12505B22Q0174 - SOW - Medical Surveillance Program.pdf

US Department of Agriculture (USDA)

Statement of Work

Contents Project

General Information

1.0 Scope of Work

2.0 Background

Contractor Requirements

3.0 Technical Requirements / Tasks

4.0 Government Furnished

5.0 Deliverables / Schedule

6.0 Travel

7.0 Contractor’s Key Personnel

8.0 Security Requirements

9.0 Data Rights

10.0 Section 508 – Electronic and Information Technology Standards

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Project NCAUR Occupational Medical Surveillance Program

General Information

1.0 Scope of Work

Provide Occupational Medical Surveillance Program services to NCAUR employees as provided by the Specifications Section. The successful Contractor shall be responsible for furnishing personnel, materials, equipment, facilities, and otherwise accomplish all things necessary for or incidental to the performance of the work set forth herein.

2.0 Background

The OMSP is provided to authorize employees considered for assignment or presently assigned to work with chemical, biological, and/or physical hazards and is established and administered by the USDA ARS Policy 414.0 “ARS Occupational Medical Surveillance Program”. The OMSP is designed for the detection of occupationally significant medical anomalies. The limited medical procedures performed are not intended, and should not be construed, to substitute for the care provided by the employee's personal physician.

Contractor Requirements

3.0 Technical Requirements / Tasks

The following specifications are set-up to provide maximum flexibility in tailoring the OMSP for each employee according to their specific workplace exposures. The Contractor shall assign a cost to the functions performed in each section. Each employee shall receive the following basic program. Table 1.0 is provided to show maximum and minimum participants and the required "Forms" discussed below are provided as Exhibits.

For new participants, a "Baseline Medical Surveillance Exam" begins with a review of the ARS-182 C2 "Initial Medical History Form" and includes a Physical Exam, General Laboratory Test, Audiogram, Chest x-ray, and Pulmonary Function Test.

For return participants, a fasting Lab test and a physical exam are required. Other tests and immunizations should be done based on exposures entered onto the ARS-182-NB Form "Participation Option and Exposure List" or at the Government's requirement/discretion.

The Contractor's physician must also review the ARS-1 82 C I "Updated Medical History Form" for the basic physical examination and document the results of the physical exam on the ARS-182 D "Physical Exam Form."

a. Physical Examination

Administration of the medical surveillance services should be under the supervision of a licensed Doctor of Medicine (MD) or doctor of osteopathy (DO). In addition, at a minimum, the MD/DO should be Board Certified in Occupational Medicine or Board Certified in Internal Medicine. If a person with these credentials is not available, then an MD/DO who is Board Eligible in Occupational Medicine or Internal Medicine would be an acceptable alternative. In either case, a physician with experience and interest in occupational medicine is preferred. The physician will note irregularities and abnormalities, which would jeopardize the health status of the employee via the performance of their normal work duties. Life threatening anomalous conditions will be reported expeditiously and directly to the employee's personal physician. These and other findings will be reported as part of the employee's health status report and incorporated into the Government's data bank.

b. General Laboratory Tests

Each employee shall receive annual laboratory screening including blood chemistries, hematologies, and urinalyses. Each of these laboratory operations shall include (but not be limited to) the following parameters:

1. Blood Chemistry Glucose, BUN, creatinine, sodium, potassium, chloride, uric acid, calcium, phosphorous, cholesterol, triglycerides, total protein, albumin, globulin, AIG Ratio, alkaline phosphatase, lactic dehydro-genase (LOH), total bilirubin (direct and indirect), serum glutamic pyruvic transaminase (SGPT) and SGPT Total, serum glutamic oxalacetic transaminase (SOOT). An alanine aminotransferase (ALT) test may be substituted for the serum glutamic pyruvic transaminase (SGPT) test.

2. Hematology (Complete Blood Count) Red cell count, red cell indices (MCV, MeH, MCHC), hemoglobin and hematocrit, reticulocyte count, platelet count, white cell count and differential.

3. Urinalysis Specific gravity, pH, microscopic examination, protein - albumin, glucose, ketones, occult blood, bile (optional- indicate if included or not.)

