East El Paso UCAS-Needs Assessment Questionnaire.pdf

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Agency Long Term Space Requirements Needs Interview Questionnaire

General Project Information

Basic Information

1. Brief description of the location’s daily operations and functions (e.g. typical office, interactions with the public, appeals office, regional office, rapid response center, & etc.) Eastside El Paso serves the densest population of veterans in El Paso County. This new leased space will provide the first ever Urgent Care Center for the

EPVAHCS Station 756 and will serve our veterans that need urgent medical care for minor illnesses and injuries. We will also establish an Infusion/Dialysis Clinic along with several specialty services such as

Behavioral Health, Radiology, Audiology, Pulmonology, Physical Therapy, Whole Health services and the

Health Promotion Disease Prevention programs, like the Move Group and Smoking Cessation classes.

This area consists of the multiple zip codes 79907, 79915, 79925, 79935 & 79936 within El Paso County, Texas.

2. Purpose of this project / move: El Paso VA Health Care System (EPVAHCS) proposes this project move forward as fast as possible to help lower continued raising costs of sending Veterans to providers out in the community for services that the Eastside facility will be able to provide.

3. How does the agency define success? EPVAHCS requests this new facility be contracted, constructed, and activated before 2nd Quarter FY26. This will then give all stakeholders 24 months to contract, design, construct, and activate the Urgent Care Center, Infusion Dialysis Center, and Ancillary services. EPVAHCS would like to utilize a space that is mostly already built out to help lower construction costs if possible.

4. Constraints: Budget , Resources , Schedule , Organizational Change , & Mission Change

a. Notes: We have identified Budget, Resources, and Schedule constraints as possible risks for this project. The purchase of furniture may also be a risk since in the past this has delayed the opening of other CBOCs.

5. Assistance needed from GSA for: IT/Network & Telecommunication Services , Local & Long Distance Phone

Service , Furniture Acquisition , Furniture & Personal Property Disposal , Office Equipment Acquisition , Security Products & Services , Move Coordination

Exhibit B

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6. Total Staff / Headcount: Current 0 Future 50

7. For restroom calculations: New location percentage of staff women 50%, staff men 50%

8. Furniture: Move Existing or Buy New

New Lease Term

9. Full Term 20 years

10. Firm Term (Period TIs are paid off) 10 years

11. Has the agency considered potential office consolidations and closings? Yes No Notes:

Square Footage

12. Total Usable Square Footage Requested 39,000 SF

13. Is circulation accounted for in the square footage? Yes No Notes:

a. Typically, Circulation is calculated as 25-35% of the total SF requested. GSA does not add circulation to the SF submitted by agencies. The initial SF submitted by the agency must include the allowance for it.

14. Does this square footage account for agency-wide space reduction goals? Yes No Notes: The healthcare system is utilizing a space model where multiple staff utilize shared clinical and administrative spaces allowing for further maximization space in our facilities.

Delineated Area Boundaries (Must form a complete closed loop of connecting streets)

Requested Delineated Area:

15. North: Montana Ave, El Paso Texas

16. East: Berryville Street, El Paso Texas

17. South: Cesar E. Chavez Border Hwy, El Paso Texas

18. West: Airway Blvd., El Paso Texas

19. Is this area within a rural county? No. If yes, please skip to question 123. If no, please proceed to question 20.

20. Obtain a justification for not locating within a rural county (see Rural Development Act) The facility’s delineated area is based on the volume of registered Veterans using EPVAHCS services. By adding this Urgent Care

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Center with Pharmacy and Pathology/Laboratory services, Infusion Dialysis clinic, Imaging/Pulmonology/Audiology Suite, Whole Health clinic, and Behavioral Health clinic EPVAHCS can expand Specialty services that will help bring back Veterans whose care is currently provided by

Community Specialty providers. This will significantly reduce our Care in the Community costs.

21. Are these boundaries within the city’s Central Business District (CBD)? Yes If yes, please skip to question 23. If no, please proceed to question 22.

22. Obtain a justification related to the mission of this office for not locating within the CBD.

23. Are there any requirements for proximity to public transportation? Yes. Public transportation is available at this location.

24. Are there any setback requirements (ex. residential, day care, churches, etc)? No.

Hours of Operation

25. Weekday hours of operation: 8:00 am to 8:00 pm

26. Weekend hours of operation: Not Applicable Notes: Some clinics will offer Saturday clinic hours. Hours unknow at this time.

