80AFRC20R0003P0002.pdf

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

PAGE OF PAGES

3. EFFECTIVE DATE 5. PROJECT NO. (If applicable)2. AMENDMENT/MODIFICATION NO.

7. ADMINISTERED BY (If other than Item 6) CODE

FACILITY CODECODE

6. ISSUED BY CODE

8. NAME AND ADDRESS OF CONTRACTOR (No., street, county, State and Zip Code)

10B. DATED (SEE ITEM 13)

10A. MODIFICATION OF CONTRACT/ORDER NO.

9B. DATED (SEE ITEM 11)

9A. AMENDMENT OF SOLICITATION NO.

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

Previous edition unusable STANDARD FORM 30 (REV. 11/2016) Prescribed by GSA FAR (48 CFR) 53.243

1. CONTRACT ID CODE

16B. UNITED STATES OF AMERICA 16C. DATE

SIGNED

15B. CONTRACTOR/OFFEROR 15C. DATE

SIGNED

(Signature of Contracting Officer)(Signature of person authorized to sign)

15A NAME AND TITLE OF SIGNER (Type or print) 16A. NAME AND TITLE OF CONTRACTING OFFICER (Type or print)

The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offers extended.

Offers must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended, by one of the following methods:

is not

(a) By completing Items 8 and 15, and returning copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted;

or (c) By separate letter or electronic communication which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGEMENT TO BE RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN REJECTION OF YOUR OFFER. If by virtue of this amendment you desire to change an offer already submitted, such change may be made by orletter provided electronic communication makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.

12. ACCOUNTING AND APPROPRIATION DATA (If required)

13. THIS ITEM APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS.

IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES (such as changes in paying office, E. IMPORTANT: Contractor is not, is required to sign this document and return

A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT ORDER NO.

IN ITEM 10A.

C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D. OTHER (Specify type of modification and authority) is extended, copies to issuing office.

4. REQUISITION/PURCHASE REQ. NO.

1 1

P00002 05/12/2020

NASA

Armstrong Flight Research Center P.O. Box 273, M/S 4811-140 Edwards CA 93523-0273

NASA

Armstrong Flight Research Center P.O. Box 273, M/S 4811-140 Edwards CA 93523-0273

X

80AFRC20R0003

04/22/2020

X

04/22/2020

See Continuation Sheet If Applicable

Contracting Officer appropriation data, etc.) SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b).

CHECK ONE

(X)

14. DESCRIPTION OF AMENDMENT/MODIFICATION (Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

The purpose of this amendment is to 1) extend the proposal due date to May 29, 2020 at 4:00 p.m. PT, 2) provide answers to the questions submitted; 3) incorporate following revised the attachments: "Performance Work Statement (PWS)", "Training and Certifications Requirements" and "Quality Assurance Surveillance Plan"; and 4) revised Section C.9 of the solicitation.

Accordingly, FAR Clause 1852.235-71 Key Personnel and Facilities (MAR 1989) shall read the following: (c) The list of personnel and/or facilities (shown below or as specified in the contract Schedule) may, with the consent of the contracting parties, be amended from time to time during the course of the contract to add or delete personnel and/or facilities.

Position Functional area Doctor (MD/DO) - Clinic Medical Director, Registered Nurse(s), Nurse Practitioner/Physician Assistant, Environmental Health Lead (CIH/lead IH), and Health Physicist

Except as provided herein, all terms and conditions of the document referenced in Item 9A or 10A, as heretofore changed, remains unchanged and in full force and effect.

electronic communication, orlettereach

Jenny Staggs

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80AFRC20AFRCR0003P00002 Page 1

Questions and Answers

Q.1: Is the contract locked into the current model or is there some interest in different models that may focus on proactive approaches, especially in regard to musculoskeletal injuries?

A.1: The Government is not locked-in to a specific occupational health model.

However, any proposed model must meet the Performance Work Statement (PWS) requirements.

Q.2: Are the Key Positions themselves locked in? Specifically, we have noted that an Occupational Health Nurse or Athletic Trainer are not listed.

A.2: Yes. Key positions are set. Please note that the key personnel positions have been revised in the PWS and solicitation.

Q.3: Will Dr. Peake be the contact person for Occupational Health?

A.3: No. During the pre-award phase, Jenny Staggs, Contracting Officer and Nydia Wilkinson, Contract Specialist will be the Government Point of Contacts for all communications.

Q.4: Is it possible to partner with another applicant to provide all of the services needed? Or must all the services be provided by one vendor?

A.4: Yes. Any potential offerors are free to partner/subcontract with other firms. The prime entity must be qualified as a Small Business under NAICS Code 621999 and meet the minimum performance requirement of FAR Clause 52.219-14 Limitations on Subcontracting.

Q.5: Does the NASA Occupational Health Department house its own electronic medical record system (EMR)? Or are we expected to bring our own system?

A.5. Yes. NASA has a medical record system that will be used by the medical personnel.

Q.6: During the call, I understood that we would all have access to the names and contact information of all the attendees. Where would we find that information?

A.6: The pre-proposal presentation and the list of attendees have been posted as part of amendment #1 to the solicitation on beta.SAM.gov.

Q.7: Does the contracted group have access to the healthcare utilization reviews for the sites in order to provide focused Health Promotion?

A.7: Yes. The contractor will have access to the healthcare utilization reviews upon award of the contract. Health Promotions strategies may depend on the Center’s health needs for information, awareness and wellness.

