ATCH_1_PWS.pdf

PERFORMANCE WORK STATEMENT

OCCUPATIONAL HEALTH

PROCUREMENT OF MEDICAL SURVEILLANCE EXAMS/SCREENINGS

Primary Date Choice – August 15 – 19, 2022 Secondary Date Choice – August 01 – 05, 2022

Tertiary Date Choice – August 22 – 26, 2022 or August 29 – September 2, 2022 Last Option Date Choice – August 08 – 12, 2022

1. GENERAL

The Performance Work Statement (PWS) supports the Nebraska Army National Guard (NEARNG) for Occupational Medical Surveillance Examination Program in accordance with the Occupation Safety and Health Association (OSHA) and other regulations.

There are 2 locations that require this service: 1111 Military Rd, Lincoln, NE 68508 and 6700 E J ST, Hastings, NE 68901. The estimated total number of personnel to be examined is 85-95; 25-30 in Hastings, 60-65 in Lincoln. Period of performance will be August 15 – 19, 2022, August 01 – 05, 2022, August 22 – 26, 2022, August 29 – September 2, 2022, or August 08 – 12, 2022. Estimated time at each location is 2 days in Hastings and 3 days in Lincoln. Final schedule will be a coordinated effort between the contractor and the Occupational Health Nurse (OHN).

2. PURPOSE

2.1. The purpose of the Occupational Medical Surveillance Examination Program is to provide job-related Medical Surveillance Examinations and Occupational Health Services to the NEARNG full-time support (FTS) and/or temporary personnel who are or could potentially be exposed to health hazards in the work environment. The examination shall include personnel assigned to positions requiring specific standards of physical fitness. Personnel not included under these examinations are State Employees, civilian contractors, and the part-time traditional Soldiers.

2.2. The Government may evaluate the quality of professional and administrative services provided, but retain no control over the medical professional aspects of services rendered such as testing procedures, etc. The Contractor will provide Board Certified Occupational Health Physician(s), supervision, all labor, tools, materials, equipment, and incidentals required to conduct the Medical Surveillance Examination / Occupational Health Services for the NEARNG.

3. PROCEDURES and STANDARDS

3.1. This contract is for “Non Personal” Health Care “Services”, as defined in 37.101.

In accordance with FAR Part 37.4 the Government may enter into a non-personal health care services contract with physicians, dentists and other health care providers under authority of 10 U.S.C. 2304 and 41 U.S.C. 253. The Government shall evaluate the quality of professional and administrative services provided, while the Government retains no control over the medical, professional aspects of services rendered. The Contractor will indemnify the Government for any liability producing act or omission by the Contractor, its employees and agents occurring during contract performance. The Contractor will maintain medical liability insurance, in a coverage amount acceptable to the Contracting Officer, which is not less than the amount normally prevailing within the local community for the medical specialty concerned. The Contractor is required to ensure that its subcontractors, if any, for provisions of health care services, contain the requirements of the clause at 52.237-7, Indemnification and Medical Liability Insurance, including the maintenance of medical liability insurance. The contractor, upon request by the Contracting Officer, shall furnish prior to contract award evidence of its insurability concerning the medical liability insurance required by this clause.

3.2. Contractor shall ensure all procedures are conducted in accordance with applicable American Board of Occupational and Environmental Medicine (ABOEM), American Association of Occupational Health Nurses (AAOHN), U.S. Department of Labor, Occupational Safety and Health Administration (OSHA), and the National Institute for Occupational Safety and Health (NIOSH) Standards.

3.3. Contractor shall ensure all clinical laboratory services are performed by a laboratory licensed through the U.S. Department of Health and Human Services (DHHS), Health Care Financing Administration pursuant to the terms of the Clinical Laboratories Improvement Act of 1967 (42 U.S.C. 263a) and the College of American Pathologies.

3.4. Contractor shall provide a Certified Occupational Medicine Physician or a Physician that has a background in Internal Medicine and has at least 3 years of experience working with Occupational Medicine to conduct job-related medical surveillance physical examinations and occupational health consultation services.

