Attachment A-SOW_Amend0005.pdf

DEPARTMENT OF COMMERCE

NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION (NOAA)

OFFICE OF MARINE AND AVIATION OPERATIONS (OMAO)

OCCUPATIONAL HEALTH SUPPORT SERVICES

STATEMENT OF WORK

I. Background

Seagoing vessels are unique work environments that often operate in remote locations and in extreme environmental conditions. Marinefrs operating on these vessels are required to meet Medical and Physical Exam requirements. Mariners must be free from health conditions that are not able to be safely managed while at sea. To ensure mariners are capable of safely working on a seagoing platform, they are required to complete an in-depth physical examination prior to employment, complete various annual screenings, and routine physical examinations every two years, whose homes and home ports may be all across the United States. There is then both a “pre-employment” examination and a “continuation (or periodic)” examination.

II. Objectives

The Department of Commerce (DOC), National Oceanic and Atmospheric Administration (NOAA), and Office of Marine and Aviation Operations (OMAO), have a requirement for the development and implementation of a contract to establish nationwide mobile and fixed access to an Occupational Health Clinic that provides physical examinations and other annual and biennial requirements outlined below for mariners working on NOAA vessels. The desired outcome of this Occupational Health Contract would include a cost effective means to provide occupational health services to NOAA mariners nationwide and in certain OCONUS locations and some international locations.

III. Scope

OMAO’s research and survey ships comprise the largest fleet of federal research ships in the Nation, ranging from large oceanographic research vessels capable of exploring the world’s deepest ocean, to smaller ships responsible for charting the shallow bays and inlets of the United States. The fleet supports a vast range of marine activities including fisheries research, nautical charting, as well as ocean and climate studies. The establishment of an Occupational Health Contract would require the servicing organization to complete forms and examinations including the CG 719-K medical certificate form, respirator medical evaluation questionnaire, audiology history questionnaire; and provide physical examinations, any as needed functional capacity evaluations, audiogram testing, spirometry testing, purified protein derivative (PPD) testing, Ishihara color testing, visual acuity testing, electrocardiograms (EKG), chest radiography, urinalysis, and labs. The servicing organization must be able to provide mobile support and fixed facility services in all 50 states (CONUS and OCONUS), the District of Columbia, Guam, Panama Canal, Puerto Rico, Virgin Islands. There must be an option of mobile unit support to be able to go to locations or hiring events for multiple same day physical exams.

IV. Tasks *(Asterisk) Indicates items that are not required, but if available, would provide additional benefit to the government / contract.

Task Number Work Requirements Projected completion date

1 Comprehensive Physical Exam Within two weeks of task order

Attachment A-SOW_Amend0005

1.1 Functional Capacity Examination Within two weeks of task order

1.2 Audiometric Testing w/ report Within two weeks of task order

1.3 Spirometry Testing (Pulmonary Function Test) Within two weeks of task order

1.4 PPD/Tuberculosis Skin Test/Reading Within two weeks of task order

1.5 PPD/Tuberculosis Screening (Screening Form Only) Within two weeks of task order

1.6 Chest X-Ray Services Within two weeks of task order

1.7 Laboratory Services Within two weeks of task order

1.8 Immunizations Within two weeks of task order

1.9 COVID-19 Testing Within two weeks of task order

2.0 Documentation of all Required Services Within two weeks of task order

2.1 OSHA Respirator Questionnaire Document Within two weeks of task order

2.2 *Quantitative respirator Fit Testing Within two weeks of task order

2.3 *Audiologist Consultation for Problem Audiograms Within two weeks of task order

Task 1.0 Comprehensive Physical Exam

All components of the comprehensive physical examination must be performed, witnessed, or reviewed by a physician, physician assistant/associate, or nurse practitioner. The Comprehensive Physical Exam must be documented on FORM CG 719-K “Application for Medical Certificate”. The CG 719-K must be filled out in its entirety (sections 1-10) and include recommendations for issuance of a medical certificate.

This physical exam must have the option of a mobile unit to come directly to a new hire event or a location with the intentions of multiple same day physical exams.