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Q.8: The RFP includes the key personnel positions of Physician/Medical Director, Nurse Practitioner, Registered Nurse, and Certified Industrial Hygienist, while the PWS lists Doctor (MD/DO) - Clinic Medical Director, Site Manager (LMP), Nurse Practitioner/Physician Assistant, Environmental Health Lead (CIH/lead IH), and Health Physicist. Please clarify key personnel requirements for the RFP E.3 (1) Technical Volume resume and contingent offer letter submission requirement. (RFP page 12, PWS page 35, RFP C.9 and PWS 8.12)

A.8: The identified key personnel positions in the solicitation and PWS have been revised in this amendment. The revised key personnel positions are: Doctor (MD/DO) – Clinic Medical Director, Registered Nurse(s), Nurse Practitioner/Physician Assistant, Environmental Health Lead (CIH/lead IH), and Health Physicist.

The Contractor shall designate one of the individuals assigned to the licensed medical professional key personnel positions (either a medical doctor [MD or DO], Nurse Practitioner/Physician Assistant, or an RN) as the Site Manager (SM).

Q.9: Will there be overlap during the 30-day contract phase-in period with the incumbent contractor? (RFP page 18, RFP E.3 (I))

A.9: Yes. The 30-day contract phase-in period will have an overlap with the incumbent contractor.

Q.10: Which positions/labor categories currently have incumbents and which are vacant? (RFP page 18, RFP E.3 (I), Table 1)

A.10: The table below provides historical and current workload relating to the OSH support and is currently listed in the Section E.3 (I) of the solicitation. The offerors may consider alternative staffing approaches that best suit their management plan and implementation of the PWS requirements. The only position that is currently vacant is the Senior Industrial Hygienist. The Health Physicist position was not required on the current contract, but it has been added as part of this OSH solictation.

80AFRC20AFRCR0003P00002 Page 3

Q.11: As part of the Price Volume, does the Government require any supporting documentation or a written narrative to detail how the CLIN pricing was developed?

(RFP page 20, RFP E.3(III))

A.11: No. Supporting documentation or a written narrative are not needed for the Pricing Volume. The Offerors are only required to submit information required in the solicitation.

Q.12: For contract award, the RFP states that the required representations or information must be submitted for consideration. Which proposal volume should this information be included in? RFP page 21, RFP E.4

A.12: The required representation can be included as part of the acknowledgement of the solicitation and amendments. It will not be included as part of the Technical, Past Performance or Pricing volumes.

Q.13: Would you accept a Doctor who possesses a license in a state other than California? (Page 1, Attachment 3 Training and Certifications Requirements)

A.13: No. The physician needs to be able to practice in California since we do medical examination in our Palmdale site, which is not a Federal facility.

Q.14: Would you consider a Doctor who possesses a license in a state other than California, but is in the process of obtaining a license in the state. (Page 1, Attachment 3 Training and Certifications Requirements)

A.14: Yes. The potential candidate would need to obtain a valid and verified California state medical license within 12 months from the award date of the contract. After the initial 12 months of the contract, any replacement Dr shall meet the qualifications immediately. See revised PWS and Training and Certification Requirements for the Dr qualifications.

Q.15: What is the average number of patients/employees that the Doctor sees per day?( Page 6, PWS 3.1)

A.15: The clinic sees around 20 employees per week. The physician/nurse practitioner might have a surge of patients in support of science missions when flight medicals are required for crew and non-crew members.

Q.16: What electronic medical records system do you use? (Page 9, PWS 3.1.12)

A.16: NASA’s electronic medical record system is Cority.

Q.17: Who is the incumbent?

A.17: The current incumbent is Professional Management Enterprises, Inc.

Q.18: What is the contract award amount?

A.18: The contract award amount including all options is $5,641,170.92.

80AFRC20AFRCR0003P00002 Page 4

Q.19: Is the information on beta.sam.gov or fpds.gov I cannot locate any similar type contract using those two. The RFP number would be great.

A.19: The information pertains to current contract can be found on FPDS-NG website under contract number NND15SA10C or solicitation number NND15531905Q.

Q.20: For pricing, has the incumbent broken the amount down by function area such as OH and EH?

A.20: The previous contract pricing has no bearing on the pricing format for this solicitation. Pricing shall follow the solicitation requirements.

Q.21: Or is it an entirely new RFP.

A.21: This is a new RFP. The offerors must review the contract requirements carefully because there are requirements that are currently not on the previous PWS.

Q.22: Is the anticipatory dates for phase in and starting still the same or is there a strong chance it may be extended.

A.22: The phase in and start date of the contract remain unchanged.

Q.23: The information on the Historical Data for NASA Edwards AFB Table 1 identifies 3 Industrial Hygienists. Is one of these IH roles for the Health Physicist or is that a separate role not on the table?

A.23: The historical data provided in Table 1 in the solicitation was in support of the current OHS contract. The new solicitation has revised Environmental Health requirements that require two key personnel positions: Environmental Health Lead (CIH/lead IH) and Health Physicist.

Q:24: Do the positions on the Table 1 correlate to the amount of work requested in the NASA/Armstrong Flight Research Center Occupational Health Services Performance Work Statement, February 28, 2020 (PWS), or does the PWS present additional scope not previously conducted by 8 roles identified on Table 1?

A.24: The PWS under this solicitation contains additional work scope, that is not presently required under the current contract.

Q:25: What type of ionizing radiation sources will be present at NASA AFRC?

A.25: NASA AFRC has the following ionizing radiation sources. We have two mail x-ray cabinets, conduct shielded (in a vault) and unshielded radiography, use x-ray tube and seal source devices for metal analysis as well as receive (via mail) during the year approximately 3-8 sealed sources in support of science missions. These sources vary in quantity and type.

