Attachment 1 Performance Work Statement for OHC Service 20 May 2022.pdf

PERFORMANCE WORK STATEMENT

Occupational Health Care and Consultation for USFORAZORES Civilian Employees

Non‐personal Services Contract

Lajes Field

20 May 2022

Table of Contents

1. Introduction

2. Description of Services

2.1 Objectives

2.2 Government Personnel

2.2.1 The Government

2.2.2 Contracting Officer

2.2.3 Contract Administrator

2.2.4 Contracting Officer’s Representative

2.2.5 Medical Occupational Health Administrator

2.2.6 MOHA Alternate

2.3 OHCP Facilities and Personnel Licenses

2.3.1 OHCP Certifications and Licenses

2.3.2 OHCP Contract Manager

2.3.3 Occupational Health Medicine Certified Physician

2.3.4 OHC Certified Nurses

2.3.5 Other Personnel

2.3.6 Sub‐contractors

2.4 Occupational Health Care

2.4.1 Scope

2.4.2 Regulations and Standards

2.4.3 List of Required Exams per LN and Other Documents

2.4.4 OHCP Hours of Operation

2.4.5 Timeframe for Scheduling Appointments upon Government Request

2.4.6 OHCP Provision of the Completion Certificates

2.4.7 LNs Attending Appointments/Exams without Government Knowledge and Authorization 8

2.4.8 Estimated Number of Appointments and Exams

2.4.9 Type of Appointments for Annual OHC

2.4.10 Follow up Exams and Appointments

2.4.11 OHC Physician Final Report Regarding Potential Occupational Health Related Disease

2.4.12 LNs Fit for Duty or Fit for Duty with Restrictions

2.5 Communication Methods and Language

2.6 Security Requirements

2.6.1 Electronic Communication

2.6.2 Confidentiality

2.6.3 Automated Data Processing System and Disposition of Employee Records

2.6.4 Assessment Data

2.6.5 Cooperation in Transition

2.7 Inclement Weather Conditions

2.8 General Information

2.8.1 Government Quality Assurance

2.8.2 OHCP Quality Control Plan

2.9 OHCP Furnished Items and Services

2.10 Government Furnished Items and Services

2.11 Invoicing

3. Service Summary (SS)

3.1 SS Description

3.1.1 SS1 – OHCP’s Punctuality

3.1.2 SS2 – LN Satisfaction with the OHCP’s Services

3.1.3 SS3 – OHC Monthly Availability for Exams/Appointments to Meet the Government Needs

3.1.4 SS4 – OHCP Provision of the Completion Certificates within the Specified Timeframe (5 work days)

4. Enterprise‐Wide Contractor Manpower Reporting Application Reporting

5. Abbreviations and Translation Terms Used within this PWS

6. List of Applicable Publications (current editions)

7. Attachment List

1. Introduction This is a non‐personal services requirement to provide Occupational Health Care (OHC) and consultation services to local national civilians (herein LNs) employed by United States Forces, Azores (USFORAZORES) at Lajes Field, Terceira, Portugal in accordance with (IAW) the United States of America Occupational Health and Safety Standards and Work Regulation of 1995.

2. Description of Services The Occupational Health Care Provider (herein OHCP) shall provide all personnel, equipment, supplies, facilities, transportation, tools, materials, supervision and non‐personal services necessary to perform OHC and consultation services as defined in this Performance Work Statement (PWS), except for those items specified in 2.10 as Government furnished items and services. The OHCP shall perform to the standards in this PWS and contract.

2.1 Objectives

The OHCP shall:

(a) Provide appropriate OHC and consultation services to industrial LN’s employed at Lajes Field IAW the US Occupational Health and Safety Standards (see attachment 1) listed under the Clinical

Occupational Health Examination Requirements (COHERS), as defined for each chop under the OHC program.

(b) Provide periodic assessments or measurements to detect abnormalities to LNs exposed to work‐ related health hazards.

(c) Provide recommendations to the US Government concerning the LN’s ability to perform the essential job functions (fit for duty). NOTE: The Government will provide guidance directly to LNs once recommendation of a medical decision is received.

2.2 Government Personnel

2.2.1 The Government

The Government refers to the United States Government, used herein specifically to refer to the

USFORAZORES, the 86th Airlift Wing and the 65th Air Base Group.

2.2.2 Contracting Officer

The Contracting Officer (CO) is the only person authorized to enter into or terminate the contract, and the only person authorized to obligate funds on behalf of the Government.

The CO will be responsible for ensuring all contract actions comply with the appropriate laws, executive orders, regulations, and other applicable procedures and approvals. The CO shall ensure performance of all necessary actions for effective contracting, verify compliance with the contract terms and conditions, and shall safeguard the interests of the Government in the contractual relationship. The CO shall also ensure that the OHCP receives impartial, fair, and equitable treatment under this contract.

Any changes to this PWS and contract requirements must be coordinated and approved through the CO, prior to any changes in work being performed.

2.2.3 Contract Administrator

The Contract Administrator (CA) is responsible for day to day administration of the contract. Any general correspondence can be sent to the CA assigned to this contract. At Lajes Field, the CA is also referred to as the Contract Specialist (CS).

