WEST LINCOLN MEMORIAL HOSPITAL POLICY AND PROCEDURE MANUAL Section: PURCHASING Title: HOSPITAL-WIDE PURCHASING

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WEST LINCOLN MEMORIAL HOSPITAL POLICY AND PROCEDURE MANUAL Section: PURCHASING Date: Originated: 28/Dec/77 Subsection: Procurement Changed: 20/Feb/07; 23/Feb/11; 19/Dec/13 Number: 155-06-05 Reviewed: 18/Oct/06 Developed By: Management Page: 1 of 6 Applies To: All Approved by: Chief Executive Officer Signature: POLICY It is the policy of this Hospital that the Purchasing Department is responsible for the procurement of all supplies, equipment, and some services required by the Hospital and acquired through Hospital funds. Staff in the Purchasing Department have been authorized as agents of the Hospital by the Chief Executive Officer, and are the only people authorized to commit Hospital funds towards the purchase of supplies, services or equipment. The Chief Executive Officer has delegated authorization for the acquisition of the day to day requirements to commit Hospital funds to other departments as follows: Pharmacy Department for pharmaceuticals; Maintenance Department for maintenance supplies, service contracts, and construction contracts; Dietary Department for dietary requirements; Laboratory Department for laboratory requirements; Diagnostic Imaging Department for x-ray and ultrasound requirements. Vice President level Management in the absence of the Chief Executive Officer. All other items must be obtained through the Purchasing Department. The Manager for each of the above mentioned departments is responsible and accountable for ensuring that purchases authorized through their department conform to this policy. No other departments or individuals within the Hospital have the authority to commit the Hospital s funds towards the purchase of any supplies, services or equipment. The Hospital will only be deemed to have made a commitment to a Vendor for the purchase of supplies, services or equipment when an official Hospital purchase order has been drawn and authorized as detailed in the Purchase Requisition Authorization table below. Exceptions Certain purchases do not require a purchase requisition, nor the involvement of the Purchasing Department, due to their utility and service nature. The following items are of such a nature: Freight and Express charges; Contracted Labour (i.e., Peak-time and Manpower Services); Utility services (Hydro, Water and Natural Gas).

Section: PURCHASING Page 2 of 7 PROCEDURE When a department requires the purchase of supplies, services, or equipment, the requisitioning department must initiate the Equipment Purchase Tracking Form (intact with all copies). The requisition must be initiated on a Hospital Request to Purchase form. Upon completion of both forms, send together to the Purchasing department for ordering. These forms must be authorized according to the guidelines indicated in the Purchase Requisition Authorization listing below. The signatures of the individual will evidence authorization. Purchase Requisition Authorization: PURCHASE CATEGORY PURCHASE VALUE REQUIRED AUTHORIZATION Day to Day Supply Purchases Supplies and Services Contracts Board Pre-Approved Capital Purchases Emergency Capital Purchases $ 1.00 - $ 5,000.00 $ 5,000.00 - $ 25,000.00 Over $ 25,000.00 $ 1.00 - $ 5,000.00 $ 5,000.00 - $ 25,000.00 Over $ 25,000.00 $ 1,000.00 - $ 25,000.00 $ 25,000.00 - $ 100,000.00 Over $ 100,000.00 $ 1,000.00 - Capital Contingency Limit Over Capital Contingency Limit Department Manager or designate Applicable Department Manager Chief Executive Officer or Vice President, Finance Department Manager or designate Applicable Department Manager Chief Executive Officer or Vice President, Finance Applicable Department Manager Vice President, Finance Chief Executive Officer Chief Executive Officer Any two of Chair, Vice Chair or Treasurer of the Board Where the Manager is required to authorize a purchase requisition, it must be the Manager most responsible for the department requesting the purchase. NOTE: Purchase requisitions that do not bear the appropriate authorization will be returned to the requisitioning department for proper authorization. Manager may delegate their signing authority to other individuals within their departments.