Q.26: Are they used in research in and out of a laboratory environment?

80AFRC20AFRCR0003P00002 Page 5

A.26: No.

Q.27: What are the general radio activity levels? i.e. low, medium (approximately 100 mR/h), or (high >500 mR/h).

A.27: The radio activity level is low.

Q.28: Is there a Radioactive Materials License for AFRC? If so is it State of CA or

NRC?

A.28: AFRC does not have an NRC license. All the sources are either exempt or excepted thus under a general license or under the owner’s NRC or CA license. The X-ray devices and sealed sources use at the facility in Palmdale are regulated by the state.

Q.29: Roughly how many lasers Category 3 and 4 are at AFRC?

A.29: Lasers - Onsite we have approximately six (6) each CAT 3-4 lasers. However, every year we evaluate and permit approximately 25-40 lasers that are brought in by investigators in support of science missions.

RF - Onsite we have numerous RF devices for communication and telemetry. In addition, every year we evaluate, survey and permit approximately 15-25 RF systems that are brought in by investigations in support of science missions.

PERFORMANCE WORK STATEMENT (PWS)

Attachment 1

NASA/Armstrong Flight Research Center

Occupational Health Services

Performance Work Statement

February 28, 2020

Revised: May 12, 2020

1.0 BACKGROUND

1.1 This Performance Works Statement (PWS) describes Occupational Health Services to be performed at the National Aeronautics and Space Administration (NASA) Neil A.

Armstrong Flight Research Center (AFRC), located on Edwards Air Force Base (EAFB) in Edwards, California (CA) and its associated site in Palmdale, CA. The specific services covered are Occupational Medicine to include Occupational Medical Clinic and Health Education and Wellness Program, as well as Environmental Health (EH) to include Industrial Hygiene and Health Physics (Ionizing and Non-Ionizing Radiation) and oversight of the AFRC Food Safety Program. Services specifically EXCLUDED from this PWS are: Employee Assistance Program (EAP), Workplace Drug-Testing (including Specimen Collection and/or Medical Review for drug testing), Workers’ Compensation Case Management, and Environmental Management.

1.2 AFRC, formerly known as the NASA Hugh L. Dryden Flight Research Center, is located approximately 80 miles northeast of Los Angeles, CA. An AFRC component facility (Building 703) supports the AFRC Science Mission Directorate aircraft, and is located in Palmdale, CA, approximately 50 miles northeast of Los Angeles, CA and 32 miles from EAFB. Overall, AFRC conducts aeronautical research and testing, along with airborne science operations, in accordance with NASA’s strategic mission, utilizing about 1,100 on-site personnel— to include Civil Servants, Contractor personnel and other visitors.

1.3 The Contractor’s primary requirement under this contract is to ensure the safety and health of workers through compliance with all applicable laws, regulations, policies standards as well as NASA’s and Center Procedural Requirements. NASA has defined the requirements for an Occupational Health Program under NASA Procedural Requirement (NPR) 1800.1, entitled, “Occupational Health Program Procedures”. Many of these requirements reflect or expand upon other Federal requirements, as promulgated through the Occupational Safety and Health Administration (OSHA), the Federal Aviation Administration (FAA), the Federal Motor Carrier Safety Administration (FMCSA), and various other organizations responsible for establishing industry standards such as the American Conference on Governmental Industrial Hygienists (ACGIH), American National Standard Institute (ANSI) and Institute of Electrical and Electronics Engineers (IEEE) . California OSHA (Cal/OSHA) requirements are also applicable to all contractors working at the Building 703 site (Palmdale, CA). More NASA-specific procedures for implementing these requirements are found in various AFRC Operational Procedures, Standards, Plans and Policies. The PWS outlines what objectives the Contractor shall accomplish to fulfill the specific elements of NPR 1800.1 and related Center documents. For the purposes of this requirement, the term ‘Occupational Medicine’ shall include the Occupational Medical Clinics and the Health Education and Wellness Program, unless otherwise noted. The term “Environmental Health” Program shall include Industrial Hygiene and Health Physics (Ionizing and Non-Ionizing Sources), unless otherwise noted.

2.0 OBJECTIVES

2.1 OCCUPATIONAL MEDICINE

The objectives of the Occupational Medicine function are accomplished through primary (e.g. job certification, fitness center or travel medical examinations), secondary (e.g.

medical surveillance examinations) and tertiary (e.g. illness and injury management, medical emergency response) prevention activities. The Occupational Medicine function also promotes the health of the AFRC workforce through the operation and management of an on-site Fitness Center and wellness campaigns (e.g. flu vaccinations, blood pressure checks). The Contractor’s Occupational Medicine staff shall provide services and materials to meet requirements in the following functional areas:

2.1.1 Job Certification Medical Examinations (e.g. Respirator Use, Crane/Equipment Operation, Aircrew Medical Examinations, etc.)

2.1.2 Federal Aviation Administration (FAA) Medical Examinations (to include

First-Class medical certification)

2.1.3 Department of Transportation (DOT) Medical Examinations, i.e. Federal Motor Carrier Safety Administration (FMCSA) Medical Examinations

2.1.4 Travel Clearances and Travel Medical Examinations

2.1.5 Medical Surveillance Examinations (e.g. Audiometry, Lead Exposure

Monitoring, Laser Eye Exams, Methylene Chloride medical surveillance, etc.)

2.1.6 Occupational Illness and Injury Examinations

2.1.7 Preventive Health Examinations

2.1.8 Fitness Center Medical Clearances

2.1.9 Health Promotion Activities, such as didactic educational events, blood pressure screenings, staffing a health promotion booth at Safety Day, Vaccination campaigns, etc.

