A2 PWS - Medical Monitoring Service.pdf

PERFORMANCE WORK STATEMENT

DC Army National Guard Occupational Health Medical Surveillance

1.0. General

1.1. Scope: DC Army National Guard Occupational Health (OH) seeks contracted services for a qualified mobile OH unit with an affiliated fixed facility to conduct job-related medical surveillance screening examinations and OH services for employees who have the potential to become exposed to health hazards in the work environment.

1.2. Background: In accordance with (IAW) the Occupational Safety and Health Administration (OSHA), Title 29 Code of Federal Regulations (CFR) § 1910, Army Regulation (AR) 40-501, National Guard Regulation (NGR) 40-5, AR 40-5, and Department of Defense Instruction (DoDI) 6055.05-M, employees must be monitored for the impacts of workplace exposures. The medical surveillance program is a risk-based medical screening and examination process intended to improve combat readiness through early recognition and prevention of occupational exposure by identifying workplace hazards and directing measures to prevent associated illnesses and injuries. Program requirements vary based on job code, work performed, and worksite exposures identified by industrial hygiene (IH) surveys.

1.3. General Information

1.3.1. Screening is required for employees exposed to potential health hazards based on Office of Personnel Management (OPM) job codes and IH survey data.

1.3.2. Personal protective equipment (PPE) is provided for known hazards not mitigated by engineering or administrative controls.

1.3.3. Medical surveillance screens for health risks from known and unknown exposures, ensures fitness for duty, and verifies the ability to use required PPE.

1.3.4. Employees in hazardous environments require medical surveillance examinations at baseline, periodically (semiannually or annually depending on exposure), and upon termination of exposure. Post-termination monitoring may be required for long-term effects.

1.4. Service Delivery and Completion

1.4.1. Service Delivery Dates: The 2-day medical surveillance event shall be scheduled on one of the following date ranges, to be finalized in coordination with the COR:

• Option 1: July 22-23

• Option 2: July 29-30

• Option 3: August 26-27

1.4.2. Service Completion: This service is considered complete once the contractor performs the 2-day medical surveillance and submits all required hard copy reports to the individual Government employees and the DCNG OHN within the subsequent 30-day period.

1.5. Place and Performance of Service

1.5.1. Location: Mobile services will be provided at: District of Columbia Army National Guard, 2001 East Capitol Street SE, Washington, DC 20003.

1.5.2. Hours of Operation: Services shall be provided between 0900-1700hrs, Wednesday through Thursday, excluding recognized US holidays or government facility closures.

1.5.3. Operations: The contractor must be onsite and ready at the pre-determined start time. The contractor will dictate service capacity during planning to determine the number of days required at each site and must maintain an adequate workforce for uninterrupted performance.

1.6. Contractor Employee Conduct & Responsibilities

1.6.1. Installation Regulations: Contractor employees shall obey all installation regulations (fire, traffic, safety, security). Access to restricted areas requires prior approval. Employees must carry proper identification at all times. The Government reserves the right to remove any contractor employee for misconduct, security reasons, or health concerns, which does not relieve the contractor of performance responsibilities.

1.6.2. Professional Conduct: The contractor must be professional at all times with good customer service. Staff shall present a professional appearance and conduct themselves accordingly, with good personal hygiene and clean, non-offensive clothing.

1.6.3. Zero Tolerance Policies: The contractor and employees must adhere to the strict policy against sexual harassment, sexual assault, and discrimination. The U.S.

Government has a zero-tolerance policy for trafficking in persons, and the contractor shall not engage in or procure commercial sex acts or use forced labor.

1.7. Recognized Holidays: The contractor shall not perform services on New Year’s Day, Martin Luther King Junior Day, President’s Day, Memorial Day, Juneteenth, Independence Day, Labor Day, Columbus Day, Veteran’s Day, Thanksgiving Day, or Christmas Day.

1.8. Security and Training

1.8.1. Installation Access: The contractor shall comply with all installation access and security policies, including providing information for background checks. Vehicle operators must have state-mandated liability coverage.

1.8.2. AT Level 1 Training: All contractor employees must complete AT Level 1 training (https://jko.jten.mil/courses/AT-level1/launch.html) within 30 days of the contract start date (or for new employees) and submit completion certificates to the COR.

1.8.3. iWATCH Training: All employees shall be briefed on the local iWATCH program to report suspicious activity within 30 days of contract start.

1.8.4. OPSEC Training: New employees must complete Level I OPSEC training (https://securityawareness.usalearning.gov/opsec/index.htm) within 30 days of reporting for duty and annually thereafter.

