P09 Performance Work Statement_Final AK Updated.docx

PERFORMANCE WORK STATEMENT (PWS)

Bedford VA Medical Center

Bedford End of Life Ceiling Lift Replacements Part 1

General Information

1. General: This is a non-personnel services contract to provide equipment and services for the installation and procurement of ceiling lift systems. The Government shall not exercise any supervision or control over the contract service providers performing the services herein. Such contract service providers shall be accountable solely to the Contractor who, in turn is responsible to the Government.

1.1 Description of Services/Introduction: The contractor shall provide all personnel, equipment, supplies, facilities, transportation, tools, materials, supervision, and other items and non-personal services necessary to perform installation and procurement of ceiling lift systems as defined in this Performance Work Statement except for those items specified as government furnished property and services. The contractor shall perform to the standards in this contract.

1.2 Background: The Bedford VA Medical Center is seeking to replace 33 Guldmann ceiling lift systems that have surpassed the end of their service life.

Overhead track ceiling lift systems primarily serve the function of safely transporting patients from one area to another when patients do not possess the ability to transport themselves.

1.3 Objectives: Bedford aims to establish a firm fixed price contract that will provide the equipment, parts, accessories, and services required to procure and install 33 replacement ceiling lift systems.

1.4 Scope: The requested contract is specific to the Bedford VA Medical Center at 200 Springs Rd, Bedford MA 01730.

The contractor is responsible for the procurement, delivery, installation, and training for at least 33 new ceiling lift systems, parts, and accessories, as well as removal and de-installation of existing ceiling lift infrastructure if required. The contractor shall provide any labor, tools, equipment, etc. necessary to complete this work. The serial numbers and locations of the ceiling lift systems to be replaced are below:

The lifts must meet the following salient characteristics:

· The transfer gate must be able to support at least 600lbs.

· The ceiling lift must be able to support at least 600lbs.

· The system must feature a transverse rail, and two parallel rails secured into the ceiling to allow for movement throughout the entire room

· Motor must be mounted to rails, which must be secured in the ceiling

· System must be motorized

· The hand control must be wired.

· Must have controls on the hand control for up/down movement and accessing scale measurements or status measurements

· Scale must be internal to the motor to maximize hanger bar height and thus lift functionality.

· Lift must charge anywhere on the track via continuous AC charging.

· Lifting speed must be minimum 1.5 inches per second at maximum load capacity, with a soft/slow start and stop.

· Any infrastructure being replaced must be compatible with the existing Guldmann infrastructure.

· Lifts must be compatible with Guldmann tracks

· Must have internal scale due to, there is not enough clearance from the bed and ceiling

· Motor must be compatible with trainer module

· Motor must be compatible with a positioning lock

· The hand control must display weight on the screen

· The hand control must have the ability to display messages The government may require these rooms to be changed out for other rooms if the need arises, however, all prior systems will be Guldmann lifts, and all systems shall be located in Bldg 4 except for one lift in Bldg 78. The Contractor agrees to allow for the flexibility of switching rooms with the above stipulations for this project.

All ceiling lifts to be replaced in this project are in Floors 1 and 2 of Building 4 and on Floor 2 of Building 78, floor plans for these spaces are below.

The Government shall support a walk-through of these floors and rooms prior to start of work.

Contractor shall evaluate existing ceiling lift infrastructure integrity prior to installation. Any infrastructure, such as tracks, anchors, unistruts, etc. determined as needing replacement shall be replaced by the Contractor.

End of life ceiling lifts located in Bldg 4 and 78 shall be added to the scope of this project until the projected cost hits the total contract ceiling. This cost was estimated based on a worst-case scenario where all 33 of the above lifts require complete infrastructure replacement.

In rooms with infrastructure deemed safe for use, ceiling lift motors and all accessories shall be replaced. The contractor shall perform all functional tests and weight tests on the new lift.

In each room with infrastructure deemed as needing replacement, the Contractor shall complete structural evaluation calculations and have the calculations signed by a third-party Certified Engineer. The contractor shall then complete engineering design drawings for each specific lift installation under the previously determined pre-existing structural conditions. The contractor must then obtain a Seismic Signoff Letter from a third-party Certified Engineer in accordance with the directives in Section 6. APPLICABLE PUBLICATIONS (CURRENT EDITIONS). Installation shall begin on these rooms once pre-existing conditions and seismic compliance are verified.

The contractor, in conjunction with the Government’s primary POC for this project, shall complete all items in the attached Installation or Relocation Checklist for Ceiling Mounted Patient Lifts for each installed ceiling lift requiring infrastructure replacement, except for items 1 (pre-existing conditions) and 3 (seismic compliance) of the Pre-Installation section.

