Surveillance Checklist - Ann Arbor Ambulance Service.pdf
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- Solicitation number
- 36C25024R0182
About this file
This document is a Surveillance Checklist for a Ground Ambulance contract between the VA Ann Arbor Healthcare System and a contractor. It outlines the key performance objectives, standards, and thresholds the contractor must meet, including providing 24/7 ambulance service with 95% on-time performance, maintaining all vehicles in a clean and safe condition, completing required training for staff, and adhering to sanitation and occupational safety protocols. The checklist indicates the methods of surveillance, such as periodic inspections and random surveillance, that will be used to ensure compliance.
The related federal contract opportunity is a solicitation for Ambulance Transportation Services for the LTC Charles S. Kettles VA Medical Center in Ann Arbor, MI and its Community Based Outpatient Clinics. The Department of Veterans Affairs Network Contracting Office 10 is issuing a 5-year Indefinite Delivery Indefinite Quantity (IDIQ) contract under NAICS code 621910 with a $22.5 million size standard.
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Surveillance Checklist
VA Ann Arbor Healthcare System
Contract: Ground Ambulance Date/Time of Inspection:
Government POC Primary: Darel Winslow Government POC Alternate: Jason Schilling
Organization: VA Ann Arbor Healthcare System
Location: LTC Charles S. Kettles VA Medical Center
SS
Performance
Objective PWS Para
Standard Performance Threshold
Method of Surveillance
Met Not Met Remarks
SS 1
Provide on-time Ambulance service, 24 hours per day, 365 days per year.
4.5
Transportation provided meeting response times within the PWS
95% Compliance
Periodic Inspection.
SS 2
Patient Safety
4.4 & 4.7
The objective of Standards for Maintenance is to protect veterans and to cause no harm to all parties. The contractor shall maintain all vehicles in a clean and orderly condition, free from debris and accumulations which may create an accident, injury, or fire hazard.
95% Compliance
Random Surveillance
Objective PWS Para
Standard Performance Threshold
Method of
Met Not Met Remarks
SS3
Vehicle Maintenance Files
4.4.3
Maintain (and furnish upon request) procedures that outline preventive maintenance and/or repairs on each vehicle. Provided statement of vehicle maintenance files is in place should be submitted at time of offer for evaluation purposes. .
97% Compliance
100%
SS4
Privacy and Security Training
All contractor employees with access to VA sensitive information complete VA privacy and information security training (TMS Course 20939)
97%
SS5
Emergency Medical Technicians (EMTs), Critical Care Transport Paramedics (CCTPs)
4.3.1
Completed training in accordance with the standards published by the Department of Health and Human Services with a minimum curriculum of 150 hours or equivalent including
100% Compliance
Objective PWS Para
Standard Performance Threshold
Method of Surveillance
Met Not Met Remarks an in-hospital training period. Such training programs must also be acceptable under the regulating requirements for local EMS Systems supported by DHHS under PL 93-154, Federal Register 39:24304. (1974).
SS6
Sanitation/Occupa tional Safety
Attachment B
A licensed MTO shall ensure that sanitation procedures are provided to all personnel in a written document that conforms with current standards as set forth in occupational safety and health administration-blood borne pathogens protocol.
95% Compliance
Random
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