S02 SOW.docx

Statement of Work: Ceiling lift Replacement, Installation, and Adjustment in the Portland VA Healthcare System IESD.

A. General Information

1. Title of Project: ARJO Ceiling lift motor update and installation of the MAXI Sky two continuous ECS systems in the Portland VA Healthcare building 100-P on 5C and 6D.

2. Scope of Work: The contractor shall provide all labor, supervision and all other resources required to deliver the requirements stated herein, except as may otherwise be specified in this statement of work. 600-pound ceiling lifts motor as specified (with fast motion, continuous-charge room-covering rail systems, and emergency lowering) are to be delivered, installed, and tested, on the Portland Healthcare Main campus building 100 on inpatient wards 5D and 6D. The company will perform weight testing and deflection test after in installation. All work must be coordinated with Facility Maintenance Management (FMS) and Supply Chain Management (SCM) Services in order to coordinate paperwork, and all new equipment must be taken to the Portland VA Warehouse (1601 E 4th Plain Blvd. Vancouver Washington 98661) for inventory record/sticker purposes. Locations are in the Portland VA Medical Center CLC; installation will need to be timed according to availability of rooms. Details are provided in sections E below, Specific Mandatory Tasks and Associated Deliverables. If proposed cost exceeds budget, VA will prioritize and specify final lift locations.

3. Background: Overhead ceiling lifts are preferred over floor-based lifts, particularly where frequent patient handling tasks are required, as stated in VHA Directive 1611. Manufacturer (ARJO) will upgrade the discontinued ARJO Maxi 600 motor on wards 6D and 5C with the Maxi Sky ll. The current overhead ceiling lift motors on wards 5D and 6D are past service life replacement. Both wards required remodeling which is scheduled to occur with the Portland VA Seismic Upgrade. Until this occurs replacement of overhead ceiling lift motors will ensure functioning equipment and remove outdated motors on 5D and 6D.

The Safe Patient Handling and Mobility equipment supports the goals of VHA Directive 1611 "Safe Patient Handling Program (SPHM) and Facility Design." This directive requires staff not to push/pull/lift over 35 pounds and also forbids the manual handling of patients to decrease organizational costs associated with staff injuries as well as decrease "Days of Lost Time" and "modified/light duty days." The VAPORHCS Facility Maintenance Service has worked with ARJO motors for over ten years. Moreover, the CLC patient care staff is familiar with ARJO products and slings.

Performance Period/Schedule: Installation dates and designs must be coordinated with Contracting Officer Representative (COR) or FMS Project Engineer, and dates for installation in remodeling projects may be adjusted by the Government as required if engineering changes are required and delayed.

4. Type of Contract: Firm-Fixed-Price

B. Contract Award Meeting

1. The contractor shall not commence performance on the tasks in this SOW/ Project manager until the CO has conducted a kick-off meeting, or has advised the contractor that a kick off meeting is waived.

C. General Requirements 1.

All installation must comply with requirements of Patient Safety Alert AL14-07, including the Checklist for Installation and Relocation. The installation checklist must be filled out for each installed lift, in addition to any checklist required by the manufacturer, and supplied to the COR.

2. Installers must have current certification to work on the overhead lift and rail systems.

3. Contractor will provide evaluation of existing structure where ceiling lifts are needed and submission of plans to VA Portland Healthcare System Engineering service, to assure that workable systems are installed and comply with VA design requirements and relevant standards.

4. Contractor will coordinate with Engineering service to verify access to engineering mechanical, HVAC, and fire systems components within the mounting area of the lift units.

5. Contractor will coordinate with Contracting Officer Representative (COR) to schedule installations.

6. Contractor will provide information on minimum clearances for operation of each lift, to be presented with the bid.

7. Contractor will provide a list of all construction or modifications required to install these lifts, to be presented with the bid. The goal is to install around any obstructions without requiring VA to make construction modifications.

8. Contractor will provide all qualified personnel, materials, equipment and services necessary to install ceiling lifts for the rooms described below under Location, including lifts, tracks, spreader bars, attachment hardware, and all other equipment necessary for safe operation. Detailed requirements are described in the Standards and Special Requirements sections. Lift systems may be configured in any way that covers the rooms best and meets the requirements.