1.8.5. COMSEC/IT Security: All communications are subject to COMSEC monitoring. The contractor shall not use Government networks for unauthorized purposes.

1.8.6. Physical Security: The contractor shall safeguard all Government property and secure facilities at the end of each work period.

1.9. Confidentiality and Data Protection

1.9.1. Protected Health Information (PHI): The contractor shall not release any medical or personal information without written approval from the individual, IAW HIPAA. All personnel handling PHI must complete annual HIPAA training.

1.9.2. Confidentiality: The contractor shall abide by AR 40-66 regarding privileged communication and confidentiality of patient records.

1.9.3. Personally Identifiable Information (PII): The contractor shall protect all PII IAW DFARS 224.103 and DoDD 5400.11. The contractor is liable for all costs resulting from a PII breach caused by its violation of these policies.

1.9.4. Data Rights: The Government has unlimited rights to all documents and materials produced under this contract.

1.10. Contract Management

1.10.1. Contract Manager (CM): The contractor shall designate a CM and an alternate with full authority to act on all contract matters.

1.10.2. Quality Control (QC): The contractor shall establish, implement, and maintain an effective Quality Control Plan (QCP) to ensure all services are performed in accordance with this PWS. The QCP shall be the primary means by which the contractor guarantees that its work complies with all contract requirements.

• Core Function: The QCP must include detailed procedures to proactively identify, prevent, and ensure the non-recurrence of defective or non-conforming services.

• Minimum Content: The plan must, at a minimum, address all areas identified in the Performance Requirements Summary (PRS), located in Technical Exhibit 1.

• Submission and Approval: A comprehensive, final QCP shall be delivered to the Contracting Officer's Representative (COR) no later than ten (10) calendar days after contract award for review and acceptance.

• Modifications: Following the Government's acceptance of the initial QCP, the contractor must obtain prior written approval from the Contracting Officer (KO) for any subsequent changes or modifications to the plan.

1.10.3. Quality Assurance (QA): The Government will evaluate performance IAW the Quality Assurance Surveillance Plan (QASP).

1.10.4. Meetings: The contractor shall attend a post-award conference and periodic progress meetings at no additional cost to the Government.

1.10.5. Identification: Contractor employees must identify themselves as "contractor" in all communications and wear badges displaying their name, company, and contractor status.

1.10.6. Conflicts of Interest (OCI): The contractor shall immediately notify the KO of any potential OCI and submit a mitigation plan. The contractor shall not introduce new services without COR approval and shall not use services rendered for studies or publications without KO consent. The contractor shall not bill any party other than the Government for services rendered.

2.0. Definitions and Acronyms

• This section contains definitions for terms like Contractor, Defective Service, and Quality Control, and a list of acronyms such as AR, COR, DoD, HIPAA, OSHA, PII, and PWS.

3.0. Government Furnished Items

3.1. Property and Utilities: The Government will provide necessary workspace, office items (desk, phone, computer), and utilities for the contractor to perform services.

3.2. Materials: Medical documentation forms will be provided to employees by the

DCNG OHN.

4.0. Contractor Furnished Items

4.1. General: The contractor shall furnish all equipment, labor, PPE, and services required. All equipment must meet calibration and maintenance standards.

Licenses, credentials, and calibrations must be current and provided to the COR upon request.

5.0. Specific Requirements

5.1. Mobile Service Delivery: Provide and operate a mobile medical unit at government-designated locations as scheduled in coordination with the government Point of Contact (POC).

5.2. Testing and Screening Requirements: The contractor shall provide services for the medical surveillance examinations as follows, but not limited to (cost by line item must be provided):

5.2.1. Audiogram: IAW Department of the Army Pamphlet (DA PAM) 40-506, Department of Defense (DoD) 6055.05-M (baseline, annual, transfer and/or termination).

5.2.2. Pulmonary Functions Test (PFT): IAW DoD 6055.05-M (Spirometry).

5.2.3. Vision Screening: IAW DoD 6055.05-M, DA PAM 40-506 (corrected near and distant monocular and binocular visual acuity, depth perception, color, confrontational visual fields).

5.2.4. Medical Screening: Consisting of the following IAW DoD 6055.05-M:

5.2.4.1. Medical History Review: Includes past medical history, current health, family history, home/work exposures, work-related complaints (past and current), hearing, ergonomic, and vision.

5.2.4.2. Screening Exam: An interview with the employee to discuss available results and questionnaires, and to annotate notes in medical records.

