Medical Exam PWS SAF 6.24.25.pdf

PERFORMANCE WORK STATEMENT (PWS)

1. General Information

1.1 Description

U.S. Secret Service law enforcement personnel are required to meet certain medical and fitness standards. The contractor shall provide medical examination services to include USSS designated documentation and upload of medical information via a proposed staff/employee-patient portal (if available) for all incumbents and applicants in the USSS Mandatory Medical Examination Program.

1.2 Contract Type

This contract shall be a Firm Fixed Price Contract.

1.3 Period of Performance

The period of performance is for one (1) Base Period and three (3) Option Periods, which includes transition in and transition out periods, respectively.

1.4 Place of Performance / Delivery

The work to be performed under this contract will be performed at the contractor’s facility and Government facilities (USSS HQ Clinic and USSS Field office locations) (to include Puerto Rico, Alaska, and Hawaii), excluding Outside Continent of the United States

OCONUS.

There will be a need for occasional in-person meetings at USSS facilities in Washington, D.C., as necessary.

1.5 Recognized Holidays

The contractor is not required to perform services on the following holidays.

New Year’s Day Labor Day Martin Luther King Jr.’s Birthday Columbus Day President’s Day Veteran’s Day Memorial Day Thanksgiving Day Juneteenth Day Christmas Day Independence Day

1.6 Hours of Operation

The contractor is responsible for conducting business, between the hours of 8:00am – 4:30pm Monday thru Friday except Federal holidays or when the Government facility is closed due to local or national emergencies, administrative closings, or similar Government directed facility closings. For other than firm fixed price contracts, the contractor will not be reimbursed when the Government facility is closed for the above reasons. The contractor must always maintain an adequate workforce for the uninterrupted performance of all tasks defined within this PWS when the Government facility is not closed for the above reasons. When hiring personnel, the contractor shall keep in mind that the stability and continuity of the workforce are essential.

The working hours for the HQ Health Unit will be from 8:00am – 4:30pm, Monday through Friday as detailed except Federal holidays or when the Government facility is closed due to local or national emergencies, administrative closings, or similar Government directed facility closings. The contractor must at all times maintain the following key personnel during working hours: Physician Assistant or Nurse Practitioner, Nurse Manager, Medical Assistant, and Staff Nurse. The contractor staff support for the HQ Health Unit may be required to work shift hours, and/or overtime. The COR will notify the contractor’s program manager of this requirement.

1.7 Key Personnel

The following personnel are considered key personnel by the Government: Contract Manager, Assistant Contract Manager, Physician Assistant, or Nurse Practitioner, Nurse Manager, Medical Assistant, and Staff Nurse. The contractor shall provide a contract manager who shall be responsible for the performance of the work. The name of this person and an alternate who shall act for the contractor when the manager is absent shall be designated in writing to the contracting officer. The contract manager or alternate shall have full authority to act for the contractor on all contract matters relating to daily operation of this contract. The contract manager or alternate shall be available between the hours of 8:00 a.m. to 4:30p.m., Monday thru Friday except Federal holidays or when the Government facility is closed for administrative reasons.

1.8 Subcontracting Plan

The contractor shall provide a subcontracting plan for the teaming partner that may be used to fulfill the requirements in this PWS. The plan should include the following:

Subcontracting Goals Subcontractor Identification Outreach Efforts Reporting Requirements Good Faith Effort Performance and Compliance Submission of Individual Subcontract Report (ISR) and the Summary

Subcontract Report (SSR) using the Electronic Subcontracting Reporting System (eSRS).

1.9 Phase In/Transition

To minimize any decreases in productivity and to prevent possible negative impacts on additional services, the contractor shall have personnel on board, during the thirty (30) day phase in/ transition periods. During the phase in period, the contractor shall become familiar with performance requirements to commence full performance of services on the contract start date. The Contractor shall provide a Phase In/Transition for the below items:

Initial start of performance.

Process the transitioning predecessor employees.

Recruitment of new employees.

Strategy for implementing supervisory functions.

Status report on submitting applications for personnel clearances.

Provide timeline showing the transition plan’s critical dates.

1.10 Billing

1. All invoices for examinations, laboratory tests, reviews and evaluation services and other services rendered under this agreement shall be submitted directly by contractor to the COR monthly under the online payment and collection system.

All contractor billing errors shall be reported in writing by the COR and charged back to the contractor.

2. In the event that any invoice or payment will be reduced for any of the performance reasons described in various sections of this contract (for example Section 1.12.2), the Contracting Officer will (a) provide written notice to the Contractor informing it of the intended reduction and the reason(s) therefore; (b) allow the Contractor five business days to provide a written response; and (c) make a final written determination on the issue before the reduction is made.

3. It should be noted that the USSS anticipates that there will be no show and/or canceled appointments during the contract. However, no show and/or canceled appointments are not separately priced and therefore, not billable under this effort. The successful offeror must be sure to include the expected cost, if any, of no show and/or canceled appointments in the price of the services as outlined in the PWS.

4. The USSS shall not be invoiced for more than one assessment charge per physical examination to determine an individual's "fitness for duty” or suitability for hire. Additional components of an examination that are received after the initial examination is considered part of the whole assessment and shall not be billed separately.