9. Contractor will provide installation and testing of all equipment for ceiling lifts, according to VA checklist requirements, resulting in a turnkey system.

10. Contractor will provide training on equipment use for all new types of equipment included in this contract, one session per shift for up to 2 shifts of personnel in each affected area and for onsite trainers (up to 10 sessions scheduled after installation and before use), in coordination with COR.

11. Contractor will provide evidence of testing of all lift systems provided and schedule testing when it can be overseen by COR.

12. Contractor will mitigate any new hazards created by installation, such as ramps over interstitial support beams that create trip hazards.

13. Contractor will meet construction safety requirements, including construction orientation, safety training requirements, dust control requirements from the Infection Control Risk Assessment, TB testing, COVID-19 proof of vaccination, electrical safety requirements, and Above Ceiling Permit requirements including re-sealing any penetrations of fire barriers.

D. NARA Records Management Language Clause:

1. Contractor shall comply with all applicable records management laws and regulations, as well as National Archives and Records Administration (NARA) records policies, including but not limited to the Federal Records Act (44 U.S.C. chs. 21, 29, 31, 33), NARA regulations at 36 CFR Chapter XII Subchapter B, and those policies associated with the safeguarding of records covered by the Privacy Act of 1974 (5 U.S.C. 552a). These policies include the preservation of all records, regardless of form or characteristics, mode of transmission, or state of completion.

2. In accordance with 36 CFR 1222.32, all data created for Government use and delivered to, or falling under the legal control of, the Government are Federal records subject to the provisions of 44 U.S.C. chapters 21, 29, 31, and 33, the Freedom of Information Act (FOIA) (5 U.S.C. 552), as amended, and the Privacy Act of 1974 (5 U.S.C. 552a), as amended and must be managed and scheduled for disposition only as permitted by statute or regulation.

3. In accordance with 36 CFR 1222.32, Contractor shall maintain all records created for Government use or created in the course of performing the contract and/or delivered to, or under the legal control of the Government and must be managed in accordance with Federal law. Electronic records and associated metadata must be accompanied by sufficient technical documentation to permit understanding and use of the records and data.

4. Portland VAHCS and its contractors are responsible for preventing the alienation or unauthorized destruction of records, including all forms of mutilation. Records may not be removed from the legal custody of Portland VAHCS or destroyed except for in accordance with the provisions of the agency records schedules and with the written concurrence of the Head of the Contracting Activity. Willful and unlawful destruction, damage or alienation of Federal records is subject to the fines and penalties imposed by 18 U.S.C. 2701.

In the event of any unlawful or accidental removal, defacing, alteration, or destruction of records, Contractor must report to Portland VAHCS. The agency must report promptly to NARA in accordance with 36 CFR 1230.

5. The Contractor shall immediately notify the appropriate Contracting Officer upon discovery of any inadvertent or unauthorized disclosures of information, data, documentary materials, records or equipment. Disclosure of non-public information is limited to authorized personnel with a need-to-know as described in the [contract vehicle]. The Contractor shall ensure that the appropriate personnel, administrative, technical, and physical safeguards are established to ensure the security and confidentiality of this information, data, documentary material, records and/or equipment is properly protected. The Contractor shall not remove material from Government facilities or systems, or facilities or systems operated or maintained on the Government’s behalf, without the express written permission of the Head of the Contracting Activity. When information, data, documentary material, records and/or equipment is no longer required, it shall be returned to Portland VAHCS control or the Contractor must hold it until otherwise directed. Items returned to the Government shall be hand carried, mailed, emailed, or securely electronically transmitted to the Contracting Officer or address prescribed in the [contract vehicle]. Destruction of records is EXPRESSLY PROHIBITED unless in accordance with Paragraph (4).

6. The 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, contracts. The Contractor (and any sub-contractor) is required to abide by Government and Portland VAHCS guidance for protecting sensitive, proprietary information, classified, and controlled unclassified information.

7. The Contractor shall only use Government IT equipment for purposes specifically tied to or authorized by the contract and in accordance with Portland VAHCS policy.