2.1.10 Health-Related Education and Training (e.g. Hearing Conservation, Blood-Borne Pathogens, etc.)

2.1.11 Infection Control

2.1.12 Medical Emergency Response, to include Basic Life Support (BLS) and the initial steps of Advanced Cardiovascular Life Support (ACLS)

2.1.13 Automated External Defibrillator (AED) Program Management. See section 4.1.12 and 4.1.15.

2.1.14 Fitness Center Management (Formal class instruction and/or personal training services are EXCLUDED). See section 4.1.11.

2.1.15 Medical support to the crew and support staff of a commercial space vehicle during simulation exercises and test landings at Edwards AFB, conducted in coordination through NASA AFRC.

2.1.16 Performance of NASA Pilot medical examinations and determination of medical qualification for flight in accordance with NASA and FAA standards.

2.1.17 Performance of FAA First, Second and Third Class Medical Certification examinations.

2.1.18 Identification of medical conditions requiring waiver, and preparation of the aeromedical documentation to support a waiver request (if justified) or for FAA Medical Certification exam cases will follow FAA requirements for FAA Special Issuance.

2.1.19 Preparing aeromedical summaries for presentation to the NASA

Aerospace Medicine Board, 2) preparing occupational medicine FMCSA NASA equivalent case summaries (Doctor and NP), 3) presenting cases for FMCSA to NASA HQ Occupational Medicine Board (Doctor and NP), and 4) presenting cases to the NASA Aerospace Medicine Board (Doctor and Doctor for NP). AFRC Chief Medical Officer shall approve documentation format and contents for NASA Aerospace Medicine Board (AMB) presentation narrative summaries.

2.1.20 Review of flight medical questionnaires of qualified non-crewmembers to determine medical qualification for flight.

2.1.21 Review of occupational audiograms to determine work-related hearing loss and OSHA recordability.

2.1.22 Medical direction and quality assurance review of the clinical activity of the Nurse Practitioner.

2.1.23 Serve as a technical expert in answering medical questions posed by

NASA Center management.

2.1.24 Provide pharmacy services of a California Board licensed medical doctor who serves as the lab’s director, including any required signatures, as well as the requisitioning or purchase, storage, safeguarding, accountability, and dispensing of all pharmacy supplies, drugs, and medicines necessary for the operation of the medical services facilities at AFRC Main Campus, and B703, Palmdale.

2.2 ENVIRONMENTAL HEALTH (EH)

The objectives of Environmental Health (EH) are accomplished through the anticipation (e.g. document reviews and permits), recognition (e.g. workplace exposure assessment), evaluation (e.g. appropriate sampling, surveillance and analysis of workplace hazards) and control (e.g. recommendation of workplace controls, as well as education, training and certification) of workplace health hazards. Controls generally include: 1) Elimination or substitution; 2) Engineering controls to prevent or minimize exposure to workers; 3) Administrative or work practice controls to prevent or minimize exposure to workers; and/or 4) Appropriate use of personal protective equipment by the worker. The Contractor’s EH staff shall provide support and services based on NPR 1800.1 and other Federal and NASA Requirements such as the following functional areas:

2.2.1 Hazard Communication/ Global Harmonization System (GHS)

2.2.2 Control of Hazardous Substances

2.2.3 Asbestos

2.2.4 Heavy Metals such as: Hexavalent Chromium (Chromium VI), Lead, Cadmium, Beryllium, Mercury, etc.

2.2.5 Benzene

2.2.6 Formaldehyde

2.2.7 Methylene chloride

2.2.8 Blood-Borne Pathogens and Biosafety

2.2.9 Additive Manufacturing

2.2.10 Reproductive and Developmental Health

2.2.11 Hearing Conservation

2.2.12 Ergonomics

2.2.13 Indoor Air Quality

2.2.14 Thermal Stress

2.2.15 Local Exhaust Ventilation

2.2.16 Respiratory Protection

2.2.17 UV Safety Program

2.2.18 Ionizing Safety Radiation

2.2.19 Radiofrequency and Microwave Safety Radiation

2.2.20 Laser and Non-Laser Optical Radiation Safety

2.2.21 Vector Related Disease (e.g. hantavirus, histoplasmosis)

2.2.22 Silica Dust

2.2.23 Food Safety Program

2.2.24 Cryogen Safety

2.2.25 Illumination

2.2.26 Water Quality

2.2.27 Hydrazine safety

3.0 SCOPE

3.1 OCCUPATIONAL MEDICINE (OM)

3.1.1 Size - The medical facility at AFRC is referred to as the “Health Unit”

(bldg. 4822). The AFRC Health Unit is located on the main campus, with a separate Medical Office operated at Building 703. Additionally, the AFRC Fitness Center (bldg. 4876) is a 4,350 square foot facility, which has two large fitness areas (one primarily for equipment, the other for stretching, aerobics and group exercise); the facility includes men’s and women’s locker rooms and shower facilities, as well as an administrative office. On average, 25-30 employees (Civil Servant and Contractor) utilize the facility each work day.

3.1.2 Job Certification Physical Examinations: Job certification physicals address the question of whether an employee is medically qualified to perform a specific job or function. These examinations assure the employing organization (as well as the individual and the individual’s Supervisor) that the individual is medically qualified to perform the job, or a specific aspect of the job (e.g. respirator use). Job certification examinations are provided by NASA at no cost to the employee (Civil Servant or Contractors). Many of these exams are accomplished in accordance with guidance from OSHA, NASA, or other regulatory authorities. Communication of the assessment is made to the responsible parties (usually the Supervisor and employee) in written format (e.g. the AFRC “Request for Medical Clearance” form).