Task 1.1 Functional Capacity Examination (FCE)

An FCE is a more in depth and active review of an individual's capacity to perform work activities related to the participation in employment. The FCE process compares the individual's health status and body functions and structures to the demands of the job and the work environment. These types of specific medical examinations must be valid, reliable, and reproducible. All components of the functional capacity examination must be performed, witnessed, or reviewed by a physician, physician assistant/associate, nurse practitioner or occupational therapist. If these components require the skills of a physical or occupational therapist, those tasks may be performed by a physical or occupational therapist or their assistants if it is within their scope of practice. The medical provider will have the applicants demonstrate the ability perform tasks listed in Table 9, Column 3 by using techniques that allow for a more in depth interpretation of one's physical ability (e.g., they may have an individual walk across an uneven surface in a controlled setting to get as close to a real-world demonstration as possible).

Task 1.2 Audiometric Testing with report.

Audiometric testing shall be performed by a physician, audiologist, or other technician who is certified by the Council of Accreditation in Occupational Hearing Conservation. Audiometric test frequencies shall include: 500 Hz, 1,000 Hz, 2,000 Hz, 3,000 Hz, 4,000 Hz and 6,000 Hz with a printable report.

Requirements for test equipment and calibration must conform, at a minimum, to the calibration and audiometric test requirements set forth in the hearing conservation amendment 29 CFR1910.95(g) to the occupational noise exposure standard. All audiometric exams performed as part of the Agency's Medical

Examination Program must take place in an appropriate test environment that does not interfere with the accuracy of the audiometric test thresholds.

Task 1.3 Spirometry Testing (Pulmonary Function Test)

A pulmonary function test and report must include forced vital capacity (FVC), forced expiratory volume in one second (FEV1) and FEV1/FVC ratio, administered by a Physician, Physician Assistant/Associate, Nurse Practitioner, Registered Nurse or other medical technician with a current certificate from a National Occupational Safety and Health (NIOSH) approved spirometry course.

Task 1.4 PPD/Tuberculosis Skin Test/Reading

All Professional Mariner applicants for a new position within OMAO will be required to undergo testing for tuberculosis. Acceptable testing includes Purified Protein Derivative (PPD), QuantiFERON Gold, or T-spot (quoted separately).

Task 1.5 PPD/Tuberculosis Screening (Screening Form Only)

Professional Mariners presenting for a continuation physical will be required to undergo tuberculosis screening utilizing NOAA Form 57-10-02.

Task 1.6 Chest X-Ray Services

The testing center will have capabilities to refer or obtain a chest radiograph (PA and LAT Screening CXR) when requested by Marine Health Services to identify any chest/lung abnormalities.

Task 1.7 Diagnostic Laboratory Services

The testing center will be able to refer or obtain as needed diagnostic laboratory testing requested by Marine Health Services including (but not limited to): Urinalysis (or Urine Dip), Hemoglobin A1C, Complete Blood Count (CBC), Hematocrit/Hemoglobin (H/H), Comprehensive Metabolic Panel (CMP), Fasting Blood Glucose (Finger Stick Acceptable), Lipid Panel (LP), MMR Titer, Hepatitis A Titer, Hepatitis B Titer, and Varicella Titer to assist in screening for certain medical disorders, monitor effectiveness of therapy for chronic medical conditions, and provide baseline information regarding organ functions.

Task 1.8 Immunizations

The testing center will be able to refer or provide routine and travel immunizations when requested by Marine Health Services including Seasonal Influenza, Tetanus (Td or Tdap), Measles, mumps, and rubella (MMR), Hepatitis A and B, *Pneumococcal, *Varicella, *Shingles (Zoster), *Yellow Fever, *COVID-19.

Task 1.9 COVID-19 Testing

The testing center will be able to perform COVID-19 testing when requested by Marine Health Services by means of an antigen test, and *molecular test(s) such as polymerase chain reaction (PCR) test or RT- LAMP Test.

Task 1.10 Mobile On-Site Services

A contractor shall provide mobile team is required to service on-site at new hire event or a location with the intentions of multiple same day physical exams. The team would include the necessary medical staff and equipment as required by the Task Order SOW. The duration of the mobile on-site services is predicted to be no more than eight hours, however the time duration may be less per the Task Order

SOW.