2.2.4 Contracting Officer’s Representative

The Contracting Officer’s Representative (COR) is a representative of the CO, and will participate in the administration of this contract. The COR is responsible for:

Providing continuous technical oversight of the OHCP’s performance, ensuring that the OHCP meets the performance standards outlined in this PWS, contract and all contract attachments;

Reporting early identification of performance problems to the CO;

Serving as liaison between the Government, the contractor and customers related to the project;

Conducting periodic surveillance and monthly reports to monitor the OHCP’s performance that will be aggregated into an annual report. The annual report will be provided to the CO which will be used in documenting past performance; and

Verifying that the invoices for services rendered to the Government adhere to the terms and conditions of the contract, before final acceptance of the services in the Procurement Integrated Enterprise

Environment (PIEE).

2.2.5 Medical Occupational Health Administrator

The Medical Occupational Health Administrator (MOHA) is the civilian Occupational Health Technician assigned to the Occupational Health Section of the 65th Air Base Group Medical Aid Station (MAS). The

MOHA will be responsible for:

Scheduling appointments and exams with the OHCP on behalf of the Government, by way of periodic phone calls and emails throughout contract performance;

Providing the OHCP with a list of the required exams for each LN; and

Providing and retrieving any paper format documentation, such as LN’s exam list requirements, fit for duty forms (generated by MAS), and any medical documentation to be added to the LN’s files for reference as completion of the annual OHC requirements.

2.2.6 MOHA Alternate

The MOHA Alternate is a civilian assigned to the Occupational Health Section of the MAS, authorized to schedule appointments and exams should the MOHA be unavailable. The MOHA alternate is also authorized to provide and retrieve any paper format documentation from the OHCP on behalf of the

MOHA.

2.3 OHCP Facilities and Personnel Licenses

The management of the OHCP personnel shall be the sole responsibility of the OHCP.

2.3.1 OHCP Certifications and Licenses

The OHCP shall ensure that all employees and sub‐contractor/s assigned to the awarded contract have current and valid professional certifications, licenses, and malpractice insurance when performing services for the Government.

The OHCP facility and sub‐contractor/s (facility or individual provider) must be licensed to practice medicine in the Republic of Portugal and in the Autonomous Region of the Azores (ARA).

The OHCP facility must be credentialed by the Azorean Regional Health Authority to practice OHC services on the island of Terceira.

The sub‐contractor/s must be credentialed by the Azorean Regional Health Authority to practice medicine in Terceira.

Any changes to the contract must be IAW Portuguese regulations and law as well as be contractually admissible; the Government must be informed before any changes and the OHCP must present the necessary documentation from the Azorean Regional Health Authority, authorizing the mentioned changes. Any modifications to OHCP personnel and facility’s status, name and location must be submitted to the CA, CO, COR and MOHA within three (3) work days, including changes to all licenses previously mentioned.

The OHCP shall ensure availability of personnel and facility’s certificates/licenses/mal‐practice insurance for Government review upon request at any time. The MAS personnel are the only authorized personnel to request review of the OHCP licenses, certifications and mal‐practice insurance.

OHCP personnel involved in the OHC program rendered to the Government must comply with the

Portuguese privacy laws indicated for Health Care Providers.

2.3.2 OHCP Contract Manager

The OHCP Contract Manager (CM) is appointed by the OHCP, and is responsible for being the primary

Point of Contact (POC) for every contact to and from the authorized personnel of the Government. The

CM will have the authority to act on behalf of the OHCP on all contract matters relating to the daily operations of the contract. An alternate CM should be identified in the absence of the primary CM.

CM names and telephone numbers shall be submitted in writing to the CA, CO, COR and MOHA within five (5) work days after contract has been awarded.

2.3.3 Occupational Health Medicine Certified Physician

The physician(s) providing services to the Government are appointed by the CM.

The appointed physician(s) must be certified by the Azorean Regional Health Authority for OHC and must be authorized to render services on Terceira Island and at the OHCP indicated in the contract.

2.3.4 OHC Certified Nurses

The nurse(s) providing services to the Government are appointed by the CM.

The appointed nurse(s) must be certified by the Azorean Regional Health Authority for OHC services provided on Terceira Island.

2.3.5 Other Personnel

OHCP personnel involved in the OHC program rendered to the Government must comply with the

Portuguese privacy laws indicated for Health Care Providers.

The OHCP shall ensure the ready availability of all medical personnel. A backfill is required when medical personnel assigned to an area is unavailable. All OHCP employees who conduct ancillary services must possess a current certification/licenses from an appropriately recognized accreditation body in Portugal.

2.3.6 Sub‐contractors

If the OHCP intends to contract a subcontractor/s as part of this contract, the OHCP shall submit their credentials to the Government for review prior to services being provided by the subcontractor.

2.4 Occupational Health Care

2.4.1 Scope

The medical services will be provided by the OHCP in the area of OHC and following the Government requirements stated in a list of exams to be provided to the OHCP. The Government will not be held accountable for any medical appointments and exams completed that are not listed and/or not authorized.

2.4.2 Regulations and Standards

The OHCP shall provide OHC and exams to designated LNs IAW U.S. regulations and standards.

The OHCP shall perform the medical examinations requirements per U. S. Air Force (USAF) regulations

(see attachment 1 and 2 for details) including, but not limited to, Air Force Instruction (AFI) 48‐145, Occupational and Environmental Health Program, Air Force Manual (AFMAN) 48‐146, Occupational and

Environmental Health Program Management and Clinical Occupational Health Examination Requirements

(COHERS).