27. After hours access required: Yes No Notes:

28. After hours utilities required: Yes No Notes: Urgent Care & Radiology demand after hours operations.

29. Are after hours or daytime cleaning services required? Notes: Yes, it’ll be done by EPVAHCS EMS staff.

Security

1. Agency’s Security Level: 4 Unknown Notes: VA Til for requirements

FPS Security Level: 4

2. Unique Security Constraints: Yes No Notes: Must have Security Alarm, Duress Alarm, Security

Closet to contain Security and Duress Servers. Servers cannot be within the OI&T Closet without being separated by an approved chain link fence.

3. Security constraints that limit the use of signage, American flags, and symbols that may indicate the presence of a federal agency? Yes No Notes:

4. How does the agency want to manage employee access to the space? Keys , Cards , Other

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5. Does the agency need to manage visitor access to the space? Yes No Notes:

Parking

6. Number of parking spaces required 100 *Government Owned Vehicles Only (Included on SF-81 & Rent)

a. Security Needs: Gate Controlled , Fenced , or Visually Private

b. Location: Inside Basement , Outside Surface , Outside Structured , or No Preference

7. Number of employee &/or visitor parking spaces 100 *Privately Owned Vehicles (Not on SF-81 & Rent)

a. Parking to be within 0.10 miles of the building.

8. Bicycle parking Yes No Notes:

Existing Space

Basic Information

1. Would the agency like to remain in their current space if possible? Yes No N/A Notes: Agency does not have a current space leased for Urgent Care Center with Pharmacy and Pathology/Laboratory services, Infusion Dialysis clinic, Imaging/Pulmonology/Audiology Suite, Whole Health clinic, and

Behavioral Health clinic.

2. Is the agency satisfied with the current space and space configuration? Yes No N/A Notes:

3. What works with the current space? N/A Notes:

4. What does not work with the current space? N/A Note

5. Has the Lessor’s performance been acceptable? Yes No N/A Notes:

6. Are there any outstanding maintenance issues that the agency would like us to address with your existing space?

Yes No N/A Notes:

Existing Space Modifications

7. List of requirements for the current space, in the event the agency remains at the same location:

8. Re-Paint Yes No N/A Notes:

9. Re-Carpet Yes No N/A Notes:

a. Security Changes Yes No Notes:

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b. Swing space required during needed alterations Yes No Notes: N/A

c. Additional Needs N/A

10. If the agency were to relocate, are there any significant or non-standard items that would have to be moved or replicated in the new space? N/A

New Space

Building / Site

1. Does the agency need to be co-located with another agency or department? Yes No

Notes: Leasing the 1st floor of the building that our Eastside CBOC is currently located in is being requested. This allows Police, Lab, Pharmacy, and the 1st floor Ancillary services to support the CBOC

(2nd floor) and the Urgent Care, Infusion Dialysis clinic, Imaging/Pulmonology/Audiology Suite, Whole

Health clinic, and Behavioral Health clinic (1st floor).

2. Must the space be contained in one contiguous block without being split by a public corridor? Yes No

Notes: If space is not contained in one contiguous block additional space needs for OIT and waiting rooms.

3. Column spacing requirement: Yes No Span

4. Must the space be located on a particular floor of a building? Yes No Notes: Yes, the Urgent Care center must be located on the 1st floor of the building for to adhere by patient access requirements.

5. External adjacency requirements (ex. proximity to courthouses, etc.) Yes No Notes:

6. Proximity to amenities / building support services? Not Applicable

a. Food Service , Fitness Center , Credit Union , &/or Onsite Health Unit

b. Other:

7. Proximity to mass transit? Yes No Distance away in miles: 0.25 miles

8. Preference for a Class of Building? Class A , Class B , Class C/Flex , & / or no preference

Notes:

9. Does the agency require the ability to display signage? Interior Exterior Not Applicable

10. Does the agency require a business directory? Yes No

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11. Does the agency require on-site vending machines? Yes No

12. Does the agency require a flagpole? Yes No

13. Ceiling Height Minimum Clearance: 9 feet

Construction & Finishes

14. Requirement for window coverings such as blinds or draperies ? No Preference Notes:

15. How frequently would the agency like the space re-carpeted? (Typically every 5-10 years) 2 years in carpeted areas.

16. How frequently would the agency like the space re-painted? (Typically every 5-10 years) 3 years

17. Are floor grills or grates required to control outside dirt from external entryways? Yes No

18. Does the agency have any sustainability goals beyond the existing regulations, existing laws, and

Executive Orders in effect? Yes No Notes:

19. Sealed conduit for telecommunications: Yes No Notes:

20. Unique HVAC requirements: Yes No Notes:

a. Server Room? Yes No Notes:

b. Mail Room? Yes No Notes:

c. Other? Yes No Notes:

21. Antennas or a satellite dish on the roof: Yes No Notes:

22. Ware yard: Yes No Notes:

23. Loading Dock: Yes No Notes:

24. Freight Elevator: Yes No Notes:

Project Schedule

1. Does the agency require pre-occupancy tenant access for the set-up of equipment? Yes No

Number of days needed 30 days. VA should be given access to the OI&T and Security Closets as soon as they are securable.

