Equipment Request

Fraser Valley Health Care Foundation aims support the hospitals in the eastern Fraser Valley to enhance patient care, or assist in funding equipment or renovations not normally funded by Fraser Health.

Equipment Funding

To apply, please fill out the form below.

If you have any questions, please contact Liz Harris at liz.harris@fraserhealth.ca

Major Equipment ($10k - $99k)

"*" indicates required fields

1. Date of request*

MM slash DD slash YYYY

2. First name*

First

3. Last name*

Last

4. Job title*

5. Email*

6. Phone*

7. What hospital / location are you requesting this for?*

ARH

MMH

CGH

FCH

Other

8. What department are you requesting this for?*

9. Has this request been approved by your supervisor / manager?*

Yes

10. Supervisor/manager name and title*

11. Supervisor/manager phone number*

12. Supervisor/manager email*

13. Have you requested funding from anywhere else?*

Yes

14. If yes, please give amount requested and where you requested

15. Name of item requested*

16. Quantity requested*

17. Is this a new piece of equipment, upgrade or replacement?

New

Upgrade

Replacement

18. Total dollar amount requested*

19. When is the funding required by?*

20. How will this equipment improve patient care, outcomes, or safety?*

21. Will this equipment expand your department’s services or capacity? If yes, by how much?*

22. How urgent is this need, and what problems are caused by not having this equipment?*

23. How does this request align with hospital or departmental priorities?*

24. What alternatives were considered (leasing, refurbishing, other vendors), and why was this option chosen?*

25. Is your department ready to implement this equipment (space, infrastructure, integration)?*

26. What is your plan for maintenance and technical support, including estimated annual costs?*

27. How will staff be trained to use this equipment safely and effectively?*

28. How will your department cover ongoing costs related to this equipment?*

29. If approved, do you agree to notify the Foundation when equipment arrives, provide photos for donor/media use, and send thank-you letters when requested?*

Yes

30. Please attach vendor quotes or supporting documents in PDF format.*

Max. file size: 50 MB.

CAPTCHA

Capital Equipment Request ($100k+)

"*" indicates required fields

1. Date of request*

MM slash DD slash YYYY

2. First name*

First

3. Last name*

Last

4. Job title*

5. Email*

6. Phone*

7. What hospital / location are you requesting this for?*

ARH

MMH

CGH

FCH

Other

8. What department are you requesting this for?*

9. Has this request been approved by your supervisor / manager?*

Yes

10. Supervisor/manager name and title*

11. Supervisor/manager phone number*

12. Supervisor/manager email*

13. Have you requested funding from anywhere else?*

Yes

14. If yes, please give amount requested and where you requested

15. Name of item requested*

16. Quantity requested*

17. Total dollar amount requested*

18. When is the funding required by?*

19. How will this equipment transform patient care and outcomes?*

20. Will this equipment expand services or establish regional leadership/referral capabilities?*

21. How does this equipment support clinical excellence, innovation, or research?*

22. How does this equipment improve access for underserved or rural populations?*

23. Why is this investment urgently needed now?*

24. What are the projected patient volumes and financial impacts (ROI, cost savings, or revenue generation)?*

25. How does this request align with Fraser Health’s strategic plan?*

26. What alternatives were considered (leasing, refurbishing, sharing), and why was this option chosen?*

27. Who was consulted in developing this request (physicians, staff, patients)?*

28. What risks are associated with this purchase, and how will they be managed?*

29. Is your site ready to implement this equipment?*

30. What is your plan for maintenance, service contracts, and lifecycle management?*

31. What specialized training is required for staff, and how will it be provided?*

32. How will ongoing operating costs be funded to ensure long-term sustainability?*

33. What metrics will you use to measure success and impact of this equipment?*

28. If approved, do you agree to notify the Foundation when equipment arrives, provide photos for donor/media use, and send thank-you letters when requested?*

Yes

30. Please attach vendor quotes or supporting documents in PDF format.*

Max. file size: 50 MB.

CAPTCHA

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Equipment Request

Equipment Funding

Major Equipment ($10k - $99k)

Capital Equipment Request ($100k+)

Staff Resources