2.4.3 List of Required Exams per LN and Other Documents

The MOHA will provide a package to the OHCP which is to include the following: a list of required exams

(see attachment 2) for each LN; a job description (if requested); an updated copy of the Occupational and

Environmental Health Exposure Data (OEHED) form where workplace conditions are described; and a fit for duty form generated by MAS (see attachment 3). The list of required exams are considered 1 service.

Each service will be listed under one of the available CLINs in this contract, to be determined by the

Government.

The documentation will be provided to the OHCP, at least 5 work days before the scheduled exams. The documentation must be signed, sealed and stamped by the Occupational Health physician, stating if the

LN is fit for duty, fit for duty with restrictions or unfit for duty, and returned to the MOHA or alternate.

2.4.4 OHCP Hours of Operation

The OHCP must be available from Monday through Saturday during work hours 09:00‐20:00.

The OHCP is responsible for conducting all appointments and exams scheduled between the above specified hours except for Portuguese holidays, when the Government facility is closed due to local or national emergencies, administrative closings, or similar Government‐directed facility closings.

The following Portuguese holidays are excluded from the regular hours of operation. The holidays listed as “variable” will be excluded IAW each calendar year.

New Year’s Day January 1st

Mardi Gras Variable

Good Friday Variable

Day of Liberty April 25th

Day of the Worker May 1st

Espirito Santo Monday Variable

Day of Portugal June 10th

Corpus Christi Variable

Praia da Vitoria Day Variable

Assumption Day August 15th

Founding of the Republic October 5th

All Saints’ Day November 1st

Restoration of Independence Day December 1st

Immaculate Conception December 8th

Christmas Day December 25th

2.4.5 Timeframe for Scheduling Appointments upon Government Request The OHCP shall provide the Government with dates and times for the requested appointments/exams within a period of five (5) work days after being requested. MAS personnel are available from Monday through Friday during work hours 09:00 – 16:00.

The OHCP is responsible for scheduling/cancelling appointments as well as discussing issues that may arise within the Program between the above specified hours except for Portuguese holidays, when the

Government facility is closed due to local or national emergencies, administrative closings, or similar

Government‐directed facility closings.

Portuguese holidays are listed in 2.4.4.

Cancellation of appointments made by the OHCP and or the LN outside of this timeframe MUST be coordinated between the OHCP and the LN. The OHCP will send a notification to MAS.

2.4.6 OHCP Provision of the Completion Certificates

The OHCP shall provide the LNs completion certificate (exam list/fit for duty form provided by the

Government) of all medical services provided within five (5) work days after examination or appointment, as appropriate.

2.4.7 LNs Attending Appointments/Exams without Government Knowledge and

Authorization No exams or appointments can be conducted without prescheduling/authorization by the Government.

The Government will not be held accountable for these appointments or any expense associated with unauthorized appointments.

It is the responsibility of the OHCP to turn away LNs should they show up without an appointment and/or exams scheduled/authorized by the Government.

2.4.8 Estimated Number of Appointments and Exams

The Government will provide the OHCP with an estimated number of appointments and exams needed per month. This list will be provided quarterly (every three months) until the 10th work day of the month prior the target quarter months. E.g. for the quarter Jan, Feb and Mar, the list will be provided in Dec.

Although the estimated number of appointments are provided, they depend upon LNs shift work availability.

The OHCP shall provide the Government with appointments covering as many exams as possible on the consultation date.

2.4.9 Type of Appointments for Annual OHC

The appointments will be held in a face to face format, IAW the LNs exam requirements, as specified by the Government.

The OHCP will ONLY evaluate exams requested by the Government for LNs.

2.4.10 Follow up Exams and Appointments

If a LN requires a follow up exams regarding any medical specialty, in order to rule out an occupational health related disease at the conclusion of the appointments from 2.4.9, the OHCP will notify the MOHA of the required exams and/or appointments. Any subsequent specialty appointments necessary to review the medical exam(s) are NOT covered in the contract.

2.4.11 OHC Physician Final Report Regarding Potential Occupational Health Related

Disease Following any appointments and/or exams under paragraph 2.4.9, the OHCP physician shall complete a final evaluation and report which is to include a determination of if the LN is fit or unfit for duty and whether or not the condition is a work/occupational related.

If the physician determines that the LN does not have an occupational illness/condition, the medical recommendation must be reported in writing and the OHCP must provide the Government with a medical report and any other documentation used to substantiate the conclusion.

If the physician determines that the LN appears to have an occupational illness, the medical recommendation must be reported in writing and the OHCP must provide the Government with a medical report and any other documentation used to substantiate the conclusion.

2.4.12 LNs Fit for Duty or Fit for Duty with Restrictions

Following any evaluation and/or exams under the paragraphs 2.4.9 and 2.4.10, if the physician determines that the LN is fit for duty or fit for duty with restrictions, the OHCP shall provide the Government with a fit for duty form generated by MAS.

If the LN is medically capable of performing the required job tasks only with some restrictions (fit for duty with restrictions), without risk to his/her health or to that of others, the physician shall provide a list of restrictions, expected duration, and therapeutics or risk‐avoiding benefits.