The contractor must coordinate installation dates with Bedford VA Medical Center’s Office of Healthcare Technology Management and/or the Technical POC at least 1 week in advance. The contractor shall include in this communication the estimated noise level during the installation process, and modify the installation process or change the time of installation to ensure noise levels are within an acceptable threshold as defined by the Government.

All employees of the Contractor and subcontractors shall comply with VA security management program and obtain the permission of the VA police, be identified by project and employer, and restricted from unauthorized access.

All installation personnel shall be trained by the manufacturer on how to properly install the equipment. Resumes and certifications shall be submitted for review if requested by the Government.

The Contractor shall provide a comprehensive onsite training program for the operating clinicians as required. This training program shall include at the minimum the following sessions: (i) Technical Training, (ii) Operational Training, (iii) Administrative Training, and (iv) Hardware and Software Trouble-shooting. Training shall occur onsite during normal business hours, 8:00am-4:30pm, Monday through Friday. Competency assessments shall be provided with the training. Onsite training is to be scheduled in advance with the Bedford VA Medical Center’s Healthcare Technology Management Service.

The contractor must have options for continued support of the ceiling systems after the initial installation.

The Contractor shall comply with any and all Infection Control Risk Assessment requirements deemed appropriate by the Bedford VA Medical Center during all portions of the work set forth in the Scope of Work.

The Contractor must comply with security, privacy, and safety issues in accordance to VA standards, policies, and directives set forth at all times while providing the work outlined in the Scope of Work.

The contractor shall take all necessary precautions to prevent damage to any government property. The contractor shall report any damages immediately and shall be assessed current replacement costs for property damaged by the contractor, unless corrective action is taken. Any damaged material (e.g. trees, shrubs, lawn/turf, cubs, gutters, sidewalks, etc.) will be replaced in a timely manner or corrected by the contractor with like materials, at no extra cost to the government, upon approval of the Contracting Officer.

1.5 Period of Performance: The period of performance shall be the date of award of this contract until all deliverables have been accepted. This period of performance shall not exceed one calendar year.

1.6 General Information

1.6.1 Quality Control N/A

1.6.2 Quality Assurance: N/A

1.6.3 Recognized Holidays: The contractor, if required by the requesting medical center, shall work during federal holidays:

New Year’s Day Martin Luther King Jr.’s Birthday Washington’s Birthday Memorial Day Juneteenth National Independence Day Independence Day Labor Day Columbus Day Veterans Day Thanksgiving Day Christmas Day

1.6.4 Hours of Operation: The contractor is responsible for conducting business at any hour required by the requesting Medical Center except when the Government facility is closed due to local or national emergencies, administrative closings, or similar Government directed facility closings. For other than firm fixed price contracts, the contractor will not be reimbursed when the government facility is closed for the above reasons. The Contractor must at all times maintain an adequate workforce for the uninterrupted performance of all tasks defined within this PWS when the Government facility is not closed for the above reasons. When hiring personnel, the Contractor shall keep in mind that the stability and continuity of the workforce are essential.

1.6.5 Place of Performance: The work to be performed under this contract will be performed at all the Bedford VA Medical Center:

· Edith Nourse Rogers Memorial Veterans Hospital 200 Springs Rd Bedford, MA 01730

1.6.6 Type of Contract: Firm Fixed Price

1.6.7 Security Requirements: Contractor personnel shall be always chaperoned by Government staff when performing work on-site.

1.6.7.1 PHYSICAL Security: The contractor shall be responsible for safeguarding all government equipment, information and property provided for contractor use. At the close of each work period, government facilities, equipment, and materials shall be secured.

1.6.7.2 Key Control: N/A

1.6.7.3 Lock Combinations: N/A

1.6.8 Special Qualifications: The contractor is responsible for all employees / subcontractors possessing required certifications to perform installation, replacement, or modification of existing overhead track ceiling lift systems. Qualifications such as certificates, training documents, etc. must be submitted to the government if asked for.

1.6.9 Post Award Conference/Periodic Progress Meetings: The Contractor agrees to attend any post award conference convened by the contracting activity or contract administration office in accordance with Federal Acquisition Regulation Subpart 42.5. The contracting officer, Contracting Officers Representative (COR), and other Government personnel, as appropriate, may meet periodically with the contractor to review the contractor's performance. At these meetings the contracting officer will apprise the contractor of how the government views the contractor's performance and the contractor will apprise the Government of problems, if any, being experienced. Appropriate action shall be taken to resolve outstanding issues. These meetings shall be at no additional cost to the government.

