
- FA461324Q1055
About this file
This document is an Attachment 6 - Pre-Award Inspection Checklist for a federal contract opportunity.
The key details are:
The checklist is for inspecting the facilities, equipment, supplies, and operations of a funeral home that is being evaluated to provide mortuary services for F.E. Warren AFB under a Blanket Purchase Agreement (BPA). The checklist covers areas such as the preparation room, storage of remains, transportation, chapel and visitation facilities, licenses, staffing, and external appearance of the establishment. The checklist is to be used by the Contracting Officer, Mortuary Officer, and other designated personnel to evaluate if the funeral home meets the required specifications to be deemed an acceptable provider of contractual mortuary services. The completed checklist, with signatures, will document the determination of the funeral home's acceptability for the BPA contract.
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ALL PURPOSE CHECKLIST
PAGE
OF
PAGES
TITLE/SUBJECT/ACTIVITY/FUNCTIONAL AREA
OPR
DATE
ITEM
NO.
(Assign a paragraph number to each item. Draw a horizontal line between each major paragraph.)
PREVIOUS EDITIONS ARE OBSOLETE.
AF IMT 2519, 19911101 V5
AF IMT 2519 (Continued).
ALL PURPOSE CHECKLIST
PAGE
OF
PAGES
ITEM
NO.
(Assign a paragraph number to each item. Draw a horizontal line between each major paragraph.)
PREVIOUS EDITIONS ARE OBSOLETE.
AF IMT 2519, 19911101 V5
8.2.1.3158.1.475346.466429
| Page: 1 |
| OfPages: 1 |
| This form is designed for electronic entry of "PAGE", "TITLE", "OPR". "DATE", "NO.", "ITEM", and 3 blank column heading fill-in only. Checkmarks of other information are intended to be entered manually in the columns. : F.E. Warren AFB Funeral Home Facilities Inspection Checklist |
Funeral Home Name/Address: _____________________________________________________
| OPR: 90 FSS |
| Enter date as YYYYMMDD: |
| Header: YES |
| Header_2: NO |
| Header_3: N/A |
| NBR: 1 |
| TAB once after row 4, if you wish to number the next item. TAB twice , if you wish to continue comments under item column.: PREPARATION ROOM REMARKS: |
A. SIZE - Size is adequate B. EQUIPMENT - Adequate for treatment of remains C. INSTRUMENTS - Sufficient to prepare remains
| ChckA: 0 |
| ChckB: 0 |
| ChckC: 0 |
| NBR_2: |
| TAB once after row 4, if you wish to number the next item. TAB twice , if you wish to continue comments under item column.: D. SUPPLIES - Sufficient for remains preparation |
E. VENTILATION - Adequate ventilation F. APPEARANCE - Clean, orderly and free of extraneous items
| ChckA_2: 0 |
| ChckB_2: 0 |
| ChckC_2: 0 |
| NBR_3: 2 |
| TAB once after row 4, if you wish to number the next item. TAB twice , if you wish to continue comments under item column.: STORAGE: |
HOLDING REMAINS - Funeral home has adequate storage space for remains
| ChckA_3: 0 |
| ChckB_3: 0 |
| ChckC_3: 0 |
| NBR_4: 3 |
TAB once after row 4, if you wish to number the next item. TAB twice , if you wish to continue comments under item column.: PRIVATE CARRIER:
TRANSPORTATION - Funeral home has a suitable funeral coach or service car
OTHER AREAS:
| ChckA_4: 0 |
| ChckB_4: 0 |
| ChckC_4: 0 |
| NBR_5: |
| TAB once after row 4, if you wish to number the next item. TAB twice , if you wish to continue comments under item column.: A. CHAPEL - Funeral home has a satisfactory chapel |
B. STATE ROOM - Funeral home has a satisfactory stateroom for visitation C. OFFICE - Office is satisfactory
| ChckA_5: 0 |
| ChckB_5: 0 |
| ChckC_5: 0 |
| NBR_6: 5 |
| TAB once after row 4, if you wish to number the next item. TAB twice , if you wish to continue comments under item column.: STANDARD CRITERIA: |
A. COMPLIANCE - Can meet all specifications, laws, and statutes on preparing remains B. LICENSE - Funeral home and manager are currently licensed C. STAFF - A competent professional staff is available
| ChckA_6: 0 |
| ChckB_6: 0 |
| ChckC_6: 0 |
| NBR_7: |
TAB once after row 4, if you wish to number the next item. TAB twice , if you wish to continue comments under item column.:
ESTABLISHMENT - EXTERNAL APPEARANCE:
A. BUILDING - Exterior appears to be clean and well maintained B. GROUNDS – Grounds and parking areas appear to be well maintained
| ChckA_7: 0 |
| ChckB_7: 0 |
| ChckC_7: 0 |
| NBR_8: |
| TAB once after row 4, if you wish to number the next item. TAB twice , if you wish to continue comments under item column.: C. LOCATION - Surrounding area appears to be well maintained and comparable to areas surrounding |
majority of local funeral homes.
| ChckA_8: 0 |
| ChckB_8: 0 |
| ChckC_8: 0 |
| NBR_9: |
| TAB once after row 4, if you wish to number the next item. TAB twice , if you wish to continue comments under item column.: We, the undersigned, certify that the funeral home named above is ( ) is not ( ) acceptable by the Air Force to provide contractual mortuary services. |
| ChckA_9: 0 |
| ChckB_9: 0 |
| ChckC_9: 0 |
| NBR_10: |
| TAB once after row 4, if you wish to number the next item. TAB twice , if you wish to continue comments under item column.: Contracting Officer: |
Grade/Name -
Signature - _________________________________________________________
| ChckA_10: 0 |
| ChckB_10: 0 |
| ChckC_10: 0 |
| NBR_11: |
| TAB once after row 4, if you wish to number the next item. TAB twice , if you wish to continue comments under item column.: Mortuary Officer: |
Grade/Name -
Signature - _________________________________________________________
| ChckA_11: 0 |
| ChckB_11: 0 |
| ChckC_11: 0 |
| NBR_12: |
| TAB once after row 4, if you wish to number the next item. TAB twice , if you wish to continue comments under item column.: Other Officer: |
Grade/Name -
Signature - _________________________________________________________
| ChckA_12: 0 |
| ChckB_12: 0 |
| ChckC_12: 0 |
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| TAB once after row 4, if you wish to number the next item. TAB twice , if you wish to continue comments under item column.: |
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File details come from the government source that posted it. Updated .