SOW_for_Med_Surv_Exams.docx

PERFORMANCE WORK STATEMENT

OCCUPATIONAL HEALTH

PROCUREMENT OF MEDICAL SURVEILLANCE EXAMINATIONS

1. GENERAL

The Performance Work Statement (PWS) supports the Michigan Army National Guard (MIARNG) for Occupational Medical Surveillance Examination Program in accordance with the Occupation Safety and Health Association (OSHA) and other regulations. The estimated number of personnel to be examined is 400. The Government has the right to increase and/or decrease the number of employees/military personnel and the locations for service. Due to the majority of personnel being in the Lansing area, hospitals within a 50 mile radius of Lansing should apply.

2. PURPOSE

2.1. The purpose of the Occupational Medical Surveillance Examination Program is to provide job-related Medical Surveillance Examinations and Occupational Health Services to the Dual-status Technician’s of the MIARNG 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, and the part-time traditional Soldiers.

2.2. The Government may 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 Occupational Health Physician(s), supervision, all labor, tools, materials, equipment, and incidentals required to conduct the Medical Surveillance Examination / Occupational Health Services for the MIARNG.

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. The Contractor will indemnify the Government for any liability producing act or omission by the Contractor, its employees and agents occurring during contract performance. The Contractor will 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 subcontractors, if any, for provisions of health care services, contain the requirements of the clause at 52.237-7, Indemnification and Medical Liability Insurance, including the maintenance of medical liability insurance.

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 consultation services.

3.5. Contractor shall arrange for the opportunity to consult with an Occupational Health Manager of the MIARNG 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 will contact and schedule a follow-up review and evaluation meeting to discuss positive and negative aspects of testing.

3.7. Contractor will provide vital signs to include height, weight, blood pressure, pulse and respirations.

3.8. Contractors will provide a Job Functional Analysis or Kraus-Weber that includs back strength and flexibility. 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 no more than 400.

a. Hearing screenings will be conducted only on employees exposed to occupational noise > 85 dBA or 140 dBA impact noise.

a. All hearing tests will be entered into DOEHRS-HC.

b. Otoscopic Exam.

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

d. Hearing aids must be removed.

e. Employee must be noise free for at least 14 hours prior to screening.

f. 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 and if there is still a STS notify the Occupational Health Manager within 10 days so that timely retesting 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 are no more than 200.

a. Screenings will only be conducted on employees exposed to respiratory hazards that will require a respirator to mitigate their hazards that are 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 no more than 200.

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.

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. Estimated quantity: 400.

b. |_| Liver Function to include AP and if abnormal include GGTP. Estimated quantity: 400.

3.14. Contractor shall ensure dermatological examinations must 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 will include the presence of any dermatomes or lesions of the skin.

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 no more than 200.

a. Chest X-rays are only performed for asbestos exposed employees.

b. Be a 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 Contracting Officer’s Representative 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. MEDICAL REPORTS AND RECORDKEEPING

7.1. Contractors shall immediately notify the Occupational Health Manager by telephone at 517.481.8368 if results of medical surveillance screening(s), which are questionable and / or of critical significance and / or require follow-up. Contractor shall send all results to include all diagnostic tests, graphs, charts, reports, questionnaires, waivers, employee consent forms, physical findings, and examination results to the Occupational Health Manager within 30 working days of completion of testing to:

7.2. 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).

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

8. EXAMINATION SCHEDULING

8.1 Coordination of scheduling shall be a joint effort between the Occupational Health Manager and the Contractor, a draft copy of the schedule will be initiated by the Occupational Health Manager and sent to the Contractor for review and any needed adjustments. One patient/employee per 15 minute intervals. All workdays include a one-hour lunch break. No testing shall be performed between 1130 – 1230 hours.

8.2 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 Manager and the Facility(ies). 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.

9. SERVICE DELIVERY SUMMARY (SDS)

9.1. 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 (see Para 3.2, 3.3, 3.7)

Equipment Certification Instrumentation meets or exceed performance standards, 100% of the time (see Para 3.8)

Medical Surveillance All FTS and/or temporary personnel has been examined, 98% of the time (see Para 5.1, 5.2, 6.1, 6.2)

Infectious Waste Disposal All sharp instruments, blood, and urine is handled and disposed of in accordance with federal, state, and local regulations, 100% of the time (see Para 7.1 and 7.2)

Medical Reports and Recordkeeping Privacy Act Statement for each FTS and/or temporary personnel and the reports are submitted in a timely manner, 100% of the time (see Para 8.1, 8.2, 8.3)