1.6.10 Contracting Officer Representative (COR): The (COR) will be identified by separate letter. The COR monitors all technical aspects of the contract and assists in contract administration The COR is authorized to perform the following functions: assure that the Contractor performs the technical requirements of the contract: perform inspections necessary in connection with contract performance: maintain written and oral communications with the Contractor concerning technical aspects of the contract: issue written interpretations of technical requirements, including Government drawings, designs, specifications: monitor Contractor's performance and notifies both the Contracting Officer and Contractor of any deficiencies; coordinate availability of government furnished property, and provide site entry of Contractor personnel. A letter of designation issued to the COR, a copy of which is sent to the Contractor, states the responsibilities and limitations of the COR, especially with regard to changes in cost or price, estimates or changes in delivery dates. The COR is not authorized to change any of the terms and conditions of the resulting order.

1.6.11 Key Personnel: The follow personnel are considered key personnel by the government:

Kyle Staubi, Primary Healthcare Technology Management POC The contractor shall provide a contract manager who shall be responsible for the performance of the work. The name of this person and an alternate who shall act for the contractor when the manager is absent shall be designated in writing to the contracting officer. The contract manager or alternate shall have full authority to act for the contractor on all contract matters relating to daily operation of this contract. The contract manager or alternate shall be available between 8:00am thru 4:30pm Monday thru Friday except Federal holidays or when the government facility is closed for administrative reasons. Key personnel must be qualified and, if applicable, certified to maintain, install, or modify overhead track ceiling lift systems.

1.6.12 Identification, Parking, Smoking, Cellular Phone Use and VA Regulations: All contract personnel attending meetings, answering Government telephones, and working in other situations where their contractor status is not obvious to third parties are required to identify themselves as such to avoid creating an impression in the minds of members of the public that they are Government officials. They must also ensure that all documents or reports produced by contractors are suitably marked as contractor products or that contractor participation is appropriately disclosed.

The contractor's employees shall wear visible identification at all times while on the premises of the VA property. It is the responsibility of the contractor to park in the appropriate designated parking areas. Information on parking is available from the VA Police-Security Service. The VA will not invalidate or make reimbursement for parking violations of the contractor under any conditions. Smoking is prohibited inside any buildings at the VA. Cellular phones and two way radios are not to be used within six feet of any medical equipment. Possession of weapons is prohibited. Enclosed containers, including tool kits, shall be subject to search. Violations of VA regulations may result in a citation answerable in the United States (Federal) District Court, not a local district state, or municipal court.

1.6.13 Contractor Travel: The contractor shall travel, if required, to the requesting medical center or where otherwise designated. The contractor shall not expense the government for travel costs.

1.6.14 Other Direct Costs N/A

1.6.15 Data Rights: The Government has unlimited rights to all documents/material produced under this contract. All documents and materials, to include the source codes of any software, produced under this contract shall be Government owned and are the property of the Government with all rights and privileges of ownership/copyright belonging exclusively to the Government. These documents and materials may not be used or sold by the contractor without written permission from the Contracting Officer. All materials supplied to the Government shall be the sole property of the Government and may not be used for any other purpose. This right does not abrogate any other Government rights.

1.6.16 Organizational Conflict of Interest: Contractor and subcontractor personnel performing work under this contract may receive, have access to or participate in the development of proprietary or source selection information (e.g., cost or pricing information, budget information or analyses, specifications or work statements, etc.) or perform evaluation services which may create a current or subsequent Organizational Conflict of Interests (OCI) as defined in FAR Subpart 9.5. The Contractor shall notify the Contracting Officer immediately whenever it becomes aware that such access or participation may result in any actual or potential OCI and shall promptly submit a plan to the Contracting Officer to avoid or mitigate any such OCI. The Contractor’s mitigation plan will be determined to be acceptable solely at the discretion of the Contracting Officer and in the event the Contracting Officer unilaterally determines that any such OCI cannot be satisfactorily avoided or mitigated, the Contracting Officer may effect other remedies as he or she deems necessary, including prohibiting the Contractor from participation in subsequent contracted requirements which may be affected by the OCI.

1.6.17 PHASE IN /PHASE OUT PERIOD: N/A

1.7 Complaince with OSHA Bloodborne Pathogens Standard: The contractor shall comply with the Federal OSHA Blood borne Pathogens Standard. The contractor shall:

A. Have methods by which all employees are educated as to risks associated with blood borne pathogens.

B. Have policies and procedures which reduce the risk of employee exposure to blood borne pathogens.

C. Have mechanisms for employee counseling and treatment following exposure to blood borne pathogens.

D. Provide appropriate personal protective equipment/clothing such as gloves, gowns, masks, protective eyewear, and mouthpieces for the employee during performance of the contract.

