ATTACHMENT D.7 - PAST PERFORMANCE SURVEY.docx
DOCX document 27 KB Posted
- Solicitation number
- 36C24923R0100
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Other files
| File | Type | Posted |
|---|---|---|
| ATTACHMENT D.5 - CONTRACTOR CERTIFICATION OF IMMIGRATION.docx | DOCX document | |
| ATTACHMENT D.1 - HEMATOLOGY ONCOLOGY PERFORMANCE WORK STATEMENT.docx | DOCX document | |
| ATTACHMENT D.2 - ADDENDUM TO PERFORMANCE WORK STATEMENT.docx | DOCX document | |
| ATTACHMENT D.6 - ORGANIZATIONAL CONFLICTS OF INTEREST.docx | DOCX document | |
| 36C24923R0100.docx | DOCX document | |
| ATTACHMENT D.3 - QUALITY ASSURANCE SURVEILLANCE PLAN (QASP).docx | DOCX document | |
| ATTACHMENT D.4 - CONTRACTOR RULES OF BEHAVIOR.docx | DOCX document |
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36C24922R0101-Onsite Board Certified Chief Therapeutic Medical Physicist Radiation Oncology – Memphis VA Medical Center
36C24923R0100-Onsite Board Certified/Eligible Hematology Oncology Physician – Robley Rex VA Medical Center D.7
PAST PERFORMANCE SURVEY
REFERENCE INSTRUCTIONS: The Department of Veterans Affairs is seeking offerors for award of a VA contract for an Onsite Board Certified/Eligible Hematology Oncology Physician Services at the Robley Rex VA Medical Center. You have been identified as a reference and your comments would be appreciated. Your comments are considered Source Selection Sensitive; therefore, you are advised that the release of the names of individuals providing reference information about Offeror’s past performance is prohibited. Survey should be completed by evaluator and submitted no later than February 27, 2023 @ 10:00AM Central Time via email directly to Olonzo.Haynes@va.gov.
NOTE: Incomplete or unsigned surveys will not be considered.
Company being evaluated: _______________________________________________ Period of Performance:
What was the average monthly volume of the services provided? (Average number of hours worked per month?) ______________________________________ Name and title/position of evaluator:
Contact telephone number:
Contact e-mail address:
Please evaluate the past performance using only the following ratings without variation. If the rating is other than Fully Acceptable, please provide additional information in the appropriate block or in the remarks section of this form.
S = Superior Performance
V = Very Good with very few issues
F = Fully Acceptable/Good
M = Marginally Acceptable
U = Unacceptable Performance
| Please rate and provide information/comments for the following: |
| Circle/indicate selection |
| Q1. Rate how well the contractor complies with requirements and/or expectations? |
| S V F M U |
| Q2. Rate contractor’s knowledge and expertise in providing these services. |
| S V F M U |
| Q3. Rate the level of access to the contractor’s personnel. (i.e. Did they respond in a timely manner? Did they meet the requirements of being available and responding as according to the contract?) |
| S V F M U |
| Q4. Rate overall ease of contractor’s scheduling process. |
| S V F M U |
| Q5. Rate how well contractor protects the privacy of patients. |
| S V F M U |
| Q6. Rate the confidence of their candidates successfully performance on their contracts. |
| S V F M U |
Q7. Would you award another contract to the firm being evaluated? If no, please explain:
Yes No
Additional Remarks: Please use this space to indicate anything else you would like to say about the contractor being referenced or to list anything you especially liked or disliked about this contractor:
| Signature of Evaluator |
| Date |
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