02. W912LP26Q4003_Attch_02_Performance Work Statement.pdf

Attachment 2

Ver. October 2022

PERFORMANCE WORK STATEMENT (PWS)

FOR

Iowa Army National Guard Occupational Health Medical Surveillance Examination Services

1.0 General: The designated contractor shall provide full-time support (FTS) to both civilian, and uniformed federal technicians employed in Field Maintenance and Aviation facilities who are potentially exposed to health hazards in the work environment are required to undergo job related Occupational Health examinations.

1.1 Scope: The contractor shall provide all personnel, equipment, tools, materials, supervision, and quality control necessary, except as specified in Paragraph 3.0 as Government Furnished, to perform Occupational Health Medical Surveillance Examinations and Occupational Health Services for 90 federal technicians, as defined in this PWS.

1.1.1 Objectives: This requirement is for “Non-Personal Health Care Services,” as defined in Federal Acquisition Regulation (FAR) Subpart 37.101, under which the contractor is an independent contractor. In accordance with FAR Part 37.4, the Government may enter into a non-personal health care services contract with physicians, dentists and other health care providers under authority of 10 U.S.C. 2304 and 41 U.S.C. 253.

1.2 Background: The purpose of the Occupational Medical Surveillance Examination Program is to provide job-related Medical Surveillance Examinations and Occupational Health Services to the IAARNG full-time support (FTS) and/or temporary personnel who are or could potentially be exposed to health hazards in the work environment. The examination shall include personnel assigned to positions requiring specific standards of physical fitness. Personnel not included under these examinations are Active Guard Reserve (AGR), state employees, civilian contractors, and the part-time traditional soldiers.

1.3 Period of Performance (PoP): The Period of Performance shall be from date of award through 31 May 2026.

1.4 General Information:

1.4.1 Place and Performance of Services: The contractor shall provide services in clinical settings within a 40-mile radius AASF # 2 and FMS# 2, 2245 West Big Rock Rd, Waterloo Iowa 50036. The contractor shall provide services between the hours of 0730

- 1630 on Monday through Friday, except on recognized US holidays. The contractor shall at all times maintain an adequate workforce for the uninterrupted performance of all tasks defined within this PWS. When hiring personnel, the contractor shall keep in mind that the stability and continuity of the workforce are essential.

1.4.1.1 Telework: The Government does not permit the contractor to telework in support of this requirement. In furtherance of Continuity of Operations Planning (COOP), a telework program may be enacted to ensure that the Government’s mission-critical operations stay operational during times of national emergency or incidents of national significance. Telework shall be at no additional cost to the Government.

1.4.1.2 Reserved.

1.4.1.3 Reserved.

1.4.2 Recognized Holidays: The following are recognized United States (US) holidays.

The contractor shall not perform services on these days:

1.4.2.1 New Year’s Day: January 1st

1.4.2.2 Martin Luther King, Jr.’s Birthday

1.4.2.3 President’s Day

1.4.2.4 Memorial Day

1.4.2.5 Juneteenth National Independence Day: June 19th

1.4.2.6 Independence Day: July 4th

1.4.2.7 Labor Day

1.4.2.8 Columbus Day

1.4.2.9 Veteran’s Day: November 11th

1.4.2.10 Thanksgiving Day

1.4.2.11 Christmas Day: December 25th

1.4.3 Quality Control (QC): The contractor shall develop and maintain an effective QC Plan (QCP) to ensure services are performed in accordance with this PWS. The contractor shall develop and implement procedures to identify, prevent, and ensure non-recurrence of defective services. The contractor’s QCP is the means by which it assures itself that its work complies with the requirements of the contract. As a minimum, the contractor shall develop QC procedures that address the areas identified in Technical Exhibit 1, Performance Requirements Summary (PRS). A final QCP shall be submitted to the Contracting Officer Representative (COR) NLT 10 days after contract award.

After acceptance of the QCP, the contractor shall obtain the Contracting Officer’s (KO’s) acceptance in writing of any proposed changes to its QCP.

1.4.4 Quality Assurance (QA): The Government will evaluate the contractor’s performance under this contract in accordance with the Quality Assurance Surveillance Plan (QASP). This plan is primarily focused on what the Government will do to ensure that the contractor has performed in accordance with the performance standards. It defines how the performance standards will be applied, the frequency of surveillance, and acceptable quality level(s) or defect rate(s).