2. Will the agency prepare the DIDs (Design Intent Drawings?) Yes No Notes: Lessor responsible.

3. Days agency needs to prepare the DIDs: N/A Business Days

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4. Days agency needs to review the DIDs, if the Lessor generates them: 20 Business Days

5. Days agency needs to review DID changes: 10 Business Days

6. Days agency needs to review the Construction Documents (CDs): 20 Business Days

7. Days agency needs to review modifications to the CDs: 10 Business Days

8. Days agency needs to review the RLP (previously known as the SFO): 10 Business Days

DID Workshops DID workshops are 1-3 day meetings held after award hosted by the Lessor with their architect. During this meeting, the agency and the Lessor’s architect develop and finalize the Design Intent Drawing. This process can substantially speed up the post award design process and can take months off of the project time, allowing the agency to occupy their space sooner. DID workshops also provide for a more collaborative design process resulting in a design that will better meet the needs of the agency which increases overall satisfaction with the space. In order for this process to be successful, the agency must bring all of the “decision makers” to the meeting and be prepared to approve the DID.

1. Is the agency willing to participate in a DID workshop? Yes No Notes:

2. Who are the individuals that will need to participate in the workshop to approve the DIDs?

Robert P. Boyea, Kevin Angeles, Angel Morales, Matthew Earls, Jessica Smith, Omar Rodriguez and possibly other VA Employees.

Please Note: Agencies must agree to the DID workshop prior to issuance of the RLP in order to ensure that the Lease document contains the proper clauses.

Turn-Key Leasing Turn-key leasing offers numerous advantages over the traditional TI Allowance method. Turn-key leasing involves GSA and the agency fully developing the agency’s tenant improvement requirements at the beginning of the project. These requirements are packaged into the “Agency Specific Requirements Package” which is then released to the Offerors as part of the Request for Lease Proposal (formally known as the SFO). The Offerors then submit costs for the tenant improvements required instead of using a generic allowance number. This means that the agency will know the actual cost of the tenant improvements including any RWA funding required prior to the Government awarding a contract. Turn-key leasing also offers much shorter project cycles due to a significantly shorter post award design and construction period.

Turn-key leasing can be done when the agency is willing to assist GSA with completing the ASRP template with 4 main types of information: 1) a room schedule with sizes, 2) a sample layout, 3) special build-out requirements, and 4) general requirements. The leasing process can be drastically reduced for small to medium sized leases compared to our standard model using the tenant improvement allowance process. Are you willing to provide GSA with this information?

Room Schedule and Details

Space Breakdown (Provide quantity, size, and finishes information). Standard office space finishes are specified below. If the space uses standard finishes, check that box. If non-standard finishes are required, specify them below.

Standard Office Finishes:

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Flooring Type: LVT, ceramic floor tiles where applicable Countertops: Solid surface countertops Millwork: Designated by the medical facility Wall Finish Type: Paint Wall Type (Interior Partitions): Ceiling Height 9 ft Ceiling Type: Acoustical Tile Quantity duplex electrical outlets (Offices): 4 (one per wall) Quantity data drops (Offices): 4 (one per wall)

1. 1st Floor Main Lobby Entrance

a. Vestibule: Quantity 1 & Size 200 sq ft each Standard Finishes? Yes No

b. Vending Machine Area: Quantity 1 & Size 150 sq ft Standard Finishes ACCORDING TO VA PACT

DESIGN MODEL FOR VENDOR MACHINE AREA REQUIREMENTS? Yes No

2. Urgent Care Center

a. Vestibule: Quantity 1 & Size 200 sq ft each Standard Finishes? Yes No

b. Waiting Room: Quantity 2 & Size 225 sq ft each Standard Finishes? Yes No

c. Reception: Quantity 1 & Size 385 sq ft each Standard Finishes? Yes No

d. Toilet, Patient Male: Quantity 1 & Size 75 sq ft each Standard Finishes? Yes No

i. Flooring type: LVT, ceramic floor tiles where applicable

ii. Wall finish type: Paint

iii. Ceiling type: Acoustical Tile

iv. Quantity duplex electrical outlets: 0

v. Quantity data drops: 0

vi. Wall Type: Gypsum wall board

vii. Sound Transmission Coefficient (STC) Requirement (if other than standard): Standard

viii. Additional Needs: Solid surface countertops.