3.1.3 Medical Surveillance Examinations: Medical surveillance exams address the question of whether the work or its environment is producing deleterious health effects on the employee. As such, medical surveillance examinations are a type of monitoring tool for health and safety in the workplace. At AFRC, various environmental health programs include requirements for medical surveillance; such as Hearing Conservation Program, Respiratory Protection Program, Bloodborne Pathogen Program, Confined Space Program, OSHA specific chemical hazards (e.g. Lead and methylene chloride), Laser Safety Program and Radiation Safety Program. A communication of certification examinations are made to the responsible parties in written format.

3.1.4 Periodic Health Maintenance Examinations: Preventive Health

Examinations (also referred to as “Executive Physicals”) consist of screening observations or tests to detect disease in an early, more treatable phase, before symptoms manifest and are more detrimental. Periodic health maintenance examinations are offered to Civil Servants as a benefit of their employment; however, these exams are voluntary. The scope and frequency of the exam is specified in NPR 1800.1.

3.1.5 Fitness Center Management: Contractor will manage the operation of the Fitness Center and provide medical clearance for use of the Fitness Center.

3.1.6 Travel Clearances: NASA Civil Servants who are traveling overseas shall receive a medical evaluation and clearance performed in accordance with NPR 1800.1. When requested or when the Health Unit recognizes the need, the Occupational Health Contractor shall perform travel medical evaluations and provide recommended travel preventive medicine services, meeting the United States Centers for Disease Control recommendations, to other NASA resident contractors traveling outside the United States.

3.1.7 Qualifying Non-Crew Member (QNC) clearance: for AFRC personnel

(Civil Servants and Contractors) who perform QNC duties, contractor will perform in-person examinations and ensure appropriate occupational health needs of these QNC workers.

Non-AFRC workers who request QNC clearance will be cleared by review of QNC medical questionnaires and further clarifying medical information will be requested from the worker when needed based on the responses to the questionnaire.

3.1.8 Occupational Illnesses & Injuries: The Occupational Medical staff shall treat and manage the occasional work-related injury or illness. All AFRC personnel (Civil Servants and Contractors) with occupational illnesses or injuries may be initially treated within the capabilities of the AFRC Health Unit. There is no on-site X-ray or laboratory capability, so more complicated or serious injuries and illnesses are referred to the patient’s private medical provider off-site. Both Civil Servants and Contractor employees have a choice as to who their treating doctor (Medical Doctor- Doctor of Medicine or DO-Doctor of Osteopathic Medicine) will be for an occupational illness or injury, i.e. the employee is encouraged, but not required, to go to the AFRC Health Unit for their illness or injury.

Contractors may have their own “preferred providers” for injured or ill employees, separate from the AFRC Health Unit. More detailed procedures for addressing workplace (occupational) injuries, illnesses, and communicating such information to the employer (i.e. the Supervisor) are provided in specific NASA and AFRC guidance.

3.1.9 Non-Occupational Injuries & Illnesses: The NASA Occupational Health

Program dictates that Health Unit staff WILL NOT act as the employee’s personal medical doctor (PMD) or primary care provider. The AFRC Health Unit generally does not address, treat, or dispense medications for non-occupational illnesses and injuries. When in the best interests of NASA, the Health Unit may address and treat—on a one-time basis— non-occupational illnesses and injuries of AFRC Civil Servants, (e.g.

respiratory infections, gastroenteritis or non-work-related injuries). All follow-up or ongoing care shall be provided by the employee’s PMD.

Contractor employees must see their PMD for all non-occupational medical needs, unless it is an urgent or emergent condition (e.g. heart attack, stroke, etc.).

3.1.10 Medical Emergency Response: Although the AFRC Health Unit does not operate a formal ambulance service, Health Unit staff shall respond to medical emergencies during regular duty hours that occur at AFRC main campus and at times contractor’s Occupational Health staff is present at Building 703. On main campus, the staff shall use the Medical Emergency Response Vehicle (MERV); at Building 703 staff shall respond by foot, as there is no MERV located at the Palmdale facility. The scene may be an industrial area such as an aircraft hangar, or elsewhere within a building.

The Health Unit staff shall NOT proceed into an area or structure unless it is safe. The determination of an area’s safety, when not obvious, will be made by the On-Scene Commander (e.g. Fire Chief, Safety, Health and Environmental Officer, Protective Services, etc.). Contractor personnel shall NOT drive the AFRC MERV off the confines of Edwards Air Force Base.

3.1.11 NASA Mishap Information System (NMIS): NASA has various safety reporting systems. The contractor’s Occupational Health staff shall ensure all occupational medical related incidents be entered into NMIS following NASA’s NPR 8621.1C- NASA Procedural Requirement for Mishap and

Close Call Reporting, Investigating, and Record Keeping.

3.1.12 Administrative and Medical Record/Document support: The AFRC

Health unit (HU) medical services and Clinic Director require the support of a technical/clinical documents/medical records information specialist.

This specialist will do at minimum the following:

3.1.12.1Coordinate with AFRC civil servant and contract employees to set-up appointments for visits to the HU in support of required occupational health certifications/approvals.

3.1.12.2 Updating clients’ medical records in the NASA

Occupational Health electronic health record system.

3.1.12.2Updating clients’ training records for required occupational health trainings.

3.1.12.3Coordinating appointments for AFRC civil servants’ executive medical examinations.

3.1.12.4Assisting Nurse Practitioner/Physician Assistant/or Doctor

(MD or DO) with the coordination of Wellness Campaigns and management of the Fitness Center.