If the LN has a large number of restrictions but is otherwise qualified, the physician shall complete a case summary outlining findings and the medical logic that led to the conclusions, recommendations and restrictions.

2.5 Communication Methods and Language

All communication between both parties must be in English, to include all types of communication methods assigned for this contract. Any reports and observations written by the OHCP physician must be in English.

2.6 Security Requirements

2.6.1 Electronic Communication

All electronic communications in reference to scheduling between both parties must be through an official secure email address.

The OHCP shall assure that only authorized personnel assigned to this contract has access to any information sent by the Government.

2.6.2 Confidentiality

The OHCP and any secondary staff shall maintain confidentiality concerning all Government internal matters revealed to them during their surveillance or appointment/s with the LNs. This also applies to all documentation in the possession of the OHCP.

2.6.3 Automated Data Processing System and Disposition of Employee Records The OHCP shall store, process, protect, and maintain all necessary medical records for LNs employed by the US Government to fulfill the requirements of this PWS. The OHCP shall maintain all LNs’ medical records IAW Portuguese standards.

The OHCP shall establish and maintain an accurate file of medical records, including but not limited to, data for all physical examinations, diagnostic data, Portuguese Social Security Institute’s occupational illness and injury forms, medical documentation provided by the patients and laboratory work.

The data processing and disposition of LNs medical records under this contract, does not require the OHCP to create or maintain any records that the OHCP does not maintain in the ordinary course of business or pursuant to a provision of law.

All medical records are considered confidential medical information, and shall not be discussed or provided to any party other than the patient without a written release from the patient.

The OHCP shall make available the records, materials, and other evidence of examination for audit by the

Government upon previous request, and for reproduction for LNs upon the LNs own request at its facilities during normal duty hours.

The OHCP shall maintain the LNs’ medical records for the time period IAW the Portuguese standards.

2.6.4 Assessment Data

The OHCP has the sole responsibility for the accuracy of assessment data inputs and outputs as well as for the safe maintenance of this data in its record keeping system.

The OHCP shall also cooperate with 86th Medical Group (MDG) Occupational Health staff responsible for implementing the accident prevention and occupational safety and health program administered at Lajes

Field by the 65th Air Base Group MAS.

2.6.5 Cooperation in Transition

If a transition of performance will become necessary upon contract expiration or termination, the OHCP shall cooperate with a subsequent OHCP to assure uninterrupted services and inform the subsequent

OHCP of all pending requirements for examinations.

Medical records (or copies) shall be forwarded to the subsequent OHCP upon request by the COR. Also the records (or copies) relating to the work expired or terminated shall be made available by the OHCP

IAW the Portuguese law.

2.7 Inclement Weather Conditions

Lajes Field closes on occasion, due to inclement weather conditions. The Government will not be financially liable for any missed scheduled appointments by LNs due extreme weather. For this or any other reason, payment will be made only for services rendered or examinations performed.

2.8 General Information

2.8.1 Government Quality Assurance

The Government will periodically evaluate the OHCP’s performance IAW a Quality Assurance Surveillance

Plan (QASP). The evaluation shall be completed by a Government appointed POC, which will monitor performance and ensure services are being executed IAW the PWS. The QASP should ensure early identification and resolution of performance issues to minimize impact on mission performance.

The Government will inform the OHCP when discrepancies occur and will request corrective action(s).

The CO will implement the QASP after contract is awarded. The point of contact (POC) may inspect each task as they are completed or increase the number of quality control inspections if deemed appropriate due to repeated issues discovered or repeated LN complaints.

The OHCP shall be responsible for addressing the LNs’ complaints.

2.8.2 OHCP Quality Control Plan

The OHCP has the contractual responsibilities for quality control and inspect services rendered to the

Government, and shall define actions to control the performance of services so that they meet the requirements of this PWS.

The Quality Control Plan (QCP) shall be documented and provided to the Government for acceptance upon issuance of the contract. The CO shall notify the OHCP of acceptance or required modifications to the plan within 15 work days after receipt of the QCP. The OHCP shall make appropriate modifications (at no additional costs to the Government) and obtain acceptance of the plan by the CO within 30 days of contract award and before any appointments and exams are provided to LNs.

The OHCP is required to notify the COR immediately when there is a problem caused by the Government.

The OHCP shall provide copies of all discrepancies to the COR.

The QCP shall be a comprehensive plan detailing how the OHCP intends to ensure the quality of services to the Government and how quality levels will be maintained. The QCP shall cover all services described in this PWS. The QCP shall include, but is not limited to the following general features:

Overall approach, internal management controls, processes, and procedures for reporting to the

Government on identified aspect of quality issues;

Methods of communication with the Government regarding quality control questions and remarks;

The QCP shall address specifically how all documentation regarding quality control will be created/maintained;

Description of what is measured, how often it is tracked and provided, and who reviews and assures that appropriate action is initiated when trends are unfavorable; and

Specific surveillance techniques of all services required in this PWS shall be described. The surveillance methods shall be comprehensive and adaptable to the reporting system of the QCP.

The OHCP shall address what corrective actions (short‐term and long‐term) will be taken to ensure responses are prompt to correct deficiencies discovered in contract performance without Government guidance. Internal records shall be kept of these situations as well as corrective action implemented.

