D.4 Surveillance Checklist.pdf
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- Solicitation number
- 36C25724Q0368
About this file
This document is a Surveillance Checklist for a Ground Ambulance contract between the VA North Texas Healthcare System and a contractor. The checklist outlines the performance objectives, performance thresholds, and methods of surveillance for the contract, which requires the contractor to provide 24/7 ambulance services for 365 days per year. Key objectives include maintaining vehicles in a clean and orderly condition, performing preventive maintenance, providing qualified personnel with appropriate training, and adhering to sanitation procedures. The performance thresholds are set at 95% compliance, with 100% surveillance of each patient pickup. The contract opportunity related to this checklist is Solicitation 36C25724Q0368, issued by the Department of Veterans Affairs Veterans Health Administration, to provide specialized patient transport services within the North Texas area.
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Text version
Surveillance Checklist
(VA NORTH TEXAS HEALTHCARE SYSTEM)
Contract: Ground Ambulance
Date/Time of Inspection:
Government POC Primary:
Government POC Alternate:
Organization:
VA NORTH TEXAS
HEALTHCARE SYSTEM
Location: Bldg. Post
SS Performance Objective PWS Para
Performance Threshold
Method of Surveillance Met
Not Met
Remarks
SS 1
The contractor shall provide Ambulance service, 24 hours per day, 365 days per year, as required in accordance with the terms and conditions contained herein.
95%
Compliance
100% Surveillance of each patient pick-up.
SS 2
The objective of Standards for Maintenance is to protect veterans and to cause no harm to all parties. The contractor shall maintain all vehicles in a clean and orderly condition, free from debris and accumulations which may create an accident, injury, or fire hazard.
4.4.3 95%
Compliance
100%
Surveillance
SS3
The contractor shall maintain (and furnish upon request) procedures that outline preventive
4.4.3 95%
Compliance
Performance Threshold
Method of Surveillance Met
Not Met
Remarks maintenance and/or repairs on each vehicle in an individual vehicle file and in chronological order, latest service on top. A statement from the Contractor indication compliance of vehicle maintenance files is in place should be submitted at time of offer for evaluation purposes.
Requested submission and verification of these documentation requirements will be a quality assurance procedure during the contract period.
SS4
The contractor shall furnish qualified personnel as required by contract specifications to accomplish all services under this contract.
4.3.1 95%
Compliance
SS5
Have completed training in accordance with the standards published by the Department of Health and Human Services with a minimum curriculum of 150 hours or equivalent including an in-hospital training period. Such training programs must also be acceptable under
4.3.1 95%
Compliance
Performance Threshold
Method of Surveillance Met
Not Met
Remarks the regulating requirements for local EMS Systems supported by DHHS under PL 93- 154, Federal Register 39:24304. (1974).
SS6
A licensed MTO shall ensure that sanitation procedures are provided to all personnel in a written document that conforms with current standards as set forth in occupational safety and health administration-blood borne pathogens protocol.
Attac hment
B
95% Compliance
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