Attachement 3 - PWS and PRS.docx

PERFORMANCE WORK STATEMENT (PWS)

FOR

Audiological Evaluation Services

1.0 General:

1.1 Scope: The contractor shall provide all personnel, equipment, tools, materials, supervision, and quality control necessary, except as specified in Paragraph 3.0 as Government Furnished, to perform audiological evaluation services, as defined in this PWS.

2.0 Background: Service members who are exposed to occupational noise greater than or equal to an 8-hour time-weighted average of 85 dBA require annual audiogram. Those who have a standard threshold shift during their annual audiogram and subsequent follow up audiograms are considered to have a permanent threshold shift and need evaluation from an audiologist to confirm the permanent threshold shift and provide elevation that determines if the shift is work-related or caused by occupational noise.

3.0 Government Furnished Property, Material, Equipment and Services): None. Except for those items specifically stated to be Government-Furnished in Paragraph 3.0, the contractor shall furnish everything required to perform these services as indicated in Paragraph 1.1.

4.0 Place and Schedule of Services: Period of Performance (PoP): The Period of Performance shall be 1 Base Year of 12 months and four 12-month option years.

4.1 Facility Requirements: The contracted entity shall be responsible to provide: Physical facility within fifteen (15.0) miles driving distance of 162nd Wing, 1500 E. Valencia Rd., Tucson, AZ 85706 at which PWS specified services are provided, all materials, labor, supervision, equipment, utilities, and any incidentals necessary to provide services detailed herein. Note: Mobile facilities and services provided at the Government’s physical location are not acceptable. No Government furnished facility, personnel, equipment, or utilities are to be provided.

4.2 Schedule of Services The contractor shall provide all services at a local Tucson off-base facility, between 8:00 AM and 5:00 PM (AZ time) Mon-Fri, except on recognized US holidays or when closed due to local or national emergencies. The vendor facility where services are to be provided shall not exceed fifteen (15.0) miles driving distance from 162nd Wing, 1500 E. Valencia Rd., Tucson, AZ 85706.

4.2.1. Recognized Holidays: The following are recognized United States (US) holidays. The contractor shall not perform services on these days:

New Year’s Day: January 1st Martin Luther King, Jr.’s Birthday President’s Day Memorial Day Juneteenth National Independence Day: June 19th Independence Day: July 4th Labor Day Columbus Day Veteran’s Day: November 11th Thanksgiving Day Christmas Day: December 25th

5.0 Deliverables:

5.1 The contractor shall perform the following exams:

a. Pure tone air conduction test, under supra-aural earphones or insert earphones, using pulsed tones for frequencies 250 Hz through 8, 000Hz (to include 3,000 and 6,000 Hz).

b. Pure tone bone conduction test, using pulsed tones for frequencies 500 through 4,000 Hz.

c. Word recognition testing, under supra-aural earphones or insert earphones, using recorded lists presented at appropriate suprathreshold levels with appropriated masking.

d. Word recognition testing using competing background noise if the patient reports difficulty hearing/understanding in the presence of background noise.

e. Immittance measures to include tympanometry, and acoustic reflexes obtained for both ipsilateral and contralateral conditions. Acoustic reflex decay at 500-1,000 Hz should be accomplished if clinically warranted.

f. Comprehensive Otoacoustic Emissions.

5.1.1 In addition to the above exams, the Contractor shall provide:

a. Proof of current audiometer calibration and serial number.

b. A graphic printout and a written report including interpretation of test results to explain the type and degree of hearing loss as well as any recommendations or referrals. Specific recommendations may also include hearing aids or hearing protection information.

c. If the referral was for OSHA reportable hearing loss, indicate the standard threshold shift is work-related or if the hearing loss has been aggravated by occupational noise exposure.

d. If recommendations include the re-establishment of a reference audiogram using the encounter results, the following information should be included: full name, social security number, audiometer make/model, audiometer serial number, and date of last audiometer electroacoustic calibration.

