Materials Management Related Forms

• Request for Approval Equipment Technical Specifications
  (F81029) revised 4/2003
  This approval form is required for: 1) All Capital Equipment requests and 2) All medical and electrical equipment intended for use in immediate patient environment in University Hospital locations, regardless of cost.
• Equipment Purchasing Standards (Under revision - contact Hospital Purchasing for assistance) text
  This is a listing of purchasing standards for general equipment
• Non-Budget Capital Equipment Justification Form  
  Use this form to initiate a capital equipment request
  
• Guidelines for ordering task chairs and keyboard trays text
  A guide for the process of selecting and ordering task chairs and keyboard trays at Unibversity Hospital
  
• Recommended task chair seating standards text
  A listing of University Hospital standard task chairs with sources and recommendations for selection from the Ergonomics Program
• Recommended keyboard and mouse tray standards text
  A listing of University Hospital standard keyboard and mouse trays with recommendations for selection from the Ergonomics Program
• Approval form for task chair orders text
  Approval form for purchase of a task chair once selection has been made.
• Hospital Purchasing Authorization and Lawson Web Requisition Authorization Form  
  This form has been replaced with an on-line authorization process through Self-Serve. Instructions can be found here: Tutorial
• Stapleslink user set-up form text
  Use this form to sign up a new user for Staples Link or to modify an existing account.
• Brio on-line report authorization form
  Use this form to apply for an access code to the Brio on-line reporting function. With this you can access your Staples purchase history as well as issues from Central Stores and Central Distribution. In the future you will be able to access even more procurement activity through this function.
• State Purchase Requisition Revised 5 / 2004 text
  The State Purchase Requisition Form number 44360 has been revised. This form REPLACES all previous requisition forms. The revised form is available now in Central Stores and should be requested with your next stores order. A limit of 5 packs is currently in affect. Destroy all old forms and implement use of new form effective immediately upon receipt.
• Hospital Purchasing Single / Sole Source Justification Form   Revised 8/29/2003
  Complete this form for general equipment and service requisitions with a value greater than $5,000.00 (for all funds) where competition may be restricted.
• Receipt of Goods and Services text
  (F86137) Rev 9/2003
  Use this form to reports goods or services recieved by your department that were not delivered from Central Receiving.
  This will allow Central Receiving to report these goods and help start the payment process.

VAP Related Forms

• Value Analysis Request for Product Review Form text
  Use this fom to request new products review by the Value Analysis Program
  
• Charter for VAP Sub-Group text
  This form is to be filled out by the Facilitator and handed out at the first Sub-Group meeting at the start of every project. The form gives a brief description of what the Value Analysis Program is and outlines the Sub-Groups tasks.
• VAP Coordinator & Facilitator text
  This form is to be filled out by the VAP Coordinator and the Facilitator. This form lists the evaluation dates and areas, and the Sub-Group members and their department.
• Sub-Group Final Recommendation Report text
  This form is the final report and recommendation to be filled out by the Facilitator and Sub-Group members based on the results of the evaluations, and are submitted to the VAP Coordinator
• Product Evaluation Sheet Template text
  This form is to be used for EVERY product evaluation, and is to be filled out by the Facilitator and Sub-Group members. The evaluation criteria can be added for each new project started.
• VAP Coordinator Final Recommendation Report text
  This form is to be filled out by the VAP Coordinator that encompasses the financial impact, clinical findings (Sub-Group Recommendation Report), reimbursement impact and any other considerations. This report is presented to the VAP Core Group for review.
• ECC Training Assessment Form text
  This form is to be filled out by the Facilitator and the Materials Management Educator. After this form has been completed, the Materials Management Educator will present this form to the ECC.
• Disposable/Reusable Cost Analysis Worksheet text
  This work sheet is to be filled out by the VAP Coordinator and Facilitator for items that are being converted from disposable to reusable or reusable to disposable.