005. Specifications - PWS.pdf

PERFORMANCE WORK STATEMENT

Occupational Medical Examination Services

Dated

November 2023

U.S. DEPARTMENT OF ENERGY

WESTERN AREA POWER ADMINISTRATION

Occupational Medical Examination Services Performance Work Statement

1. INTRODUCTION/BACKGROUND

1.1 Introduction and Description of Services

The Contractor shall manage the medical service program by provide the necessary facilities, staff, materials, and equipment for periodic occupational health examinations in accordance with this Performance Work Statement (PWS), for employees of the Western Area Power Administration, Rocky Mountain Region (WAPA), located in and around Loveland, Craig, and Montrose, Colorado; Gering, Nebraska; Cody and Casper, Wyoming; Farmington, New Mexico;

Vernal Utah.

1.2 Background

WAPA is a Power Marketing Administration and part of DOE. WAPA manages federal electric power transmission and markets power across 15 western and central states. WAPA sells wholesale power and bulk wholesale transmission to local utilities. WAPA annually markets and transmits more than 10,000 megawatts of power and 37 billion kWh of energy from hydroelectric power plants owned and operated by the Bureau of Reclamation, U.S. Army Corps of Engineers, and the International Boundary and Water Commission. WAPA operates as a bulk electric utility.

• WAPA’s Headquarters is located at 12155 W. Alameda Parkway, Lakewood, CO 80228.

• There are four regional offices.

o Desert Southwest Region (DSW) – Phoenix, Arizona o Rocky Mountain Region (RMR) – Loveland, Colorado o Sierra Nevada Region (SNR) – Folsom, California o Upper Great Plain Region (UGP) – Billings, Montana

• And one service center located in Salt Lake City, Utah.

• There are about 1500 employees spread across headquarters, regional offices, substations, and maintenance offices as far north as Fort Peck, Montana, to as far south as Yuma, Arizona, and as far west as Redding, California, to as far east as Fargo, North Dakota.

1.3 Government Personnel

The Contracting Officer (CO) is the individual executing this delivery order on behalf of the Government and is responsible for the overall administration of the delivery order. He/she is the only person authorized to make any changes in the prices, terms, or other conditions of the delivery order.

The Primary Point of Contact (PPOC) is responsible for specialized technical instructions and issues pertaining to contract execution and assists in the technical monitoring or administration of the contract.

1.4 Points of Contact

Please contact the following WAPA personnel for technical questions regarding tasks or site locations:

Primary Point of Contact (PPOC): Kristopher (“Kris”) Latimer, latimer@wapa.gov, 970-646-

1.5 Contractor Personnel

The Contractor shall have a representative managing the PWS and authorized to act on behalf of the Contractor, available to the WAPA CO or PPOC to receive instructions or information regarding work under the contract. The representative shall be able to fluently speak and understand English.

1.5.1 Contractor has access to confidential government information and personal identification information (PII). The contractor shall prevent the unauthorized release of information obtained by employees in the performance of work required by this contract, see clause WES-H-2017 Confidentiality of Information below. The contractor shall ensure that employees are aware of and receive training, but not limited to the most recent edition of applicable department and agency orders, policies, and regulations. A signed copy of the Nondisclosure statement shall be submitted to the CO within 30 days after contract award.

WES-H-2017 CONFIDENTIALITY OF INFORMATION (WAPA, JUL 2009)

a. Performance of work under this contract may result in the Contractor having access to confidential information via written or electronic documents or by virtue of having access to Western's electronic business systems. This confidential information may include some or all of the following information: personally identifiable information (such as social security account numbers), and/or proprietary business, technical, or financial information belonging to the Government or other companies or organizations doing business with the Government. The Contractor shall treat this information as confidential and agrees not to use this information for its own purposes or to disclose the information to third parties unless specifically authorized to do so in writing by the Contracting Officer.

b. The foregoing restrictions, however, do not apply to:

(1) Information which, at the time of receipt by the Contractor, is in the public domain.

(2) Information which subsequently becomes part of the public domain through no fault or action of the Contractor.

(3) Information which the Contractor can demonstrate was previously in its possession and was not acquired directly or indirectly as a result of access obtained for performing work under this contract.