5. The contractor shall submit detailed billing reports for every service provided:

the employee/applicant’s name, itemized list of services, unit cost of services, date of service, and location delivered. The contractor shall provide a bundled cost for services provided in the HQ Health Unit.

1.11 Records Management and Retention

1. Employee records, including but not limited to medical records, shall be stored and handled in compliance with the Code of Federal Regulations, 5 CFR Part 293.101 to 293.511, Personnel Records. Only the USSS Medical Officer, Contractor physician and medical staff (and those authorized in accordance with 29 CFR 1960) shall have access to the results of the examinations.

2. Acceptable security containers are defined as metal cabinets or vaults, which contain combination of, key locks, and which are in areas not accessible to the general public or visitors.

3. The USSS, SAF is the repository of all employee’s medical examination records; all records shall be turned over or destroyed at the Government’s request. Medical examinations (both paper and electronic) for Law Enforcement positions described in this PWS are the sole property of the USSS and disclosures will only be in accordance with the Privacy Act of 1974.

4. The Contractor (and/or any subcontractor) shall maintain all information in accordance with Executive Order 13556 – Controlled Unclassified Information, National Archives and Records Administration (NARA) records retention policies and schedules and USSS policies and shall destroy records thirty (30) days after contract ends unless authorized in writing by the COR.

5. USSS is in the process of developing an Electronic Medical Records (EMR)

System. Upon the successfully completion of the EMR system, the awardee of the medical examination services contract; the contractor of the (medical examination services contract) will be required to work closely with EMR contractor to transfer all medical examination documents (i.e. exam reports, lab results, etc.) into the new EMR system. Prior to introduction of the new EMR System, the medical services provider will use the currently approved system provided by the US Secret Service.

1.12 Contract Oversight

1. The contractor is responsible for the quality and timeliness of all services and products under this PWS. The contractor shall monitor pending exams/tests and follow up with facilities to ensure the completion of services are within required timeframes stated in this PWS.

2. All forms shall be completed in their entirety. Incomplete examinations shall not be accepted by the USSS. Personally Identifiable Information (PII) shall be correct, comprehensive, and decipherable on all documents in each file received by the USSS. It is the responsibility of the contractor to contact the examining facility to obtain any missing portions of the physical, examination report or laboratory reports. Examining physician shall complete all sections of the examining form (SSF 3300) to include interpretation of the electrocardiogram, conducted and normal/abnormal.

Submission of an exam containing missing items will result in a reduction of payment of $10.00 per missing item and must be reported in the monthly report.

3. If any findings are based on the inconclusive results of a test conducted as part of the physical examination or examining physician has not provided sufficient documentation concerning medical conditions, the employee will be directed to return to the examining facility for re-testing at the contractor’s expense.

4. The contractor shall insure that all USSS employees and applicants are able to begin the examination and testing process within twenty (20) minutes of the scheduled appointment time.

Failure to meet this schedule shall be considered unacceptable performance on the part of contractor or any subcontractor and may result in a reduction of payment of $10.00 per individual employee or applicant beyond 1 hour of the scheduled appointment time.

5. If the examining facility does not perform a required test on an applicant and the applicant is over 50 miles from the contractor facility, arrangements shall be made to conduct the test in a facility in relative proximity to the applicant.

6. The USSS will provide the contractor with an obligated threshold amount at the beginning of each month to ensure the contractor is within the threshold when scheduling applicants and incumbents’ exams. If the obligation amount exceeds the threshold, the contractor shall stop scheduling exams and notify the COR immediately for authorization to continue scheduling.

7. The contractor shall submit monthly reports electronically to the USSS COR consisting of the status of pending exams, upcoming appointments, exams delivered (with employee name, DOB, and last 4 of the SSN), status of contractor sites for USSS areas without medical facilities, reports for testing performed for all Law Enforcement Instructors, and an updated address and physician list of all contractor and subcontracted facilities. The contractor shall so provide a list of services completed in the HQ Health Unit.

8. The contractor shall have at a minimum, a telephonic via Microsoft Teams, or in person meeting once per quarter throughout the fiscal year, without cost to the USSS. The contractor shall have at a minimum, regular contact with the USSS COR every other week, telephonically or face to face as needed. This will be without cost to the USSS.

9. The contractor shall have a contingency plan in place to ensure temporary replacement personnel, such as medical assistants, providers (e.g., physician assistants, nurse practitioners), and nurses are available on an as needed (i.e., backup) basis to perform the requirements in section 2.2 of this PWS in the event of the sudden absence of the specified personnel assigned to the HQ

Health Unit. Failure to replace staff for HQ Health Unit may be considered a material breach of the contract at the USSS’ sole discretion.

2 Requirements/Tasks

2.1 Background

There is an estimated number of 6,000 USSS employees who are subject to the mandatory medical program requirements. The below table outlines the volume of exams performed annually and immunizations given.

Fiscal Year

Incumbent Exams

Applicant Exams

Total

FY20 1608 802 2410

FY21 2727 1785 4512

FY22 1991 921 2912

FY23 934 421 1355

Immunizations

FY20 FY21 FY22 FY23

2502 792 862 1733

2.2 Scope

The contractor shall provide medical examination services for incumbents and applicants.

The contractor shall upload medical information via a government-provided staff/employee-patient portal (if available).