3.1.12.5Compiling metrics data from several Occupation health programs, including participation in activities or use of the AFRC Fitness Center.

3.1.12.6Assisting and managing with the coordination and Center logistics of all Occupational Health audit visits, including the tri-annual OCHMO audit (rooms, phones, computers, and setting up of Center Management meetings/ presentations in support of the audit visit).

3.2 ENVIRONMENTAL HEALTH (EH)

3.2.1 Size: The AFRC main campus occupies approximately 880 acres, and consists of buildings with approximately 900,000 square feet of structural floor space. Building 703, in Palmdale, occupies approximately 16 acres and consists of one building with approximately 428,000 square feet of structural floor space. Overall, AFRC structures include cafeteria, gift shop, aircraft hangars, industrial shops, fuel stations, a motor pool, research engineering workshops, flight simulation facilities, fabrication shop, research aircraft platforms, fiber optics labs, material testing lab, ejection seat maintenance shop, communication and telemetry facilities, a mirror coating facility, an airborne science integration facility, an occupation health clinic, and office space. AFRC has a workforce composed of approximately 533 Civil Servants and 786 on-site contractors, as well as a few visiting researchers and investigators.

3.2.2 Hazardous Operation review/evaluation and permitting: Various work processes and hazardous operations may have a need for

Environmental Health reviews and evaluations, and in some cases, formal permitting. Various workgroups throughout the Center will often utilize regulated chemicals or have other hazardous operations.

These may require the issuance of an Evaluation and Recommendation/Requirements Report, as well as formal permits/authorizations (e.g. Class IIIb or 4 lasers, Ionizing Radiation and Radio Frequency Devices, nuclear gauge permits). In addition, Changes to the infrastructure, facilities or work processes can potentially expose workers to health hazards not previously identified or mitigated (e.g. new chemicals, unforeseen ergonomic challenges, increases in power of radiation devices, etc.) and these will require Environmental Health evaluations. There are also isolated incidents (e.g. foul smell in the work area, unusual taste to the drinking water, etc.) that occasionally require prompt IH evaluations and recommendations.

3.2.3 Exposure Assessments: Exposure assessments are a proactive method by which the IH staff evaluate a functional work area with regards to the hazards and programs identified in Section 2.2. In this on-going process the presence, or absence, of the specific hazard for a given work area is documented, and if present, its potential hazard to workers is assessed in a quantifiable manner. Workers potentially exposed to the hazard(s) are identified, and mitigation steps are developed. These steps may include required training, medical examination, engineering or administrative controls, and/or the use of personal protective equipment (PPE).

3.2.4 Sampling and Surveillance: AFRC utilizes two common sampling techniques: a) surveys and monitoring of exposure conducted with direct reading instruments or passive samplers and b) sampling of specific substances, with subsequent shipping to an appropriate laboratory for processing and analysis. The various equipment and instruments used for surveying and sampling must be maintained on a regular basis, bump-tested on a regular schedule and calibrated to established standards. Environmental Health contract staff shall maintain such equipment and instruments according to established standard operating procedures, and ensure items are bump tested and calibrated on the prescribe schedule per standards and NASA requirements. Contractor shall also maintain associated logs, records, and databases. NASA will provide the actual equipment or instruments. NASA will also perform and/or coordinate the calibration. Contract staff will coordinate the with NASA AFRC’s Calibration group. NASA will provide any additional costs of maintenance beyond normal inspection and care of the equipment or instrument.

3.2.5 Dosimetry and Direct Readers for Radiation Exposure: The AFRC

Radiation Safety Program provides Thermoluminescent (TLDs) dosimeter to all radiation workers. The Environmental Health contractor shall coordinate and implement the TLD program, which consists of processing new program participant requests, “Safe Use of TLD” training, quarterly TLD exchanging, retrieving TLDs from employees leaving the TLD program, and providing each employee with their individual annual exposure reports.

3.2.6 Reports: A variety of reports or other methods of documentation are produced by the Environmental Health group. These include: survey reports, evaluations, exposure assessments, annual program self-assessments, data analysis, trending analysis, deficiencies within regulatory requirements, document reviews, mishap reports, progress and metric reporting, improvement and recommendation/requirements reporting, and detail requirements for mitigation and control of the potential hazard(s). In addition, the Radiation Safety Program has an annual requirement for a report based on a comprehensive review of the ionizing and non-ionizing radiation program.

3.2.6.1 The contract Environmental Health personnel shall provide the appropriate draft reports (information, requirements and recommendations) to the responsible NASA AFRC Program Manager for IH or HP for their review and concurrence thus facilitating informed decisions that minimize health risk of center personnel. NASA will provide the contractor with any required templates and/or format for these reports.

3.2.7 Implementation and Coordination of Hazard Controls:

There may be the need for the coordination and implementation of hazard controls based on surveys, assessments, and evaluations. The Environmental Health Contractor shall provide the IH and HP PM with viable options for the coordination and/or implementation of EH controls. For example, training, signage, permits and engineering controls. The contractor shall support the implementation of these controls.

3.2.8 Education and Training: The AFRC workplace safety and health program requires specific training to be accomplished by the worker. Some training can be accomplished online through the NASA-provided online learning system. However, some training must be accomplished in-person (e.g.

respirator use and fit-testing).

3.2.8.1 The Environmental Health staff shall provide required training, as defined within their areas of responsibility, in accordance with nationally recognized standards. In addition, the contractor staff shall coordinate two annual awareness training campaigns for Center employees. Campaign subject will be coordinated with the AFRC EH Program Managers. One of these may be in conjunction with the AFRC Safety Day Activities.