5.2.4.3. Respiratory History/Clearance: IAW 29 CFR § 1910.134 App C and AR 11-34;

includes review of spirometry results as applicable. Personnel must be appropriately trained to perform qualitative and quantitative fit testing IAW appendix A of 29 CFR §

1910.134 for mandatory fit testing procedures.

5.3. Fitness for Duty (FFD): IAW DoD 6055.05-M (determining whether an employee is medically and physically able to perform the assigned duties without substantial risk of harm to themselves, others, or the mission).

5.4. Scope of Services Clarification: The services requested are for testing, screening and evaluation purposes therefore medical treatment is not required or authorized. In the event additional testing is required for a suspected occupational related issue, the contractor must consult with the COR prior to conducting.

5.5. Personnel Qualifications:

• All performance medical test results will be reviewed by a licensed Medical Doctor (MD), Physician Assistant (PA), or Nurse Practitioner (NP).

• Personnel performing audiograms must be CAOHC certified.

• Personnel performing PFTs must be NIOSH certified.

• All personnel must be appropriately licensed, trained, and skilled for their respective tasks (e.g., phlebotomy).

5.6. Documentation and Reporting:

• The contractor shall provide a by-name list of employees seen and tests performed to the COR prior to departing the work site each day.

• If abnormal findings are identified, the contractor shall notify the employee and the DCNG OHN immediately to be referred accordingly.

• All medical records must be identified with the employee's full name, last four of SSN, DOB, and job code.

• Hard copies of exam results shall be provided in duplicate: one copy mailed directly to the employee's home and one copy sent to the DCNG OHN within 30 working days.

• Personnel files and medical information will only be sent to and discussed with the individual and the

DCNG OHN.

• A cover letter summarizing results in lay terms must be provided to each employee.

• An itemized invoice must be submitted to the DCNG OHN within 30 days of the examination.

5.7. Estimated Workload and Services: The following table outlines the estimated workload for the medical surveillance services. The base requirement is for up to 39 employees, with a clear understanding that any services rendered beyond this baseline will be charged as additional line items.

Service / Requirement Estimated Baseline Quantity Notes

Core Medical Testing

Baseline Audiometric Exams Up to 39 exams Additional exams will be charged separately.

Titmus Vision Screening Up to 39 exams Additional exams will be charged separately.

Occupational Health Clearances

OSHA Medical Questionnaire Review & Clearance

Up to 39 clearances Additional clearances will be charged separately.

Qualitative Respirator Fit Tests

(QLFT)

Up to 39 fit tests Additional fit tests will be charged separately.

Administrative & Records

Employee Medical Records Management

Up to 39 records Creation and management of one record per employee.

5.8. Detailed Audiometric Requirements:

• Personnel performing audiograms must have a current course completion of a Council for Accreditation in Occupational Hearing Conservation (CAOHC) or equivalent course work and be able to perform an otoscopic examination IAW DA Pam 40-501. This certificate must be provided to verify training.

• The DD Form 2215 (Reference Audiogram) and DD Form 2216 (Hearing Conservation Data) are the forms of record for all audiograms. The DD Form 2215 will be provided for all baseline hearing tests, and the DD Form 2216 will be provided for all annual tests.

• Audiometric testing shall be conducted IAW DoDI 6055.12, 4(e) and DA PAM 40-501, chapter 3, (3-6) and chapter 7, (7-5) guidelines.

• The contractor will ensure all equipment is appropriately licensed, calibrated, and maintained to the standards governing its use and the manufacturer’s guidance.

• Annual comprehensive electro-acoustical calibration data for each audiometer must be provided to the COR within fifteen (15) days of each scheduled site location. Daily calibration and functional checks will be provided to the COR on each day prior to the start of testing.

• Audiometric testing must be conducted in a sound booth in a testing environment with noise levels not to exceed the requirements outlined in DA PAM 40-501, Table 3-2.

6.0. Additional Requirements and POC

6.1. The DCNG has a strict policy against sexual harassment, sexual assault and discrimination of any kind.

6.2. Initial coordination of services must occur within 15 working days after contract award.

6.3. The Point of Contact (POC) is the DCNG OHN, Eun Kim, at the District of Columbia Army National Guard, 2001 East Capitol Street SE, Washington, DC 20003. All correspondence, reports, and invoices should be sent to her attention.

Her email is eun.j.kim.civ@army.mil.