The contractor shall provide all necessary staff, materials, services, and equipment to provide pre-employment, mandatory, and medical surveillance examinations detailed in this performance work statement (PWS) for the USSS nationwide (to include Puerto Rico, Alaska, and Hawaii). All USSS required forms will be provided to the contractor. The contractor will maintain copies of examination form (SSF3300A and SSF3300) without cost to the USSS.

All USSS physical examinations shall be conducted by a state licensed, board certified or board eligible physician, physician assistant, and nurse practitioner in internal, family practice, preventative, or occupational medicine.

The contractor shall provide complete physical examinations for all employees and applicants in the USSS Mandatory Medical Examination Program for SAF to determine the examinee’s ability to perform strenuous physical exertion and to identify any physical defects or abnormalities which would restrict or prohibit the employee's participation in required physical fitness testing, defensive tactics, training, or dangerous assignments which may require the use of firearms or physical force.

The contractor shall provide designated medical surveillance testing to specific employees who are potentially exposed to hazardous chemicals, excessive noise, lead, and other occupational hazards.

The contractor shall provide medical specialty services concerning specific employee “Fitness for Duty” issues, as designated by the USSS Medical Officer, or designee. This shall include Independent Medical Examinations as stated on the Fee Schedule.

The contractor shall provide immunizations for eligible employees. Outreach services shall be provided using registered nurses for incumbents and recruits (Mobile clinics if available), All tests conducted in conjunction with the physical examination shall be conducted only by certified medical or health technicians or nurses specifically trained in the use of the required examination instruments including EKG, audiometric testing equipment, visual testing equipment, pulmonary function, and any other technical equipment necessary for completion of the medical examination program.

All laboratory testing and analysis of body fluids shall be conducted at a laboratory facility that is licensed in accordance with the laws of the state in which it operates and all applicable federal license requirements.

Appropriate clinical tests shall be designated by the USSS Medical Officer or designee through the USSS Mandatory Medical Examination Program and performed by the contractor and subcontracted facilities. The examining medical provider shall discuss all clinical results of the physical examination with the employee at the time of the examination. Any findings, by the examining medical provider, that may significantly impact the health or safety of others (e.g., critical lab values, etc.), must be reported to the contractor program manager within 24 hours by the vendor; the examining physician or examining facility should contact the examinee and render appropriate urgent care and/or guidance to the employee, as soon as possible. The contractor program manager shall notify the USSS Medical Officer or designee within 1 business days of occurrence. Any necessary medical follow up/referral (except in the case of a medical emergency) shall be determined by the USSS Medical Officer or designee.

Employees shall be able to provide blood and urine samples, and other diagnostic tests by appointment prior to the physical examination.

All USSS medical examinations for applicants and incumbents shall be completed as described in the USSS Mandatory Medical Examination Program policy manual, SAF- 03(01). Examinations that are incomplete will not be accepted. Incomplete exams include examinations without blood work, laboratory results or medical history; partial blood work and laboratory results; missing original electrocardiogram (EKG/ECG) tracings, examinations without or incomplete technical testing and measurements and/or examinations without complete medical documentation.

USSS employees shall receive the complete standard physical examination at intervals designated based on age or position as identified in the USSS Mandatory Medical Examination Program policy manual. For any medical examinations conducted same sex chaperones must be made available upon request.

The contractor medical provider(s), including subcontract medical providers, shall maintain sufficient malpractice insurance and appropriate state licensure during the term of the agreement. Contractor nursing and health professional staff shall maintain appropriate state licensure during the term of the agreement.

The contractor shall provide a certified Federal Motor Carrier Safety Administration (FMCSA) National Registry medical examiner (physician or physician assistant) capable of completing the medical certification for a USSS incumbent’s commercial driver’s license.

The contractor shall be able to provide EKG over-read services on applicant and incumbent exams.

(USSS) HQ Health Unit:

The contractor is responsible for supporting the day-to-day operations and the staffing of the Washington, D.C. area Headquarters’ (HQs) Health Unit under the oversight of the USSS Medical Officer.

The contractor shall provide all the necessary medical supplies, vaccines, labs, and materials for the HQ Health Unit. The contractor shall order, obtain, and process specimen collections for courier pick-up in accordance with clinical standards.

The following contract support staff will be required for the HQ Health Unit: Physician

Assistant (PA) or Nurse Practitioner (NP), Registered Nurse, Nurse Manager (RN), and a Medical Assistant (MA).

All support staff assigned to the HQ Health Unit shall hold current, valid, and unrestricted state licenses for their professional designation, board certification or board eligibility (if appropriate to their respective professional degrees or fields), and current and valid certification in Basic Life Saving/AED (via the Red Cross). In addition, any staff performing audiometry or spirometry should have a current and valid audiometry DOEHRS/CAOHC certification and spirometry NIOSH certification.

Full staffing shall be provided daily and according to the Hours of Operation in Sect. 1.6.

**On occasions, the USSS Medical staff may assist with performing examination services in the USSS HQ Health Unit as needed.