Section: PURCHASING Page 3 of 7 A Purchase Order (PO) is issued and ordered by the Purchasing department. [Note: the yellow copy of the P.O. will be returned to the authorized individual after processing.] When WLMH Purchasing department receives the order the authorized individual will be notified. Equipment Purchase Tracking Form The product will then be given to the applicable personnel/department as per the Equipment Purchase Tracking Form indicates (i.e. Part II, III, IV), along with the applicable colour copy. The applicable department must complete the work indicated on the form, initial and date. Upon completion this coloured copy must be sent back to the Purchasing department. NOTE: The Purchasing department will keep all copies of these forms upon completion for proper filing. Licensing Ensure that investigation into a valid Medical License by the Purchasing Agent has been completed prior to purchase. Accessibility Accessibility features will also be considered, where applicable, in the hospital s procurement of goods and services. Education Does this new piece of equipment will require education before staff put it into use? If Yes - Ensure that the appropriate education has been arranged for staff, i.e., Supervisor/Manager - for non-medical equipment Education Coordinator - for medical equipment Ensure all education has been documented into the database after training has been completed. Manuals All manuals received with the product should be sent to the indicated department below for review and storage/filing. Operation / Instruction: User Department & Inservice Educator Service: Maintenance Department Group Purchasing The Hospital believes that a long term commitment to and continued support of group purchasing efforts will reap financial benefits for the Hospital. In this regard, the Hospital is a member of Medbuy and HealthPro, who acts as an agent on behalf of many Hospitals in Ontario by negotiating group contracts for commodity items. When the Hospital enters into a contract for an item or group of items, the Hospital will use the equivalent Medbuy or HealthPro contract, if available, unless the products are deemed grossly deficient in some regard or are not compatible with existing equipment or processes.

Section: PURCHASING Page 4 of 7 Employee Purchases and Shipments Employees are not permitted, under any circumstances, to order supplies, equipment or services for personal use or consumption using a Hospital account established with any of the Hospital suppliers. Employees may purchase supplies, equipment or services from suppliers with whom the Hospital conducts business as long as the employee does not do so under the guise of the purchase being conducted on the Hospital s behalf. Employees are not permitted, under any circumstances, to have personal supplies or equipment shipped to the Hospital for their personal ease of receipt of such shipments. Only supplies and equipment purchased by the Hospital and for the Hospital may be shipped to the Hospital. The purpose of this procedure is to ensure that any goods purchased are assessed for existing or potential hazards and ensuring that appropriate controls are put in place. This procedure also applies to any modifications of existing processes or equipment. Regulatory compliance and industry standard safety practices are expected to be adhered to: At the design stage In the purchase specifications During construction and/or Installation phases. The Health and Safety Coordinator will: Review the new/modified main activities to determine whether hazards exist. If a major hazard is identified then Safe Operating Procedures are to be developed. Ensure that the new purchase or modification meets all appropriate legislation and industry standards (i.e., CSA). Include a review of any material safety data sheets as they apply to any chemicals being introduced into the workplace. Ensure the review outlines the use, storage or disposition requirements. Ensure that the appropriate controls are put in place to either eliminate or control the hazard. Complete the purchase/modification health and safety form with all relevant information. Forward the purchase/modification health and safety form to the joint health and safety committee for their review. The Joint Health and Safety Committee will: Review the Purchase/Modification Health and Safety Form Provide input on any additional hazard(s) or control(s) Provide feedback to the Health and Safety Coordinator The Department Manager/Supervisor will: Assist the Health and Safety Coordinator with the Hazard review. Train the appropriate staff who will be exposed to or work with the new/modified equipment/process on the Safe Operating Procedures. Pre-start up inspections (prior to the initial use of new/modified equipment/process) will be conducted with the involvement of the:

Section: PURCHASING Page 5 of 7 Health and Safety Representative or Joint Health and Safety Committee Health and Safety Coordinator Department Managers and/or supervisors Any operators or person who has potential to operate the machinery, or involved in the new or modified process All new/modified equipment will be added to the existing list of equipment that requires pre-use operator inspections. Implementation of the Pre-use/Pre-shift inspection program will commence upon initial use of the equipment/process. FORMS Equipment Purchase Tracking Form, #00014 Appendix A, pg.6 Request to Purchase Form, #730-19 (Stores # Z0301) Appendix B, pg.7 RELATED POLICIES 65-09-10 Capital Asset Acquisition 80-07-60 Gifts from Suppliers 90-01-10 Purchasing Guidelines for Infection Control 155-06-20 Requirement for Competitive Procurement 155-06-30 Conflict of Interest DEFINITIONS Staff in the Purchasing Department include: Vice President, Finance; Manager, Financial Services ; Regional Purchaser (Purchasing Agent); Purchasing Coordinator-Associate Hospitals; and Stores Clerk/Buyer. Purchase Order (PO): Authorized, numbered, computer generated WLMH form used to acquisition a purchase item from a supplier/vendor. Medical Equipment: Medical equipment are devises intended for the diagnosis and treatment of human beings as defined under the Food and Drug Act (FDA) and covered under medical devices regulations. Non-Medical Equipment: All equipment that does not fit the Medical Equipment description, stated above. Capital Equipment: Board Pre-Approved Capital Purchases Minor Equipment: Purchases Less than $1000.00 Emergency Equipment: Non-Board Approved Purchases and Non-Budgeted Operational Purchases

Section: PURCHASING Page 6 of 7 Appendix A - Equipment Purchase Tracking Form, #00014

Section: PURCHASING Page 7 of 7 Appendix B - Request to Purchase Form, #730-19 (Stores # Z0301)