ATCH_1_PWS_Tech Exams_20Q4528.pdf

ATTACHMENT 1

Ver. May 2018

PERFORMANCE WORK STATEMENT (PWS)

FOR

OCCUPATIONAL HEALTH

MEDICAL SURVEILLANCE EXAMINATION SERVICES

1.0 General: This contract is for “Non Personal Health Care Services,” as defined in 37.101, under which the contractor is an independent contractor. 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.

1.1 Scope: The contractor shall provide all personnel, equipment, tools, materials, supervision, and quality control necessary, except as defined in Paragraph 3.0 as Government Furnished, to perform Medical Surveillance Examination Services, as defined in this PWS.

1.2 Background: The purpose of the Occupational Medical Surveillance Examination Program is to provide job-related Medical Surveillance Examinations and Occupational Health Services to the IAARNG 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 Active Guard Reserve (AGR), state employees, civilian contractors, and the part-time traditional soldiers.

1.3 Period of Performance (PoP): The Period of Performance shall be from date of award through October 30, 2020. Individual exam schedule will be coordinated between the Occupational Health Nurse (OHN) and the Contractor, but shall be scheduled within the PoP.

1.4 General Information:

1.4.1 RESERVED

1.4.2 RESERVED

1.4.3 Recognized Holidays: The following are recognized United States (US) holidays.

The contractor shall not perform services on these days:

1.4.3.1 New Year’s Day: January 1st

1.4.3.2 Martin Luther King, Jr.’s Birthday

1.4.3.3 President’s Day

1.4.3.4 Memorial Day

1.4.3.5 Independence Day: July 4th

1.4.3.6 Labor Day

1.4.3.7 Columbus Day

1.4.3.8 Veteran’s Day: November 11th

1.4.3.9 Thanksgiving Day

1.4.3.10 Christmas Day: December 25th

1.4.4 Place and Performance of Services: Services shall be provided in clinical settings within a 40 mile radius of Camp Dodge Joint Maneuver Training Center (CDJMTC) located at 7105 NW 70th Avenue Johnston, Iowa, 50131 and within a 40 mile radius of Boone Armory located at 700 Snedden Drive Boone, Iowa, 50036. The contractor shall at all times maintain an adequate work force for uninterrupted performance of all tasks defined within the PWS. When hiring personnel, the contractor shall keep in mind that the stability and continuity of the work force are essential.

1.4.4.1 RESERVED

1.4.4.2 RESERVED

1.4.4.3 RESERVED

1.4.5 Security Requirements: Protection of Personally Identifiable Information (PII). The contractor shall protect all Personally Identifiable Information (PII) encountered in the performance of services in accordance with DFARS 224.103 and DoDD 5400.11, Department of Defense Privacy Program, and DoD 5400.11-R. If a PII breach results from the contractor’s violation of the aforementioned policies, the contractor shall bear all notification costs, call-center support costs, and credit monitoring service costs for all individuals who’s PII has been compromised.

1.4.6 RESERVED

1.4.6.1 RESERVED

1.4.6.2 RESERVED

1.4.6.3. Homeland Security Presidential Directive (HSPD) 12 Considerations:

1.4.6.3.1 Routine access to Government-controlled facilities is not required.

1.4.6.3.2 Routine access to Government Information Systems is not required.

1.4.6.3.3 NACI or other security check is not required.

1.4.6.3.4 Government-issued identification and/or building passes are not required.

1.4.6.3.5 Contractor personnel do not require a Government escort while performing work on the installation. Contractor personnel will not be working on the installation.

1.4.6.3.6 Contractor is not required to provide employee and/or vehicle information for an Entry Authorization List (EAL).

1.4.7 Special Qualifications:

1.4.7.1 All procedures shall be 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.

1.4.7.2 All clinical laboratory services shall be 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; and personnel certified under the American Society of Clinical Pathology.

1.4.7.3 All job-related medical surveillance physical examinations and occupational health consultation services shall be conducted by Board eligible or Certified Occupational Medicine Physicians.