2.3 Examination Categories

2.3.1 Incumbent Mandatory Medical Examination Program

Category

1. Special Agents

2. Special Officers

3. Investigative Protection Officers

4. Technical Security Investigators

5. Protective Support Technicians

6. Operations Support Technicians

7. Physical Security Specialist

8. Unformed Division

9. Detection Systems Specialist

2.3.2 Medical Surveillance Programs

10. Firearms Instructors/Firing Range Maintenance Workers

11. Respirator Fitness Certifications

12. Counter Sniper Team (Uniformed Division

13. Special Services Division/Remote Mail Delivery Site Special Services Division/PST

Auto Technicians

14. Forensic Services Division (series/title specific employees- non- administrative personnel)

15. Any other employees who may require surveillance testing.

2.3.3 Pre-Employment Examinations (Categories 1-9 above)

2.3.4 Immunizations

All recommended immunizations shall be provided for incumbents listed below with scheduled official business travel. In the case of conflicting recommendations regarding travel immunizations, the USSS Medical Officer shall be contacted.

Special Agents Special Officers Investigative Protection Officers Technical Security Investigators Physical Security Specialists Protective Support Technicians Operations Support Technicians Criminal Investigative Division Uniformed Division Officers Civilian Employees going overseas on official business

2.3.5 Department of State Examinations (refer to section 2.6)

Incumbent Examinations

Incumbents (Categories 1-9)

Standard exam and testing: Physical examination, height and weight, vital signs, hearing testing, vision testing (to include uncorrected and corrected near and far visual acuity), color vision testing, depth perception vision testing, visual fields, resting electrocardiogram, laboratory testing (complete metabolic panel, complete blood count and urinalysis), are generally conducted in the incumbent's month of birth as required every two years. Hemoccult testing offered for incumbents after age 40 during physical examination.

Prostate-specific Antigen (PSA) Test - (Male). Optional at incumbent's request and in accordance with the most current American Cancer Society (ACS) recommendations.

Category (10) - Plumbism Blood Lead and Zinc Protoporphyrin (ZPP) testing to be conducted semi-annually for all Firearms Instructors assigned to the James J. Rowley Training Center (RTC) and/or the DC Post Office Range. For field-based Firearms Instructors, Plumbism testing will be performed at the time of their Mandatory Medical exam. For USSS Field Office and Protective Detail firearms instructors who have experienced an unusually high demand of firearms instruction or have reason to be concerned that they have been overexposed to Lead, additional testing may be requested on a case-by-case basis by the USSS Medical Officer or designee.

Category (11) - Respirator Fit Testing.

Category (12) – Histoplasmosis Testing.

Category (13) - Cholinesterase Testing.

Category (14) - Amsler Grid, Vision Testing (distant and near vision, color and depth), Chemistry, CBC & Urinalysis, Urine Hippuric Acid and Hepatitis B Vaccination Series and Titer (specific testing is dependent upon Job Tiles/Series)

Category (15) - Lead Testing, Chest X-Ray with B Reading, and Pulmonary Function Testing (specific testing is dependent upon exposure level and/or position).

Applicant Examination

Standard physical examination, resting electrocardiogram, lab testing and blood work, Quantiferon - TB Gold In-Tube test (QFT-GIT), pulmonary function test, TSH, free T4.

2.4 USSS Mandatory Medical Examination Program Physical Examination Requirements

2.4.1 Complete Medical History

Past medical history inquiry shall include:

Alcohol history (drinks per day/number of years) Smoking

Medications (both prescription and over the counter) Surgeries Allergies Serious illnesses Hospitalizations

An original of the medical history forms shall be supplied by the USSS to the contractor.

Duplicate copies will be the responsibility of the contractor. The examining physician will review the medical history with the examinee and ensure that all questions of the USSS Medical History Questionnaire (SSF3300A) are complete. The examining physician will ensure that the date of the USSS Medical History Questionnaire (SSF3300A) at the top of page one is current.

2.4.2 Laboratory Testing

1. The following laboratory tests shall be conducted as part of all physical examinations*:

Urinalysis (with reflex) - pH, specific gravity, glucose, blood, protein, leukocyte esterase, nitrite, ketones, bilirubin. Microscopic as needed.

Complete Blood Cell Count (CBC) w/Differential and Platelets - white cells, red blood cells, hematocrit, hemoglobin, platelets, differential.

Complete Metabolic Panel, to include:

• Alkaline Phosphatase

• Albumin and Albumin/Globulin ration

• AST and ALT

• Bilirubin – total

• Calcium

• Chloride

• Carbon Dioxide

• Creatinine

• eGFR

• Globulin

• Glucose

• Potassium

• Protein – total

• Sodium

• Urea nitrogen (BUN)

• Urea nitrogen (BUN)/Creatinine ratio

• Uric acid

Lipid Panel (Cholesterol – total, HDL, LDL; triglycerides)

*TSH and T4 testing shall be added to testing for all applicants

2. Position/Medical Condition Specific Testing:

Incumbents on the Counter Sniper Team Uniformed Division will receive annual

Histoplasmosis screening.

Incumbents in Special Services Division (SSD)/Auto Technicians will have a

Pulmonary Function Test and complete the OSHA Questionnaire with every physical examination.

Incumbents who are currently receiving treatment for Asthma or have other current pulmonary diagnoses shall receive a Pulmonary Function Test with the physical examination.