(4) Information which the Contractor can demonstrate was received from a third party who did not require the Contractor to hold it in confidence.

mailto:ramsay@wapa.gov

(5) Information which is subject to release under applicable law.

c. The Contractor shall obtain a written agreement from each of its employees who are granted access to confidential data that the employee agrees that he or she will not discuss, divulge, or disclose any such information or data to any person or entity except those persons within the Contractor's organization directly concerned with the performance of the contract. The agreement shall be in a form satisfactory to the Contracting Officer.

d. Upon request of the Contracting Officer, the Contractor agrees to execute an agreement that includes all material aspects of this clause, subject to the approval of the Contracting Officer, with any party whose facilities or proprietary data it is given access to that restrict use and disclosure of the data or information obtained in those the facilities. A copy of the agreement shall be provided to the Contracting Officer.

e. Upon request of the Contracting Officer, the Contractor shall supply the Government with reports itemizing the confidential or proprietary information it receives under this contract and identify the source (company or companies) of the information.

f. The contractor agrees to flow down this clause to all subcontracts under this contract.

End of Clause

1.5.2 Contractor and personnel assigned to this PWS shall sign confidentiality and conflict of interest statements, see clause WES-H-2018 Contractor Employee Conflict of Interest and Nondisclosure Agreements below.

WES-H-2018 CONTRACTOR EMPLOYEE CONFLICT OF INTEREST AND

NONDISCLOSURE AGREEMENTS (WAPA, FEB 2008)

The Contractor is required to obtain the following "Nondisclosure and Employee Conflict of Interest" statements from all support service personnel employed under this effort.

"NONDISCLOSURE AND EMPLOYEE CONFLICT OF INTEREST"

NON-DISCLOSURE: I, (employee's name), hereby agree as a condition of employment, and in certain cases under penalty of law, that I will not, unless authorized, disclose to the public or any unauthorized government employees, any oral or written information which was obtained in the performance of this contract with the U.S. Department of Energy. This agreement applies to classified and unclassified information and materials relating to all aspects of contractual performance.

CONFLICT OF INTEREST: I, (employee's name), hereby agree as a condition of employment, to report to my immediate supervisor any actual or apparent conflict of interest during my term of employment with regards to contractual support for the U.S.

Department of Energy. This reporting applies to financial or employment interests in subcontractors, or potential subcontractors to the prime support contract, employment or financial relationships with prime or subcontractors doing business with the Western Area Power Administration of the U.S. Department of Energy, or any present or future personal or business relationships with government employees who are employed within the Western Area Power Administration or other DOE activity. This information will be supplied to the Western Contracting Officer or his contract representative upon request or upon the identification of an actual or apparent conflict of interest. The disclosures will be made on a continuing basis and reaffirmed in writing at least annually.

End of Clause

1.6 Contractor

1.6.1 Quality Control

The Contractor shall develop and maintain a Quality Control Plan (QCP) to ensure all services are performed in accordance with the standards outlined in this PWS.

1.6.2 Work Schedule

The performance period is for a Base Year with Four Option Years with the start date to be determined after award. The Contractor shall provide appropriate staffing to perform the work specified in this PWS. A list of employees shall be submitted to the POC within 30 days after contract award.

The work performed under this contract shall be subject to inspection by the WAPA PPOC.

Whenever possible, electronic communications, teleconferences and other visual aids will be used to minimize delays in meeting objectives. Work is performed remotely.

1.7 Licenses and Permits

The Contractor shall have the necessary licenses to perform this work.

1.8 Performance

The Government may use various methods to perform surveillance of Contractor performance, including customer input, random sampling, periodic inspection, contractor reporting, etc.

The Contract Discrepancy Report (CDR) located in Exhibit A, will be utilized if the CO determines that the unacceptable performance was not caused by the Government.

Instructions for completing the CDR are as follows:

The POC completes Blocks l through 6 and sends the form to the CO.

The CO evaluates the CDR, and if appropriate, signs it and sends it to the Contractor with a cover letter requesting a response within a specified number of days.

The Contractor shall complete Blocks 7 through 10 and return the CDR to the CO within the specified time period on the cover letter.