2.9 OHCP Furnished Items and Services

Except for those services to be Government furnished, in paragraph 2.10, the OHCP shall furnish all items and services required to perform the work described in this PWS and contract.

All OHC and examinations shall be at the OHCP facility address or at the sub‐contractor facility address designated in the contract, and ensure that the facilities contain the appropriate equipment for the required examinations.

2.10 Government Furnished Items and Services

Upon a detailed written request, the Government will be available for the OHCP to visit LNs worksites.

2.11 Invoicing

The OHCP shall provide invoices on a monthly basis. The invoice must include LN name and the list of completed exams per LN. The OHCP shall ONLY submit the invoice when the requested package of appointment/s and/or exam/s are completed.

The invoice shall be sent to the MOHA, via email, up to the 15th calendar day of the following month, for preliminary validation. The MOHA has 5 work days to validate and inform the OHCP. If no discrepancies are found, the OHCP shall submit the invoice into Wide Area Workflow (WAWF) under 252.232‐7006 Wide

Area Workflow Payment Instructions (May 2013) or its successor; if discrepancies are found the OHCP has

5 work days to correct it and submit into WAWF, which will then validated by COR.

3. Service Summary (SS) Explanations and clarifications of the table items are given below the table.

Performance Objective 1.

PWS

Paragraph reference

Performance Threshold

Method of assessment How long for the OHCP to improve

SS1 - OHCP’s punctuality 1.4.9

Average of 4 or above

Punctuality survey completed by the LNs, tracked by MOHA.

Assessed on a monthly basis

1 month after the communication of non-compliance with the performance threshold

SS2 – LNs satisfaction with the OHCP’s services

1.4.9

Average of 4 or above

Satisfaction survey completed by the LNs, tracked by MOHA.

Assessed on a monthly basis

1 month after the communication of non-compliance with the performance threshold

SS3 - OHCP monthly availability for exams and appointments to meet the

Government needs

1.4.5 Maintain 90% of

availability referring to the monthly requests

Inspection tracked by MOHA, monthly basis

2 months after the communication of non-compliance with the performance threshold

SS4 - OHCP provision of the completion certificates within the specified timeframes (5 work days).

1.4.6 Maintain 90%

accuracy and timeliness

Inspection tracked by MOHA, monthly basis

1 month after the communication of non-compliance with the performance threshold

Notes: Performance objectives define the desired outcomes and relate directly to mission‐essential items.

Performance thresholds define the level of service required under the contract to successfully meet the performance objective. Defines the minimum acceptable levels of service necessary for each requirement.

These thresholds are critical to the contract success.

Method of assessment defines how the service will be assessed in measuring performance. The methods and degree of performance assessment may change over the course of the contract in direct relation to the COR’s level of confidence in the OHCP’s performance.

3.1 SS Description

3.1.1 SS1 – OHCP’s Punctuality

The OHCP will be evaluated regarding punctuality by utilizing anonymous LNs surveys. This will represent firsthand information of the service being provided by the OHCP personnel. The survey will evaluate the

OHCP within a scale from 0 to 5. The average must to be of 4 or above to meet the performance threshold.

The MOHA will collect the surveys, process the data and inform the COR and CO of the results.

The survey evaluation will be performed monthly and communicated to the COR and CO until the 10th day of the following month. If any discrepancies are found the OHCP has up to one (1) month upon being informed of the result to resolve the situation and meet the performance standards.

3.1.2 SS2 – LN Satisfaction with the OHCP’s Services

The OHCP will be evaluated regarding LN satisfaction by utilizing anonymous LNs surveys. This will represent firsthand information of the service being provided by the OHCP personnel. The survey will evaluate the OHCP within a scale from 0 to 5. The average must to be of 4 or above to meet the performance threshold.

The MOHA will collect the surveys, process the data and inform the COR and CO on the results.

The survey evaluation will be monthly and will be communicated to the COR and CO until the 10th day of the following month. If any discrepancies are found the OHCP has up to one (1) month upon being informed of the result to resolve the situation and meet the performance threshold.

3.1.3 SS3 – OHC Monthly Availability for Exams/Appointments to Meet the Government

Needs The OHCP’s monthly availability for exams and appointments is an important mission‐essential item as it will guarantee that the LNs fall under the “current” status for the OHC program.

The OHCP shall fulfill the Government monthly requests for exams and appointments in at least 90% of the number of requests. This will be reviewed on a monthly basis as the MOHA has direct access to the numbers of requests and availability. If discrepancies are found then the OHCP has two (2) months to improve the situation.

3.1.4 SS4 – OHCP Provision of the Completion Certificates within the Specified

Timeframe (5 work days) The MOHA will collect the completion certificates and keep a log with dates of delivery signed by the MOHA and the OHCP.

To meet the performance threshold, the certificates need to be delivered within 5 work days after exam or appointments, as applicable, for at least 90% of the times. The MOHA will, on a monthly basis, evaluate this SS and the results will be provided to the COR and CO up to the 10th day to the following month. In case of non‐compliance, the OHCP has one (1) month to resolve the situation and meet the performance threshold.

4. Enterprise‐Wide Contractor Manpower Reporting Application

Reporting The OHCP shall ensure ALL contractor labor hours including subcontractor, at all levels/tiers, labor hours required for the performance of services provided under this contract are reported via a secure data collection site.