Task 2.0 Documentation of all Required Services

The testing center will be able to complete the required documentation utilizing the Form CG 719-K, OSHA approved respirator medical evaluation questionnaire, tuberculosis screening NOAA Form 57-10- 02, audiology history questionnaire and acquire any results (or print outs) of laboratory studies, chest radiographs, PFT results, or EKG results. We must be able to download directly from the contractor’s HIPAA approved EHR via a web link, received via fax, or received via secure email (sent to marine health services) within 72 hours of completion. A physician, physician assistant/associate, or nurse practitioner will be able to attest the physical requirements as outlined in Table 9, Column 3 physical examination have been met or not met after examination.

Task 2.1 Respirator Medical Clearance Evaluations

The testing center will be able to complete an evaluation to assess physically ability to wear a respirator and identify any symptoms or conditions that could undermine the effectiveness of a respirator by means of the OSHA Respirator Medical Evaluation Questionnaire or a medical examination that obtains the same information per OSHA protocols.

*Task 2.2 Quantitative Respirator Fit Testing

The testing center will be able to complete fit testing via qualitative test using Bitrex or saccharin or quantitative tests using a PortaCount or another appropriate instrument according to OSHA fit testing requirements.

*Task 2.3 Audiologist Consulting for Problem Audiograms

The testing center will be able to provide an audiologist who can identify abnormal/problem audiograms, confirm a standard threshold shift (STS) had occurred, establish a new baseline audiogram, and provide recommendations for further evaluation and management per OSHA requirements.

Policy/Directives/Handbooks

NOAA Marine Medical Policy Manual (NMMPM)

The National Oceanic and Atmospheric Administration (NOAA) Marine Medicine Policy Manual provides physical and medical standards required for civilian professional mariners to sail on NOAA ships, waivers to the established medical standards, and medical clearance for scientists and other non- NOAA embarked personnel. This manual is also a source for individuals assigned/determined by NOAA’s Office of Health Services to oversee medical practices for civilian professional mariners (CPMs), which includes wage mariners and commerce alternative personnel (CAP), other civil service personnel, scientists, and other embarked personnel onboard NOAA ships. Marine Medicine staff, shall review all received medical documents for completion, thoroughness and applicability.

Credentialing and Privileging

Marine Medicine explicitly disclaims any responsibility for the credentialing and privileging process of contracted personnel engaged in the provision of physical exams, as mandated by the terms outlined in this agreement. The singular responsibility for ensuring that their personnel possess valid licensure, appropriate credentials, and requisite training, as well as the necessary privileges to execute the tasks itemized herein, rests solely with the employer. This provision underscores the legal demarcation of responsibilities and underscores the imperative for the employer to uphold compliance with regulatory and licensing requirements.

Place of Performance

The servicing organization must be able to provide mobile and fixed location support for personnel in all 50 states (CONUS and OCONUS), the District of Columbia, *Guam, *Panama Canal, *Puerto Rico, *Virgin Islands.

Period of Performance

The anticipated Indefinite Delivery, Indefinite Quantity (IDIQ) is for 60 month ordering period.

Medical Qualifications (or Special Qualifications)

Sample Text: Medical qualifications are conducted IAW Part 339 of Title 5, Civilian Personnel Authority.

Quality Control

Contractor performance will be monitored by the government using the standards as outlined in this Statement of Work (SOW) and methods of surveillance detailed in the Quality Assurance Surveillance Plan (QASP). The QASP shall be attached to the resultant contract vehicle and shall define the methods and frequency of surveillance conducted.

All documents received are reviewed for completeness and accuracy and shall be returned to the sender in the event that forms are incomplete, inaccurate or invalid.

Protection of Personally Identifiable Information (PII)

Adequate security controls for collecting, processing, transmitting, and storing of Personally Identifiable Information (PII), as determined by NOAA Privacy Act Statement, must be in place, tested, and approved by NOAA prior to hosting, operation, maintenance, or use of the information system, or systems by or on behalf of NOAA. These security controls are to be assessed and stated within the Privacy Act Statement and if these controls are determined not to be in place, or inadequate, action must be submitted and approved prior to the collection of PII.