8. The Contractor shall not create or maintain any records containing any non-public Portland VAHCS information that are not specifically tied to or authorized by the contract.

9. The 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 from public disclosure by an exemption to the Freedom of Information Act.

10. The Portland VAHCS owns the rights to all data and records produced as part of this contract. All deliverables under the contract are the property of the U.S. Government for which Portland VAHCS shall have unlimited rights to use, dispose of, or disclose such data contained therein as it determines to be in the public interest. Any Contractor rights in the data or deliverables must be identified as required by FAR 52.227-11 through FAR 52.227-20.

11. Training. All Contractor employees assigned to this contract who create, work with, or otherwise handle records are required to take VHA-provided records management training, Talent Management System (TMS) Item #3873736, Records Management for Records Officers and Liaisons. The Contractor is responsible for confirming training has been completed according to agency policies, including initial training and any annual or refresher training.

E. Specific Mandatory Tasks and Associated Deliverables Project: 36C260-22-AP-0493

5. Location of Ceiling Lift Installations: Portland VA Healthcare System Community Living Center (CLC).

1. (1601 E. Fourth Plain Blvd. Vancouver, WA 98661). Ceiling lifts will be installed in B-Wing, C-Wing and E-Wing. Rooms are listed below, along with the required capacity and details of design.

1. Description of Tasks and Associated Deliverables: The contractor shall provide the specific deliverables described below within the performance period stated in Section A.4 of this SOW.

2. Standards:

a. Ceiling Lift Performance Requirements:

i. Ceiling Lifts shall meet all Underwriters Laboratory requirements, life safety codes, national electric codes, fire safety codes, and all other applicable federal, state and local codes. Appropriate documentation should be provided.

ii. Ceiling Lifts shall comply with ISO 10535 (Hoists for the transfer of disabled persons – Requirements and test methods).

iii. Ceiling lift manufacturer must allow and warrant the use of their lifts with the full range of Guldmann, Alpha Modalities, and Barton/Humancare loop slings.

iv. The lifts shall be mounted (using ceiling, wall, or floor support as determined by building structure and room covering layout needs) to provide lifting capability for the maximum area possible within each room which means wall to wall – not just over the bed.

v. Lifts must be capable of picking patients up off the floor.

vi. The lift hand control must be attached to the lift in a way that allows it not to be lost.

vii. Lifts must not beep or flash during normal operation.

viii. Contractor must install lifts without relocating or interfering with operations of existing sprinkler heads, lights, HVAC grills, curtain tracks, IV tracks, televisions, permanent furniture, or other permanent structure. Contractor must describe any such fixtures that must be moved during contract bid and pre-construction meetings. Installation may be delayed, canceled, or moved to a mutually acceptable location if building changes cannot be made in ways that allow lift installation.

ix. Contractor shall not breach any firewalls during installation of these lifts. Any fire barrier that must be penetrated must be discussed with VA safety personnel and must immediately have fire barrier repaired. An Above Ceiling Permit must be filled out before ceiling work, and FMS will check the ceiling after ceiling work, to make sure any fire barrier penetration was repaired.

x. Each room where lifts are installed shall be returned to original condition, excluding the newly installed ceiling lift. Holes in the wall or ceiling tile must be patched with appropriate materials.

xi. Ceilings must not be slotted exposing space above ceiling to the room below.

xii. Ceiling lift motors shall be capable of lifting at least 600 or 1000 pounds with single motor, as specified on the Location list.

xiii. A specific opportunity for Service Agreements, Preventive Maintenance Agreements, and Extended Warranty Agreements should be presented.

xiv. Warranty shall include all travel or shipping associated with any warranty repair.

xv. New lifts shall accept generic type replacement batteries without voiding any warranties.

xvi. Motors shall be GFCI protected.

xvii. Ceiling lifts’ vertical motion must be motorized.

xviii. Ceiling lifts must include a 2-point hanger bar suitable and allowable for use with the full range of Guldmann slings, Humancare/Barton slings, and Alpha Modalities repositioning slings, without easily breakable parts such as rubber flaps.