Incumbents with respirators shall have a pulmonary function test at the time of their mandatory medical examination. Otherwise, pulmonary function testing will not be performed for incumbents unless approved by the USSS Medical Officer or designee.

Incumbents who are currently being treated for thyroid disease will receive TSH and Free T4 with the physical examination.

Incumbents diagnosed as Diabetics, whether on medication or not, and incumbents with a Fasting Blood sugar of 126 or higher, will have HgbAlC with each physical examination.

Incumbents Requiring Follow Up Testing for a Blood Borne Pathogen Exposure will have the following lab tests: HIV antigen/antibody test, Hepatitis B (HBsAg and HBeAg and HBs-Antibody), Hepatitis C (Anti-HCV)

If questions arise regarding any of the position specific tests, the USSS Medical Officer or designee should be contacted.

3. Collection and reporting requirements of laboratory specimens:

The collection of blood and urine specimens is the responsibility of contractor.

For physical examinations conducted on employees in the Washington, D.C. area, collections may be made during established open hours on a walk-in basis. The collection site(s) for the Metropolitan Washington, D.C. area USSS HQ Health Unit. Employees should be provided with the option to have collection of laboratory specimens (e.g., blood work and urine specimens) performed in advance of their medical examination and at a national or regional laboratory services provider with multiple locations in the Maryland, Virginia, and Washington, D.C. regions, and with whom the contractor has an account or business relationship, so that final results can be available at the time of the examination.

Contractor shall be able to submit laboratory orders for the employee electronically to the laboratory services provider; and the laboratory services provider shall be able to accept scheduled appointments and walk-in (unscheduled) services for the employee.

Employees in field offices, resident offices, and resident agencies will have the option of providing blood work and urine specimens, prior to the physical examination so that the final results will be available at the time of examination.

Incomplete blood work and/or urine shall not be accepted, and the examination shall be considered incomplete. Examples of incomplete blood work include red cells in serum, undetermined or abnormal, specimen received is unsuitable and test was not performed.

Laboratory mishandling of blood work and urine is the responsibility of Contractor and repeat testing shall be at no cost to the USSS.

A national service-based or local laboratory shall be used to test blood and urine specimens.

*Note – additional laboratory testing may be required as a standalone.

2.4.3 Technical Testing and Measurements

1. The following tests shall be conducted as part of all physical examinations except as noted:

a) Visual testing – For applicants: Test uncorrected and corrected near vision and uncorrected and corrected distant vision, for each eye and binocular; color testing (14-plate Ishihara color plates), depth perception (binocular stereo test in seconds of arc.), field of vision/peripheral vision. For applicants:

If best distant vision corrected or uncorrected is worse than 20/20, binocular, or each individual eye, repeat testing should be performed using Snellen wall chart.

Results shall be recorded for both vision machine testing and Snellen chart (if applicable).

b) For employees: Test best corrected (or uncorrected, if employee does not use corrective lenses or glasses) near vision and distant vision, for each eye and binocular (if employee uses corrective lenses, test only corrected vision using corrective lenses/glasses); color testing (14-plate Ishihara color plates), depth perception (binocular stereo test in seconds of arc.), field of vision/peripheral vision. For employees: If best distant vision corrected (or uncorrected, if employee does not use corrective lenses or glasses) is worse than 20/20, binocular, or each individual eye, repeat testing should be performed using Snellen wall chart. Results shall be recorded for both vision machine testing and Snellen chart (if applicable).

Amsler Grid will be used for selected FSD lab employees.

c) Audiometric screening – 500,1000,2000,3000,4000,6000,8000 Hz levels for each ear per OSHA standards. Hearing tests shall be conducted at the time of the physical examination for Mandatory Medical Examination Program.

d) Blood pressure measurement. If initial blood pressure result is >140 systolic OR >90 diastolic, blood pressure shall be repeated after 5-10 minutes and recorded; if blood pressure is still >140 systolic OR >90 diastolic, blood pressure shall be repeated a third time after 5-10 minutes and recorded.

e) Physical measurement – height measurement conducted barefoot, total body weight measurement, and body mass index.

f) Pulse rate

g) Oral and/or tympanic temperature

h) Hemoccult – Offered for incumbents older than age 40. Slide to be prepared, if possible, by the examining physician, during optional rectal examination.

2. Tuberculosis (TB) Screening and Testing

The contractor shall provide and complete the Quantiferon-TB Gold test for all applicants. TB testing is optional for incumbent exams covered under the Mandatory Medical Examination Program.

The contractor shall provide medical referral in the event of an employee occupational exposure and/or a “positive” or “indeterminate” Quantiferon Gold TB test result. With “positive” or “indeterminate” Quantiferon Gold test results, the applicant or employee will be referred for a Chest x-ray as well as a medical provider to determine if medical treatment is warranted.

If it is not possible to complete the Quantiferon Gold test, the TB Mantoux test may be substituted.

3. Electrocardiogram (EKG/ECG)

The contractor shall provide a legible copy without artifact of the complete report and interpretation by the examining physician. The examining physician shall complete his/her interpretation of the electrocardiogram on SSF 3300. The EKG/ECG shall be performed at the time of the physical examination.

*Note – additional technical testing and measurements may be required as a standalone.

