PWS Lock Out Tag Out 2026 Chilicothe VAMC Revised 9.14.2026.pdf

Performance Work Statement

Title: Lock Out – Tag Out (LOTO)

Date: As of 6-16-2026

1. Background:

The Chillicothe VAMC requires performance-based services to ensure machines, equipment, and related components are properly stopped, isolated from hazardous energy, and locked out before maintenance or servicing to prevent unexpected energization or start-up, in accordance with ANSI and OSHA requirements.

2. Place of Performance:

Chillicothe, Ohio Veterans Affairs Medical Center (VAMC) 17273 State Route 104, Chillicothe, OH 45601.

3. Period of Performance:

Base Year: Date of award through one year Option Years: Four (4) one-year option periods, for a total potential period of five (5) years

4. Scope of Work:

The Contractor shall provide all labor, materials, supervision, equipment, and services necessary to develop, implement, and annually review graphical Lock Out Tag Out (LOTO) procedures for all identified equipment at the Chillicothe VAMC.

Work includes creating graphical LOTO procedures to ensure the machines, equipment, and other components and systems is stopped, isolated from all potentially hazardous energy sources, and locked out before employees perform any servicing or maintenance where the unexpected energization or start-up of the machine or equipment or release stored energy, developing and affixing placards, providing digital and hard copy documentation, labeling assets, training VA employees, and evaluating additional equipment annually as required.

5. Conformance Standards:

All work shall meet or exceed the following standards:

• OSHA 29 CFR 1910.147 – Control of Hazardous Energy

• OSHA 29 CFR 1910.301-399, Subpart S – Electrical

• ANSI standards as applicable

• VA policies and procedures as provided in contract documents

6. Qualifications of Contractors:

Contractors must demonstrate documented experience with electrical safety programs and implementation of OSHA/ANSI LOTO programs in healthcare or similar environments.

7. Codes and Standards:

29 CFR 1910.147: Control of Hazardous Energy (LOTO) 29 CFR 1910.301-399, Subpart S: Electrical Standards ANSI Z244.1 – Control of Hazardous Energy All applicable VA policies and regulatory guidance

8. Specific Tasks and Deliverables:

Develop Graphical LOTO Procedures:

• Create a minimum of 454 equipment-specific, graphical procedures.

• Each procedure shall incorporate direct collaboration with assigned VA electricians for field verification; reliance on drawings alone is not allowed.

• Where shutdowns are not possible, contractors and VA personnel will create procedures that ensure safe, effective verification of energy isolation.

Provide and Affix Placards:

• Provide durable, laminated placards for each asset.

• Placards must be attached to the equipment and clearly display the correct

LOTO procedure.

Create Documentation Binders:

• Two tabbed and indexed binders listing all covered equipment, locations, and associated procedures.

• Deliver digital and hard copy files to COR.

Asset Labeling:

• Include asset number labels on all covered equipment.

Annual Review & Additional Assets:

• Perform annual review; update LOTO program as equipment inventory changes.

• First year to cover base list of 137 assets from VA Chillicothe Engineering and each option year will be a minimum of 90 assets. Assets to be included in option years will be provided prior to coordinated visits

Training:

• Required training: All employees in the Engineering/Facilities Management, approximately 75 employees and annual, in person training on LOTO regulations and facility-specific LOTO procedures. Specifics will be discussed with the COR.

Collaboration and Scheduling:

• Coordinate with VA Facilities and Engineering to minimize operational disruption.

• Provide service with minimal/no operational downtime. When equipment cannot be shut down, collaborative hazard analysis with VA electricians is required.

9. Covered Equipment:

All machinery and equipment designated by Chillicothe VAMC Engineering, initially identified as 137 assets and increasing up to 454 during the contract period. Asset lists will be updated at each annual review. A complete inventory will be provided to the Contractor at project initiation and annually thereafter.

10. Hours of Operation:

Scheduled service will be performed during normal business hours which considered to be Monday-Friday 7:30am to 4:00pm, (excluding the Federal Holidays of New Year’s Day; Martin Luther King Day; President’s Day; Memorial Day; Independence Day; Labor Day; Columbus Day; Veteran’s Day; Thanksgiving Day; Christmas Day; and any other declared Federal Holiday by the President of the United States).

11. Reporting Requirements:

The Contractor shall be required to schedule an appropriate service date with Facilities Management for the equipment to be taken out of service with little or no disruption to the normal operation of the VA Medical Center. The Contracting Officer Representative (COR) shall have the final approval of the time for the Emergent Maintenance.