In most cases, the preferred action is re-performance by the Contractor at no additional cost to the Government. If deduction from payment is the appropriate action, the CO will calculate the payment deduction based on the performance period in which the discrepancy occurred. The deduction is taken from the Contractor’s payment as close as possible to the month in which the discrepancy occurred, but not necessarily the same month.

The POC will complete Blocks 13a and 13b. The CO signs the CDR in Block 13c. These signatures indicate concurrence with the actions taken.

In the event the CO determines that issuance of a CDR is not appropriate, the CO shall document the contract file indicating why such action is not appropriate.

2.0 Scope

In Scope, the contractor shall support WAPA in providing in scope tasks. The contractor is obligated contractually to perform all requirement in this PWS.

2.1 General

The Contractor shall manage the medical service program for periodic occupational health examinations for approximately 60 to 80 WAPA RMR employees. The Contractor shall provide the required documentation in accordance with WAPA Order 340.1c - FEDERAL EMPLOYEE OCCUPATIONAL MEDICAL PROGRAM (Attachment A), to the Occupational Health Clinic/Facility conducting the examination.

2.1.1 The occupational health examinations shall be conducted by or under the direction of a qualified and licensed occupational health physician. Physicians must be qualified in occupational health and assisted by licensed nurses or physician's assistants qualified in the occupational field. Each Certified Medical Examiner must be licensed to practice in the state in which they reside. Staff must include certified medical examiners listed on the National Registry of Certified Medical Examiners in accordance with Title 49, 1C.F.R. §391.41-49.

2.1.2 The purpose of the exam is to determine fitness for duty according to the requirements of the employee's position. Any deficiencies must be identified and documented, especially in connection with hearing, respiratory, lifting, and other adverse environmental conditions and hazardous or arduous duties. The examining physician must report these deficiencies to the employee and the DOE HR POC, in a written analysis (see Part 2.3 below).

2.2 Periodic Occupational Health Examinations

The Contractor shall assemble and provide the medical facility with all required forms and a checklist of required medical services for each employee in their medical forms packet, within 24 hours of an employee’s scheduled appointment. The forms and sample packets of designated job positions will be provided by the WAPA PPOC.

The requirements for periodic occupational health examinations are listed in WAPA Order 340.1c, under Attachment 3. The examination services are dependent upon the employee's position.

2.2.1 Lab results shall be accurate. Re-testing required due to Contractor/lab error or loss, shall be minimal and immediate, and shall be performed at no additional cost to WAPA.

2.2.2 Examinations shall be coordinated and complete within 60 days after receipt of employee list from the PPOC. If appointments are canceled/rescheduled WAPA will not incur charges.

2.3 Medical Facility

The medical facility shall be an Occupational Health clinic where all examinations required by this PWS, are provided in one location.

2.3.1 For each medical examination, the examining physician shall:

a) Become familiar with the employee's physical duty requirements.

b) Ensure medical equipment is adequate in terms of present day accepted standards of medical practice, maintained in good working order, and properly calibrated.

c) Complete documentation required by the WAPA Order 340.1c.

d) Complete Part B of WAPA F 5400.31, Medical Examination Form

(complete all parts of the position specific exam packet}

e) Compare previous physical examination data with current results for all periodic exams, when available. The clinics will review current results with past results once the initial exams results have been established.

f) Review and discuss the abnormal examination results with the employee at the time of the examination.

g) Physician will obtain employee's signature on the Medical Release Form, authorizing the physician to provide the examination results to WAPA.

h) This section required only for Commercial Driver Fitness Determinations.

Complete the Medical Examination Report form for Commercial Driver Medical Certification, and the Medical Examiner's Certificate (MCSA-5875), when provided in the examination packets. A copy of the Medical Examiner’s Certificate shall be provided to the WAPA PPOC, on week following employee’s completed exam.

h) The completed Respirator Medical Evaluation Questionnaire shall only be given to the employee.

i) Medical History: The Genetic Information Non-Discrimination Act of 2008 prohibits WAPA from acquiring or using information about an employee or applicant's genetic information, including family medical history. The Contractor, physician or physician-designee are not to inquire about an individual's family medical history or other genetic information. If such information is disclosed to the Contractor, the physician or the physician-designee, the information must be redacted and/or withheld from any findings reported.