1.8 Records Management Language for Statement of Work (SOW): he following standard items relate to records generated in executing the contract and should be included in a typical procurement contract:

1. Citations to pertinent laws, codes and regulations such as 44 U.S.C chapters 21, 29, 31 and 33; Freedom of Information Act (5 U.S.C. 552); Privacy Act (5 U.S.C. 552a); 36 CFR Part 1222 and Part 1228.

2. Contractor shall treat all deliverables under the contract as the property of the U.S. Government for which the Government Agency shall have unlimited rights to use, dispose of, or disclose

3. such data contained therein as it determines to be in the public interest.

4. Contractor shall not create or maintain any records that are not specifically tied to or authorized by the contract using Government IT equipment and/or Government records.

5. Contractor shall not retain, use, sell, or disseminate copies of any deliverable that contains information covered by the Privacy Act of 1974 or that which is generally protected by the Freedom of Information Act.

6. Contractor shall not create or maintain any records containing any Government Agency records that are not specifically tied to or authorized by the contract.

7. The Government Agency owns the rights to all data/records produced as part of this contract.

8. The Government Agency owns the rights to all electronic information (electronic data, electronic information systems, electronic databases, etc.) and all supporting documentation created as part of this contract. Contractor must deliver sufficient technical documentation with all data deliverables to permit the agency to use the data.

9. Contractor agrees to comply with Federal and Agency records management policies, including those policies associated with the safeguarding of records covered by the Privacy Act of 1974. These policies include the preservation of all records created or received regardless of format [paper, electronic, etc.] or mode of transmission [e-mail, fax, etc.] or state of completion [draft, final, etc.].

10. No disposition of documents will be allowed without the prior written consent of the Contracting Officer. The Agency and its contractors are responsible for preventing the alienation or unauthorized destruction of records, including all forms of mutilation. Willful and unlawful destruction, damage or alienation of Federal records is subject to the fines and penalties imposed by 18 U.S.C. 2701. Records may not be removed from the legal custody of the Agency or destroyed without regard to the provisions of the agency records schedules.

Contractor is required to obtain the Contracting Officer's approval prior to engaging in any contractual relationship (sub-contractor) in support of this contract requiring the disclosure of information, documentary material and/or records generated under, or relating to, this contract. The Contractor (and any sub-contractor) is required to abide by Government and Agency guidance for protecting sensitive and proprietary information

1.9 Security Language for Scope of Work: The contractor, their personnel, and their subcontractors shall be subject to the Federal laws, regulations, standards, and VA Directives and Handbooks regarding information and information system security as delineated in this contract.

PART 2

DEFINITIONS & ACRONYMS

2. DEFINITIONS AND ACRONYMS:

2.1. DEFINITIONS:

2.1.1. CONTRACTOR. A supplier or vendor awarded a contract to provide specific supplies or service to the government. The term used in this contract refers to the prime.

2.1.2. CONTRACTING OFFICER. A person with authority to enter into, administer, and or terminate contracts, and make related determinations and findings on behalf of the government. Note: The only individual who can legally bind the government.

2.1.3. CONTRACTING OFFICER'S REPRESENTATIVE (COR). An employee of the U.S. Government appointed by the contracting officer to administer the contract. Such appointment shall be in writing and shall state the scope of authority and limitations. This individual has authority to provide technical direction to the Contractor as long as that direction is within the scope of the contract, does not constitute a change, and has no funding implications. This individual does NOT have authority to change the terms and conditions of the contract.

2.1.4. DEFECTIVE SERVICE. A service output that does not meet the standard of performance associated with the Performance Work Statement.

2.1.5. DELIVERABLE. Anything that can be physically delivered, but may include non-manufactured things such as meeting minutes or reports.

2.1.6. KEY PERSONNEL. Contractor personnel that are evaluated in a source selection process and that may be required to be used in the performance of a contract by the Key Personnel listed in the PWS. When key personnel are used as an evaluation factor in best value procurement, an offer can be rejected if it does not have a firm commitment from the persons that are listed in the proposal.

2.1.7. PHYSICAL SECURITY. Actions that prevent the loss or damage of Government property.

2.1.8. QUALITY ASSURANCE. The government procedures to verify that services being performed by the Contractor are performed according to acceptable standards.

2.1.9. QUALITY ASSURANCE Surveillance Plan (QASP). An organized written document specifying the surveillance methodology to be used for surveillance of contractor performance.