The contractor and all subcontractors, at all levels/tiers, providing direct labor under this contract shall report complete and accurate data for the labor executed during the period of performance during each

Government fiscal year (FY), which runs from October 1 to September 30. The Contractor shall input the data into the appropriate eCMRA reporting tool, which can be accessed via a secure web site at http://www.ecmra.mil/. There are four separate eCMRA tools: Army, Air Force, Navy and All Other

Defense Components. The appropriate eCMRA reporting tool to use is determined by the requiring activity being supported (e.g., if DISA awards a contract for an Air Force requiring activity, the contractor shall load the required reporting data in the “Department of Air Force CMRA” tool). While inputs may be reported any time during the FY, all data shall be reported no later than October 31 of each calendar year.

The contractor shall completely fill in all required data fields. The contractor shall enter initial data into the appropriate eCMRA tool to establish the basic contract record no later than 15 working days after receipt of contract award or contract modification incorporating this clause. The contractor shall notify the COR when the basic contract record has been established in the appropriate eCMRA tool.

The eCMRA User Manuals and Frequently Asked Questions (FAQs) are available at http://www.ecmra.mil/. Contractors may direct technical questions to the eCMRA help desk at usaf.pentagon.safaq. mbx.cmra‐help‐desk‐dod@mail.mil

5. Abbreviations and Translation Terms Used within this PWS AFI Air Force Regulations

AFMAN Air Force Manual

CA Contract Administrator

CM Contract Manager

CO Contracting Officer

COHERS Clinical Occupational Health Examinations Requirements

COR Contracting Officer Representative

CTIP Combating Trafficking in Persons

IAW in accordance with

LN Local National

MAS Medical Aid Station

MDG Medical Group

MOHA Medical Occupational Health Administrator

OEHED Occupational and environmental Health Exposure Data

OHC Occupational Health Care

OHCP Occupational Health Care Provider

PIEE Procurement Integrated Enterprise Environment

POC Point of Contact

PWS Performance Work Statement

QASP Quality Assurance surveillance Plan

QCP Quality Control Plan

RAA Autonomous Region of the Azores

SS Services Summary

USAF United States Air Force

USFORAZORES United States Forces Azores

WAWF Wide Area Work Flow

6. List of Applicable Publications (current editions) NFPA 1582 – Standard on comprehensive occupational medical program for fire Departments, 2018

NFPA 1582‐18 Technical implementation Guide (TIG) 2018

29 Code of Federal Regulations (CFR) 1910 ‐ Occupational Safety and Health Administration (OSHA)

5 CFR 339 ‐ OSHA Medical qualification determinations

AFI 48‐123 ‐ Medical Examinations and standards (5 November 2013)

AFI 48‐127 ‐ Occupational noise and Hearing conservation program. (26 Feb 2016)

AFI 8‐137 – Respiratory Protection Program (12 Sep 2018)

AFI 48‐145 ‐ Occupational and Environmental Health Program (11 July 2018)

AFMAN 48‐146 ‐ Occupational and Environmental Health Program Management (15 October 2018)

DoDM 6055.5 M ‐ Occupational Health Surveillance Manual (2 May 2007 incorporating change 3, august

31, 2018)

DoDI 6055.12 – Hearing Conservation Plan (14 August 2019)

Work Regulation of 1995

7. Attachment List Attachment 1. Annual exams and appointments list

Attachment 2. Exams/appointments description and requirements, when applicable

Attachment 3. Employee Occupational Health list of exam requirements (examples)

Attachment 4. Applicable references

Attachments

Attachment 1

Annual exams and appointments list

ID EXAM TYPE/DESCRIPTION

QUANTITY BY YEAR

Year

Year

Year

Year

Year

Year

Face to face appointment To include when applicable, but not limited to, a face to face patient – physician appointment, a documented review of results from any applicable exams performed under the below IDs, medical history questionnaire, physical examination and LNs immunization record review. Also if necessary should include the Occ Health illness report in case any Occ health illness is determined.

50 64 64 64 64 64

Face to face appointment for audiogram

To only include a face to face patient – physician appointment and a documented review of an audiogram.

Also if necessary should include the Occ Health illness report in case any Occ health illness is determined.

76 115 115 115 115 115

0003 Audiogram 126 179 179 179 179 179

0004 BUN and Creatinine 40 60 56 62 56 62

0005 CBC with Diff 37 49 61 59 62 60

0006 HIV screening 2 0 0 0 0 0

0007 Lipid panel 37 50 60 56 56 59

0008 Liver function panel 37 50 60 56 56 59

0009 AST liver function panel 48 52 56 60 58 59

0010 Urine Glucose 37 54 60 57 59 62

0011 Confrontational Fields 50 64 64 64 64 64

0012 Visual acuity 50 64 64 64 64 64

0013 Electrocardiogram 36 50 62 56 56 59

0014 X‐Ray to the chest 9 33 21 1 0 9

0015 Mammogram 0 1 0 1 0 1

0016 Spirometry 50 64 64 64 64 64

Attachment 2

Exams/appointments description and requirements, when applicable

7.1 ID 001 ‐ Face to face appointment

The LN will attend to an appointment with an occupational health physician.