2.4 Reporting

A copy of the examination results shall be provided to the employee within 45 calendar days of the examination. A copy of the examination results shall also be provided to the attention of the DOE HR POC, within 45 days following employees’ examinations in the self-addressed stamped envelope, marked Confidential, that will be provided with the medical forms packets.

Western Area Power Administration Human Resources, A7200 P.O. Box 281111 Lakewood, CO 80228-8111

2.5 Additional Diagnostic Tests or Special Exams

Any diagnostic test or special examination which the examining physician deems necessary, but not specifically required in this Contract, are not permitted. The examining physician shall refer the individual to their private health care provider.

3.0 Meeting

The contractor shall work with the WAPA PPOC to schedule the following:

Kickoff meeting within 30 days after contract award.

Follow-up meeting(s) as needed.

4.0 Invoicing

The Contractor shall only invoice for services and/or tests required by this Performance Work Statement. Invoices shall be itemized, detailed and clear as to which services and tests were performed for each employee, on which date. All invoices shall be processed using IPP.gov.

Invoice example:

Date of Physical

Employee Name Charge Description

Charge Amount

01/01/2023 WAPA Employee Audiogram $ DOT Recertification $

5.0 Deliverables

Unless otherwise specified, all deliverables shall be delivered in electronic format. The Contractor shall provide the deliverable as an attachment(s) to an email to the WAPA PPOC.

The Contractor shall develop documentation to be placed on the intranet in Portable Document Format (PDF) and the latest Microsoft Office suite products. No other office automation software shall be used.

Description Reference Section Distribution Due Date Contractor Personal – Submit signed copies of the NDA to the

CO

1.5.1 Email

.pdf document

Within 30 calendar days following contract award

Work Schedule - The Contractor shall provide appropriate staffing to perform the work specified in this PWS.

1.6.2 Email Within 30 calendar

days following contract award

Periodic Occupational Health Examinations - The Contractor shall assemble and provide the medical facility with all required forms and a checklist of required medical services for each employee in their medical forms packet.

2.2 Paper copy Within 24 hours of

an employee’s scheduled appointment

Periodic Occupational Health Examinations - Examinations shall be coordinated and complete.

2.2.2 NA Within 60 days after

receipt of employee list from the PPOC

Medical Facility - A copy of the Medical Examiner’s Certificate shall be provided to the WAPA

PPOC.

2.3(h) Email .pdf document

One week following employee’s completed exam

Reporting - A copy of the examination results shall be provided to the employee. A copy of the examination results shall also be provided to the attention of the

DOE HR POC

2.4 Employee: Paper

copy

DOE HR POC:

Original paper forms that were provided to the clinic

45 days following employees’ examinations

Exhibit A

CONTRACT DISCREPANCY REPORT

CONTRACT NO. 1. REPORT NO. FOR THIS DISCREPANCY:

CONTRACTOR’S NAME: 2. FROM: (NAME OF CONTRACTING OFFICER

REPRESENTATIVE)

DATES

3. PREPARED:

4. RETURNED BY

CONTRACTOR:

5. ACTION COMPLETE:

6. DISCREPANCY OR PROBLEM: (DESCRIBE IN DETAIL; INCLUDE REFERENCE TO

PWS DIRECTIVE; ATTACH CONTINUATION SHEET, IF NECESSARY):

SIGNATURE OF CO:

7. TO: (CONTRACTING OFFICER)

8. FROM: (CONTRACTOR)

9. CONTRACTOR RESPONSE AS TO CAUSE, CORRECTIVE ACTION AND ACTIONS TO

PREVENT RECURRENCE (ATTACH CONTINUATION SHEET IF NECESSARY)

10. SIGNATURE OF CONTRACTOR REPRESENTATIVE:

DATE:

11. GOVERNMENT EVALUATION:

12. GOVERNMENT ACTIONS:

13 CLOSE- OUT

NAME TITLE SIGNATURE DATE

(13A)

CONTRACTOR

NOTIFIED

(13B) COR