2.1.10. QUALITY CONTROL. All necessary measures taken by the Contractor to assure that the quality of an end product or service shall meet contract requirements.

2.1.11. SUBCONTRACTOR. One that enters into a contract with a prime contractor. The Government does not have privity of contract with the subcontractor.

2.1.12. WORK DAY. The number of hours per day the Contractor provides services in accordance with the contract.

2.1.12. WORK WEEK. Monday through Friday, unless specified otherwise.

2.2. ACRONYMS:

PART 3

GOVERNMENT FURNISHED PROPERTY, EQUIPMENT, AND SERVICES

3. GOVERNMENT FURNISHED ITEMS AND SERVICES:

3.1. Services: The Government will provide personnel to escort contractors throughout the facility if required.

3.2 Facilities: Workspace required for the installation of new ceiling lift systems will be provided by the Government. The Government is responsible for ensuring spaces are ready for installation of new systems.

3.3 Utilities: The Government will provide all utilities in the facility for the contractor’s use in performance of tasks outlined in this PWS. The Contractor shall instruct employees in utilities conservation practices. The contractor shall be responsible for operating under conditions that preclude the waste of utilities, which include turning off the water faucets or valves after using the required amount to accomplish cleaning vehicles and equipment.

3.4 Equipment: N/A

3.5 Materials: The Government will provide Standard Operating Procedures and Policies to be followed for structural design and drawing documents.

PART 4

CONTRACTOR FURNISHED ITEMS AND SERVICES

4. CONTRACTOR FURNISHED ITEMS AND RESPONSIBILITIES:

4.1 General: The Contractor shall furnish all supplies, equipment, facilities and services required to perform work under this contract that are not listed under Section 3 of this PWS.

4.2 Secret Facility Clearance: N/A

4.3. Materials: The Contractor shall furnish materials, supplies, and equipment necessary to meet the requirements under this PWS.

4.4. Equipment: The Contractor shall furnish all equipment, including motors, belts, tracks, charging systems, hardware, spreader bars, etc. to meet the requirements under this PWS.

PART 5

SPECIFIC TASKS

5. Specific Tasks:

5.1. Basic Services: The contractor shall provide services for the procurement and installation of new overhead ceiling lift systems, parts, accessories, and training.

· Implementation services shall include the following:

· A project manager

· Detailed project timeline with defined roles and responsibilities (including vendor and VA resources)

· On-site installation coordination of all equipment and accessories, a training plan, and schedule for go-live

· The contractor shall develop a detailed structural design and drawing document for each room prior to installation. All structural design and drawings shall follow: (1) Department of Veterans Affairs, VHA Directive 2005-019, May 19, 2005 (2) Department of Veterans Affairs, Specifications SECTION 13 05 41 – SEISMIC RESTRAINT REQUIREMENTS FOR NO -STRUCTURAL COMPONENTS (3) Strategic Management Office, Seismic Design Requirements H-18-8, Nov 2019 Revised May 2020.

· The contractor shall revise the structural design and drawing document if instructed to do so by the VA Medical Center.

· The Contractor shall evaluate existing infrastructure integrity prior to installation. Any infrastructure determined as needing replacement shall be replaced by the Contractor.

· Additional ceiling lifts located in Bldg 4 will be added to the scope of this project until the projected cost hits $573,337.90.

· In rooms with infrastructure deemed safe for use, the contractor shall replace the motor and all motor accessories, and perform full functional and weight tests on the new motor.

· In rooms with infrastructure deemed as needing replacement, the contractor, in conjunction with the Government’s primary POC for this project, shall complete all items in the attached Installation or Relocation Checklist for Ceiling Mounted Patient Lifts for each installed ceiling lift.

· The Contractor shall complete structural evaluation calculations and have the calculations signed by a third-party Certified Engineer.

· The contractor shall then complete engineering design drawings for each specific lift installation under the previously determined pre-existing structural conditions.

· The contractor must then obtain a Seismic Signoff Letter from a third-party Certified Engineer in accordance with the directives in 6. APPLICABLE PUBLICATIONS (CURRENT EDITIONS)

· Installation shall continue after the signed structural calculations, the engineering design drawing set, and the Seismic Signoff Letter are returned to the Government.

· Materials shall be new equipment, parts and accessories as specified in this PWS.

· The vendor shall deliver materials to the job site in original equipment manufacturer’s (OEM) original unopened containers, clearly labeled with the OEM’s name, equipment model and serial identification numbers, delivery order number, and VA purchase order number.

· The vendor is responsible for inventorying materials prior to delivery to VA sites to check for accuracy in quantity and part number.