4. Reticulocyte (red blood count being produced in the bone marrow).

For employees working with radio isotopes or X-ray machines and/or diffraction equipment.

Based upon the employee occupational exposure record, referred to as an ARS 182AB, the following tests shall be provided by the examining physician. Additional tests may be recommended by the examining physician and performed with prior approval.

c. Pulmonary Lung Function (Spirometry)

The Contractor shall demonstrate the capability to provide measurements of employee lung function and capacity. Test methods shall comply with Occupational Safety and Health Administration (OSHA) requirements and results shall be interpreted and reported by experienced, qualified, competent personnel. Tests to be performed and parameters to be measure include:

• Forced Vital Capacity (FVC)

• Forced Expiratory Volume Timed for One Second (FEV I)

• Ratio of FEVllFVC

Employees requiring respiratory protection for their job function must have a medical evaluation and release stating their ability to wear respiratory protective equipment. The Contractor shall provide examinations and written certification as specified by OSHA in 29 CFR 1910.132 and 134 and provide NCAUR with the Respiratory Usability Certification.

d. Audiometric Examination

The Contractor shall provide a sound shielded facility in which any loss of hearing may be determined for each ear. Each ear shall be tested at the frequencies of 500, 1000, 2000, 3000, 4000, 6000, and 8000 HZ. International Standards Organization (ISO) standards apply. Hearing loss shall be identified and categorized as to probable cause.

e. Chest X-ray

Initial baseline and as needed when determined by the examining physician, the Contractor shall provide a full-size chest x-ray of the employee. X- rays will be used judiciously, and all Illinois State and Federal regulations pertaining to leakage, scatterings, and procedures will be strictly adhered to. Films will be interpreted by board certified radiologists. Those employees occupationally exposed to asbestos containing material as specified in current OSHA Standards (29 CFR 1910 and 29 CFR 1926 as applicable) shall be X-rayed as noted above, except that "B" reader techniques shall be used and the films will be read by a board-certified radiologist qualified as a "B" reader.

f. Specific Cancer Screening Tests

We believe that there are three applicable laboratory screening procedures for detection of a limited number of types of cancer in large populations. These tests are the PAP smear (for women), sputum cytology, and urinary sediment cytology. The PAP smear is not within the scope or intent of this program, therefore, the Contractor shall provide the two latter procedures for employees who have been designated eligible. Specimens shall be carefully processed and slides shall be examined and interpreted by experienced, certified pathologists. The Contractor may provide suggestions and rationale for the inclusion of additional screening procedures in this section.

g. Cholinesterase Determination

Several approved methods for the determination of cholinesterase levels in the serum and in RBC's exist. The Contractor shall justify the choice of a particular laboratory method and adhere to it throughout the course of this contract. Regardless of the particular analytical technique selected, the Contractor shall perform cholinesterase testing for both serum and RBC cholinesterase levels. The determination of only serum cholinesterase levels is unacceptable.

Results and normal comparative values shall be reported uniformly and accurately for each cholinesterase determination.

h. EKG Testing

When so directed, the Contractor shall provide the employee 12 Lead EKG testing.

SCREENING ANALYSIS AND REPORTING

The results of all tests are to be initially evaluated by the Contractor's physician and professional staff. Those abnormal parameters identified as being occupationally related or are likely to be aggravated by continued similar occupational exposure, will be brought to the attention of the appropriate Government personnel (to be designated upon award of the contract). All data will then be forwarded to the Government's occupational health physician.

ADDITIONAL TESTS

Additional tests other than the screening procedures listed above may be required or warranted.

The Contractor is invited to recommend additional requirements and shall have the capability to perform screening tests prescribed. Additional screening tests will be directed by the Federal Occupational Health (FOH) Physician and are not within the scope of this contract.

SCHEDULING

The Government will provide the Contractor with a list of names of employees and tests required on a monthly basis, at least one month prior to the desired examination date. The Government will have their employees contact the Contractor directly and negotiate their appointment time.

Appointment times shall be between 8:00 a.m. and 4:00 p.m., Monday through Friday, Federal Holidays excepted. A list of Federal Holidays for the specific year will be provided to the Contractor.