7.0. Applicable Publications

Publication Date of Publication Website

Federal Acquisition Regulation

Defense Federal Acquisition Regulation Supplement

Joint Travel Regulation (JTR)

DoDM 1000.13-M-V1, DoD Identification (ID) Cards

01/23/2014 (Change 1:

07/28/2020)

FIPS Publication 201-2, Personal Identity Verification (PIV)

August 2013

DoDM 5200.2, Procedures for the DoD Personnel Security Program

(PSP)

04/03/2017

DoDI 5200.46, DoD Investigative and Adjudicative Guidance for Issuing the CAC

09/09/14 (Change 1: 05/04/2018)

HSPD-12, Policy for a Common Identification Standard

08/27/2004

Publication Date of Publication Website

DoDI 5400.11, Department of Defense Privacy and Civil Liberties Programs

01/29/2019

DoD 5400.11-R, Department of Defense Privacy Program

05/14/2007

DoDD 8140.01, Cyberspace Workforce Management

10/05/2020

DoD 8570.01-M, Information Assurance Workforce Improvement Program

12/19/2005 (Change 4:

11/10/2015)

DoD 5220.22-M, National Industrial Security Program Operating Manual (NISPOM)

02/28/2006 (Change 2:

05/18/2016)

Army Directive 2014-05, Policy for CAC Credentialing

03/07/2014

AR 25-2, Information Assurance 04/04/2019

AR 530-1, Operations Security 09/26/2014

AR 525-13, Antiterrorism 12/09/2019

AR 381-12, Threat Awareness and Reporting Program (TARP)

06/01/2016

AFI 10-245, Antiterrorism 03/28/2013 (Certified current 03/30/2017)

AFI 31-101, Security Forces Standards and Procedures

08/18/2020

AFMAN 31-113, Security Forces Standards and Procedures

03/05/2013 (Change 1:

12/02/2015)

AFPD 17-1, Information Dominance Governance and Management

04/12/2016

AFMAN 17-1301, Computer Security (COMPUSEC)

02/12/2020

AFI 10-701, Operations Security 7/24/2019 (Change 1: 06/09/2020)

7.1. Applicable Forms

Form Description Date Website

DD 1172-2

Application for Identification Card/DEERS Enrollment

Mar 2017

I-9 Employment Eligibility Verification

10/21/2019

DD 441

Department of Defense Security Agreement

Feb 2020

DD 250

Material Inspection and Receiving Report

Aug 2000

TECHNICAL EXHIBIT 1

Performance Requirements Summary (PRS)

This PRS includes performance objectives the Government will use to determine contractor performance and will compare contractor performance to the Acceptable Quality Level (AQL).

Performance Objective Performance Standard Acceptable Quality Levels (AQL)

Surveillance Method / By Whom

1.4.1 Contractor shall provide a mobile unit onsite and on time.

Onsite mobile unit arrived on time to the designated DCNG facilities.

Observation

1.4.8

The contractor shall develop and implement procedures to identify, prevent, and ensure non-recurrence of defective services.

The contractor developed and maintained an effective QC Plan (QCP) to ensure services are performed in compliance with contract.

Employee Feedback

1.4.14 The contractor shall abide by the privacy of the employee.

The contractor provided confidential areas at the time of examination for all services as well protected health information records.

Employee Feedback;

Documentation

1.4.15 The contractor shall protect all health information.

The contractor protected health information IAW with HIPAA.

Observation;

Documentation

Performance Objective Performance Standard Acceptable Quality Levels (AQL)

Surveillance Method / By Whom

1.4.18

Contractor will attend post award conference and periodic progress meetings.

Contractor attended all post award meetings and conference.

Observation

1.4.19

Contractor is to designate a POC in writing to the KO for contracting actions.

The contractor designated a contracting manager who is fully working with the KO and COR on contracting actions.

Observation

1.4.26.4 Contractor will comply with all installation safety requirements.

Contractors maintained safety compliance at all times.

Observation; Employee Feedback

4.0

Contractor is to furnish the equipment, labor and services as prescribed by the PWS.

Contractor furnished required materials and equipment to perform services.

Documentation

5.0

The contractor will conduct testing based upon the list provided to them by the DCNG Occupational Health Nurse (OHN).

Testing requirements were conducted according to the spreadsheet provided by

DCNG OHN.

Documentation

5.6

If abnormal findings are identified that may be a serious health concern, the contractor shall notify the employee and the DCNG OHN immediately.

Abnormal findings, if any, were communicated immediately to the employee and DCNG

OHN.

Documentation;

Communication

5.10

Ensure the health care team are current and appropriately licensed, trained, boarded and certified.

Contractor provided licensing and certifications, to include calibration, prescribed in

PWS.

Documentation