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EVHC Forms

Several Eastern Virginia Healthcare Coalition (EVHC) forms are available at the bottom of this page for download and use.  

NEW PREPAREDNESS AND RESPONSE PROJECTS: New project proposals, including requests for training, exercises, equipment and material purchases and maintenance should be submitted using the EVHC Project Funding Request Form. 

GRANT FUNDED EQUIPMENT AND MATERIALS AND FORMS: Healthcare organizations that have custody of any DHHS ASPR Grant purchased equipment and materials may not transfer or destroy the grant purchased equipment and materials without approval from the Coalition. In cases where the original purchase price of the item was $5000 or more, the Department of Health and Human Services (DHHS), Office of the Assistant Secretary of Preparedness and Response (ASPR) must approve item destruction.  

  • ASPR GRANT PROPERTY TRANSFER FORM: Use this form to request the transfer of item sbewtween healthcare organizations or to retun items to the Coalition. 
  • GRANT PURCHASED EQUIPMENT AND MATERIAL DESTRUCTION FORM: Use this form if you have an item that is slated for disposal becasue it has been severly damaged beyond repair, is no longer supported by the vendor, or it has been lost or stolen, etc. Do NOT discard or destroy the item until approval has been receved from DHHS ASPR. ( A new version of this form will be posted shortly. Please call the office to obtain this form.)

NEED HELP? HAVE QUESTIONS? Please contact the Ms. Carolyn Malloy, RHCC Manager, EVHC Program Office at (757) 963-0632 Ext. 321 if you have questions regarding these forms and their associated processes.  

Last modified on Tuesday, 07 September 2021 14:30
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Our Location

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Our office is co-located with the Tidewater Emergency Medical Services Council (TEMS) at 1104 Madison Plaza, Chesapeake, Virginia 23320.

 

Our Mission.

The Eastern Virginia Healthcare Coalition is a collaboration of healthcare organizations and providers, public health departments, and community partners working together to care for our community before, during and after an emergency.

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