Confidentiality

The contractor shall adhere to all professional and legal standards of confidientiality of records consistent with the needs and requirements related to specific medical services including Health Insurance Portability and Accountability Act (HIPPA).

Documentation and Forms

● CG 719K “Application for Medical Certificate” (Standard Form)

● Functional Capacity Evaluation (Attachment 3)

● Audiometry Questionnaire and Results (Per Vendor)

● Respirator Questionnaire and Spirometry Results (Per Vendor)

● PPD/Tuberculosis Screening (Attachment 4)

● PPD/Tuberculosis Results (Per Vendor)

● Chest X-Ray Results (Per Vendor)

● Diagnostic Lab Results (Per Vendor)

● Immunization Documentation/Administration (Per Vendor)

● COVID-19 Results (Per Vendor)

● Quantitative Respirator Fit Testing (Per Vendor)

Attachments:

1. Table 9, Column 3

2. Functional Capacity Evaluation Form

3. NOAA Form 57-10-02 Tuberculosis Screening Document

4. Audiology Questionnaire (upon request)

5. Respirator Questionnaire (upon request)

Attachment 1: Table 9. Physical Ability Requirements and Demonstration

Shipboard Task, Function, Event, or Condition

Related Physical Ability

Applicant Must Demonstrate Functional Capacity Evaluation

Examples of Potential Techniques

(If FCE Requested)

Routine movement on slippery, uneven, and unstable surfaces, on a potentially pitching and rolling ship

Maintain balance (equilibrium) and move with agility

No abnormality of balance or gait

Specific, but not exclusive, tests to pass: Romberg, pronator drift, heel-to-shin, heal-to-toe walking, and observation of walking

No impairment or disease that prevents or limits any of the movements and physical activities listed in this table.

Walk across an uneven surface

Routine access between deck levels

Climb up and down ladders and stairways

Full range of motion (ROM) and full muscle strength of upper and lower extremities and spine

More specifically, but not exclusively, must have full ROM and strength of ankles, knees, hips, and spine

Go up and down ladders or stairs

Condition

Related Physical Ability

Applicant Must Demonstrate Functional Capacity Evaluation

Examples of Potential Techniques

(If FCE Requested)

Routine movement between constricted spaces, compartments, or restricted openings

Step over a door sill or coaming that is 24 inches (in) (61 cm) in height, and move through a rigid, restricted opening of 24 in x 24 in (61 x 61 cm)

Full ROM and full muscle strength of upper and lower extremities and spine exclusively, must demonstrate full ROM and strength of ankles, knees, hips, and spine

Step over a height of 24 in and fit through an opening of 24 in x 24 in

Enter through watertight doors, utilize hand-cranking systems, and valve wheels

Manipulate mechanical devices to open and close valve wheels in vertical and horizontal directions

Full ROM and full muscle exclusively, demonstrate full ROM and strength of both shoulders, elbows, wrists, hands, and fingers

Open and close (simulated or otherwise) valves or watertight doors

Handle ship’s stores Lift, pull, push, and carry a load of up to 40 lb

Full ROM and full muscle strength of upper and lower extremities and spine

Lift a 40-pound load off the ground, and carry, push, or pull it, using safe techniques and body mechanics

Condition

Related Physical Ability

Applicant Must Demonstrate Functional Capacity Evaluation

Examples of Potential Techniques

(If FCE Requested)

General vessel maintenance

Crouching, kneeling and stooping and utilizing hand tools, such as spanners, valve wrenches, hammers, screwdrivers, and pliers sometimes above one’s head

Full ROM and full muscle exclusively, must be able to do the following: Squatting then rising, crouching, and walking (“duck walk”)

Full ROM and strength of both shoulders, elbows, wrists, hands, and fingers

Manipulate common tools (objects), crouching and walking, kneeling, and stooping

Reaching above head to grasp an object

Emergency response procedures, including escape from smoke-filled spaces

Crawl (the ability to move the body on hands and knees) to escape from smoke-filled spaces