1.4.5 Reserved.

1.4.6 Physical Security. The contractor shall safeguard all Government property provided for contractor use. At the close of each work period, Government facilities, equipment and materials shall be secured.

1.4.6.1 Key Control. NOTE: All references to keys include key cards. The contractor shall establish and implement methods of ensuring that no keys/key cards issued by the Government are lost or misplaced or are used by unauthorized persons. No keys issued by the Government shall be duplicated. Such procedures shall include turn-in of any issued keys by personnel who no longer require access to locked areas. The contractor shall include procedures covering key control in the QCP.

1.4.6.1.1 The contractor shall immediately report any occurrences of lost or duplicated keys/key cards to the COR.

1.4.6.1.2 In the event keys, other than master keys, are lost or duplicated, the contractor shall, upon direction by the KO, re-key or replace the affected lock or locks; however, the Government, at its option, may replace the affected lock or locks or perform re-keying. When the Government replaces or re-keys the locks, the Government will deduct the total cost of lock replacement or re-keying from the monthly payment due the contractor. In the event a master key is lost or duplicated, the Government will replace all locks and keys for that system and will deduct the total cost from the monthly payment due the contractor.

1.4.6.1.3 The contactor shall prohibit the use of the Government issued keys/key cards by any persons other than the contractor’s employees. The contractor shall prohibit the opening of locked areas by contractor employees to permit entrance of persons other than contactor employees engaged in the performance of services in those areas, or personnel authorized entrance by the KO.

1.4.6.2 Lock Combinations: The contractor shall establish and implement methods of ensuring that no lock combinations are revealed to unauthorized persons. The contractor shall ensure that lock combinations are changed when personnel having access to the combinations no longer have a need to know such combinations. These procedures shall be included in the contractor’s QCP.

1.4.7 Special Qualifications: The contractor shall ensure all employees possess all required licenses for performing Occupational Health Medical Surveillance Exams used in the performance of this contract. This does not include education or other qualifications for the position in which the contractor employee is performing, dress codes, or other information. (NOTE: The Government does not provide training to contractors. Contractors must ensure that any personnel performing under a contract are fully trained, licensed, certified, and otherwise qualified to provide services.)

1.4.7.1 All procedures shall be conducted in accordance with applicable American Board of Occupational and Environmental Medicine (ABOEM), American Association of Occupational Health Nurses (AAOHN), U.S. Department of Labor, Occupational Safety and Health Administration (OSHA), and the National Institute for Occupational Safety and Health (NIOSH) Standards.

1.4.7.2 All clinical laboratory services shall be performed by a laboratory licensed through the U.S. Department of Health and Human Services (DHHS), Health Care Financing Administration pursuant to the terms of the Clinical Laboratories Improvement Act of 1967 (42 U.S.C. 263a) and the College of American Pathologies; and personnel certified under the American Society of Clinical Pathology.

1.4.7.3 All job-related medical surveillance physical examinations and occupational health consultation services shall be conducted by physicians, chiropractors or mid-level providers with experience and knowledge in occupational medicine.

1.4.8 Post Award Conference/Periodic Progress Meetings: The contractor agrees to attend any post award conference convened by the KO. The KO, COR and other Government personnel, as appropriate, may meet periodically with the contractor to review the contactor’s performance. At these meetings, the KO will apprise the contractor of how the Government views the contractor’s performance and the contractor shall apprise the Government of problems, if any, being experienced. The contractor shall resolve outstanding issues raised by the Government. Contractor attendance at these meetings shall be at no additional cost to the Government.

1.4.9 Contract Manager (CM): The contactor shall designate a CM who shall ensure performance under this contract. The name of this person, and an alternate who shall act for the contractor when the CM is absent, shall be designated in writing to the KO NLT 10 days after contract award, and within 10 days of designation of a replacement CM if applicable. The CM or alternate shall have full authority to act for the contractor on all contract matters relating to daily operation of this contract. The CM shall work through the COR, to resolve issues, receive technical instructions, and ensure adequate performance of services. The CM shall ensure that contractor employees do not perform any services outside the scope of the contract without an official modification issued by the KO. The CM shall ensure contractor employees understand that services performed outside the scope of the contract are performed wholly at the expense of the contractor.