e. Toilet, Patient Female: Quantity 1 & Size 75 sq ft each Standard Finishes? Yes No

i. Flooring type: LVT, ceramic floor tiles where applicable

ii. Wall finish type: Paint

iii. Ceiling type: Acoustical Tile

iv. Quantity duplex electrical outlets: 0

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v. Quantity data drops: 0

vi. Wall Type: Gypsum wall board

vii. Sound Transmission Coefficient (STC) Requirement (if other than standard): Standard

viii. Additional Needs: Solid surface countertops.

f. Alcove, Height / Weight Accessible Station: Quantity 3 & Size 40 sq ft each Standard Finishes? Yes

No

g. Triage Room: Quantity 8 & Size 150 sq ft each Standard Finishes? Yes No

h. Bariatric Triage Room: Quantity 2 & Size 180 sq ft each Standard Finishes? Yes No

i. General Exam / Treatment Room: Quantity 2 & Size 160 sq ft each Standard Finishes? Yes No

j. Bariatric Patient Exam / Treatment Room: Quantity 1 & Size 190 sq ft each Standard Finishes? Yes

No

k. Toilet, Universal Patient: Quantity 2 & Size 60 sq ft each Standard Finishes? Yes No

i. Flooring type: LVT, ceramic floor tiles where applicable

ii. Wall finish type: Paint

iii. Ceiling type: Acoustical Tile

iv. Quantity duplex electrical outlets: 0

v. Quantity data drops: 0

vi. Wall Type: Gypsum wall board

vii. Sound Transmission Coefficient (STC) Requirement (if other than standard): Standard

viii. Additional Needs: Solid surface countertops.

l. Toilet, Universal Non-Patient: Quantity 2 & Size 60 sq ft each Standard Finishes? Yes No

i. Flooring type: LVT, ceramic floor tiles where applicable

ii. Wall finish type: Paint

iii. Ceiling type: Acoustical Tile

iv. Quantity duplex electrical outlets: 0

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v. Quantity data drops: 0

vi. Wall Type: Gypsum wall board

vii. Sound Transmission Coefficient (STC) Requirement (if other than standard): Standard

viii. Additional Needs: Solid surface countertops.

m. Clean Equipment Storage Room: Quantity 1 & Size 100 sq ft Standard Finishes? Yes No

n. Linen Room, Clean: Quantity 1 & Size 120 sq ft Standard Finishes? Yes No

o. Soiled Linen Room: Quantity 1 & Size 100 sq ft Standard Finishes? Yes No

p. Nurse Station: Quantity 3 & Size 120 sq ft Standard Finishes? Yes No

q. Alcove, Medication: Quantity 1 & Size 20 sq ft Standard Finishes ACCORDING TO VA PACT DESIGN

MODEL FOR ALCOVE MEDICATION SPACE REQUIREMENTS? Yes No

i. Area is used for OMNI CELLS.

r. Alcove, Resuscitation Cart: Quantity 1 & Size 20 sq ft Standard Finishes ACCORDING TO VA PACT

DESIGN MODEL FOR ALCOVE RESUSCITATION SPACE REQUIREMENTS? Yes No

3. Infusion & Dialysis Center

a. Vestibule: Quantity 1 & Size 200 sq ft each Standard Finishes? Yes No

b. Waiting Room: Quantity 2 & Size 225 sq ft each Standard Finishes? Yes No

c. Reception: Quantity 1 & Size 385 sq ft each Standard Finishes? Yes No

d. Toilet, Patient Male: Quantity 1 & Size 75 sq ft each Standard Finishes? Yes No

i. Flooring type: LVT, ceramic floor tiles where applicable

ii. Wall finish type: Paint

iii. Ceiling type: Acoustical Tile

iv. Quantity duplex electrical outlets: 0

v. Quantity data drops: 0

vi. Wall Type: Gypsum wall board

vii. Sound Transmission Coefficient (STC) Requirement (if other than standard): Standard

viii. Additional Needs: Solid surface countertops.

