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Winkler County Memorial Hospital
                             821 Jeffee Drive – Drawer H
                                 Kermit, Texas 79745
                                    (432)586-5864


                   PERFORMANCE IMPROVEMENT REPORT
                          CONTRACT SERVICES


PERFORMANCE IMPROVEMENT UNIT RESPONSIBLE: Infection Control____

NAME OF CONTRACTOR: _____________Highland Pest Control_______________

TYPE OF SERVICE RENDERED BY CONTRACTOR: ______Extermination_____

DATES:___October 1st_____TO: _____December 31st 2007______________________

During the quarter, the outcome of the monitoring of the quality of service rendered by
the above contractor reports:

COMMENTS: ____The contractor performs services every two weeks or more often if
the need arises.___________________________________________________________
_______________________________________________________________________

If problems are reported above:

The above contractor was contacted on ___________________________ to discuss the
above problems with the following outcome:

COMMENTS:___________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
__




_______________________________________________________________________
_
Signature, P.I. Unit Director                               Date
VII. FOCUSED REVIEW DONE DURING QUARTER:

          None




   VIII. COMPLIANCE ISSUES:

          Compliance with state/federal rules and regulations and reporting to the
          TDSHS when appropriate.




_______________________________________________________________________
_
Signature P.I. Unit Supervisor                                    Date




VIII. COMPLIANCE ISSUES:

   None

 _______________________________________________________________________
_
Signature P.I. Unit Supervisor                                  Date
VIII. COMPLIANCE ISSUES:

     None




_______________________________________________________________________
_
Signature P.I. Unit Supervisor                              Date

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\\Winklerdc\Users\Jtaylor\My Documents\Winkler County Memorial Hospita5

  • 1. Winkler County Memorial Hospital 821 Jeffee Drive – Drawer H Kermit, Texas 79745 (432)586-5864 PERFORMANCE IMPROVEMENT REPORT CONTRACT SERVICES PERFORMANCE IMPROVEMENT UNIT RESPONSIBLE: Infection Control____ NAME OF CONTRACTOR: _____________Highland Pest Control_______________ TYPE OF SERVICE RENDERED BY CONTRACTOR: ______Extermination_____ DATES:___October 1st_____TO: _____December 31st 2007______________________ During the quarter, the outcome of the monitoring of the quality of service rendered by the above contractor reports: COMMENTS: ____The contractor performs services every two weeks or more often if the need arises.___________________________________________________________ _______________________________________________________________________ If problems are reported above: The above contractor was contacted on ___________________________ to discuss the above problems with the following outcome: COMMENTS:___________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ __ _______________________________________________________________________ _ Signature, P.I. Unit Director Date
  • 2. VII. FOCUSED REVIEW DONE DURING QUARTER: None VIII. COMPLIANCE ISSUES: Compliance with state/federal rules and regulations and reporting to the TDSHS when appropriate. _______________________________________________________________________ _ Signature P.I. Unit Supervisor Date VIII. COMPLIANCE ISSUES: None _______________________________________________________________________ _ Signature P.I. Unit Supervisor Date
  • 3. VIII. COMPLIANCE ISSUES: None _______________________________________________________________________ _ Signature P.I. Unit Supervisor Date