3.2.8.2 The Environmental Health Staff will track and document training.

3.2.9 Recordkeeping:

The AFRC EH Program requires accurate and updated record keeping information. NASA has a prescribe Record Management Program for these functional areas. The contractor is to ensure that all EH records are kept in accordance to NASA Record Management requirements NPR 1440.6I.

3.2.10 Database Development and Management System

The EH program is intensively regulated with very prescribe requirements that may have prescribed schedules. The Environmental Health Contract Staff is to develop a management scheduling database for the EH Program that may include, among its functional components: EH equipment maintenance, bump-test and calibration schedules, regular exposure surveys and assessments (e.g. x-ray cabinet annual surveys, x-ray producing devices, x-ray vault annual survey, noise surveys, and chemical surveys), area radiation surveys, leak tests, annual radiation areas and devices inspections, exposure assessment schedule, dosimetry schedule, AFRC permit schedules, updating of AFRC’s radiation devices inventories (RF, Laser and Ionizing Radiation), training schedule, annual awareness trainings (RF, lasers, asbestos, lead) and EH facility inspections.

3.2.11 Development of an Occupational Medicine and Environmental Health

Newsletter

3.2.11.1 Newsletter will be electronic and sent to customers on a quarterly basis (Winter, Spring, Summer and Fall)

3.2.11.2 Newsletter is to include:

3.2.11.2.1 General short article on the season related to EH

and/or Occupational Medicine.

3.2.11.2.2 An example may be an AFRC research project that

may be partnering with the EH group for intensive support.

3.2.11.2.3 Another example may be an article on flu season.

3.2.11.2.4 Any upcoming event of interest to customer related to

EH and/or occupational medicine.

3.2.11.2.5 Upcoming permit due-dates.

3.2.11.3 Environmental Health Contractor may use format and

information from the OCHMO newsletter and the Goddard Radiation Safety Newsletter, as well as any other vetted document.

3.2.11.4 Inclusion of any trends based on hazard exposure data.

3.2.11.4.1 For example, highest ergonomic risk factors observed at AFRC during the year (e.g. bad posture).

3.2.11.4.2 Most prevalent hazard at AFRC (e.g. noise).

3.2.11.5 Newsletter will be approved by the COR prior to distribution.

4.0 Requirements

4.1 Occupational Medicine (OM), the Contractor shall:

4.1.1 Operate the AFRC Health Unit at Edwards campus and bldg. 703 in accordance with the operational hours and work schedule for AFRC, provided under the Section entitled, “Standard Work Hours”.

4.1.2 The AFRC Edwards Campus will operate with a minimum of one Licensed Medical Professional (LMP) between the hours of 07:00 - 07:30 AM, and 4:00 – 4:30 PM (3:00 – 3:30 PM on working Fridays) on work days.

4.1.3 The AFRC Edwards Campus will operate with a minimum of TWO of the following Licensed Medical Professionals (LMP) will be required on working weekdays Monday - Friday (7:30-4:00pm):

a) (e.g. A Nurse Practitioner/ Physician Assistant and a Registered

Nurse (with a doctor available for consultation when needed) or

b) A doctor (MD or DO) and a Registered Nurse

4.1.4 A doctor (MD or DO) shall be the Medical Director of the Health Unit and shall perform, as needed, aviation medical examinations including NASA First, Second, and Third Class Aviation Medical Exams, FAA First, Second, and Third Class medical certification exams (i.e. must be a FAA Senior Aviation Medical Examiner), and NASA Qualified Non-crewmember certification, in addition to other duties consistent with required qualifications for the doctor (MD or DO) position.

4.1.4.1 The Contractor is expected to operate at AFRC’s bldg. 703

Medical Office one 8-hour day per week. There may be times when the contract doctor (MD or DO) might need to schedule two days in a week in support of science missions. This will not be the norm. When the civil servant doctor (MD or DO) is operating out of bldg. 703, only one contractor staff member will be required to be scheduled the same day and time at the bldg. 703 - Medical Office.

4.1.4.2 When the civil servant doctor (MD or DO) is NOT operating outof bldg.703 that week, the Contractor shall provide at least two (2) personnel one (1) doctor (MD or DO), Clinician, or Registered Nurse, and another staff member who may be a LMP or a clerical contractor staff member scheduled on the same day and during the same hours, in accordance with the operational hours and work schedule for AFRC, bldg.703, provided under the Section entitled, “Standard Work Hours”. This staff member does not need to be an LMP.

4.1.4.3 The AFRC Chief Medical Officer may request a change on the distribution for hours of coverage on weeks, based on the AFC Health Unit priorities. This request will not change the total hours of contractor support, just the location of the support for a week.

4.1.4.4 Contractor staff support shall register arrival and discharge of emloyees presenting for evaluation into the Electronic Health Record and serve as a chaperone to the LMP or civil servant doctor (MD or DO) while employees are present for exams.

4.1.4.5 Required Contractor support hours to the medical office at blg.

703 does not include other contractor responsibilities such as first aid and AED training.

4.1.5 Prepare a variety of medical presentations such as: aeromedical summaries for presentation to the NASA Aerospace Medicine Board, 2) occupational medicine FMCSA NASA equivalent case summaries (Doctor and NP), 3) presenting cases for FMCSA to NASA HQ Occupational Medicine Board (Doctor and NP), and 4) presenting cases to the NASA Aerospace Medicine Board (Doctor and Doctor for NP).