· All on-site installation services shall be vendor-provided by technical staff (not sales reps) fully trained to service and install ceiling lift products, parts, and accessories as specified.

· The vendor shall provide, maintain, and dispose all material waste and packaging associated with the ceiling lift products and/or waste generated during the installation services.

· The vendor will be responsible for moving waste materials from job site(s) to a vendor-provided waste container, and then off-site.

· The vendor shall provide the following documentation for the proposed ceiling lift configuration and setup:

· Hard and soft copy of operator’s manual

· Hard and soft copy of technical service manuals including troubleshooting guides, necessary diagnostic software and equipment, schematic diagrams, and parts lists

· DVD or web-based training if available

PART 6

APPLICABLE PUBLICATIONS

6. APPLICABLE PUBLICATIONS (CURRENT EDITIONS)

6.1. The Contractor must abide by all applicable regulations, publications, manuals, and local policies and procedures.

(1) Department of Veterans Affairs, VHA Directive 2005-019, May 19, 2005

(2) Department of Veterans Affairs, Specifications SECTION 13 05 41 – SEISMIC RESTRAINT REQUIREMENTS FOR NO -STRUCTURAL COMPONENTS

(3) Strategic Management Office, Seismic Design Requirements H-18-8, Nov 2019 Revised May 2020 Bldg 4 Floors 1 and 2.pdf

BUILDING 04 - FIRST FLOOR

N.T.S.

BUILDING 04 - SECOND FLOOR

N.T.S.

image2.emf

Installation Relocation_1.pdf

Revision 2.1 1 of 4 Serial #: ____________________

Verify NFPA 99 and NFPA 70 compliance for access to electrical and safety systems.

Verify required access to mechanical, HVAC, and fire systems components within the lift installation area.

Verifiy minimum clearances for operation are compliant with manufacturer recommendations. (Ensure room clearance and that the ceiling height is adequate for lift usage.)

Facility: Manufacturer:

Model:

COMPLETE

Mfgr Contact:VAMC Contact's Phone Number:

Installer:

Serial Number: EE Number:

Work Order:

Installation or Relocation Checklist for Ceiling Mounted Patient Lifts The commissioning for a patient ceiling lift system(s) shall include, but not be limited to, the following points as components of the commissioning procedures.

NOTE: Ceiling mounted patient lifts are not to be installed in treatment units with actively suicidal patients.

Lift Location:

VAMC Contact:

Pre-Installation COMPLETE

Obtain structural and related engineering design drawings and calculations for the new lift installation.

Design drawings shall be developed for specific lift installation under specific pre-existing conditions of the facility.

Mfgr Contact's Phone Number:

Date:Installer's Phone Number:

Verify NFPA 99 and NFPA 70 compliance for proper grounding and bonding.

Verify that the lift is listed by the manufacturer to be installed and operated in the environment that the lift is operating under. (For example, water tight lifts shall be installed and operated in wet, damp or humid locations such as pools or bathrooms.)

Verify NFPA 13 compliance for fire sprinkler system (including but not limited to fire sprinkler heads and piping).

If the facility is located in a seismic area, as identified in VA Handbook H-18-8 Seismic Design Requirements, verify that the ceiling mounted patient lift system installation is in compliance with the requirements of VA Directive 7512 Seismic Safety of VA Buildings and VA Master Design Specification

13.05.041 Seismic Restraint Requirements for Non-Structural Components.

Perform site survey of the pre-existing conditions and as-built drawings above and below finish ceiling at the installation location to confirm existing structural and ceiling conditions.

Perform pre-installation walkthrough to confirm full understanding and consensus of design drawing(s) and installation conditions.

Verify proper connections of the lift's structural system to the building’s structure (including seismic bracing if applicable).

Verify proper interface at the ceiling (hard deck or soft tile) and proper installation of all protective features around the support rods and rails/tracks.

NOTES:

Installation

Revision 2.1 2 of 4 Serial #: ____________________

PASS FAIL

Rails/Tracks and End Stops

Lift Unit and Straps

Inspection of lift unit casing for cracks and alignment.

Inspection and activation of hand control for full operation (e.g., up, down, left, right) and “return to charge” function if applicable.

Confirm any and all lift unit indicator lights are functioning. (e.g., red service warning light, charging state light) Inspection and verification of all emergency functions of the lift unit.

Verification that all fasteners and set screws are properly tightened on the trollies and rails/tracks.

Ensure that the rail/track is free of gaps (unless required by design). If included in installation, verify rail turntable function, exchanger function, gate alignment, and safety block installation.