3.5. Privacy and Security. The Contractor shall ensure that all findings are clearly recorded on Government or other approved forms, and are protected by Privacy Act of 1974 and Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandated safeguards to ensure confidentiality of health information.

3.6. Contractor shall arrange for the opportunity to consult with the Occupational Health Nurse of the NEARNG by telephone to coordinate or resolve issues that might arise before, during, and after the testing period.

3.7. Contractor shall perform a comprehensive review and written evaluation within 30-days following the conclusion of testing. The Occupational Health Nurse may contact and schedule a follow-up review and evaluation meeting to discuss positive and negative aspects of testing.

4. EXAMS

4.1. Vitals: Contractor will provide vital signs to include height, weight, blood pressure, pulse and respirations for all scheduled Government personnel.

4.2. Job Functional Analysis: Contractors will provide a Job Functional Analysis or Kraus-Weber that includes back strength and flexibility for all scheduled Government personnel. Note any pain or recommended lifting limitations if less than 50 lbs.

4.3. Audiogram: Contractor shall ensure the hearing tech is certified by the Council for Accreditation in Occupational Hearing Conservation (CAOHC) or the equivalent military Defense Occupational and Environmental Health Readiness System-Hearing Conservation (DOEHRS-HC) training in accordance with 29 CFR 1910.95. The number of personnel to receive audiograms is 5-10; 3-5 in Hastings, 3-5 in Lincoln.

a. Hearing screenings will be conducted only on employees exposed to occupational noise > 85 dBA or 140 dBA impact noise.

b. All hearing tests will be provided to the Occupational Health Nurse.

c. Otoscopic Exam.

d. Test Only 500, 1000, 2000, 3000, 4000 and 6000 Hz.

e. Hearing aids must be removed.

f. Employee must be noise free for at least 14 hours prior to screening.

g. If using DOEHRS-HC, all hearing screenings besides the baseline will be compared against the employee’s baseline to determine if there is a Significant Threshold Shift (STS) and retested immediately and if there is still a STS notify the Occupational Health Nurse within 10 days so that timely retesting can be scheduled.

4.4. Pulmonary Function Test: Contractor shall ensure Pulmonary Function Tests (PFTs) Performed by a licensed physician, Certified Pulmonary Function Technologist, or Registered Respiratory Therapist in accordance with 29 CFR 1910.1001. The number of personnel to receive pulmonary function tests is 25-35; 10-15 in Hastings and 15-20 in Lincoln.

a. Screenings will only be conducted on employees exposed to respiratory hazards that will require a respirator to mitigate their hazards that are above the action level.

b. Test will include as a minimum Forced Expiratory Volume in one second (FEV1), Forced Vital Capacity (FVC), comparison with recognized normals for the individual's height and weight, sex, race, age and a documented interpretation by a pulmonologist or certified Occupational Health physician.

c. Follow NIOSH and American Thoracic Society – European Respiratory Society (ATS-ERS) standard requirements:

1. Continue testing individual when the patient is improving until improvement is <30ml.

2. Test results are acceptable with a minimum of three acceptable maneuvers that are free from a leak, obstructed mouthpiece, hesitation, false starts, cough, glottis closure, early termination, and have a good curve of at least 6 seconds duration.

3. Test results are reproducible in that they have the same result from the individual (two largest FVCs are within 0.150 L of each other and two largest FEV1's are within 0.150 L of each other) when the test is repeated several times. Testing is continued until criteria are met or 8 trials are attempted, or the employee being tested cannot or should not continue.

4. If three (3) acceptable and two (2) repeatable tests cannot be obtained, the technician performing the PFT must document the reason the standard could not be met.