REPORTING

All required examination forms shall be completed and forwarded to the Government occupational health physician within 14 calendar days of the date of the examination.

INSPECTION AND ACCEPTANCE

The Government will check the accuracy of completed reports after receipt from the Contractor.

Errors shall be corrected at no cost to the Government. Correction of this category of errors shall be accomplished within five working days after the Contractor has been notified by the Government of the errors.

INVOICES

Invoices shall be submitted within 10 days of the end of the month and submitted monthly for payment via the Invoice Processing Platform (IPP). The invoices shall contain:

Names(s) of employee(s) tested Work location(s) of employee(s) tested Date of test Type of test(s) performed Unit cost of test(s) performed

4.0 Government Furnished

The Contractor shall provide all equipment and personnel necessary to conduct the specific exams and/or draw the necessary specimens to conduct the required medical surveillance procedures. The Procedures and examinations should be conducted at the Contractor's facility, which must be within a 10 miles distance from the NCAUR.

However, the Contractor may conduct physical examinations and applicable test procedures at NCAUR. Space will be made available in the Nurse's Office for these purposes. The physical examination forms and patient history forms are provided by the Government and all information shall be entered on these forms. Examples of applicable forms are enclosed.

5.0 Deliverables / Schedule

Key Deliverables

Item No. Deliverable Objective Due 1 Examination

Appointments The Government will provide the Contractor with a list of names of employees and tests required on a monthly basis, at least one month prior to the desired examination date. The Government will have their employees contact the Contractor directly and negotiate their appointment time. Appointment times shall be between 8:00 a.m. and 4:00 p.m., Monday through Friday, Federal Holidays excepted. A list of Federal Holidays for the specific year will be provided to the Contractor.

As coordinated with NCAUR officials.

2 Screening Analysis & Reporting

The results of all tests are to be initially evaluated by the Contractor's physician and professional staff. Those abnormal parameters identified as being occupationally related or are likely to be aggravated by continued similar occupational exposure, will be brought to the attention of the appropriate Government personnel (to be designated upon award of the contract).

Within 14 calendar days of the date of the examination.

3 Records All required examination forms shall be completed and forwarded to the Government occupational health physician within 14 calendar days of the date of the examination.

Within 14 calendar days of the date of the examination.

4 Invoicing Invoices shall be submitted within 10 days of the end of the month and submitted monthly for payment via the Invoice Processing Platform (IPP).

Invoices shall be submitted within 10 days of the end of the month and submitted monthly.

6.0 Travel

The Procedures and examinations should be conducted at the Contractor's facility, which must be within a 10 miles distance from the NCAUR.

7.0 Contractor’s Key Personnel

N/A

8.0 Security Requirements

A copy of an official government photo ID (State-issued driver’s license or ID card, passport, green card, etc.) must be provided no later than one week before arrival of contract service technician(s) except in the case of emergency service, were only the name of the technician provided via email or telephone will be necessary. Security access to the NCAUR facility will be provided based on this identification requirement. All visitors must comply with NCAUR COVID-19 pandemic guidelines that may include the wearing of face masks and maintaining 6 foot social distancing.

9.0 Data Rights

All medical records generated will be maintained in a classified data handling system, administered in such a way as to ensure confidentiality. Only the Government occupational health physician, the Government Safety and Health Program Staff, and the Contractor's physician and medical staff shall have access to the results of the medical screening. Copies of all medical screening results will be provided to the employee or the employee's physician of choice, upon receipt of a formal written request.

10.0 Section 508 – Electronic and Information Technology Standards Contractor must comply with applicable Section 508 requirements.

11.0 Supporting Information

Table 1.0 – Minimum and Maximum Participants

Service Minimum Number of

Participants Maximum Number of

Participants Physical Exam 50 200 General Lab Tests 50 200 Pulmonary Function Test 25 125 Respirator Usability Certificate 15 60 Audiometric Testing 15 60 Chest X-Ray 1 5

EKG 1 5

Cholinesterase Testing 1 5 Onsite General Laboratory Tests 50 200