Any Hospital
Medical Center
Your HealthSystems
1901 N. Mike St. Biomed Services Dept.
Kauffman, PA.
91111
FAX -
MEMO
TO:
FROM:
Joe Biomed, C.B.E.T., Coordinator, Biomedical
Services
Shop: 800-265-5656; Bp:215-777-0000;
Fax: 215-555-1212
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Here is a sample questionnaire/checklist for use in the review of possible new equipment selection and purchases.
It has been derived from several observed formats. It would be good for equipment reviewers to have a common mechanism for consistently, fairly, and comprehensively evaluating potential purchases.
Make:__________ Model:
__________ Description: __________________
V alue:
(Cost of equipment compared to Benefits of use & $
Savings)
____ Score (1 - 20)
E
asy to Use:
(User friendly, logical,
intuitive)
____ Score (1-20)
R eliable:
(Good Repair Record; little
down-time)
____ Score (1-10)
D
esign Technology:
(State-of-the-Art, Standardized)
____ Score (1-10)
I
ncentives:
(Extended Warranty, Supply, Service Discounts,
etc.)
____
Score (1-20)
C
ompany Support:
(Stable, Good Sales & Service Reps., Training, etc.)
____ Score (1-20)
T otal Score:
(May be weighted* by evaluator, i.e. M.D.
x 2)
____ Score (% 100)
Evaluator:
________________
Date:
_______________
V E R D I C T
:
Adjusted
Score*: ______