1.4.8 RESERVED

1.4.9 RESERVED

1.4.10 RESERVED

1.4.11 Combating Trafficking in Persons: The United States Government has adopted a zero tolerance policy regarding trafficking in persons. Contractors and contractor employees shall not engage in severe forms of trafficking in persons during the period of performance of the contract; procure commercial sex acts during the period of performance of the contract; or use forced labor in the performance of the contract. The Contractor shall notify its employees of the United States Government’s zero tolerance policy, the actions that will be taken against employees for violations of this policy. The contractor shall take appropriate action, up to and including termination, against employees or subcontractors that violate the US Government policy as described at

FAR 22.17.

1.4.12 RESERVED

1.4.13 RESERVED

1.4.14 Organizational Conflicts of Interest (OCI): The contractor and subcontractor personnel performing services under this contract may receive, have access to or participate in the development of proprietary or source selection information (e.g., cost or pricing information, budget information or analyses, specifications or work statements, etc.) or perform evaluation services which may create a current or subsequent OCIs, as defined in FAR Subpart 9.5. The contractor shall notify the KO immediately whenever it becomes aware that such access or participation may result in any actual or potential OCI and shall promptly submit a plan to the KO to avoid or mitigate any such OCI. The contractor’s mitigation plan will be determined to be acceptable solely at the discretion of the KO. In the event the KO unilaterally determines that any such OCI cannot be satisfactorily avoided or mitigated, the KO may impose other remedies as he or she deems necessary, including prohibiting the contractor from participation in subsequent contracted requirements which may be affected by the OCI.

1.4.15 RESERVED

2.0 Definitions and Acronyms:

2.1 Definitions:

2.1.1 Contractor: A supplier or vendor awarded a contract to provide specific supplies or service to the government. The term used in this contract refers to the prime.

2.1.2 Contracting Officer (KO): A person with authority to enter into, administer, and or terminate contracts, and make related determinations and findings on behalf of the government. Note: The only individual who can legally bind the government.

2.1.3 Contracting Officer Representative (COR): An employee of the U.S. Government designated by the KO to monitor contractor performance. Such appointment will be in writing and will state the scope of authority and limitations. This individual has authority to provide technical direction to the Contractor as long as that direction is within the scope of the contract, does not constitute a change, and has no funding implications.

This individual does NOT have authority to change the terms and conditions of the contract.

2.1.4 Defective Service: A service output that does not meet the standard of performance associated with the PWS.

2.1.5 Deliverable: Anything that can be physically delivered and includes non-manufactured things such as meeting minutes or reports.

2.1.6 Key Personnel: Contractor personnel that are evaluated in a source selection process and that may be required to be used in the performance of a contract by the PWS. When key personnel are used as an evaluation factor in best value procurement, an offer can be rejected if it does not have a firm commitment from the persons that are listed in the proposal.

2.1.7 Physical Security: Actions that prevent the loss or damage of Government property.

2.1.8 Quality Assurance: The government procedures to verify that services being performed by the Contractor are performed according to acceptable standards.

2.1.9 Quality Assurance Surveillance Plan (QASP): An organized written document specifying the surveillance methodology to be used for surveillance of contractor performance.

2.1.10 Quality Control: All necessary measures taken by the Contractor to ensure that the quality of an end product or service shall meet contract requirements.

2.1.11 Subcontractor: One that enters into a contract with a prime contractor. The Government does not have privity of contract with the subcontractor.

2.2 Acronyms:

AAOHN American Association of Occupational Health Nurses ABOEM American Board of Occupational and Environmental Medicine AEI Army Enterprise Infostructure AGR Active Guard Reserve AR Army Regulation AT/OPSEC Antiterrorism/Operational Security BI Background Investigation CDJMTC Camp Dodge Joint Maneuver Training Center CFP/M/E Contractor Furnished Property, Materials, and Equipment CM Contract Manager CMRA Contractor Manpower Reporting Application COR Contracting Officer Representative DA Department of the Army DD254 Department of Defense Contract Security Classification Specification DFARS Defense Federal Acquisition Regulation Supplement DHHS Department of Health and Human Services DoD Department of Defense FAR Federal Acquisition Regulation FTS Full Time Support GFP/M/E/S Government Furnished Property/Material/Equipment/Services HQDA Headquarters, Department of the Army HSPD Homeland Security Presidential Directive IA Information Assurance IAARNG Iowa Army National Guard IS Information System(s) KO Contracting Officer NGB National Guard Bureau