1.4.10 Reserved.

1.4.11. Combating Trafficking in Persons: The United States Government has adopted a zero-tolerance policy regarding trafficking in persons. Contractors and contractor employees shall not engage in severe forms of trafficking in persons during the period of performance of the contract; procure commercial sex acts during the period of performance of the contract; or use forced labor in the performance of the contract. The Contractor shall notify its employees of the United States Government’s zero tolerance policy, the actions that will be taken against employees for violations of this policy. The contractor shall take appropriate action, up to and including termination, against employees or subcontractors that violate the US Government policy as described at

FAR 22.17.

1.4.12 Reserved.

1.4.13 Reserved.

1.4.14 Organizational Conflicts of Interest (OCI): The contractor and subcontractor personnel performing services under this contract may receive, have access to or participate in the development of proprietary or source selection information (e.g., cost or pricing information, budget information or analyses, specifications or work statements, etc.) or perform evaluation services which may create a current or subsequent OCIs, as defined in FAR Subpart 9.5. The contractor shall notify the KO immediately whenever it becomes aware that such access or participation may result in any actual or potential OCI and shall promptly submit a plan to the KO to avoid or mitigate any such OCI. The contractor’s mitigation plan will be determined to be acceptable solely at the discretion of the KO. In the event the KO unilaterally determines that any such OCI cannot be satisfactorily avoided or mitigated, the KO may impose other remedies as he or she deems necessary, including prohibiting the contractor from participation in subsequent contracted requirements which may be affected by the OCI.

1.4.15 Reserved.

2.0 Definitions and Acronyms:

2.1 Definitions:

2.1.1 Contractor: A supplier or vendor awarded a contract to provide specific supplies or service to the Government. The term used in this contract refers to the prime.

2.1.2 Defective Service: A service output that does not meet the standard of performance associated with the PWS.

2.1.3 Deliverable: Anything that can be physically delivered and includes non-manufactured things such as meeting minutes or reports.

2.1.4 Key Personnel: Contractor personnel that are evaluated in a source selection process and that may be required to be used in the performance of a contract by the PWS. When key personnel are used as an evaluation factor in best value procurement, an offer can be rejected if it does not have a firm commitment from the persons that are listed in the proposal.

2.1.5 Physical Security: Actions that prevent the loss or damage of Government property.

2.1.6 Quality Assurance: The Government procedures to verify that services being performed by the Contractor are performed according to acceptable standards.

2.1.7 Quality Assurance Surveillance Plan (QASP): An organized written document specifying the surveillance methodology to be used for surveillance of contractor performance.

2.1.8 Quality Control: All necessary measures taken by the Contractor to ensure that the quality of an end product or service shall meet contract requirements.

2.1.9 Subcontractor: One that enters into a contract with a prime contractor. The Government does not have privity of contract with the subcontractor.

2.2 Acronyms:

AAOHN American Association of Occupational Nurses ABOEM American Board of Occupational and Environmental Medicine AEI Army Enterprise Infostructure AGR Active Guard Reserve AR Army Regulation AT/OPSEC Antiterrorism/Operational Security BI Background Investigation CM Contract Manager COR Contracting Officer Representative DA Department of the Army DHHS Department of Health and Human Service DoD Department of Defense DSCA Defense Counterintelligence and Security Agency FAR Federal Acquisition Regulation FTS Full- time support GFP/M/E/S Government Furnished Property/Material/Equipment/Services HQDA Headquarters, Department of the Army HSPD Homeland Security Presidential Directive IA Information Assurance IAARNG Iowa Army national Guard IS Information System(s) KO Contracting Officer NGB National Guard Bureau NIOSH National Institute for Occupational Safety and Health OCI Organizational Conflict of Interest OHN Occupational health Nurse PII Personally Identifiable Information PIPO Phase In/Phase Out POC Point of Contact POP Period of Performance PRS Performance Requirements Summary PWS Performance Work Statement QA Quality Assurance

QASP Quality Assurance Surveillance Plan QC Quality Control QCP Quality Control Program RFO FAR Revolutionary FAR Overhaul SCR Service Contract Reporting SSN Social Security Number TE Technical Exhibit USD(I) Under Secretary of Defense for Intelligence

3.0 Government Furnished Property, Material, Equipment and Services (GFP/M/E/S):

The Government will provide the property, material, equipment, and/or services listed below solely for the purpose of performance under this contract: NONE.

