Exhibit A Delivery Checklist.docx
DOCX document 17 KB Posted
- Solicitation number
- 36C25626R0016
About this file
The document is a Delivery Checklist (Exhibit 1) for medical equipment delivery, designed to ensure proper equipment handling and customer satisfaction. The checklist is divided into two sections: Section I to be signed by the veteran or caregiver, and Section II to be completed by the delivery person. It includes verification points such as equipment condition, functionality, proper instruction provision, electrical safety, and delivery documentation.
This checklist appears to be associated with the VA's 36C25626R0016 solicitation for Durable Home Medical Equipment Accessories Services, a small business set-aside contract for the Alexandria VA Healthcare System. The contract will provide DME/HME services in Pineville, Louisiana, with technical questions due by 11/03/2025 and offer submissions required by 11/07/2025. Interested vendors must be registered in SAM and certified as Service-Disabled Veteran-Owned Small Businesses (SDVOSBs) through the SBA's VetCert platform.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| S06 - 36C25626R0016 0002.pdf | ||
| 36C25626R0016 0002_1.docx | DOCX document | |
| 36C25626R0016 0001_1.docx | DOCX document | |
| S05 - Technical Questions 36C25626R0016 .pdf | ||
| S02 - 36C25626R0016 Updated.pdf | ||
| S06 - 36C25626R0016 0001.pdf | ||
| Attachment 3 Conbined WDs 2015-5175 5183 5197 5209.pdf | ||
| Attachment 1 Performance Work Statement.pdf | ||
| 36C25626R0016.pdf | ||
| Exhibit B Patient Rights and Responsibilities.docx | DOCX document | |
| Exhibit C Safety Checklist.docx | DOCX document | |
| Attachment 2 QASP.pdf | ||
| 36C25626R0016_1.docx | DOCX document |
Show all 13
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
DELIVERY CHECKLIST (Exhibit 1)
SECTION I- TO BE SIGNED BY VETERAN/CAREGIVER YES NO
| 1. Did items delivered appear clean? | 1. ( ) | ( ) | ||
| 2. Did equipment appear to be working properly at time delivery? | 2. ( ) | ( ) | ||
| 3. Were you given instructions in the care and mechanical use of | 3. ( ) | ( ) |
The equipment
4. You are responsible for assuring that any electrical outlets needed 4. ( ) ( ) For prescribed equipment are properly grounded and safe for such equipment. Were you informed of this requirement?
5. Were you provided with a receipt or delivery notice showing the 5. ( ) ( ) name & telephone number of the contractor in the event service or repairs are needed?
SIGNATURE OF VETERAN/CAREGIVER DATE
SECTION II-TO BE COMPLETED BY DELIVERY PERSON YES NO
| 0. Was equipment working properly at time of delivery | 1. ( ) | ( ) | |||
| 0. Were electrical cords, plugs, etc. undamaged? | 2. ( ) | ( ) | |||
| 0. Did you instruct veteran/caregiver in the proper care and | 3. ( ) | ( ) |
Mechanical use of delivered equipment?
0. If veteran/caregiver had questions about equipment which 4. ( ) ( ) you could not answer, did you contact either the contractor or Prosthetics personnel?
0. Did you provide a receipt or delivery notice showing 5. ( ) ( ) Contractor’s name and telephone number?
0. If recovered equipment was picked up during this or a prior 6. ( ) ( ) Delivery this day, did you segregate such equipment from New/cleaned items and use prescribed precautions for handling Such equipment?
SIGNATURE OF DELIVERY PERSON DATE
File details come from the government source that posted it. Updated .