Confirm track is clean and clear of all debris. (Use manufacturer’s recommended cleaning materials to avoid damage to the motor case and other components.)

Verify proper installation of electric motor per manufacturer's instructions to ensure operational rigidity of motor mounting.

Verify proper electrical connections per design drawings and manufacturer's instructions.

Verification that the lift unit charges properly.

Perform operational test to verify lift functionality.

Perform walkthrough to ensure compliance of the installation per the design drawing(s) and manufacturer's instructions.

Post-Installation

Verify structural component sizing and physical installation to ensure that the correct structural system is in place and properly installed to support the lift.

Verification that all manufacturer specified end stops or docking gates are properly installed.

Revision 2.1 3 of 4 Serial #: ____________________

2 Verify that training and competency are documented prior to release for use with patients.

Verify that manufacturer or manufacturer’s representative has provided training on the use of patient handling equipment to clinicians and other staff who move and handle patients.

Full extension and inspection of lift strap for loose threads or frays.

Verification of any “soft start” or “soft stop” features and that lifting speed does not exceed 2.5 inches per second with “zero” load.

Verification of load testing and deflection testing at the manufacturer's specified maximum rated lift capacity.

Verification of any “soft start” and “soft stop” features and that lifting speed does not exceed 1.5 inches per second under maximum rated lift capacity.

Verification of function of emergency stop at maximum rated lift capacity.

Verification of emergency lowering feature at maximum rated lift capacity.

Training

Inspection of spreader bar and clips for cracks and for loose or missing rings or cotter pins.

Confirm that the manufacturer's operating and maintenance manuals for this lift have been received.

Load Testing

Manuals

Revision 2.1 4 of 4 Serial #: ____________________

DATE:

SIGNATURE:

Installing Contractor

ADDITIONAL NOTES:

Manager of the Service Using the Ceiling Mounted Lifts COMPLETE After the activities listed in the above checklist and in the manufacturer's installation/operations/owner’s manual(s) have been completed, the manager of the service using the ceiling mounted lifts confirms that the current staff have received initial training on ceiling mounted lifts and that there is a process in place to provide ongoing training on the proper use of ceiling mounted lifts.

After the activities listed in the above checklist and in the manufacturer's installation/operations/owner’s manual(s) have been completed, the installing contractor shall release the ceiling mounted lift installation to VA representative.

TITLE:

VA Representative After the activities listed in the above checklist and in the manufacturer's installation/operations/owner’s manual(s) have been completed, the VA representative shall review those items with the installing contractor prior to releasing the ceiling mounted lift into service to ensure completion of all requirements.

Install and Relocation

Facility:

Work Order:

Manufacturer:

Lift Location:

Model:

VAMC Contact:

Serial Number:

EE Number:

VAMC Contacts Phone Number:

Mfgr Contact:

Installer:

Mfgr Contacts Phone Number:

Installers Phone Number:

Date:

NOTES:

Serial:

NOTES_2:

NOTES_3:

NOTES_4:

Serial_2:

NOTES_5:

NOTES_6:

NOTES_7:

NOTES_8:

Serial_3:

DATE:

TITLE:

DATE_2:

TITLE_2:

DATE_3:

TITLE_3:

ADDITIONAL NOTES:

Serial_4:

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Installation Relocation_1.pdf

Revision 2.1 1 of 4 Serial #: ____________________

Verify NFPA 99 and NFPA 70 compliance for access to electrical and safety systems.

Verify required access to mechanical, HVAC, and fire systems components within the lift installation area.

Verifiy minimum clearances for operation are compliant with manufacturer recommendations. (Ensure room clearance and that the ceiling height is adequate for lift usage.)

Facility: Manufacturer:

Model:

Mfgr Contact:VAMC Contact's Phone Number:

Installer:

Serial Number: EE Number:

Work Order:

Installation or Relocation Checklist for Ceiling Mounted Patient Lifts The commissioning for a patient ceiling lift system(s) shall include, but not be limited to, the following points as components of the commissioning procedures.

NOTE: Ceiling mounted patient lifts are not to be installed in treatment units with actively suicidal patients.

Lift Location:

VAMC Contact:

Pre-Installation COMPLETE

Obtain structural and related engineering design drawings and calculations for the new lift installation.

Design drawings shall be developed for specific lift installation under specific pre-existing conditions of the facility.

Mfgr Contact's Phone Number:

Date:Installer's Phone Number:

Verify NFPA 99 and NFPA 70 compliance for proper grounding and bonding.