4.0 Contractor Furnished Property, Materials, and Equipment (CFP/M/E):

4.1 General: Except for those items specifically stated to be Government-Furnished in Paragraph 3.0, the contractor shall furnish everything required to perform these services as indicated in Paragraph 1.1

5.0 Requirements: The contractor shall:

5.1 Perform Medical Surveillance Examinations/Occupational Health Services

5.2 Maintain medical liability insurance, in a coverage amount acceptable to the Contracting Officer, which is not less than the amount normally prevailing within the local community for the medical specialty concerned. The contractor is required to ensure that its subcontracts for provisions of health care services contain the requirements of the clause at FAR 52.237-7, Indemnification and Medical Liability Insurance, including the maintenance of medical liability insurance.

5.3 Coordinate individual exam schedule in coordination with the OHN and the individuals. All exams shall be scheduled within the PoP identified in paragraph 1.3.

5.4 Consult with the OHN by telephone to coordinate or resolve issues that might arise before, during, and after the testing period.

5.5 Perform a comprehensive review and evaluation within 30 days following the conclusion of testing. The OHN will contact and schedule a follow-up review and evaluation meeting to discuss positive and negative aspects of testing.

5.6 Immediately notify the OHN of any abnormal testing results, to include significant abnormal laboratory results and significant abnormal exam findings.

5.7 Specific Tasks:

5.7.1 Vital signs: Provide vital signs to include height (Barefoot, boots or shoes removed), weight (Boots and Military top removed, T-shirt okay), blood pressure, pulse and respirations. Estimated quantity for vital signs- 23.

5.7.2 Labs: Provide laboratory tests processed by certified clinical laboratories and performed by personnel certified under the American Society of Clinical Pathology. The supporting laboratory shall provide employee instruction and equipment necessary for tests requiring special collection methods and/or containers. Document that each employee has been counseled by examining provider about laboratory test results.

Provide a copy of lab results to employee for their primary care physician within 30 days after completion of testing.

5.7.2.1 Complete Lab Draws: The following labs are to be drawn only as indicated by the Occupational Health Manager: Estimated quantity of labs 23 each.

5.7.2.1.1 Vision Screenings. Estimated quantity – 23 each.

5.7.2.1.2 Chromium blood level. Estimated quantity – 19 each.

5.7.2.1.3 Lead blood level. Estimated quantity – 23 each

5.7.2.1.4 Cadmium blood level. Estimated quantity – 19 each

5.7.2.2.5 Zinc Protoporphyrin Estimated quantity- 23 Each

5.7.3 Vision Screenings - 8each shall be in accordance with DA PAM 40-506, using multi-phasic vision screening equipment (TITMUS or equivalent) to measure the following primary visual skills:

5.7.3.1 Visual acuity for distance and near corrected and uncorrected.

5.7.3.2 Lateral phorias for distance and near.

5.7.3.3 Vertical phorias for distance and near.

5.7.3.4 Depth perception.

5.7.3.5 Color perception.

5.7.3.6 Peripheral vision.

5.7.4 Physical/dermatological Exam. Estimated quantity – 23 each.

5.7.4.1 Provide a Job Functional Analysis or Kraus-Weber that includes back strength and flexibility. Note any pain or recommended lifting limitations if less than 50 lbs.

5.7.4.2 Complete a physical exam by a physician or mid-level provider by reviewing all systems and occupational history with focus on medical abnormalities related to occupational exposures.

5.7.4.3 Dermatological examinations, which shall be performed by a physician and include an inspection of the entire integumentary system with emphasis on areas most likely to be affected by the employee's occupational (i.e., radiation) exposures.

Documentation shall include the presence of any dermatomes or lesions of the skin.

5.8. Medial Reports and Recordkeeping. The contractor shall:

5.8.1 Utilize the Occupational Health Report Medical Examination form for every exam.

Reference Technical Exhibit 3.

5.8.2 Immediately report to the OHN, by telephone at (515) 252-4910, if results of medical surveillance screening(s) are questionable and/or are of critical significance, and/or require follow-up.