NIOSH National Institute of Occupational Safety and Health OCI Organizational Conflict of Interest OHN Occupational Health Nurse OSHA Occupational Safety and Health Administration PII Personally Identifiable Information PIPO Phase In/Phase Out POC Point of Contact POP Period of Performance PRS Performance Requirements Summary PWS Performance Work Statement QA Quality Assurance QASP Quality Assurance Surveillance Plan QC Quality Control QCP Quality Control Program SSN Social Security Number TE Technical Exhibit US United States USD(I) Under Secretary of Defense for Intelligence

3.0 Government Furnished Property, Material, Equipment and Services (GFP/M/E/S):

The Government will provide the property, material, equipment, and/or services listed below solely for the purpose of performance under this contract:

3.1 Property: NONE

3.2 Material: NONE

3.3 Equipment: NONE

3.4 Services: NONE

3.5 Utilities: NONE

4.0 Contractor Furnished Property, Materials, and Equipment (CFP/M/E):

4.1 General: Except for those items specifically stated to be Government-Furnished in Paragraph 3.0, the contractor shall furnish everything required to perform the services indicated in Paragraph 1.1.

4.2 RESERVED

5.0 Requirements: This PWS supports the IAARNG for the Occupational Medical Surveillance Examination Program in accordance with the OSHA and other regulations.

The contractor shall:

5.1 Provide Board Certified Occupational Health Physician(s), supervision, labor, tools, materials, equipment, and incidentals required to conduct Medical Surveillance Examinations/Occupational Health Services for the IAARNG as described below. The estimated number of personnel to be examined is 143. The actual number of personnel to be examined may change due to military deployments or training requirements.

5.1.1 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 subcontracts for provisions of health care services, contain the requirements of the clause at FAR 52.237-7, Indemnification and Medical Liability Insurance, including the maintenance of medical liability insurance.

5.2 Consult with an Occupational Health Nurse (OHN) of the IAARNG by telephone to coordinate or resolve issues that might arise before, during, and after the testing period.

5.3 Perform a comprehensive review and evaluation within 30 days following the conclusion of testing. The Government Point of Contact (POC) will contact and schedule a follow-up review and evaluation meeting to discuss positive and negative aspects of testing.

5.4 Designate a POC to work directly with the OHN to resolve any issues that may arise during the execution of this contract.

5.5 Immediately notify the OHN of any abnormal testing results, to include significant abnormal laboratory results and significant abnormal exam findings.

5.6 Specific Tasks.

5.6.1 Vital signs: Provide vital signs to include height (Barefoot, boots or shoes removed), weight (Boots & Military top removed, T-shirt okay), blood pressure, pulse and respirations. Estimated quantity for vital signs –143 each.

5.6.2 Labs: Provide laboratory tests processed by certified clinical laboratories and performed by personnel certified under the American Society of Clinical Pathology. The supporting laboratory shall provide employee instruction and equipment necessary for tests requiring special collection methods and/or containers. Document that each employee has been counseled by examining provider about laboratory test results.

Provide a copy of lab results to employee for their primary care physician.

5.6.2.1 Complete Lab Draws: The following labs are to be drawn only as indicated by the Occupational Health Manager: Estimated quantity of labs– 126.

5.6.2.2 Lead blood level-estimated quantity-27

5.6.2.3 Heavy metal panel (arsenic, cadmium, lead, mercury) - estimated quantity-15

5.6.2.4 Chromium blood level-estimated quantity-17

5.6.2.5 Manganese blood level- estimated quantity-14

5.6.2.6 Hex methylene isocyanate (HDI)-specific IgE, Methylene diphenyl isocyanate (MDI) specific IgE, Toluene isocyanate (TDI) IgE- estimated quantity-5

5.6.2.7 Zinc Protoporhyrin (ZPP)- estimated quantity-36

5.6.2.8 Cadmium blood level- estimated quantity-12

5.7 Vision Screenings: (Estimated quantity – 142 each):

5.7.1 Ensure that vision screenings are in accordance with DA PAM 40-506 using multi-phasic vision screening equipment (TITMUS or equivalent) to measure the following primary visual skills:

5.7.2 Visual acuity for distance and near corrected and uncorrected

5.7.3 Lateral phorias for distance and near

5.7.4 Vertical phorias for distance and near

5.7.5 Depth perception

5.7.6 Color perception

5.7.7 Peripheral vision

5.8 Physical/dermatological Exam: (Estimated quantity – 143 each)

5.8.1 Provide a Job Functional Analysis or Kraus-Weber that includes back strength and flexibility. Note any pain or recommended lifting limitations if less than 50 lbs.