Verify that the lift is listed by the manufacturer to be installed and operated in the environment that the lift is operating under. (For example, water tight lifts shall be installed and operated in wet, damp or humid locations such as pools or bathrooms.)

Verify NFPA 13 compliance for fire sprinkler system (including but not limited to fire sprinkler heads and piping).

If the facility is located in a seismic area, as identified in VA Handbook H-18-8 Seismic Design Requirements, verify that the ceiling mounted patient lift system installation is in compliance with the requirements of VA Directive 7512 Seismic Safety of VA Buildings and VA Master Design Specification

13.05.041 Seismic Restraint Requirements for Non-Structural Components.

Perform site survey of the pre-existing conditions and as-built drawings above and below finish ceiling at the installation location to confirm existing structural and ceiling conditions.

Perform pre-installation walkthrough to confirm full understanding and consensus of design drawing(s) and installation conditions.

Verify proper connections of the lift's structural system to the building’s structure (including seismic bracing if applicable).

Verify proper interface at the ceiling (hard deck or soft tile) and proper installation of all protective features around the support rods and rails/tracks.

Installation

Revision 2.1 2 of 4 Serial #: ____________________

Rails/Tracks and End Stops

Lift Unit and Straps

Inspection of lift unit casing for cracks and alignment.

Inspection and activation of hand control for full operation (e.g., up, down, left, right) and “return to charge” function if applicable.

Confirm any and all lift unit indicator lights are functioning. (e.g., red service warning light, charging state light) Inspection and verification of all emergency functions of the lift unit.

Verification that all fasteners and set screws are properly tightened on the trollies and rails/tracks.

Ensure that the rail/track is free of gaps (unless required by design). If included in installation, verify rail turntable function, exchanger function, gate alignment, and safety block installation.

Confirm track is clean and clear of all debris. (Use manufacturer’s recommended cleaning materials to avoid damage to the motor case and other components.)

Verify proper installation of electric motor per manufacturer's instructions to ensure operational rigidity of motor mounting.

Verify proper electrical connections per design drawings and manufacturer's instructions.

Verification that the lift unit charges properly.

Perform operational test to verify lift functionality.

Perform walkthrough to ensure compliance of the installation per the design drawing(s) and manufacturer's instructions.

Post-Installation

Verify structural component sizing and physical installation to ensure that the correct structural system is in place and properly installed to support the lift.

Verification that all manufacturer specified end stops or docking gates are properly installed.

Revision 2.1 3 of 4 Serial #: ____________________

2 Verify that training and competency are documented prior to release for use with patients.

Verify that manufacturer or manufacturer’s representative has provided training on the use of patient handling equipment to clinicians and other staff who move and handle patients.

Full extension and inspection of lift strap for loose threads or frays.

Verification of any “soft start” or “soft stop” features and that lifting speed does not exceed 2.5 inches per second with “zero” load.

Verification of load testing and deflection testing at the manufacturer's specified maximum rated lift capacity.

Verification of any “soft start” and “soft stop” features and that lifting speed does not exceed 1.5 inches per second under maximum rated lift capacity.

Verification of function of emergency stop at maximum rated lift capacity.

Verification of emergency lowering feature at maximum rated lift capacity.

Training

Inspection of spreader bar and clips for cracks and for loose or missing rings or cotter pins.

Confirm that the manufacturer's operating and maintenance manuals for this lift have been received.

Load Testing

Manuals

Revision 2.1 4 of 4 Serial #: ____________________

Installing Contractor

ADDITIONAL NOTES:

Manager of the Service Using the Ceiling Mounted Lifts COMPLETE After the activities listed in the above checklist and in the manufacturer's installation/operations/owner’s manual(s) have been completed, the manager of the service using the ceiling mounted lifts confirms that the current staff have received initial training on ceiling mounted lifts and that there is a process in place to provide ongoing training on the proper use of ceiling mounted lifts.

After the activities listed in the above checklist and in the manufacturer's installation/operations/owner’s manual(s) have been completed, the installing contractor shall release the ceiling mounted lift installation to VA representative.

VA Representative After the activities listed in the above checklist and in the manufacturer's installation/operations/owner’s manual(s) have been completed, the VA representative shall review those items with the installing contractor prior to releasing the ceiling mounted lift into service to ensure completion of all requirements.

Install and Relocation

Facility:

Work Order:

Manufacturer:

Lift Location:

Model:

VAMC Contact:

Serial Number:

EE Number:

VAMC Contacts Phone Number:

Mfgr Contact:

Installer:

Mfgr Contacts Phone Number:

Installers Phone Number:

Date:

NOTES:

Serial:

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DATE:

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ADDITIONAL NOTES:

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