5.8.3 Send documentation, to include all diagnostic tests, graphs, charts, reports, questionnaires, waivers, employee consent forms, physical findings, and examination results, to the OHN within 30 days after completion of exam/testing to:

Iowa Army National Guard ATTN: Emmanuel Bempah, MSN, RN, Occupational Health Nurse Occupation Health and Safety Office, JFHQ 7105 NW 70th Avenue Johnston, IA 50131-1824 Phone (515) 252-4910 Fax (515) 727-3389 E-mail emmanuel.o.bempah.mil@army.mil

5.8.4 Identify all medical records with the employee’s full name, social security number, date of birth, job code, and the name of the employee’s work place or facility, at a minimum. The contractor shall ensure work/health history forms and medical reports are complete and legible (typed/printed).

5.8.5 Prepare two (2) copies of all exam results to be distributed within 30 days after completion of exam/testing, as follows:

5.8.5.1 One (1) complete copy of all exam components shall be faxed or mailed to the

OHN.

5.8.5.2 One (1) complete copy of all exam components shall be placed in a sealed envelope and mailed to the individual receiving the exam.

mailto:emmanuel.o.bempah.mil@army.mil

5.8.5.3 Exam results that cannot be mailed to individuals shall be individually sealed and mailed to the OHN for dissemination.

5.8.5.4 The estimated number of personnel to be examined and tested is approximately 17 this year. The Government has the right to increase or decrease the number of personnel depending on employee population.

5.8.5.5 Service Contract Reporting: Reserved.

6.0 Applicable Publications: Publications applicable to this PWS are listed below:

Publication (Chapter/Page)

Date of Publicatio n

Mandato ry or Advisory

Website

Federal Acquisition Regulation Current Mandator y https://www.acquisition.gov/?q=browsefar

Defense Federal Acquisition Regulation Supplement

Current Mandator y http://www.acq.osd.mil/dpap/dars/dfarspgi/ current/index.html or https://www.acquisition.gov/dfars

DoDI 5400.11 Department of Defense Privacy and Civil Liberties Programs

01/29/2019

Advisory https://www.esd.whs.mil/Directives/issuan ces/dodi/

DoD 5400.11-R Department of Defense Privacy Program

05/14/2007 Advisory https://www.esd.whs.mil/Directives/issuan ces/dodm/

29 CFR 1910: Occupational Safety & Health Standards

Current Mandator y https://www.osha.gov/pls/oshaweb/owasr ch.search_form?p_doc_type=STANDAR DS&p_toc_level=1&p_keyvalue=1910

29 CFR 1960: Program Elements for Federal Employee Occupational Safety & Health Programs

Current Mandator y https://www.osha.gov/pls/oshaweb/owasr ch.search_form?p_doc_type=STANDAR DS&p_toc_level=1&p_keyvalue=1960

Occupational Safety & health Programs

Department of Defense (DoD) 6055.05-M: Occupational Medical Examinations and Surveillance Manual change 16 Sep 2008