xix. Ceiling lifts must recharge automatically, by recharging at any location on the rail. Lifts that recharge without employee action will be preferred.

xx. Ceiling lifts must include safeguards to prevent patients from being trapped or hurt, such as emergency stop buttons or emergency lowering devices in case of power failure.

xxi. For any ceiling lift that will be combined with a second manufacturer’s rail or hardware, contractor must provide documentation in the bid that the ceiling lift is tested and approved by the lift manufacturer and the rail/hardware manufacturer to work safely and charge anywhere on the rail in combination with the other manufacturer’s rail system, and the contractor selling the new lift must take responsibility for assuring that the whole structure is safe.

3. Contractor shall provide the following with the bid:

a. Provide proof of multiple ceiling lift installations of the room covering style with continuous charge, direct connections between two traverse systems in different rooms, and minimum 20’x12’ coverage in this or other Veterans Administration Hospitals.

b. Provide proof of ongoing service quality and consistent management, including failure reports and any other applicable documentation.

4. Training:

a. Contractor shall provide certified in-service training for all shifts of direct patient care staff in units where lifts are installed at no additional cost to the Government, for any equipment new to this facility (up to 10 sessions in coordination with the Safe Patient Handling and Mobility Facility Coordinator). This training must include hands-on lift use and be extensive enough to prepare participants to train others.

b. Training must include each new type of equipment and sling used in an area.

c. Contractor shall provide certified in-service training on each site, multiple times in a day, for biomedical engineering staff in coordination with the COR.

5. Manuals: Contractor shall provide electronic copies of the user manuals and repair manuals for each different model of lift installed under this order or contract at no additional cost to the government.

6. Inspection:

a. Each room’s lift system shall be weight and function tested after installation in compliance with the VHA checklist required by Patient Safety Alert AL14-07. Each checklist shall be provided to Contracting Officer Technical Representative within 3 days of installation along with any checklist required by the manufacturer. Any changes in inspection requirements during the period of installation will be communicated to the Contractor immediately.

b. In accordance with Patient Safety Alert AL14-07, design and structural drawings must be provided, and VA Portland stakeholders must have an opportunity to approve or ask for changes before installation.

7. Contractor conduct requirements:

a. Equipment and supplies must not be shipped before designs are approved and contractor has approval to install. VA Portland Healthcare System cannot store uninstalled equipment for a significant length of time.

b. All employees and subcontractors must wear a visible name and company identification when onsite. When more than one person is onsite performing work under this contract, one must be designated as a supervisor and must be fully responsible for the work to be performed.

c. The Contractor shall provide all supplies, materials, equipment, qualified personnel, supervision, management, and transportation to perform all tasks as identified herein. All work is to be performed in accordance with the guidelines established by Federal, State, and local ordinances and The Joint Commission. The Contractor’s procedures and quality control procedures shall conform to these guidelines.

d. Contractor personnel must conduct their work so as not to interfere with the normal functioning of the facility and will stop work if asked by VA Portland Healthcare System personnel. Hours of work will need to be limited to daytime on units where patients sleep or to night time or weekends in areas where patients would be exposed by daytime work.

e. The Contractor shall take all precautions necessary to protect the lives and health of occupants of the building.

f. The Contractor must follow procedures required by VA Portland Healthcare System Infection Control personnel and the construction safety committee, to include any required dust control specified in the Infection Control Risk Assessment.

g. The Contractor must state what efforts will be made to minimize noise during installation of equipment.

h. The Contractor shall immediately correct any fire and safety deficiencies caused by his personnel. If the contractor fails or refuses to correct deficiencies promptly, the Contracting Officer may issue an order stopping all or any part of the work and may hold the contractor in default of the contract.

i. The Contractor shall comply with applicable Federal, State, and local safety and fire regulations and codes which are in effect at the beginning of the contract period. The contractor shall keep abreast of any changes in these regulations and codes applicable to the contract.

j. All material and equipment will be removed from the facility or stored properly at the end of each work day and secured during the work day in the areas specified by the Contracting Officer’s Technical Representative.