4.1.6 Coordinate the disposal of regulated medical waste and expired pharmaceuticals with a disposal contractor. The government will pay all costs associated with disposal.

4.1.7 Perform work-related medical examinations in accordance with NPR

1800.1 and other applicable regulatory agencies. The Contractor shall provide staff who possess the knowledge, skills and abilities to perform medical examinations, to include:

4.1.7.1 Vital Signs (i.e. height and weight measurement, blood pressure measurement using an automated sphygmomanometer, oral temperature using an automated oral probe, respiratory rate and heart rate);

4.1.7.2 Pure-Tone Audiometry;

4.1.7.3 12-lead Electrocardiography (EKG);

4.1.7.4 Phlebotomy;

4.1.7.5 Intravenous (IV) Line Insertion and Maintenance;

4.1.7.6 Spirometry (Pulmonary Function Testing);

4.1.7.7 Vision Testing (Using a standard Optec® or Titmus®

Vision Testing Machine provided by NASA);

4.1.7.8 Urine Dipstick Analysis;

4.1.7.9 Finger stick glucose sample collection and analysis as well as:

4.1.7.10 FMCSA Medical Certification;

4.1.7.11 FAA Aviation Medical Certification, to include First-Class, Second-Class and Third-Class Medical Certifications (FAA Senior Aviation Medical Examiner is required to perform First-Class exams and certifications).

4.1.7.12 NASA First, Second, and Third-Class Aviation Medical

Exam Certifications (FAA Senior Aviation Medical Examiner is required to perform NASA First Class exams and certifications)

4.1.7.13 Qualified Non-crewmember Certifications [A doctor (MD or DO) is required to perform these certifications].

4.1.8 Review appropriate tests and laboratory results required by such exams (e.g. hearing tests, pulmonary function tests, laboratory tests, etc.), and direct appropriate follow-up as indicated.

4.1.9 Assess, treat and manage workplace illnesses and injuries within the purview of the Health Unit (i.e. there is no "STAT" lab capability except for dip urinalysis and finger stick glucose, no radiology capability, and no inpatient capability on-site).

4.1.10 Assess and treat (within the Clinician’s scope of practice and within the purview of the Health Unit) urgent or emergent conditions, such as acute coronary syndrome, acute myocardial infarction, or cerebrovascular accident (stroke) on an initial (i.e. urgent or emergence) basis. The staff shall immediately arrange urgent/emergent transport of the patient to higher levels of care via ambulance when the need is identified.

4.1.11 Respond immediately to 911 emergency calls in accordance with the

Center’s Emergency Preparedness and Response Plan. The response shall specifically include:

4.1.11.1 The cessation of all current activities (assuming they are not themselves life-saving activities);

4.1.11.2 Acquiring the necessary emergency information for

response;

4.1.11.3 Loading the MERV (when at Edward’s campus) with pre-determined bags and equipment (NASA will determine the medications and equipment in these bags);

4.1.11.4 Driving the MERV (and other staff when emergency is at

Edward’s campus) in an emergency manner (i.e. emergency lights and siren, if indicated—with due regard for safety) to the scene of the emergency;

4.1.11.5 Stabilizing the patient(s) to the extent possible in accordance with standard BLS and/or ACLS protocols;

4.1.11.6 Ensuring patients needing further care are transported to an off- site hospital using the paramedic ambulance service, i.e. the Edwards Air Force Base Paramedic Ambulance Service (AFRC Main Campus), or the Los Angeles County Fire Department (Bldg. 703 Palmdale), as outlined in AFRC guidance.

4.1.12 Respond to all Center Mass Casualty Emergencies following

AFPL8710.1-001-Emergency Management.

4.1.13 Assess non-work-related illnesses. The Clinician shall not prescribe or furnish medications unavailable in the Health Unit.

4.1.13.1 Medications will only be furnished from the AFRC Health

Unit in accordance with Health Unit policies and protocols.

Medications shall be furnished in dosages routinely prescribed, when indicated and appropriate for the patient.

No prescriptions shall be written by the Contractor Clinician. Drug, strength and directions for use shall be documented in the electronic health record system, and patients shall be provided with the appropriate educational information regarding furnished drugs or devices. The medications available in the Health Unit will be determined by NASA. The Contractor shall be provided access to NASA Occupational Health Databases used in the performance of these requirements (e.g. Electronic Health Record System).

4.1.14 Manage AFRC’s Fitness Center by performing the following:

4.1.14.1 Conduct a walk-through each morning of the Fitness Center during the regular work-week.

4.1.14.2 Health Unit staff shall provide sporadic monitoring for safety purposes of the Fitness Center via closed-circuit television monitors provided by the Government located in the Health Unit.

4.1.14.3 Evaluate employees’ medical clearances required to use the

Fitness Center facility. Clearances are valid for one year.

4.1.14.4 Grant card reader access to the Fitness Center, only to participants that hold a current medical clearance.

4.1.14.5 Coordinate with AFRC Code 220 (Facility) for any

custodial or maintenance issue regarding the Fitness Center building. Coordinate new or existing equipment placement and/or rearrangement within the facility, routine AFRC safety inspections, routine equipment inspections as well as the purchase and removal of any malfunctioning, recalled or broken equipment. NASA will approve and procure of the required services. The Contractor shall be responsible for notifying the Government if/when equipment is not functional. The Government will then direct its repair or removal, at the expense of the Government. For issues identified in the regular safety inspection or any other audit, the contractor will ensure deficiencies are resolved.

The contractor will provide a list to the government of needed locker supplies to ensure locker/bathroom area is safe and functional. Contractor will ensure these are properly installed. This will include coordinating with AFRC housekeeping.