NV_PWS_Occupational_Health.docx

STATE OF NEVADA OFFICE OF THE MILITARY

Office of the Adjutant General 2460 Fairview Drive Carson City, Nevada 89701-6807

WILLIAM R. BURKS

Brigadier General The Adjutant General

PERFORMANCE WORK STATEMENT

NEVADA OCCUPATIONAL HEALTH

PROCUREMENT OF OCCUPATIONAL HEALTH EXAMS

1. GENERAL

The Performance Work Statement (PWS) supports the Nevada Army National Guard (NVARNG) for Occupational Medical Surveillance Examination Program in accordance with the Occupation Safety and Health Association (OSHA) and other regulations. There are 9 shops at six locations that require this service in Nevada: Reno, Carson City, Yerington, Henderson and two locations in Las Vegas. The estimated number of personnel to be examined is 150. The Government has the right to increase and/or decrease the number of employees/military personnel and the locations for service.

2. PURPOSE

2.1. The purpose of the Occupational Medical Surveillance Examination Program is to provide job-related Occupational Health Examinations and Medical Surveillance Services to the NVARNG 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 State Employees, civilian contractors, Active Guard Reserve, Active Duty for Operational Support (ADOS) and part-time traditional Soldiers.

2.2. The Government will evaluate the quality of professional and administrative services provided, but retain no control over the medical professional aspects of services rendered such as testing procedures, etc. The Contractor will provide Board Certified Physician(s) with experience in Occupational Health, supervision, all labor, tools, materials, equipment, and incidentals required to conduct the Occupational Health Examinations / Medical Surveillance Services for the NVARNG.

3. PROCEDURES and STANDARDS

3.1. This contract is for “Non Personal” Health Care “Services”, as defined in 37.101. 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. The Government shall evaluate the quality of professional and administrative services provided, while the Government retains no control over the medical, professional aspects of services rendered.

3.2. Contractor shall ensure all procedures are 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.

3.3. Contractor shall ensure all clinical laboratory services are 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.

3.4. Contractor shall provide a Board eligible or Certified Occupational Medicine Physician to conduct job-related medical surveillance physical examinations and occupational health specialty examinations.

3.5. Contractor shall arrange for the opportunity to consult with the Occupational Health Nurse (OHN) of the NVARNG by telephone to coordinate or resolve issues that might arise before, during, and after the testing period.

3.6. Contractor shall perform a comprehensive review and evaluation within 30-days following the conclusion of testing. The Contracting Officer’s Representative (COR) will contact and schedule a follow-up review and evaluation meeting to discuss positive and negative aspects of testing.

3.7. Contractor will use documentation provided by NVARNG to conduct and document the physicals and is responsible to ensure all equipment and personnel are available to complete specific exams requirements.

3.8. Contractor will provide a Job Functional Analysis or Kraus-Weber that includes back strength and flexibility if requested. Note any pain or recommended lifting limitations if less than 50 lbs.

3.9. Contractor shall ensure audiogram must be certified by the Council for Accreditation in Occupational Hearing Conservation (CAOHC) or the equivalent military Defense Occupational and Environmental Health Readiness System-Hearing Conservation (DOEHRS-HC) training in accordance with 29 CFR 1910.95. The estimated number of personnel to receive audiograms are approximately 150.

a. Hearing screenings will be conducted on employees designated by the OHN to include all workers exposed to occupational noise > 85 dBA or 140 dBA impact noise as part of their job duties.

b. All hearing tests will be entered into DOEHRS-HC by the contractor.

c. An otoscopic exam will be conducted to ensure

d. Test Only 500, 1000, 2000, 3000, 4000 and 6000.

e. Hearing aids must be removed.

f. Contractor must verify that worker has been noise free for at least 14 hours prior to screening.

g. All hearing screenings besides the baseline will be compared against the employee’s baseline to determine if there is a Significant Threshold Shift (STS) and retested immediately to verify results. Contractor will notify the Occupational Health Nurse within 10 days so that timely follow-up can be scheduled.

3.10. Contractor shall ensure Pulmonary Function Tests (PFTs) Performed by a licensed physician, Certified Pulmonary Function Technologist, or Registered Respiratory Therapist in accordance with 29 CFR 1910.1001. The estimated number of personnel to receive PFTs is approximately 15.

a. Screenings will only be conducted on employees designated by the OHN to include all those exposed to respiratory hazards that will require a respirator to mitigate hazards identified as above the action level.

b. Test will include as a minimum Forced Expiratory Volume in one second (FEV1), Forced Vital Capacity (FVC), comparison with recognized normal’s for the individual's height and weight, sex, race, age and a documented interpretation by a pulmonologist or certified Occupational Health physician.

3.11. Contractor will provide quantitative fit testing in accordance with 29 CFR 1910. 134 appendix A. The estimated number of personnel to receive fit testing is approximately 10.

a. The masks/respirator will be brought to the testing site by the individual employee who has one assigned to them for their utilization.