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e. Toilet, Patient Female: Quantity 1 & Size 75 sq ft each Standard Finishes? Yes No

i. Flooring type: LVT, ceramic floor tiles where applicable

ii. Wall finish type: Paint

iii. Ceiling type: Acoustical Tile

iv. Quantity duplex electrical outlets: 0

v. Quantity data drops: 0

vi. Wall Type: Gypsum wall board

vii. Sound Transmission Coefficient (STC) Requirement (if other than standard): Standard

viii. Additional Needs: Solid surface countertops.

f. Alcove, Height / Weight Accessible Station: Quantity 2 & Size 40 sq ft each Standard Finishes? Yes

No

g. Exam Room, DIsys Ctr: Quantity 8 & Size 120 sq ft each Standard Finishes? Yes No

h. Consultation Room: Quantity 4 & Size 125 sq ft each Standard Finishes? Yes No

i. Conference Room: Quantity 1 & Size 240 sq ft each Standard Finishes? Yes No

j. Team Room (2 workstations), Clncl Sprt: Quantity 4 & Size 120 sq ft each Standard Finishes? Yes

No

k. Linen Room, Clean: Quantity 1 & Size 120 sq ft Standard Finishes? Yes No

l. Soiled Linen Room: Quantity 1 & Size 100 sq ft Standard Finishes? Yes No

m. Utility Room, Clean: Quantity 1 & Size 60 sq ft Standard Finishes? Yes No

n. Utility Room, Soiled: Quantity 1 & Size 40 sq ft Standard Finishes? Yes No

o. Clean Supply Storage Room, Dlsys Ctr: Quantity 1 & Size 80 sq ft Standard Finishes? Yes No

p. Equipment Processing/Clean Preparation Room, Dlsys Ctr: Quantity 1 & Size 200 sq ft Standard

Finishes? Yes No

q. Equipment Processing/Clean Storage Room, Dlsys Ctr: Quantity 1 & Size 200 sq ft Standard

Finishes? Yes No

r. Water Treatment Room, Dlsys Ctr: Quantity 2 & Size 200 sq ft Standard Finishes? Yes No

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4. Police Area

a. Control Room, Police Services: Quantity 1 & Size 100 sq ft Standard Finishes? Yes No

i. Flooring type LVT

ii. Wall finish type PAINT,

iii. Ceiling type Acoustical Tile,

iv. Quantity duplex electrical outlets 8,

v. Quantity data outlets 4

vi. Wall Type: Paint

vii. Sound Transmission Coefficient (STC) Requirement (if other than standard): Standard

viii. Additional Needs: PACs Entry into room. PACs and Duress Systems Server(s) can be located in this room so room needs the required wall mount board to mount server which should also be located behind the desk of the officer.

b. Identification/Registration Room, Police Services: Quantity 1 & Size 80 sq ft Standard Finishes? Yes

No

c. CBOC Armory/Weapon Storage Room, Police Services: Quantity 2 & Size 60 sq ft Standard

Finishes? Yes No

i. Flooring type LVT

ii. Wall finish type PAINT,

iii. Ceiling type Acoustical Tile,

iv. Quantity duplex electrical outlets 4,

v. Quantity data outlets 4

vi. Wall Type: Paint

vii. Sound Transmission Coefficient (STC) Requirement (if other than standard): Standard

viii. Additional Needs: PACs Entry into room. PACs and Duress Systems Server(s) can be located in this room so room needs the required wall mount board to mount server which should also be located behind the desk of the officer.

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d. CBOC Operation Room, Police Services: Quantity 1 & Size 60 sq ft Standard Finishes? Yes No

e. Security Room, Police Services: Quantity 1 & Size 60 sq ft Standard Finishes? Yes No

5. Pathology/Laboratory Area

a. Blood Draw Station: Quantity 1 & Size 80 sq ft each Standard Finishes? Yes No

b. Bariatric Blood Draw Station: Quantity 1 & Size 100 sq ft each Standard Finishes? Yes No

c. Laboratory Specimen Processing: Quantity 1 & Size 120 sq ft each Standard Finishes? Yes No

d. Toilet, Specimen Collection: Quantity 1 & Size 65 sq ft each Standard Finishes? Yes No

e. Handwashing Station: Quantity 1 & Size 10 sq ft each Standard Finishes? Yes No

f. Laboratory Tech workstation: Quantity 2 & Size 56 sq ft each Standard Finishes? Yes No

6. Pharmacy

a. Automated Drug Dispensing System: Quantity 1 & Size 100 sq ft each Standard Finishes? Yes