2.4.4 Medical Examination and Consultation

1. This examination shall be conducted by a state licensed, board certified or board eligible physician (MD or DO), Physician Assistant (PA), or Nurse Practitioner (NP), as previously defined:

a) Eyes - examination to determine presence of cataracts, proliferative retinopathy, nystagmus, retinal detachment, papilledema, visual changes, visual acuity (distant and near) and visual tumors. Physician shall note presence of glasses or contact lenses and pupil reactivity.

b) Ears, Nose, Throat (ENT) - headaches, dizzy spells, tinnitus, neck lumps/masses, glandular exam, throat, sinus, carotid bruit, otoscopic exam of ear for wax.

c) Skin - rashes, moles, scars, and allergies.

d) Chest - asthma, tuberculosis, cough, shortness of breath, exertion, rib fractures, pneumothorax, smoking history, rales, rhonchi, wheezes, chest expansion, diaphragm movements, trachea.

e) Cardiovascular - chest pain, heart murmurs, level of exercise tolerance, edema, intermittent claudication, varicose veins, A2 and P2 murmurs, gallops, thrills, PMI, all major pulses. If there is a history of a heart murmur, the Examining Physician must document cardiac findings, and if no murmur heard, must state, “no murmur heard”.

f) Gastrointestinal - abdominal pain, occult blood in stool, change in bowel habits, food intolerance, weight loss, hemorrhoids, scars, liver/spleen, bowel sounds, tenderness, and history of ulcers.

g) Musculoskeletal - bone fractures, joint pain, paresthesia, muscle weakness, body trauma, low back pain, arthritis, reflexes, range of motion, edema, and muscle tone. If there is a recent (past 2 years) history of orthopedic condition, the Examining Physician shall document pertinent history and physical findings and provide determination of whether physical limitations are present due to condition.

h) Endocrinology - diabetes mellitus, temperature intolerance, thyroid disease, glandular exam.

i) Neurology - seizures, head trauma, paresthesia, gait, reflexes, cranial nerves, sensory examination, vibration sense.

j) Females - menstrual cycle, pregnancy, masses, tenderness, breast examination

(voluntary), hemorrhoids.

k) Males - hernia examination, prostate (voluntary), hemorrhoids, genital exam.

l) Psychological - weight loss or gain, appetite changes, crying spells, sleep habits, depression, anxiety, stress, mental problems, family problems, drug abuse.

m) Medications – Listing of all medications used currently, both prescription and over the counter.

2. The Examining Physician shall personally consult with the employee regarding the physical examination, making the employee aware of the preliminary findings and recommendations. This also includes review of the medical history questionnaire with the employee at the time of the physical. The physician shall allow an appropriate amount of time (at least 15 minutes) to answer any questions.

3. The examining physician shall complete all sections of SSF 3300 to include interpretation of all electrocardiograms and chest x-rays performed. Any findings that may significantly impact the health or safety of others (e.g., critical lab values, etc.)

must be reported to the contracting COR within 24 hours by the vendor; the examining physician or examining facility should contact the examinee and render appropriate urgent care and/or guidance to the employee, as soon as possible. The contracting COR and/or contractor manager shall notify the USSS Medical Officer within (1) one business days of occurrence. Any necessary medical follow up/referral (except of a medical emergency) shall be determined by the USSS Medical Officer or designee.

2.4.5 Other Standalone Medical Testing

1. The USSS Medical Officer may require the following medical examinations:

a. Chest X-ray (PA)

b. PSA Test (optional and in accordance to testing guidelines)

c. Pulmonary Function Test (PFT)

d. TSH and Thyroid Panel

e. Hemoglobin A1C Test

f. HIV Serology

g. Hepatitis A, B and C Serology

h. Independent Medical Examination (IME)-Fit for Duty Determination

i. Functional Hearing Test (formal clinical evaluation of hearing loss performed by an audiologist)

j. Aided Audiogram (performed by an audiologist)

k. Repeat Audiogram

The following medical examination is optional and may be requested by the employee, during specific intervals, at the time of the physical examination:

PSA Test

2.4.6 Consultation Services

The contractor shall offer consultation services in conjunction with the USSS Medical Officer for cases necessitating additional evaluations (i.e., optometrist, audiologist, etc.) as determined by the specific requirements of each individual case.

2.5 USSS Medical Surveillance Examinations

The Medical Surveillance Program may require modified history, physical examination and specify lab work for employees covered under this requirement. The USSS Medical Officer and/or designee will provide a list of names of employees who have been approved and assigned to the Medical Surveillance Program.

Services (for selected employees)

A. Selected employees will be provided the Hepatitis B immunization series. A Hepatitis B Surface Antibody titer will be drawn 1-2 months after the 3rd dose. If the Hepatitis B titer is negative (less than or equal to 10), a second series of Hepatitis B immunizations will be given, followed by re- titer. A titer will be attained by the USSS HQs Health Unit yearly.

B. Selected employees shall receive an annual Medical Surveillance Examination, which mirrors the requirements for the Mandatory Medical Examination Program and includes Spirometry with the addition of the following testing based on their potential exposures:

Baseline Chest X-ray with B-reading (Asbestos (Brake lining) Annual Blood Lead and ZPP levels (Exposure to Lead in Welding, Paints and

Enamels)

Employees associated with spray-painting operations, paint mixing operations or other procedures where respirators are or could be used should receive respirator medical clearance.