5.8.2 Complete a physical exam by a physician or mid-level provider by a reviewing all systems and occupational history with focus on medical abnormalities related to occupational exposures.

5.8.3 Ensure dermatological examinations are performed by a physician and include an inspection of the entire integumentary system with emphasis on areas most likely to be affected by the employee's occupational (i.e. radiation) exposures. Documentation shall include the presence of any dermatomes or lesions of the skin.

5.9 EXAMINATION SCHEDULING

5.9.1 Coordination of scheduling shall be a joint effort between the OHN, the Contractor, and the individual.

5.10 MEDICAL REPORTS & RECORDKEEPING. The contractor shall:

5.10.1 Utilize Enclosure 1, Occupational Health Report Medical Examination for every exam.

5.10.2 Immediately report to the OHN, by telephone at (515) 252-4910, if results of medical surveillance screening(s) are questionable and/or are of critical significance, and/or require follow-up.

5.10.3 Send documentation, to include all diagnostic tests, graphs, charts, reports, questionnaires, waivers, employee consent forms, physical findings, and examination results, to the OHN within 30 business days after completion of testing to:

Iowa Army National Guard ATTN: Lana Martinez, MSN, RN, Occupational Health Nurse 7105 NW 70th Ave-BLDG S-70 Johnston, IA 50131-1824 Phone (515) 252-4910 Fax (515) 252-4140 E-mail lana.m.martinez2.civ@mail.mil

5.11 Identify all medical records with the employee’s full name, social security 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).

5.12 Prepare two (2) copies of all exam results to be distributed within 30 business days after completion of testing, as follows:

5.12.1 One (1) complete copy of all exam components shall be faxed or mailed to the

OHN.

5.12.2 One (1) complete copy of all exam components shall be placed in a sealed envelope and sent to the individual receiving the exam.

5.12.3 Exam results that cannot be sent to individuals shall be mailed to the OHN, individually sealed, for dissemination.

5.13 Contractor Manpower Reporting (CMR):

5.13.1 The contractor shall report manpower data relating to the performance of service contracts into the System for Award Management (www.sam.gov).

5.13.2 The contractor shall report, annually by October 31, for services under the contract during the preceding Government fiscal year (October 1 – September 30). The contractor shall report the following information:

5.13.2.1 Contract number and, as applicable, order number.

5.13.2.2 The total dollar amount invoiced for services performed during the previous Government fiscal year under the contract.

5.13.2.3 The number of Contractor direct labor hours expended on the services performed during the previous Government fiscal year.

5.13.2.4 Data reported by subcontractors.

http://www.sam.gov/

6.0 Applicable Publications: Publications applicable to this PWS are listed below:

Publication (Chapter/Page)

Date of Publication

Mandatory or Advisory

Website

29 CFR 1910: Occupational Safety & Health Standards

Mandatory https://www.osha.gov/pls/oshaweb/owasrch.searc h_form?p_doc_type=STANDARDS&p_toc_level= 1&p_keyvalue=1910

29 CFR 1960: Program Elements for Federal Employee Occupational

Safety & Health Programs

Mandatory https://www.osha.gov/pls/oshaweb/owasrch.searc h_form?p_doc_type=STANDARDS&p_toc_level= 1&p_keyvalue=1960

Department of Defense (DoD) 6055.05-M: Occupational Medical

Examinations and Surveillance Manual change 16 Sep 2008

Mandatory http://www.dtic.mil/whs/directives/corres/pdf/6055 05m.pdf

DA PAM 40-506: The Army Vision Conservation and Readiness

Program

15 July 2009 Mandatory https://armypubs.army.mil/epubs/DR_pubs/DR_a/ pdf/web/p40_506.pdf

DoDI 6055.1: Safety and Occupational Health (SOH) Program

Oct. 2014 Mandatory https://www.hsdl.org/?view&did=758821

NGR 40-5: The Army National Guard Preventive Medicine Program

Feb. 2013 Mandatory https://www.ngbpdc.ngb.army.mil/Portals/27/Publi cations/ngr/ngr%2040-5.pdf?ver=2018-09-07-