The face to face appointments should include but not limited to:

- A documented review of the results from any applicable exams performed under IDs 0003 to

0016.

- Medical history questionnaire (References: NFPA 1582; NFPA 1582‐18; DoDM 6055.5 M).

o An initial medical history questionnaire shall be completed to provide baseline information with which to compare future medical concerns. The annual medical history questionnaire shall also be completed, and shall include any changes to the health status of the LN and known occupational exposures since last annual evaluation. Each questionnaire must be signed by the LN, validating the information provided.

- Physical examination (References: NFPA 1582; NFPA 1582‐18; DoDM 6055.5 M), that shall include:

o Vital signs, height, weight, body mass index and overall physical fitness.

o Head, neck, abdomen, extremities and back

The head and general body appearance and form should be checked (especially for deformities that might affect respirator or eyewear or other PPE use). Neck, extremities and back range of motion (ROM) should be checked. Check for abdomen hernia and liver status.

o Eyes, ears, nose, throat and oral cavity o Neurological exam that must include:

A general mental status evaluation and general assessment of the major crania/peripheral nerves (motor, sensory, reflexes). Evaluation of balance, deep tendon reflexes, gait, coordination, and tremors. Any symptomatic balance disturbance, vertigo, change of gait and coordination, or history of these that has not resolved completely should be fully investigated. Current use of medication needs careful evaluation to be certain that the condition is completely controlled and that the side effects of the medication do not impose additional unacceptable risks for the successful and safe performance of critical job tasks.

Evaluation of the ability to communicate (hearing and speaking), including ability to articulate understandably. Evaluation of the general behavior, including evidence of inappropriate behavior, abnormal speech, hyperactivity, or lethargy.

o Lymph nodes and skin o Heart, lungs and thorax o Should include pulses at both wrists and feet.

- LNs immunization record review according to the COHER requirements.

o Tuberculosis (PPD) (References: NFPA 1582)

Verification of PPD immunity through documentation of vaccination.

o Hepatitis B virus (References: NFPA 1582)

Verification of Hepatitis B immunity through antibody testing or documentation of vaccination.

o Hepatitis A (References: NFPA 1582)

Verification of Hepatitis A immunity through antibody testing or documentation of vaccination.

o Tetanus/diphtheria (Td) (References: NFPA 1582; DoDM 6055.5 M)

Verification of Tetanus (Td) immunity through documentation of vaccination.

7.2 ID 002 ‐ Face to face appointment or audiogram

The LN will attend to an appointment with an occupational health physician.

The face to face appointment will only include a documented review of the audiogram results (ID 0003).

7.3 ID 003 ‐ Audiogram

(References: NFPA 1582; NFPA 1582‐18; 29 Code of Federal Regulations (CFR) 1910; AFI 48‐127; DoDM

6055.5 M; DoDI 6055.12)

The OHCP shall compare audiogram results obtained during annual evaluations with baseline test results to determine if there is a threshold shift.

The OHCP shall ensure that any medical recommendations to LNs, restricting hazardous noise exposure are based on:

- Inability of the worker to perform the essential functions of the job.

- Probability of the worker endangering himself/herself or other if allowed to work in a noise hazard environment.

The OHCP may assume a LN meets the minimum medical qualifications to perform a job in hazardous noise environment if one of the following conditions is true:

- The LN can wear standard HPDs, and does not report difficulty in hearing and understanding routine spoken communications, auditory cues, or signals.

- The LN has undergone a previous fitness and risk evaluation, hearing thresholds have not changed significantly (no significant threshold shift (STS) compared to most current reference), and medical condition that may affect job performance in a hazardous noise job has remained stable.

Also the OHC physician should send the LN for follow ups and referral procedures if a STS is detected during the annual examination.

7.3.1 Audiograms, audiometer and sound room standards and guidelines

7.3.1.1 Audiograms

Pure‐tone, unaided, air‐conducted hearing threshold examination shall be assessed annually in each ear at each of the following frequencies: 500 Hz, 1000 Hz, 2000 Hz, 3000 Hz, 4000 Hz and 6000 Hz. The threshold is 80 dBA.

7.3.1.2 Audiometers

Earphones must ONLY be used with the audiometer they were calibrated.

7.3.1.3 Audiometric sound rooms

Rooms used for audiometric testing shall not have background octave band sound pressure levels exceeding the below.

For 500 Hertz (Hz), 27 dB.

For 1,000 Hz, 29 dB.

For 2,000 Hz, 34 dB.

For 4,000 Hz, 39 dB.

For 8,000 Hz, 41 dB.

7.3.2 STS

A STS (significant threshold shift) includes a change in hearing threshold relative to the current reference audiogram of an average of 10 db or more at 2.000, 3.000, and 4.000 Hz, in either ear. That is, if the sum of the shifts at 2.000, 3.000, and 4.000 Hz equals or exceeds 30 dB in either ear, an STS has occurred. Age corrections will not be applied.

A single frequency 15 dB shift at 1.000, 2.000, 3.000, or 4.000 Hz is considered an early warning flag with no requirements for follow up testing or referrals, but with a requirement to advice the patient and check hearing protections.