C. Plumbism Testing - Blood Lead and Zinc Protoporphyrin (ZPP) testing to be conducted semi-annually for selected employees.

D. Annual Respiratory Protection Medical Fitness Certification - Contractor shall perform respiratory protection medical fitness certifications for USSS employees designated by the USSS Medical Officer in accordance with 29 Code of Federal Regulations (CFR) 1910.134 and ANSI Z88.6 1984 on designated employees. The medical fitness certification will require completion of the OSHA questionnaire and may require: a standard physical examination with emphasis on HEENT, lungs, and cardiovascular, including assessment of blood pressure, review of occupational history and medical history. A pulmonary function test shall be performed as part of the Medical Fitness Certification and at the time of the mandatory medical examination.

E. Hearing Conservation - Employees shall be tested at the time of the physical examination for baseline threshold hearing changes. The USSS Medical Officer or designee may request an audiologist to review and evaluate these tests as needed. Selected employees that are not in the Washington, D.C. area shall be tested annually. The testing shall be provided by certified technicians and reviewed by the USSS Medical Officer. Selected employees in the Washington, D.C. area shall receive an audiogram semi-annually, regardless of their required physical examination interval, by certified technicians and reviewed by the USSS Medical Officer or designee.

Audiometric testing shall be conducted with audiometers (including microprocessors audiometers) that meet the specifications of, and are maintained and used in accordance with, American National Specification for Audiometers.

Pulsed tone and self-recording audiometers shall be used and meet the requirements specified by the OSHA Occupational Noise Standard. Audiometric examinations shall be administered in a room meeting the requirements specified in the OSHA Occupational Noise Standard. Audiometer functional operation shall be checked before each day’s use by testing with a person with known stable hearing thresholds by listening to the audiometer’s outputs and assuring that the output is free of distortions or unwanted sounds.

Audiometer calibration shall also be checked acoustically, at least annually, in accordance with the OSHA Occupational Noise standard. An exhaustive audiometer calibration shall be performed at last every two years in accordance with the American national Standard Specification for Audiometers.

F. Histoplasmosis – Selected employees, shall receive a blood test for Histoplasmosis exposure (serology). All members shall receive baseline testing and testing annually thereafter. The USSS Medical Officer shall review the results.

G. RBC and Plasma Cholinesterase Testing – Selected employees shall receive periodic and/or annual Cholinesterase Testing for pesticide exposure. All members shall receive baseline testing and may be repeated annually and/or with noted exposure. The USSS Medical Officer shall review results and make appropriate recommendations.

If any questions arise regarding the need for scheduling related to medical surveillance for any incumbent, the contractor or sub-contractor site should contact the Medical Officer and/or designee prior to scheduling an appointment for testing and/or physical examination. Medical Surveillance exam requirements shall be revised as needed.

2.5.1 Medical Surveillance Testing

The contractor shall provide medical surveillance testing at the James J. Rowley Training Center (RTC). The medical surveillance testing consists of blood lead, ZPP and audiogram testing for Law Enforcements Instructors. Staffing (personnel) expected to service such medical surveillance testing at RTC requires 2-3 personnel that are qualified and/or certified to administer the required testing (i.e., blood specimen collection, audiogram testing); staff servicing the HQ Health Unit should not be utilized for this purpose.

Note - Additional lab testing may be required.

2.5.2 Immunizations

The contractor shall comply with USSS Immunization requirements and update a USSS employee’s vaccination status, if needed. The USSS requires the following vaccines to be available for administration to USSS employees, but not limited to: Hepatitis A, Hepatitis B, Influenza, malarial prophylactic medications, Measles/Mumps/Rubella (MMR), Meningococcal, Polio, Tetanus/Diphtheria and Acellular Pertussis (Tdap), Typhoid (injection), and Yellow Fever.

Immunization

Outreaches

Hepatitis A

Travel Vaccines/Medications

Hepatitis A Hepatitis B Hepatitis B

Typhoid Influenza Tdap Malarial Prophylactic

Medications

MMR MMR

Polio Meningococcal

Meningococcal Polio Influenza Tdap

Yellow Fever Typhoid Yellow Fever

Additional immunizations may be required. This includes, but is not limited to, additional vaccines that are included on the CDC recommended vaccination schedule for adults, travel vaccinations that may be required for entry to foreign countries or overseas travel destinations, or vaccinations that may be required by the CDC or WHO for immunization against pathogens that pose a threat of community spread, to include an epidemic or pandemic.

2.5.3 Vaccines

The contractor shall provide the necessary vaccinations as required in 2.5.2, including all foreign travel related immunizations, to all incumbents in the Mandatory Medical Examination Program during their physical examination, and during training at the James J. Rowley Training Center (RTC). Additionally, all necessary vaccinations, including all foreign travel related vaccination and medications shall be available and provided on a walk-in basis at the USSS HQ Health Clinic. Each incumbent shall be provided an updated and comprehensive International Certificate of Immunization (Yellow Card) by the contractor. USSS Safety, Health, and Environmental Programs Division (SAF) shall be provided documentation of all immunizations provided for each incumbent by the contractor. Civilian employees who travel overseas for official business shall be offered all necessary vaccinations and/or foreign travel immunizations.