No

b. Consult Room: Quantity 1 & Size 100 sq ft each Standard Finishes? Yes No

c. Team Room: Quantity 1 & Size 240 sq ft each Standard Finishes? Yes No

7. Radiology

a. Conference Room: Quantity 1 & Size 240 sq ft each Standard Finishes? Yes No

b. Radiology Class 1 Imagining Room: Quantity 1 & Size 325 sq ft each Standard Finishes? Yes No

c. Radiology Class 1 Imagining Control Alcove: Quantity 1 & Size 75 sq ft each Standard Finishes? Yes

No

d. Radiology Class 1 Imagining System Component Room: Quantity 1 & Size 20 sq ft each Standard

Finishes? Yes No

e. Radiology Class 1 Imagining Supply Alcove: Quantity 1 & Size 20 sq ft each Standard Finishes? Yes

No

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f. Ultrasound Class 1 Scanning Room: Quantity 2 & Size 255 sq ft each Standard Finishes? Yes No

g. Ultrasound Class 1 Scanning Supply Alcove: Quantity 2 & Size 20 sq ft each Standard Finishes? Yes

No

h. Toilet, Ultrasound Patient: Quantity 2 & Size 60 sq ft each Standard Finishes? Yes No

i. CT Class 1 Scanning Room: Quantity 2 & Size 560 sq ft each Standard Finishes? Yes No

j. CT Class 1 Control Room: Quantity 1 & Size 210 sq ft each Standard Finishes? Yes No

k. CT Class 1 System Component Room: Quantity 2 & Size 105 sq ft each Standard Finishes? Yes

No

l. Imaging Storage Room: Quantity 1 & Size 120 sq ft each Standard Finishes? Yes No

m. Imagining Physician Reading Room: Quantity 3 & Size 145 sq ft each Standard Finishes? Yes No

n. CT Medication Preparation Room: Quantity 1 & Size 80 sq ft each Standard Finishes? Yes No

o. Standing Breast Class 1 Imaging Room: Quantity 2 & Size 290 sq ft each Standard Finishes? Yes

No

p. Standing Breast Class 1 Imaging System Component Room: Quantity 2 & Size 20 sq ft each

Standard Finishes? Yes No

q. Standing Breast Class 1 Imaging Supply Alcove: Quantity 2 & Size 20 sq ft each Standard Finishes?

Yes No

r. Imaging Gowned Patient Seating Alcove: Quantity 6 & Size 60 sq ft each Standard Finishes? Yes

No

s. Imaging Patient Dressing Room: Quantity 4 & Size 60 sq ft each Standard Finishes? Yes No

t. Imaging Patient Property Locker Alcove: Quantity 6 & Size 20 sq ft each Standard Finishes? Yes

No

u. Toilet, Imaging Patient: Quantity 2 & Size 60 sq ft each Standard Finishes? Yes No

v. Imaging Soiled Holding Room: Quantity 2 & Size 60 sq ft each Standard Finishes? Yes No

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w. Imaging Tech Workstation: Quantity 4 & Size 56 sq ft each Standard Finishes? Yes No

8. Ancillary Services Waiting Room

a. Waiting Room: Quantity 2 & Size 225 sq ft each Standard Finishes? Yes No

b. Reception: Quantity 1 & Size 385 sq ft each Standard Finishes? Yes No

9. Pulmonology Clinic

a. Pulmonology Function Testing Lab: Quantity 1 & Size 120 sq ft each Standard Finishes? Yes No

b. Respiratory Therapy Room: Quantity 1 & Size 120 sq ft each Standard Finishes? Yes No

c. Team Room (2 workstations): Quantity 1 & Size 120 sq ft each Standard Finishes? Yes No

10. Audiology Clinic

a. Hearing Aid Fitting Room: Quantity 1 & Size 125 sq ft each Standard Finishes? Yes No

b. Audiology Audiometric Examination Room w/ Control Room: Quantity 1 & Size 300 sq ft each

Standard Finishes? Yes No

c. Audiology Exam/Consult Room: Quantity 1 & Size 120 sq ft each Standard Finishes? Yes No

d. Team Room (2 workstations): Quantity 1 & Size 120 sq ft each Standard Finishes? Yes No

11. Behavioral Health Clinic

a. Waiting Room: Quantity 4 & Size 80 sq ft each Standard Finishes? Yes No

b. Reception, Clncl Sprt: Quantity 2 & Size 85 sq ft each Standard Finishes? Yes No

c. Toilet, Patient Male: Quantity 1 & Size 75 sq ft each Standard Finishes? Yes No

i. Flooring type: LVT, ceramic floor tiles where applicable

ii. Wall finish type: Paint

iii. Ceiling type: Acoustical Tile

iv. Quantity duplex electrical outlets: 0

v. Quantity data drops: 0

vi. Wall Type: Gypsum wall board

vii. Sound Transmission Coefficient (STC) Requirement (if other than standard): Standard