082539-203 42 OSC 263A Mandatory https://www.law.cornell.edu/uscode/text/42/263a

DOD 5400 11-R May 14, 2007 Advisory https://www.esd.whs.mil/Portals/54/Documents/D D/issuances/dodm/540011r.pdf

DFARS 224.103 Revised Nov 22, 2014

Advisory http://farsite.hill.af.mil/reghtml/regs/far2afmcfars/f ardfars/dfars/dfars224.htm

FAR 9.5 Advisory http://farsite.hill.af.mil/reghtml/regs/far2afmcfars/f ardfars/far/09.htm

FAR 22.17 Jan 29, 2015 Advisory https://www.federalregister.gov/documents/2015/ 01/29/2015-01524/federal-acquisition-regulation-ending-trafficking-in-persons FAR 52.347-7 Advisory https://www.acquisition.gov/sites/default/files/curr ent/far/pdf/FAR.pdf

6.1 Applicable Forms: Forms applicable to the PWS are listed below:

Form

Occupational Health Report Medical

Examination

See Attachment #1 – Occupational Health Exam https://www.osha.gov/pls/oshaweb/owasrch.search_form?p_doc_type=STANDARDS&p_toc_level=1&p_keyvalue=1910 https://www.osha.gov/pls/oshaweb/owasrch.search_form?p_doc_type=STANDARDS&p_toc_level=1&p_keyvalue=1910 https://www.osha.gov/pls/oshaweb/owasrch.search_form?p_doc_type=STANDARDS&p_toc_level=1&p_keyvalue=1910 https://www.osha.gov/pls/oshaweb/owasrch.search_form?p_doc_type=STANDARDS&p_toc_level=1&p_keyvalue=1960 https://www.osha.gov/pls/oshaweb/owasrch.search_form?p_doc_type=STANDARDS&p_toc_level=1&p_keyvalue=1960 https://www.osha.gov/pls/oshaweb/owasrch.search_form?p_doc_type=STANDARDS&p_toc_level=1&p_keyvalue=1960 http://www.dtic.mil/whs/directives/corres/pdf/605505m.pdf http://www.dtic.mil/whs/directives/corres/pdf/605505m.pdf https://www.ngbpdc.ngb.army.mil/Portals/27/Publications/ngr/ngr%2040-5.pdf?ver=2018-09-07-082539-203 https://www.ngbpdc.ngb.army.mil/Portals/27/Publications/ngr/ngr%2040-5.pdf?ver=2018-09-07-082539-203 https://www.ngbpdc.ngb.army.mil/Portals/27/Publications/ngr/ngr%2040-5.pdf?ver=2018-09-07-082539-203

TECHNICAL EXHIBIT 1

Performance Requirements Summary (PRS)

This Performance Requirements Summary includes performance standards the Government will use to determine contractor performance and will compare contractor performance to the Acceptable Quality Level (AQL).

PWS

Paragraph

Task Performance Standard

Acceptable Quality Levels

(AQL)

Surveillance Method / By Whom

1.4.5

Protection of Personally Identifiable Information (PII)

Contractor shall protect PII 100% of the time

0% failure rate Government POC observation

5.1.1 Insurance & Licensed

and/or certified staff

Contractor shall provide insured & licensed/ certified staff 100% of the time

0% failure rate Government POC observation

1.4.7.1, 5.0,6.0

Procedures and Standards

Contractor shall comply with Procedures and Standards 98% of the time

2% failure rate Government POC observation

5.10 Medical Reports and

Recordkeeping

Contractor shall utilize required forms and provide timely reporting 98% of the time

2% failure rate Government POC observation

TECHNICAL EXHIBIT 2

Deliverables Schedule

PWS Reference / Deliverable Title

Frequency Number of Copies

Medium/Format Submit To

5.6.2 Labs Not to exceed 30 business

days after completion of testing

1 Hard Copy Individual

5.10.3 Documentation

Not to exceed 30 business days after completion of testing

1 Hard copy or electronic

OHN

5.12.1 Exam

Results

Not to exceed 30 business days after completion of exams

1 Hard copy or electronic

OHN

5.12.2 Exam

Results

Not to exceed 30 business days after completion of exams

1 Hard copy Individual

5.12.3 Exam

Results

Not to exceed 30 business days after completion of exams

1 Hard copy OHN