3.12. Contractor will ensure that vision screenings are in accordance with DA PAM 40-506 using multiphasic vision screening equipment to measure the following primary visual skills and will be documented on a form provided by NVARNG.

a. Visual acuity for distance and near.

b. Lateral phorias for distance and near.

c. Vertical phorias for distance and near.

d. Depth perception.

e. Color perception.

f. Peripheral vision.

3.13. Contractor shall ensure laboratory tests will be processed by certified clinical laboratories and performed by personnel certified under the American Society of Clinical Pathology. The supporting laboratory will provide employee instruction and equipment necessary for tests requiring special collection methods and/or containers. Document that employee has been counseled by examining provider about laboratory test results. Provide a copy of lab results to employee for their primary care physician. Tests include:

a. |_| Blood Chemistries (serum) with H&H, BUN and Creatinine.

b. |_| Liver Function to include AP and if abnormal include GGTP.

3.14. Contractor shall ensure a review of systems on physical examinations must be performed by a physician with emphasis on areas most likely to be affected by the employee's occupational exposures or desired certification.

3.15. Contractors shall ensure that chest X-rays will be performed by a certified X-ray technician. The interpretation and classification will be performed by a B-reader, or a board eligible or certified radiologist meeting the requirements of 29 CFR 1910.1001 Appendix E: The estimated number of personnel to receive chest X-rays are none, but services must be available if requested.

a. Chest X-rays are only performed for employees that have documented enrollment into an asbestos program or other medical surveillance program as required.

b. Chest X-ray will include posterior-anterior and left lateral view.

3.16. Contractor shall ensure instrumentation must meet or exceed appropriate performance standards, and accuracy must be verified in accordance with current Occupational Medicine Certification standards.

3.17. Contractor shall provide the COR with a Quality Assurance Medical Surveillance Plan listing the procedures or processes, which shall be utilized to meet the requirements discussed in the PWS.

4. REFERENCES

4.1. Title 29, Code of Federal Regulations, Part 1910: Occupational Safety and Health Standards.

4.2. Title 29, Code of Federal Regulations, Part 1960: Safety and Health Provisions for Federal Employees.

4.3. American National Standards Institute (ANSI) 288.6-1884, American National Standard for Respiratory Protection, Respirator Use, Physical Qualifications for Personnel.

4.4. Threshold Limit Values and Biological Exposure Indices (TLVs), American Conference of Governmental Industrial Hygienists (ACGIH), Cincinnati, Ohio.

4.5. Army Regulation 40-5, Preventive Medicine 25 May 2007

4.6. Department of Defense 6055.05M, Occupational Medical Surveillance Manual 2 May 2007

4.7. U.S. Department of Labor, Code of Federal Regulations 29 (CFR) 1910.120 (b) (5), (f), Medical Surveillance

4.8. Army Regulation 11-34, The Army Respiratory Protection Program 15 Feb 1990

4.8. Headquarters, Department of the Army Pamphlet (DA PAM) 40-501 Hearing Conservation 10 Dec 1998

4.9. Headquarters, Department of the Army Pamphlet (DA PAM) 40-506 Vision Conservation 15 Jul 2009

5. PERSONAL PROTECTIVE EQUIPMENT (PPE)

5.1. Contractor shall furnish and assure healthcare workers are provided with the appropriate PPE such as, but not limited to: gloves, protective eyewear, and etc., where there is a potential for exposure to blood or other potentially infectious materials.

5.2. Contractor shall ensure each healthcare worker complies with the requirements of 29 CFR 1910.1030 Blood borne Pathogens Standard.

6. INFECTIOUS WASTE DISPOSAL

6.1. Disposal of all infectious waste shall be in accordance with local, state, and federal regulation and disposed of by the contractor unless other accommodations have been coordinated in writing.

6.2. Contractor shall ensure puncture resistant sharps containers are readily accessible to healthcare workers and located in all treatment areas where sharps could potentially be used.

7. MOBILE UNIT CONFIGURATION

7.1. Occupational Health exams and services shall be accomplished via mobile unit designed to ensure complete individual privacy. Features of the unit shall include, but are not limed to, a climate-controlled atmosphere, testing / phlebotomy station, audiometric testing booth, and physical examination area.

7.2. Mobile units shall be equipped with a self-contained power source. The Government shall not provide power to the contractor’s mobile unit unless other accommodations have been coordinated in writing.

8. MEDICAL REPORTS AND RECORDKEEPING

8.1. Contractors shall immediately contact the Occupational Health Nurse by telephone at (775)887-7253 if results of medical surveillance screening(s), which are questionable and / or of critical significance and / or require follow-up. Contractor shall ensure that all results to include all diagnostic tests, graphs, charts, reports, questionnaires, waivers, employee consent forms, physical findings, and examination results are made available to the Occupational Health Nurse within 30 working days of completion of testing. Any electronic access to records must be in printable format suitable to be filed in the employee’s medical record. Mailed documentation will be sent to the address listed below and the contractor is responsible for all postage fees.

8.2. Contractor shall 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).

8.3. Contractor shall ensure that each employee signs the Privacy Act Statement (DD Form 2005) during the registration process.