5. Always use measured height not reported height by the nearest half inch without footwear.

6. Always indicate source of reference value on reports for adjusted predicted value

7. No smoking within 1 hour prior

8. No cold, flu or allergies within two weeks

9. No inhaler use prior to test that would still be in the patient’s system

d. Specifications regarding equipment guidelines and calibration, test administration, and test interpretation must meet applicable OSHA and ANSI standards. Supporting documentation will be provided to this office daily or annually depending on manufacturing guidelines of spirometer

e. Respirator clearance documented and a copy given to employee at time of visit.

4.5. Quantitative Fit Testing: Contractor will provide quantitative fit testing in accordance with 29 CFR 1910. 134 appendix A. The number of personnel to receive fit testing is 25-35; 10-15 in Hastings and 15-20 in Lincoln.

a. The masks/respirator will be brought to the testing site by the individual employee who has one assigned to them for their utilization.

b. The Occupational Health Nurse will provide surrogate masks/respirators for employees that are required to have a mask/respirator but do not have one issued and/or need to know their proper size.

4.6. Vision Screenings: Contractor will ensure that vision screenings are in accordance with DA PAM 40-506 (http://www.apd.army.mil/jw2/xmldemo/p40_506/head.asp) using multiphasic vision screening equipment to measure the following primary visual skills.

The number of personnel to receive vision screenings is 85-95; 25-30 in Hastings, 60- 65 in Lincoln.

a. Visual acuity for distance and near.

b. Lateral phorias for distance and near.

c. Vertical phorias for distance and near.

d. Depth perception.

e. Color perception.

f. Peripheral vision.

g. Amsler grid: The number of personnel to receive Amsler grid is 3-6; 1-2 in

Hastings, 2-4 in Lincoln.

4.7. Laboratory Tests: Contractor shall ensure laboratory tests will be processed by certified clinical laboratories and performed by personnel certified under the American Society of Clinical Pathology. The supporting laboratory will provide employee instruction and equipment necessary for tests requiring special collection methods and/or containers. Document that employee has been counseled by examining provider about laboratory test results. Provide a copy of lab results to employee for their primary care physician. Tests include:

a. Complete Blood Count (CBC)

b. Complete Metabolic Panel (CMP) 12

c. Urinalysis. Fasting is required.

1. The number of personnel to receive laboratory testing is 5-10; 3-5 in Hastings, 2-5 in Lincoln.

d. Blood lead

1. The number of personnel to receive Blood Lead is 1 in Lincoln.

5. REFERENCES

5.1. Title 29, Code of Federal Regulations, Part 1910: Occupational Safety and Health Standards.

5.2. Title 29, Code of Federal Regulations, Part 1960: Safety and Health Provisions for Federal Employees.

5.3. American National Standards Institute (ANSI) 288.6-1884, American National

Standard for Respiratory Protection, Respirator Use, Physical Qualifications for Personnel.

5.4. Threshold Limit Values and Biological Exposure Indices (TLVs), American

Conference of Governmental Industrial Hygienists (ACGIH), Cincinnati, Ohio.

5.5. Army Regulation 40-5, Preventive Medicine 25 May 2007

5.6. Department of Defense 6055.05M, Occupational Medical Surveillance Manual 2 May 2007

5.7. U.S. Department of Labor, Code of Federal Regulations 29 (CFR) 1910.120 (b) (5), (f), Medical Surveillance

5.8. Army Regulation 11-34, The Army Respiratory Protection Program 15 Feb 1990

5.9. Headquarters, Department of the Army Pamphlet (DA PAM) 40-501 Hearing Conservation 10 Dec 1998

5.10. Headquarters, Department of the Army Pamphlet (DA PAM) 40-506 Vision Conservation 15 Jul 2009

6. PERSONAL PROTECTIVE EQUIPMENT (PPE)

6.1. Contractor shall furnish and assure healthcare workers are provided with the appropriate PPE such as, but not limited to: gloves, protective eyewear, and etc., where there is a potential for exposure to blood or other potentially infectious materials.

6.2. Contractor shall ensure each healthcare worker complies with the requirements of 29 CFR 1910.1030 Blood borne Pathogens Standard.