k. The Contractor is responsible for supplying, completing, and submitting all reports required or requested by Federal, State, or local ordinances which pertain to any duties contained in the contract.

l. The Contractor will be required to furnish the VA Portland Healthcare System with material safety data sheets for all chemicals used during installation. This information is required by the VA for emergency treatment in the event of ingestion of and/or contact with the material by humans and is required by OSHA regulations.

m. The Contractor’s onsite lead installer supply job hazard analyses as required by Construction Safety Officer to show how hazards to Contractor and VA Portland Healthcare System personnel are being minimized.

n. All Contractor personnel must have OSHA 10-hour construction safety training cards.

o. The Contractor’s personnel shall follow applicable policies of the VA Portland Healthcare System, to include policies concerning fire and disaster preparedness programs.

p. The contractor shall furnish at his own expense all labor, materials, machinery, and appliances which may be necessary or appropriate in the performance of this contract.

q. All accumulated rubbish is to be collected and placed in the dumpster provided by the Government. Large quantities need to be disposed of in ways that do not overload the dumpsters.

8. Special Requirements:

a. The contractor must have visited the sites and assessed the structure of each ceiling lift location to ensure safe installation of the equipment and shall supply the installation plans to the VA Portland Healthcare System Engineering Service and Construction Safety Group, who must accept them before installation.

b. Ceiling lift installations shall comply with NFPA 13 for fire sprinklers and with NFPA 99 and NFPA 70 for proper grounding and bonding and access to electrical and safety systems.

c. The contractor should not require movement of any lights, sprinklers, televisions, or other fixtures in order to install ceiling lifts. If movement of preexisting fixtures is unavoidable, the contractor must include such notice when the bid is submitted.

d. Wall mounted lifts are acceptable in the place of ceiling mounts where they are more effective or cause less risk to install.

e. Ceiling lifts must not add obstacles or impair any normal operations in patient care rooms.

f. It is permissible to raise the lifting height or extend the range of a lift system that is being replaced, so long as designs are approved by the facility in advance and all obstacles are avoided to avoid interference with the operation of curtains, ventilation, or other moving or ceiling mounted items.

g. All installation that affects existing areas and electrical work shall be coordinated with the VA Portland Healthcare System Engineering service. New electrical outlets required must be coordinated with Engineering Service and the COR.

h. The contractor will install all necessary mounts, braces, and any other components needed for full lift function and safety.

i. Any electrical subcontractor must have health care experience, must have positive references, and must be directly overseen by the Contractor.

9. Schedule for Deliverables: If for any reason any deliverable cannot be delivered within the scheduled time frame, the contractor is required to explain why in writing to the contracting officer (CO), including a firm commitment of when the work shall be completed.

This notice to the CO shall cite the reasons for the delay, and the impact on the overall project. The CO will then review the facts and issue a response, in accordance with applicable regulations.

10. Changes to Statement of Work: Any changes to this SOW shall be authorized and approved only through written correspondence from the CO. A copy of each change will be kept in a project folder along with all other products of the project. Costs incurred by the contractor through the actions of parties other than the CO shall be borne by the contractor.

11. Reporting Requirements: The VHA checklist and any manufacturer’s checklist are the sole report and must be provided to the COR by 2 weeks after installation. Lift installation is not considered complete and cannot be paid for until the checklist is complete and provided to the COR.

12. Government Responsibilities: VA Portland Healthcare System will provide:

a. Guidance for contractor site visits and information on which rooms need lifts. (Safety service/COR in association with affected services.)

b. Coordination to allow for lift installation as rooms are available. (Safety service/COR in association with affected services.)

c. Technical information on the building and requirements for construction. (Engineering service.)

d. Coordination and scheduling for training efforts. (Safety service/COR in association with affected services.)

e. Oversight of installation testing. (Safety service.)

f. Coordination for electrical outlet installation where necessary. (COR in association with Engineering.)

g. Answers to Contractor questions during the purchasing and installation process. (CO and COR.)

h. Prioritization and final specification of lift locations in case proposed cost exceeds budget. (COR in association with affected services.)

AL14-07PSAChecklistforInstallationandRelocation-Fillable.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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