D.7 PAST PERFORMANCE SURVEY.pdf
PDF 146 KB Posted
- Attached to
- Q519--Psychiatry Physician Services
- Solicitation number
- 36C25722R0052
About this file
This document contains a past performance survey template for evaluating offerors for the Department of Veterans Affairs contract number 36C25722R0052 to provide psychiatry physician services at the North Texas Veterans Healthcare System. The survey requests evaluation of offerors on a scale of Superior, Very Good, Fully Acceptable, Marginally Acceptable, and Unacceptable for compliance with requirements, knowledge and expertise in providing psychiatry services, access to personnel, ease of scheduling process, and protecting patient privacy. Respondents are asked if they would award another contract to the firm and to provide any additional remarks. Completed surveys must be submitted to dewana.raynor@va.gov by July 12, 2023 at 4:00PM Central Time.
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Other files
| File | Type | Posted |
|---|---|---|
| 36C25722R0052 0002.docx | DOCX document | |
| 36C25722R0052 0001.docx | DOCX document | |
| D.6 VHA Supplemental Contract Requirements for Combatting COVID-19.pdf | ||
| 36C25722R0052_1.docx | DOCX document | |
| D.1 QUALITY ASSURANCE SURVEILLANCE PLAN.pdf | ||
| D.5 VHA Handbook 6500.6 Contract Security Appendix C.pdf | ||
| D.2 CONTRACTOR CERTIFICATION.pdf | ||
| D.3 ORGANIZATIONAL CONFLICT OF INTEREST.pdf | ||
| D.4 CONTRACTOR RULES OF BEHAVIOR.pdf |
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D.6 36C25722R0052 PAST PERFORMANCE SURVEY
Psychiatry Physician Services
REFERENCE INSTRUCTIONS: The Department of Veterans Affairs is seeking offerors for award of a VA contract for Psychiatry Physician Services at the North Texas Veterans Healthcare System. 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 July 12, 2023 @ 4:00PM CT via email directly to dewana.raynor@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 Psychiatry 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. Would you award another contract to the firm being evaluated? If no, please explain:
Yes No mailto:dewana.raynor@va.gov
D.6 36C25722R0052 PAST PERFORMANCE SURVEY
Psychiatry Physician Services
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
File details come from the government source that posted it. Updated .