7. INFECTIOUS WASTE DISPOSAL

7.1. Disposal of all infectious waste shall be in accordance with local, state, and federal regulation and disposed of by the contractor unless other accommodations have been coordinated in writing.

7.2. Contractor shall ensure puncture resistant sharps containers are readily accessible to healthcare workers and located in all treatment areas where sharps could potentially be used.

8. MOBILE UNIT CONFIGURATION

8.1. Medical Surveillance screening shall be accomplished via mobile unit, a facility, or area designed to ensure complete individual privacy during testing. Use of Government facilities and resources is not allowed. Features of the test site shall include, but are not limed to, a climate-controlled atmosphere, patient waiting / holding area for registration, changing room, or restroom, testing / phlebotomy station, individual audiometric testing booth, physical examination area and a private consultation office for patient interviews.

8.2. Mobile units shall be equipped with a self-contained power source.

8.3. Contractor shall ensure instrumentation must meet or exceed appropriate performance standards, and accuracy must be verified in accordance with current Occupational Medicine Certification standards.

9. MEDICAL REPORTS AND RECORDKEEPING

9.1. Contractors shall immediately contact the Occupational Health Nurse by telephone at 402-309-1832 if results of medical surveillance screening(s), which are questionable and / or of critical significance and / or require follow-up. Contractor shall send 2 copies of all results to include all diagnostic tests, graphs, charts, reports, questionnaires, waivers, employee consent forms, physical findings, and examination results to the Occupational Health Nurse within 30 working days of completion of testing to:

Nebraska Army National Guard ATTN: Mr. Josiah Unger, OHN 1111 Military Road Lincoln, NE 68508

9.2. Contractor shall identify all medical records with the employee’s full name, social security number or DoD ID number, date of birth, job code, and the name of the employee’s work place or facility at a minimum. The contractor shall ensure work / health history forms and medical reports are complete and legible (typed / printed).

9.3. Contractor shall ensure that each employee signs the Privacy Act Statement (DD Form 2005) during the registration process.

9.4. Contractor shall provide the Occupational Health Nurse with a Quality Assurance Medical Surveillance Plan listing the procedures or processes, which shall be utilized to meet the requirements discussed in the PWS.

10. EXAMINATION SCHEDULING

10.1. Coordination of scheduling shall be a joint effort between the Occupational Health Nurse and the Contractor, a draft copy of the schedule will be initiated by the Occupational Health Nurse and sent to the Contractor for review and any needed adjustments. One patient/employee per 15-30 minute intervals.

10.2. In the event of a Contractor equipment failure, specific testing and / or parts of examinations that are not completed during the testing period shall be completed at a scheduled time mutually convenient for the Contractor, Occupational Health Nurse and the Facility(ies). Unfinished testing / examinations will be completed at no additional cost to the Government. The option to schedule physicals not completed due to equipment failure, through a local occupational medical facility shall be done at no cost to the Government. The Contractor shall be directly responsible to cover costs for completing these make-up screenings.

10.3. The number of people for any one test is a firm number except for unforeseen circumstances keeping an individual from attending, i.e. sickness, work demand, anything to interrupt normal attendance. For either location with an actual variance of 5 percent above or below the stated number of personnel, an equitable adjustment in the contract price can be made upon demand of either party