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viii. Additional Needs: Solid surface countertops.

d. Toilet, Patient Female: Quantity 1 & Size 75 sq ft each Standard Finishes? Yes No

i. Flooring type: LVT, ceramic floor tiles where applicable

ii. Wall finish type: Paint

iii. Ceiling type: Acoustical Tile

iv. Quantity duplex electrical outlets: 0

v. Quantity data drops: 0

vi. Wall Type: Gypsum wall board

vii. Sound Transmission Coefficient (STC) Requirement (if other than standard): Standard

viii. Additional Needs: Solid surface countertops.

e. Exam/Treatment Room: Quantity 10 & Size 120 sq ft each Standard Finishes ACCORDING TO VA

PACT DESIGN MODEL FOR MENTAL HEALTH GROUP THERAPY ROOM AREA REQUIREMENTS?

Yes No

f. Consult Room: Quantity 4 & Size 100 sq ft each Standard Finishes? Yes No

g. Team Room (2 workstations): Quantity 1 & Size 120 sq ft each Standard Finishes? Yes No

h. Storage Room: Quantity 1 & Size 100 sq ft each Standard Finishes ACCORDING TO VA PACT

DESIGN MODEL FOR MENTAL HEALTH GROUP THERAPY ROOM AREA REQUIREMENTS? Yes

No

i. Shared Group/Multifunction Room: Quantity 1 & Size 360 sq ft each Standard Finishes ACCORDING

TO VA PACT DESIGN MODEL FOR MENTAL HEALTH GROUP THERAPY ROOM AREA

REQUIREMENTS? Yes No

j. Shared Group/Multifunction Storage Room: Quantity 1 & Size 60 sq ft each Standard Finishes

ACCORDING TO VA PACT DESIGN MODEL FOR MENTAL HEALTH GROUP THERAPY ROOM AREA

REQUIREMENTS? Yes No

12. Whole Health Clinic

a. Waiting Room: Quantity 2 & Size 225 sq ft each Standard Finishes? Yes No

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b. Reception: Quantity 1 & Size 385 sq ft each Standard Finishes? Yes No

c. Toilet, Patient Male: Quantity 2 & Size 75 sq ft each Standard Finishes? Yes No

i. Flooring type: LVT, ceramic floor tiles where applicable

ii. Wall finish type: Paint

iii. Ceiling type: Acoustical Tile

iv. Quantity duplex electrical outlets: 0

v. Quantity data drops: 0

vi. Wall Type: Gypsum wall board

vii. Sound Transmission Coefficient (STC) Requirement (if other than standard): Standard

viii. Additional Needs: Solid surface countertops.

d. Toilet, Patient Female: Quantity 2 & Size 75 sq ft each Standard Finishes? Yes No

i. Flooring type: LVT, ceramic floor tiles where applicable

ii. Wall finish type: Paint

iii. Ceiling type: Acoustical Tile

iv. Quantity duplex electrical outlets: 0

v. Quantity data drops: 0

vi. Wall Type: Gypsum wall board

vii. Sound Transmission Coefficient (STC) Requirement (if other than standard): Standard

viii. Additional Needs: Solid surface countertops.

e. Consult Room: Quantity 2 & Size 100 sq ft each Standard Finishes? Yes No

f. Chiropractic Patient Care Room: Quantity 2 & Size 140 sq ft each Standard Finishes? Yes No

g. Acupuncture Patient Care Room: Quantity 2 & Size 140 sq ft each Standard Finishes? Yes No

h. Workstation: Quantity 2 & Size 56 sq ft each Standard Finishes? Yes No

i. Team Room (2 workstations): Quantity 1 & Size 120 sq ft each Standard Finishes? Yes No

j. Storage Room: Quantity 1 & Size 100 sq ft each Standard Finishes? Yes No

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k. Shared Group/Multifunction Room: Quantity 1 & Size 360 sq ft each Standard Finishes? Yes No

l. Shared Group/Multifunction Storage Room: Quantity 1 & Size 60 sq ft each Standard Finishes? Yes

No

13. Environmental Management Services

a. Housekeeping Aides Closet (HAC): Quantity 6 & Size 60 Standard Finishes? Yes No

b. Kitchen Housekeeping Closet: Quantity 2 & Size 15 Standard Finishes? Yes No

c. Central Liquid Supply Room: Quantity 1 & Size 200 Standard Finishes? Yes No

d. Distribution Cart Storage Room: Quantity 1 & Size 200 Standard Finishes? Yes No

e. Trash Collection Room: Quantity 1 & Size 200 Standard Finishes? Yes No

f. Environmental management Storage Room: Quantity 2 & Size 60 Standard Finishes? Yes No