Full ROM and full muscle strength of upper (e.g., shoulders, elbows, wrists, hands, and fingers) and lower extremities and spine do the following: squatting then rising, crouching, and walking (“duck walk”)

Intact sensory abilities (to sense differences in texture and temperature)

Manipulate common tools (objects), crawling, crouching and walking, kneeling, stooping

Reaching above head to grasp an object

Condition

Related Physical Ability

Applicant Must Demonstrate Functional Capacity Evaluation

Examples of Potential Techniques

(If FCE Requested)

Stand a routine watch

Stand and/or walk for 4–8 hours with minimal rest periods and remain awake and mentally alert for a 4-8 hour shift

Full ROM and full muscle strength of upper and lower extremities and spine, (including a thorough foot exam)

Erect posture while standing

Normal gait while walking

Also, refer to visual, hearing, communication, and maritime adaptability standards engage in conversation without cognitive delay or incoherent speech

See hearing and visual standards

Emergency response procedures: react and respond to visual alarms, warnings, and instructions

Visually distinguish objects, shapes, and signals

Fulfills the eyesight

See Section 10 of Physical Standards for Civilian Mariners and Embarked Personnel

N/A, possible RAI to optometry or ophthalmology

Condition

Related Physical Ability

Applicant Must Demonstrate Functional Capacity Evaluation

Examples of Potential Techniques

(If FCE Requested)

Emergency response procedures: react to audible alarms, warnings, and instructions

Hear, distinguish, and understand warnings, alarms, and instructions

Fulfills the hearing standards. See Section 10 of Physical Standards for Civilian Mariners and Embarked Personnel

N/A, possible RAI to audiology or ear, nose, throat (ENT) specialist

Make verbal reports or call attention to suspicious or emergency conditions

Describe immediate surroundings and activities in clearly pronounced words

Capable of conversation, comprehension and appropriate responses and can take verbal instruction for action.

engage in conversation without cognitive delay or incoherent speech and/or pass appropriate screening tools such as the Montreal Cognitive Assessment

(MOCA)

See hearing and visual

Condition

Related Physical Ability

Applicant Must Demonstrate Functional Capacity Evaluation

Examples of Potential Techniques

(If FCE Requested)

Participate in firefighting activities

Use a breathing apparatus

Carry and handle fire hoses and fire extinguishers: pull an uncharged 1.5-inch diameter, 50-foot fire hose with nozzle to full extension, and lift a charged 1.5-inch diameter fire hose to fire-fighting position

Full ROM and full muscle strength of upper and lower extremities and spine.

More specifically, but not exclusively, demonstrate the following:

Full ROM and strength of both shoulders, elbows, wrists, hands, fingers, ankles, knees, hips, spine

Has no condition that is likely to impair their ability to safely tolerate wearing a respirator/ breathing apparatus

Lift a 40-pound load off the ground, and carry, push, or pull it. (Using safe techniques and body mechanics)

Abandon ship Take part in emergency vessel evacuation procedures

Don a lifejacket or immersion suit in under 2 minutes

Pull full body weight up into a life raft in potentially rough seas

Full ROM and full muscle

Refer to visual, hearing, communication, and maritime adaptability exclusively, confirm the following: full ROM and strength of both shoulders, elbows, wrists, hands, fingers, ankles, knees, hips, and spine

Don an immersion suit in under 2 minutes (in-house).

Lift a 40-pound load off the ground, and carry, push, or pull it (using safe techniques and body mechanics)

Condition

Related Physical Ability

Applicant Must Demonstrate Functional Capacity Evaluation

Examples of Potential Techniques

(If FCE Requested)

Environmental:

Workplace hazards that cannot be fully eliminated, such as temperature, excessive dust, noise, or biological and chemical agents, austere environments.

Maritime adaptability

Can satisfy components of a general mental status examination, including but not limited to, (normal) cognitive function, memory, communication, attention, concentration, object identification, and an ability to follow basic commands, and use abstract reasoning and sound judgment and/or pass/clear appropriate screening tools such as the Montreal Cognitive Assessment (MOCA) and/or PHQ-2 (depression screener).

N/A, [possible RAI from psychology or psychiatry]