Failure to meet the requirements for vaccine/immunization services and travel medications will be considered substandard performance and may result in a payment reduction of $50.00 for each business day that such requirement is not satisfactorily met.

Not to exceed $1000.00 per incidence.

2.5.4 Travel Medication

For travel medications requirements many include travel medications to be dispensed to USSS employees. The contractor shall maintain stock on-hand to distribute travel medications through their PPN providers, and at the USSS HQ Health Clinic on a walk-in basis, when needed. The Provider shall review travel destination (s), provide counseling related to travel risks, supply travel medications [prescriptions or dispense medications (antibiotics for traveler’s diarrhea, malaria prophylaxis medication, altitude sickness prophylaxis, anti-diarrhea medication, etc.)] in accordance with the most up - to - date CDC recommendations. Contractor shall ensure network Providers have access to the most up to date TRAVAX and / or CDC guidelines. A written summary of the visit is required. Medications provided are not to exceed the length of official travel or a thirty

(30) - day supply, whichever is less.

2.5.5 Immunization Outreaches

Outreach services shall be conducted at the James J. Rowley Training Center (RTC).

Outreach services are medical services provided to employees, such as administration of required vaccines and flu shot clinics, that require the vendor to deploy staff that travel to specified locations/sites and deliver those services to the employee(s) at these locations/sites (e.g., staffing a clinic at our training center on a scheduled day that provide all trainees in a given class at our training center with their required vaccines). Outreach services provided are vaccination/immunization services to all trainees attending certain classes/training programs at RTC. Average number of Outreaches per year: 48.

Staffing (personnel) expected to service such Outreach Services at our training center requires 2-3 personnel that are qualified and/or certified to administer the required vaccinations, hold current (unexpired) state licenses in their respective medical field and certification for Basic Life Saving/AED (via the Red Cross); staff servicing the HQ Health Unit should not be utilized for this purpose.

Immunization/testing

A. The contractor shall administer Hepatitis B vaccinations to eligible employees listed in categories 1-7, FSD employees (identified by the job titles and series noted on pages 10-12 of this summary) and specified civilian employees who must travel overseas for official purposes. The above procedure is in accordance with the OSHA requirements set forth in 29 CFR 1910.1030.

The contractor shall administer the vaccine by three intramuscular injections. The first injection shall be administered at the time requested by the employee. The second injection shall be administered one month after the first injection, and the third injection shall be administered within six months after the first injection.

On request by the USSS Medical Officer or designee, the contractor shall offer optional post-vaccination testing for serologic response to all eligible USSS employees that have completed the hepatitis B vaccine series (3 doses). This post-vaccination testing should be performed 1 to 6 months after completion of the vaccine series.

When post-vaccination shows a lack of response to the initial 3 dose series (antibody laboratory results of less than or equal to 10), the contractor shall re-vaccination with the 3-dose series (using the appropriate timetable for vaccination).

If requested, the USSS SAF shall be advised of the vaccination schedule for any employee with a prior lack of response to vaccination. The employee shall be notified of when the next injection is due. The notice shall be provided to the employee 14 working days prior to the due date for the next injection.

B. The contractor shall administer Hepatitis A/B vaccination to eligible employees listed in categories 1-7 and employees who must travel overseas for official purposes.

The contractor shall administer the vaccine by 2 intramuscular injections. The first injection shall be administered at the time requested by the employee. The final injection shall be administered within 6 to 12 months after the first injection.

On request by the USSS Medical Officer or designee, the contractor shall offer optional post-vaccination testing for serologic response to all eligible USSS employees that have completed the hepatitis A vaccine series (2 doses). This post-vaccination testing should be performed 1 to 3 months after completion of the vaccine series.

When post-vaccination shows a lack of response to the initial 3 dose series (antibody laboratory results of less than or equal to 10), the contractor shall re-vaccination with the 2-dose series (using the appropriate timetable for vaccination).

If requested, the USSS SAF shall be advised of the vaccination schedule for any employee with a prior lack of response to vaccination. The employee shall be notified of when the next injection is due. The notice shall be provided to the employee 14 working days prior to the due date for the next injection.

C. The contractor shall provide TB screening Hepatitis B screening, Hepatitis C screening and HIV screening for applicants and employees subsequent to an exposure and offer TB screening to all employees during their medical examination. The contractor shall provide medical referral in the event of an employee occupational exposure.

2.6 Department of State Medical Examinations

All employees (gun carriers and civilian employees) who transfer overseas shall receive a medical clearance from the Department of State. The contract medical facility in the employee's district will provide the examination, per Department of State requirements, for USSS employees only. The contractor shall refer to the most recent State Department overseas examination form for information regarding examination requirements.

Required Labs (Must attach)

A. Hematology (must include Hematocrit, Hemoglobin, White Blood Cell Count, and Platelets)

B. Chemistry (must include Fasting Blood Sugar, Creatinine, and ALT.

Hemoglobin A1c if indicated)

C. Serology (must include HEP B Surface Antigen, HEP C Antibody, RPR/VDRL, and HIV I/II Antibody)

D. Lipid Profile (only if > 50 years of age: Total Cholesterol, LDL, HDL, and Triglycerides)

The USSS will notify the contractor of the employee who…