D.2 QUALITY ASSURANCE SURVEILLANCE CHECKLIST_01.pdf

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Attached to
V999--EL Paso GROUND AMBULANCE SERVICES (ALS/BLS) Amendment
Solicitation number
36C25724Q0815
Issued by

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This document is a Quality Assurance Surveillance Checklist for a Ground Ambulance contract between the VA El Paso Texas Healthcare System and a contractor. The key requirements include providing patient pickups within 45 minutes of a request, maintaining proper certifications and training for staff, submitting monthly reports within 5 calendar days, and ensuring all ambulances are in proper condition and fit for patient and public safety. The Performance Standards, Acceptable Quality Levels, and Monitoring Methods are defined for each requirement. This checklist is related to a Federal Contract Opportunity with Solicitation Number 36C25724Q0815 for Ground Ambulance Services (ALS/BLS) for the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 17. The solicitation is an unrestricted open market Request for Quotation.

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D.2 QUALITY ASSURANCE SURVEILLANCE CHECKLIST

VA EL PASO TEXAS HEALTHCARE SYSTEM

Contract: Ground Ambulance

Date/Time of Inspection:

Government POC: Primary

Government POC Alternate:

Organization:

VA EL PASO TEXAS

HEALTHCARE SYSTEM

Location: Bldg. Post

Required Services (Tasks)

Performance Standard

Acceptable Quality Level

(AQL)

Method of Monitoring Met Not Met

ALS/BLS SMT

Service

The Contractor shall provide patient pickups within 45 minutes of receiving a request or within 45 minutes of the scheduled pick-up time.

100% 100% review of each patient pick-up

Certifications and Training/Customer Service

Contractor/employee shall maintain current proper licenses and ensure all attendants are properly trained and competent to provide service

100% Random Surveillance/Customer Complaint record

Submit Monthly Reports

Contractor shall ensure monthly reports are submitted within 5 calendar days of the due date.

90% 100% inspection of all monthly deliverables

ALS/BLS Vehicle Maintenance/Safety

Contractor shall ensure all ALS/BLS Vehicles are in proper condition and fit for the patient and public safety

100% Random Surveillance

File details come from the government source that posted it. Updated .