14. Facility Support Service

a. Electrical Storage Room: Quantity 6 & Size 250 Standard Finishes? Yes No

b. Mechanical Storage Room: Quantity 4 & Size 100 Standard Finishes? Yes No

15. OI&T

a. Remote (Server) Room: Quantity 1 & Size 100 Standard Finishes? Yes No

i. Flooring type: Per OIT Standard Requirements (VA TIL)

ii. Wall finish type: Per OIT Standard Requirements (VA TIL)

iii. Ceiling type: Per OIT Standard Requirements (VA TIL)

iv. Quantity duplex electrical outlets: Per OIT Standard Requirements (VA TIL)

v. Quantity data drops: Per OIT Standard Requirements (VA TIL)

vi. Wall Type (if other than standard specified by code): Per OIT Standard Requirements (VA TIL)

vii. Sound Transmission Coefficient (STC) Requirement (if other than standard):

viii. Additional Needs: Uninterrupted Power Supply (UPS) with its own dedicated electrical circuit per OIT Standard Requirements (VA TIL)

b. Demarc Room: Quantity 1 & Size 420 Standard Finishes? Yes No

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i. Flooring type: Per OIT Standard Requirements (VA TIL)

ii. Wall finish type: Per OIT Standard Requirements (VA TIL)

iii. Ceiling type: Per OIT Standard Requirements (VA TIL)

iv. Quantity duplex electrical outlets: Per OIT Standard Requirements (VA TIL)

v. Quantity data drops: Per OIT Standard Requirements (VA TIL)

vi. Wall Type (if other than standard specified by code): Per OIT Standard Requirements (VA TIL)

vii. Sound Transmission Coefficient (STC) Requirement (if other than standard):

viii. Additional Needs: Uninterrupted Power Supply (UPS) with its own dedicated electrical circuit per OIT Standard Requirements (VA TIL)

c. Telecommunications Room: Quantity 3 & Size 20 Standard Finishes? Yes No

i. Flooring type: Per OIT Standard Requirements (VA TIL)

ii. Wall finish type: Per OIT Standard Requirements (VA TIL)

iii. Ceiling type: Per OIT Standard Requirements (VA TIL)

iv. Quantity duplex electrical outlets: Per OIT Standard Requirements (VA TIL)

v. Quantity data drops: Per OIT Standard Requirements (VA TIL)

vi. Wall Type (if other than standard specified by code): Per OIT Standard Requirements (VA TIL)

vii. Sound Transmission Coefficient (STC) Requirement (if other than standard):

viii. Additional Needs: Uninterrupted Power Supply (UPS) with its own dedicated electrical circuit per OIT Standard Requirements (VA TIL)

16. Video Conferencing Equipment: Yes No

17. Internal (departments or other) space adjacencies required: Yes No Notes:

Design Schematic Layout (recommended, but not required for the Streamlined model TI allowance option)

1. Do you have a required layout for this office? Yes No Notes:

2. Do you have any adjacency plans? Yes No Notes:

Special Requirements

1. Do you have any specialty items which are not standard to an office? Yes No Notes:

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Needs Interview Questionnaire

2. Do you have construction specifications for these items? Yes No Notes:

General Requirements

1. Do you have any special IT requirements or standards other than specified above? Yes No Notes:

Are cable trays required? Yes Who is purchasing data cable? Landlord Who is responsible for installing data cable? Landlord Who is purchasing telecommunications cable? Landlord Who is responsible for installing telecommunications cable? Landlord Are sealed conduits required for wall mounted outlets? Yes Who is responsible for termination data/telecommunication connections? Landlord

2. Do you have any special security requirements (intrusion detection system, access control system, etc.) Yes

No Notes: Intrusion Detection System, Fire Systems, PACs (Access Control Systems) can be located in OIT Room(s) but made separate from OI&T Servers with chain link fence (size must be VA approved), LAB Room(s), Doors to enter buildings, Doors to gain access from entry from the main waiting area, Police Room(s), and Lounge Room(s).

Are cable trays required?

Who is purchasing data cable?

Who is responsible for installing data cable?

Who is purchasing tele-communications cable?

Who is responsible for installing tele-communications cable?

Are sealed conduits required for wall mounted outlets?

Who is responsible for terminating data/telecommunication connections?

Yes Landlord Landlord Landlord Landlord Yes, back to demark Landlord