5.1.2 The Contractor shall provide the 162d WG Air National Guard (ANG) Public Health office with a copy of exams results from 5.1 and 5.1.1 within (14) calendar days.

5.1.3 The contractor shall schedule appointments as requested by the department within (10) business days.

6.0. Other Requirements

6.1 Quality Control (QC): The contractor shall develop and maintain an effective QC Plan (QCP) to ensure services are performed in accordance with this PWS. The contractor shall develop and implement procedures to identify, prevent, and ensure non-recurrence of defective services. The contractor’s QCP is the means by which it assures itself that its work complies with the requirements of the contract. As a minimum, the contractor shall develop QC procedures that address the areas identified in Technical Exhibit 1, Performance Requirements Summary (PRS).

6.2 Quality Assurance (QA): The Government will evaluate the contractor’s performance under this contract in accordance with the Quality Assurance Surveillance Plan (QASP). This plan is primarily focused on what the Government will do to ensure that the contractor has performed in accordance with the performance standards. It defines how the performance standards will be applied, the frequency of surveillance, and acceptable quality level(s) or defect rate(s).

6.3 Protection of Personally Identifiable Information (PII). The contractor shall protect all PII encountered in the performance of services in accordance with Defense Federal Acquisition Regulation Supplement (DFARS) 224.103 Personally Identifiable Information and Department of Defense Directive (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 whose PII has been compromised.

6.4 Special Qualifications: The contractor shall ensure all employees possess all required licenses for operating audiological testing equipment in the performance of this contract. This does not include education or other qualifications for the position in which the contractor employee is performing, dress codes, or other information. (NOTE: The Government does not provide training to contractors. Contractors must ensure that any personnel performing under a contract are fully trained, licensed, certified, and otherwise qualified to provide services.)

6.5 Post Award Conference/Periodic Progress Meetings: The contractor agrees to attend any post award conference convened by the KO in accordance with FAR 42.5. The KO, COR and other Government personnel, as appropriate, may meet periodically with the contractor to review the contactor’s performance. At these meetings, the KO will apprise the contractor of how the Government views the contractor’s performance and the contractor shall apprise the Government of problems, if any, being experienced. The contractor shall resolve outstanding issues raised by the Government. Contractor attendance at these meetings shall be at no additional cost to the Government.

6.6 Contract Manager (CM): The contactor shall designate a CM who shall ensure performance under this contract. The name of this person, and an alternate who shall act for the contractor when the CM is absent, shall be designated in writing to the KO. The CM or alternate shall have full authority to act for the contractor on all contract matters relating to daily operation of this contract. The CM shall work through the COR to resolve issues, receive technical instructions, and ensure adequate performance of services. The CM shall ensure that contractor employees do not perform any services outside the scope of the contract without an official modification issued by the KO. The CM shall ensure contractor employees understand that services performed outside the scope of the contract are performed wholly at the expense of the contractor.

6.7 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.

6.8 Data Rights: The Government has unlimited rights to all documents/materials produced under this contract. All documents and materials, to include the source codes of any software, produced under this contract shall be Government owned and are the property of the Government with all rights and privileges of ownership/copyright belonging exclusively to the Government. These documents and materials may not be used or sold by the contractor without written permission from the KO. All materials supplied to the Government shall be the sole property of the Government and may not be used for any other purpose. This right does not abrogate any other Government rights.

6.9 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.

7.0 Definitions and Acronyms:

7.1 Definitions:

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.

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

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

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.

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

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

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

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

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

7.2 Acronyms:

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

AFI 48-127

Occupational Noise and Hearing Conservation Program 02/26/2016 (Change 1: 08/20/2024) https://static.e-publishing.af.mil/production/1/af_sg/publication/afi48-127/afi48-127.pdf

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).

5.1 Perform Audiological evaluation exams

162D MDG PUBLIC HEALTH

TECHNICAL EXHIBIT 2

Deliverables Schedule

5.1.2 Exam(s) results

5.1.1 Audiometer information, graphic print out and written report with interpretation of results, work related hearing loss disposition, re-establishment of baseline information.

Ver. October 2022