9. Summary Report:

The Contractor will provide a comprehensive report as follows:

a. Shop Binders – These binders will be provided to each shop (9 identified) within 30 days of completing their shop specific medical exam event. An additional binder will be provided to the shop 7 months after the event to include any additional medical exams done after the main event. Each binder will include a summary of the shops employees by name and the date and type of physical(s) performed and indicate qualified or not qualified for each type and expiration. Documentation of these qualifications with expirations will be provided as a certification card for each worker examined and copies of these cards will be included in the shop binder. All information contained within the binder must be sufficient for the supervisor to refer to during an inspection without violating HIPAA.

b. A duplicate of each binder will be sent to the Occupational Health Nurse via electronic format.

10. EXAMINATION SCHEDULING

10.1. Coordination of scheduling shall be a joint effort between the Occupational Health Nurse and the Contractor, a draft copy of the scheduled will be initiated by the Occupational Health Nurse and sent to the Contractor for review and any needed adjustments. Contractor will provide the Occupational Health Nurse the estimated time needed for each employee based on physical components required to ensure efficient use of scheduled time. Contractor will schedule mobile unit within 30 days before or after requested target date and will make every effort to accommodate the corresponding shops schedule. Scheduling of employees to be examined at clinic locations will be accommodated by the Contractor within 30 days for routine visits and 7 days for urgent.

10.2. In the event of a Contractor equipment failure, specific testing and / or parts of examinations that are not completed during the testing period shall be completed at a scheduled time mutually convenient for the Contractor, Occupational Health Nurse and the Shops. Unfinished testing / examinations will be completed at no additional cost to the Government. The option to schedule physicals not completed due to equipment failure, through a local occupational medical facility shall be done at no cost to the Government. The Contractor shall be directly responsible to cover costs for completing these make-up screenings.

11. SERVICE DELIVERY SUMMARY (SDS)

11.1. The service delivery summary is designed to be a concise statement of key deliverables which are measured to determine the contractor's performance success or failure.

PERFORMANCE OBJECTIVE

PERFORMANCE SCHEDULE

Insurance & Licensed and/or certified staff for all physicians and technicians, 100% of the time

Equipment Certification Instrumentation meets or exceed performance standards, 100% of the time

Occupational Exams

Sche duled within contract timeframe and proper exam elements performed

100 % of the time

Medical Reports and Recordkeeping

Completed records are accessible within agreed time frame and reports are submitted in a timely manner, Infectious Waste Disposal All sharp instruments, blood, and urine is handled and disposed of in accordance with federal, state, and local regulations, 11.2.

The following standard services are to be provided under this PWS:

Lab Services

Frequently Used Labs Units Schedule Unit

Occ Health Profile (Bundle: CBC, liver function test, BUN, Creatinine, Urinalysis) Each CBC (HGB, HCT, WBC, MCV, MCH, MCHC) with diff Each CBC (HGB, HCT, WBC, MCV, MCH, MCHC) without diff Each Liver Function Test (AST, ALT, ALB, ALK PHOS, dBil, TBil, Protein) Each BUN /Creatinine Each Urinalysis with Micro Each Urinalysis without Micro Each Lipid (TC, LDL, HDL, Trig, VLDL) Panel Each Fasting Blood Glucose Each

Infrequently Used Labs Units Schedule Unit Price

Cadmium Profile (Per Lab Corp) Each Human Chorionic Gonadotropin HCG beta Each Chromium (Blood) Each Lead, industrial whole blood Each ZPP, Blood Protoporphyrins, zinc Each Blood Ethanol Each

Procedures & Exams

Procedures Units Schedule Unit Price

Audiometry Each B Audiometry Each J B-Reading Each B B-Reading Each J Chest X-Ray (PA View) Each B Chest X-Ray (PA View) Each J Chest X-Ray (PA & Lat View) Each B Chest X-Ray (PA & Lat View) Each J Electrocardiogram Each B Electrocardiogram Each J Spirometry Each B Spirometry Each J Comprehensive Vision Each B Comprehensive Vision Each J Vital Signs / Body Ht and Wt (no charge with exam) Each Vital Signs/Body Height and Weight Each J Venipuncture and Specimen Handling Each

Exams Units Schedule Unit Price

Comprehensive Exam (Pre-placement employment, OF178) B Each Comprehensive Exam (Pre-placement employment, OF178) J Each Comprehensive Exam (Pre-Placement+Medical Surveillance) B Each Comprehensive Exam (Pre-Placement+Medical Surveillance) J Each Mobile Unit Charge Per day/ Per hour/ Per exam

Billing Terms OHC Terms Units Schedule Unit Price Record Processing services as related to Exams or Clearances Each B Record Processing services as related to Exams or Clearances Each J Record Processing (Mailing of X-rays) Each B Record Processing (Mailing of X-rays) Each J Missed Work-up or missed procedure Each B Missed Work-up or missed procedure Each J Missed Exam Each B $185.25 Missed Exam Each J $92.75

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