Mandator y http://www.dtic.mil/whs/directives/corres/ pdf/605505m.pdf

DA PAM 40-506: The Army Vision Conservation and Readiness Program

15 July

Mandator y https://armypubs.army.mil/epubs/DR_pub s/DR_a/pdf/web/p40_506.pdf

DoDI 6055.1: Safety and Occupational Health (SOH) Program

Oct. 2014 Mandator y https://www.hsdl.org/?view&did=758821

NGR 40-5: The Army National Guard Preventive Medicine Program

Feb. 2013 Mandator y https://www.ngbpdc.ngb.army.mil/Portals/ 27/Publications/ngr/ngr%2040- 5.pdf?ver=2018-09-07-082539-203 https://www.acquisition.gov/?q=browsefar http://www.acq.osd.mil/dpap/dars/dfarspgi/current/index.html http://www.acq.osd.mil/dpap/dars/dfarspgi/current/index.html https://www.acquisition.gov/dfars https://www.esd.whs.mil/Directives/issuances/dodi/ https://www.esd.whs.mil/Directives/issuances/dodi/ https://www.esd.whs.mil/Directives/issuances/dodm/ https://www.esd.whs.mil/Directives/issuances/dodm/ https://www.osha.gov/pls/oshaweb/owasrch.search_form?p_doc_type=STANDARDS&p_toc_level=1&p_keyvalue=1910 https://www.osha.gov/pls/oshaweb/owasrch.search_form?p_doc_type=STANDARDS&p_toc_level=1&p_keyvalue=1910 https://www.osha.gov/pls/oshaweb/owasrch.search_form?p_doc_type=STANDARDS&p_toc_level=1&p_keyvalue=1910 https://www.osha.gov/pls/oshaweb/owasrch.search_form?p_doc_type=STANDARDS&p_toc_level=1&p_keyvalue=1960 https://www.osha.gov/pls/oshaweb/owasrch.search_form?p_doc_type=STANDARDS&p_toc_level=1&p_keyvalue=1960 https://www.osha.gov/pls/oshaweb/owasrch.search_form?p_doc_type=STANDARDS&p_toc_level=1&p_keyvalue=1960 http://www.dtic.mil/whs/directives/corres/pdf/605505m.pdf http://www.dtic.mil/whs/directives/corres/pdf/605505m.pdf https://armypubs.army.mil/epubs/DR_pubs/DR_a/pdf/web/p40_506.pdf https://armypubs.army.mil/epubs/DR_pubs/DR_a/pdf/web/p40_506.pdf https://www.hsdl.org/?view&did=758821 https://www.ngbpdc.ngb.army.mil/Portals/27/Publications/ngr/ngr%2040-5.pdf?ver=2018-09-07-082539-203 https://www.ngbpdc.ngb.army.mil/Portals/27/Publications/ngr/ngr%2040-5.pdf?ver=2018-09-07-082539-203 https://www.ngbpdc.ngb.army.mil/Portals/27/Publications/ngr/ngr%2040-5.pdf?ver=2018-09-07-082539-203

42 U.S.C. 263A Current Mandator y https://www.law.cornell.edu/uscode/text/4 2/263a

DOD 5400 11-R May 14, Advisory https://www.esd.whs.mil/Portals/54/Docu ments/DD/issuances/dodm/540011r.pdf

6.1 Applicable Forms: Forms applicable to the PWS are listed below:

Form Date Website Occupational Health Report Medical Examination

See Technical Exhibit 3

TECHNICAL EXHIBIT 1

Performance Requirements Summary (PRS)

Performance Objective Performance Standard

Acceptable Quality Levels

(AQL)

Surveillance Method / By Whom

5.0 Procedures and

Standards

Contractor shall follow the procedures and standards identified in this PWS 98% of the time

2% failure to follow procedures and standards identified in the

PWS

OHN Observation /

OHN/COR

5.8.3 Medical Records and Recordkeeping. Send documentation to OHN within 30 days after completion of exam/testing

98% of the time

2% failure to provide reports and records within 30 days

OHN Observation /

OHN/COR

https://www.law.cornell.edu/uscode/text/42/263a https://www.law.cornell.edu/uscode/text/42/263a https://www.esd.whs.mil/Portals/54/Documents/DD/issuances/dodm/540011r.pdf https://www.esd.whs.mil/Portals/54/Documents/DD/issuances/dodm/540011r.pdf

TECHNICAL EXHIBIT 2

Deliverables Schedule

PWS Reference / Deliverable Title Frequency Number of Copies Medium/Format Submit To

1.4.3 Final Quality Control Plan (QCP) submission

NLT 10 days after contract award. After acceptance of the QCP, receive KO’s acceptance in writing of any proposed changes to the QCP.

1 Electronic COR / KO

1.4.9 Contract Manager

No later than 10 days after contract award, then within 10 days after new CM has been identified to replace current one, if applicable.

1 Electronic KO and COR

5.5 Comprehensive Review & Evaluation

Within 30 days following the conclusion of the testing

1 Hard copy or Electronic COR

5.7.2 Lab Results

After each test, within 30 days after completion of testing

1 Hard Copy Individual

5.8.3 Documentation

After each exam/testing, within 30 days after completion of exam/testing

1 Hard copy or electronic OHN

5.8.5 Exam Results

After each exam, within 30 days after completion of exam

1 Electronic and hard copy OHN

TECHNICAL EXHIBIT 3

Occupational Health Report Medical Examination Questionnaire attached.