11. ABBREVIATIONS AND ACRONYMS

AAOHN – American Association of Occupational Health Nurses ABOEM – American Board of Occupational and Environmental Medicine ACGIH – American Conference of Governmental Industrial Hygienists ANSI – American National Standards Institute ATS-ERS – American Thoracic Society-European Respiratory Society BEI – Biological Exposure Indices CAOHC – Council for Accreditation in Occupational Hearing Conservation CBC – Complete Blood Count CFR – Code of Federal Regulation CMP – Complete Metabolic Panel DA PAM – Department of the Army Pamphlet dBA – Decibels DHHS – Department of Health and Human Services DoD – Department of Defense DOEHRS-HC – Defense Occupational and Environmental Health Readiness System- Hearing Conservation FAR – Federal Acquisition Regulation FEV1 – Forced Expiratory Volume in one second FTS – Full-time support FVC – Forced Vital Capacity Hz – Hertz NEARNG – Nebraska Army National Guard NIOSH – National Institute for Occupational Safety and Health OSHA – Occupation Safety and Health Association PFT – Pulmonary Function Test PPE – Personal Protective Equipment PWS – Performance Work Statement SDS – Service Delivery Summary STS – Significant Threshold Shift TLV – Threshold Limit Value U.S.C. – United States Code

12. SERVICE DELIVERY SUMMARY (SDS)

12.1. The service delivery summary is designed to be a concise statement of key deliverables which are measured to determine the contractor's performance success or failure.

PERFORMANCE OBJECTIVE PERFORMANCE SCHEDULE

Insurance & Licensed and/or certified staff

For all physicians and technicians, 100% of the time (see Para 3.1, 3.3, 3.4, 3.9)

Equipment Certification Instrumentation meets or exceeds performance standards, 100% of the time (see Para 8.3)

Medical Surveillance All FTS and/or temporary personnel has been examined, 98% of the time (see Section 4)

Infectious Waste Disposal

All sharp instruments, blood, and urine is handled and disposed of in accordance with federal, state, and local regulations, 100% of the time (see Para 6.1, 6.2, 7.1, 7.2)

Medical Reports and Recordkeeping

Privacy Act Statement for each FTS and/or temporary personnel and the reports are submitted in a timely manner, 100% of the time (see Para 3.5, 9.1, 9.2, 9.3, 9.4)

13. Not used

14. SECURITY

14.1. Contractor and all associated sub‐contractors employees shall provide all information required for background checks to meet installation access requirements to be accomplished by installation Provost Marshal Office, Director of Emergency Services or Security Office. Contractor workforce must comply with all personal identity verification requirements( FAR clause 52.204‐9, Personal Identity Verification of Contractor Personnel) as directed by DOD, HQDA and/or local policy. In addition to the changes otherwise authorized by the changes clause of this contract, should the Force Protection Condition (FPCON) at any individual facility or installation change, the Government may require changes in contractor security matters or processes.

14.2. Contractor and all associated sub‐contractors employees shall comply with adjudication standards and procedures using the National Crime Information Center Interstate Identification Index (NCIC‐III) and Terrorist Screening Database (TSDB) (Army Directive 2014‐05/AR 190-13), applicable installation, facility and area commander installation/facility access and local security policies and procedures (provided by government representative), or, at OCONUS locations, in accordance with status of forces agreements and other theater regulations.

14.3. The contractor and all associated sub‐contractors shall brief all employees on the local iWATCH program (training standards provided by the requiring activity ATO). This local developed training will be used to inform employees of the types of behavior to watch for and instruct employees to report suspicious activity to the COR. This training shall be completed within 30 calendar days of contract award and within 5 calendar days of new employees commencing performance with the results reported to the COR NLT 30 calendar days after contract award.

14.4. Per AR 530‐1 Operations Security, the contractor employees must complete Level I OPSEC Awareness training. New employees must be trained within 30 calendar days of their reporting for duty and annually thereafter.

14.5. AT Level I training. This standard language is for contractor employees with an area of performance within an Army controlled installation, facility or area. All contractor employees, to include subcontractor employees, requiring access Army installations, facilities and controlled access areas shall complete AT Level I awareness training within 30 calendar days after contract start date or effective date of incorporation of this requirement into the contract, whichever is applicable. The contractor shall submit certificates of completion for each affected contractor employee and subcontractor employee, to the COR or to the contracting officer, if a COR is not assigned, within 30 calendar days after completion of training by all employees and subcontractor personnel. AT level I awareness training is available at the following website:

http://jko.jten.mil.