Exhibit C - Safety Checklist.pdf
PDF 119 KB Posted
- Attached to
- DME Services Federal contract opportunity
- Solicitation number
- 36C25624Q1457
About this file
This document is an Exhibit C - Safety Checklist that appears to be part of a federal contract opportunity for Durable Medical Equipment (DME) contract services. The checklist is designed to ensure the proper and safe delivery of equipment to veterans, covering topics such as equipment operation, electrical safety, infection control, and documentation of any issues. The related federal contract opportunity is a Request for Quotation (RFQ) issued by the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 16 for DME contract services. The solicitation is a Total SDVOSB Set-Aside with a NAICS code of 621610 and a small business size standard of $19 million. The solicitation is open until December 3rd, 2024, and all questions must be submitted to kevin.pollard2@va.gov by that date.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| 36C25624Q1457 0001 DME 12052024.pdf | ||
| 36C25624Q1457 DME.docx | DOCX document | |
| Attachment 1 DME PWS Template 09032024.docx | DOCX document | |
| Attachment 6 Bay County FL WD 2015-4559 R25 dtd 05-07-2024.pdf | ||
| Attachment 5 Mobile County AL WD 2015-4605 R22 dtd 05-08-2024.pdf | ||
| Attachment 3 Escambia County FL WD 2015-4561 R25 dtd 05-07-2024.pdf | ||
| Attachment 2 - Quality Assurance Surveillance Plan.pdf | ||
| Attachment 4 Harrison County MS WD 2015-5147 R23 dtd 04-20-2024.pdf | ||
| Exhibit A - Delivery Checklist.pdf | ||
| Exhibit B - Patient Rights and Responsibilities.pdf |
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Text version
Exhibit C
C-1
SAFETY CHECKLIST
VETERAN NAME:
SAFETY CHECKLIST: YES NO NA
a. Was equipment operating in accordance with the ( ) ( ) ( ) manufacturer’s guidelines?
b. Were the electrical outlets to be used with the equipment ( ) ( ) ( ) checked for safety?
c. Was a three (3) prong grounded adapter provided/installed? ( ) ( ) ( )
d. Was the equipment properly checked for electrical leakage? ( ) ( ) ( )
e. Were unsafe conditions discovered/identified? ( ) ( ) ( )
f. Were unsafe conditions reported to the VA/Prosthetics? ( ) ( ) ( )
INFECTION CONTROL:
1. Does the veteran/caregiver know the cleaning techniques to ( ) ( ) ( ) be used for the equipment provided?
COMMENTS:
Any additional instructions reviewed with patient/caregiver:
VETERANS/CAREGIVER SIGNATURE DATE
DELIVERY PERSON’S SIGNATURE DATE
File details come from the government source that posted it. Updated .