Instructions for Listing Available Equipment

• Research equipment for reassignment must be reported electronically to the REQUIP Coordinating Officer at Requip@va.gov by the local Research Office ACOS/R&D or designee on a completed online editable version of VA Form 10-1274 (Research Equipment Available to VA REQUIP Program).
• An e-mail directly from the ACOS' computer containing an electronic signature or typed name and title is acceptable signature on all required forms for the REQUIP Program.
• Forms are considered complete when ALL numbered blocks or spaces on the forms are answered appropriately. Insert N/A if item is unknown or not applicable.
• Submit completed VA Form 10-1274 directly to the REQUIP mailbox by clicking the "E-mail Button" at the bottom of the form.
• A separate VA Form 10-1274 must be submitted for each instrument.
• The local Research Office must e-mail a completed local safety officer/industrial hygienist checklist and biomedical engineer checklist, as PDF files, in addition to the VA Form 10-1274 to Requip@va.gov.
• The completed checklists must have original signatures and should be submitted to Requip@va.gov as pdf files.
• Separate checklists must be submitted for each instrument.
• An individual *digital color photo of available equipment may be submitted (encouraged but not required) along with VA Form 10-1274.

*Digital Color Photo of Equipment

• E-mail a JPG, TIF, or BMP file to Requip@va.gov along with the completed VA Form 10-1274 (Research Equipment Available to VA REQUIP Program).
• The website support staff will size the photo appropriately.

Criteria for Screening Equipment for Redistribution

• Acquisition cost of equipment is $5,000 or greater;
• Equipment is confirmed to be functional (unless prior arrangements are made through the REQUIP Coordinator) by the local biomedical engineer;
• Local industrial hygienist certifies that equipment has no detectable contamination; and
• All required completed forms are received by the REQUIP Coordinating Officer at Requip@va.gov:
  a. VA Form 10-1274 (Research Equipment Available to VA REQUIP Program);
  b. Biomedical engineer checklist;
  c. Local safety officer/industrial hygienist checklist; and
  d. Digital photo (any size) of instrument (encouraged but not required).

Equipment Listing

The originating facility will be notified via e-mail of the date the screening criteria are satisfied. The REQUIP Coordinating Officer will then contact the originating facility within 3 business days to request that the Research Office either

1. hold the equipment for posting on the ORD website at http://www.research.va.gov/programs/requip (post for maximum of 45 calendar days) or
2. excess the equipment through the local Property Manager using VA Form 10-1274 (Research Equipment Available to VA REQUIP Program).

Links to Forms

Note: Word documents not "form-fill"; must be printed, completed, and sent as PDF file attachments to REQUIP@va.gov.

• Local safety officer/industrial hygienist checklist (32 KB, MS WORD)
• Biomedical engineer checklist (32 KB, MS WORD)

These PDF forms are available on the VA Intranet only.

• VA Form 134 - Combination Requisition and Shipping Ticket
• VA Form 222 - Request for and Notice of Shipment
• VA Form 10-1274 - Research Equipment Available To VA REQUIP Program
• VA Form 10-1274A - Inquiry On Availability Of An Instrument From VA REQUIP Program

If you have Intranet access, please see the Intranet version of this page at http://vaww.research.va.gov/requip/list-equipment.cfm to download the forms.

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Any health information on this website is strictly for informational purposes and is not intended as medical advice. It should not be used to diagnose or treat any condition.