Contractors shall check in with the Engineering Department currently located on the NE side of Building 21. Scheduled service will be performed during normal business hours which considered to be Monday-Friday 7:30am to 4:00pm, (excluding the Federal Holidays of New Year’s Day; Martin Luther King Day;

President’s Day; Memorial Day; Independence Day; Labor Day; Columbus Day;

Veteran’s Day; Thanksgiving Day; Christmas Day; and any other declared

Federal Holiday by the President of the United States).

Checking in is mandatory. When the service is complete, the Contractor shall document services rendered on a legible field service report. The Contractor shall log out at the Facilities Management Office and submit the field service report to the Contracting Officer Representative (COR) for a signature, during normal working hours.

If this work is to be performed after normal work hours, then check-in will occur with the Utility Systems Employee on Duty, at the Energy Center, Building 261. This area is staffed 24 hours/day and 7 days a week

12. Safety Requirements:

In the performance of this contract, the Contractor shall take such safety precautions as OSHA may determine to be reasonably necessary to protect the lives and health of occupants of the building. The Contracting Officer shall notify the Contractor of any safety issues and the action necessary to correct these issues. Such notice, when served on the Contractor or his representative at the work site shall be deemed sufficient for the corrective actions to be taken. If the Contractor fails or refuses to comply promptly, the Contracting Officer may issue an order stopping all or part of the work and hold the Contractor in default.

13. General Security:

Contractors, contractor personnel, subcontractors, and subcontractor personnel shall be subject to the same Federal laws, regulations, standards, and VA Directives and Handbooks as VA and VA personnel regarding information and information system security.

Contractor is also responsible for checking in with the Engineering Department northeast side of building 21. The contractor will sign out a temporary badge for all contractor/subcontractor personnel. Every worker must have a badge and form of identification when working on VA property and is subject to VA security checks and enforcement actions while working on VA property.

14. Risk Control:

Work performed within the Chillicothe VAMC may present health risks including exposure to illness and infection control. Contractor will take action to recognize and follow warning information throughout the facility.

15. Performance Requirements Summary:

PWS Task Performance Standard

Acceptable Quality Level (AQL)

Surveillance Method

Incentive Rating

(Met/Not Met AQL)

Develop graphical LOTO procedures for all identified assets

100% completion by end of the contract

90% Compliance

Inspection and review of contractor records quarterly

Satisfactory performance results in positive CPARS review

Met / Not Met

Submit LOTO procedure documentation to COR

Procedures submitted within 30 business days of completion

90% Compliance

Review of records and submission dates

Continued eligibility for future contracts, positive past performance

Met / Not Met

Address identified deficiencies in procedures

Correction within 10 business days of notification

100%

Compliance

Review of records, inspection follow-up

None;

Noncompliance may result in a Contract Discrepancy Report (CDR)

Met / Not Met

Attach placards to the equipment

100% completion by end of the contract

90% Compliance

Direct observation Satisfactory performance results in positive CPARS review

Met / Not Met

16. Quality Control Program Requirement –

a. General Requirements: The contractor shall establish, implement and maintain a comprehensive Quality Control Program (QCP) to ensure all services are performed in accordance with the Performance Work Statement and the metrics outlined in the Performance Requirements Summary.

b. Submissions and Updates: The contractor shall submit a detailed written Quality Control Plan the Contracting Officer (CO) and the Contracting Officer’s Representative for review and approval within 14 calendar says of contractor award. Contractor shall update the plan annually or within 7 calendar days of any significant changes to the internal process.

c. Inspection System: The QCP must detail the Contractors internal inspection mechanics, covering all tasks and deliverables. The plan must specify the metrics tracked, the frequency of internal audits, and identify by name or role the specific personnel responsible for conducting the inspections.

d. Deficiency Resolution: The QCP must include a clear methodology for identifying, tracking and correcting deficiencies in service quality. It must prevent the recurrence of defective work without relying on government intervention.

e. Record Keeping and Audits: The contractor shall maintain records of all internal inspections, including corrective actions taken. These records shall be made available to the government upon request at any point during contract performance. T

f. NOTE: The QCP shall be in compliance with the following OSHA standards:

a) Code of Federal Regulations, Title 29, part 1910.147, “The Control of

Hazardous Energy (Lockout and Tagout)”

b) Code of Federal Regulations, Title 29, part 1910.301-399, Subpart S, “Electrical”

c) OSHA Letters of Interpretation