7.3.2.1 Negative STS

If a negative STS (improved hearing threshold from reference audiogram) is noted, a follow up test will be administrated, which may be on the same day as the periodic test. Noise free hours are not required in the presence of a negative STS. The results may be used to re‐establish a reference audiogram to reflect the improvement in pure tone acuity.

7.3.2.2 Positive STS

If a positive STS (decrease in hearing threshold from reference audiogram) is noted, one or two noise‐free (i.e. no hazardous noise exposure at least 14‐hours prior the test, less than 80dBA) follow up tests are administered to confirm, according to:

- The noise‐free follow up tests may be administered on the same day, but not on the same day as the periodic audiogram.

- The OHCP should perform a lighted ear inspection prior to the noise‐free audiogram.

- Follow up testing must be done within 30 days of the annual audiogram. If no follow up tests are performed within 30 days after the annual audiogram, then the annual audiogram is considered a PTS until further evaluation is completed.

- If the result of the first noise‐free follow up test does not indicate an STS, a second follow up test is not required, and the shift is a temporary threshold shift (TTS). If the results of the first follow up does indicate an STS, a second noise‐free follow up is, but if the second follow up test does not indicate an STS, then the shift is also a TTS.

- If an STS is noted on the two required follow up tests, then the STS should be considered a PTS and patient referred back to the OHCP or ENT for further testing, and if needed, confirmation and determination if it is work‐related or not, or if it has been aggravated by occupational noise exposure. For medical referrals for noise induced PTS, include a comprehensive audiological evaluation to determine the type and degree of hearing loss, and possible causation, to assist in determining work relatedness.

Replace the original reference audiogram with the new reference audiogram when the medical evaluation confirms the STS, noted during the annual and follow ups audiograms, is permanent. The results of the most recent follow up test can be used.

7.4 ID 0004 ‐ BUN and Creatinine

(References: NFPA 1582)

Blood urea nitrogen and creatinine.

7.5 ID 0005 ‐ CBC with diff

(References: NFPA 1582; DoDM 6055.5 M)

Should include CBC with differential, white blood cell count, red blood cell count (Hematocrit), RBC indices and morphology and platelets count.

7.6 ID 0006 ‐ HIV screening

7.7 ID 0007 ‐ Lipid panel

The lipid panel shall include total cholesterol, HDL, LDL, total cholesterol/HDL ratio, and clinically useful lipid ratios (eg. Percent LDL) and triglycerides.

7.8 ID 0008 ‐ Liver function panel

The Liver function test should include Alanine aminotransferase (ALT), Aspartate aminotransferase (AST), alkaline phosphatase and direct and indirect bilirubin.

7.9 ID 0009 ‐ AST liver function panel

7.10 ID 0010 ‐ Urine Glucose

7.11 ID 0011 ‐ Confrontational fields

Peripheral vision and test each quadrant of the patient’s visual field.

Some very specialized tasks can be difficult to safely perform, and the physician should consider the depth of the field deficiency and consider the depth of field requirements of the LN’s job in order to reach an individual determination. In view of this and the increased dependence on visual cues when driving emergency vehicles, monocular LNs should be restricted from driving fire apparatus and other emergency vehicles.

7.12 ID 0012 ‐ Visual acuity

Evaluation of far and near vision.

7.13 ID 0013 ‐ Electrocardiogram

The EKG should be completed with a resting 12‐lead ECG equipment. The OHCP shall compare EKG’s results obtained during yearly evaluations with baseline and subsequent test results.

7.14 ID 0014 ‐ X‐ray to the chest

Chest X‐ray should be posterior‐anterior and lateral views.

7.15 ID 0015 ‐ Mammogram

(References: NFPA 1582)

The OHC physician shall compare the mammogram to previous mammograms.

7.16 ID 0016 ‐ Spirometry

The OHCP shall compare spirometry results obtained during yearly evaluations with baseline and subsequent test results.

The spirometry, pulmonary function testing, shall be conducted to measure the LN forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1) and Absolute FEV1/FVC ratio.

FEV1 and FVC results shall be expressed as the absolute value (liter or milliliters) and as a percent predicted adjusted for gender, age, height, and ethnicity.

7.16.1 Criteria for results.

The results of spirometry shall meet the following criteria:

7.16.1.1 Number of trials.

At least three acceptable tracings.

7.16.1.2 Acceptability.

The three most important criteria are:

- No coughing in the first second.

- Complete inability to exhale any more air, or demonstration of a good plateau on the volume time spirogram (less than 25ml change in volume per second after at least 6 seconds of expiration).

- Starting test without hesitation.

7.16.1.3 Reproducibility

The two highest FVCs should not vary more than 150ml. The two highest FEV‐1 should not vary more than 150ml.

7.16.1.4 Reporting results

The largest FVC and FEV‐1 should be reported even if they do not come from the same curve.

7.16.1.5 Interpreting results

The lower limit of normal (LLN) is given as the lowest 5 percent of a given populations (i.e. 95 percent of workers with the same age and height have a larger test value).

FVCs, FEV‐1s, and FEV‐1/FVC ratios below the LLN identify workers with abnormal patterns. LNs with a FVC less than the LLN have a restriction pattern. LNs with a FEV‐1/FVC ratio less than the LLN are considered to have an obstructive pattern (with the exception of tall workers with large FEV‐1s). If both the FVC and the FEV‐1 are low, the LN is considered to have a mixed obstructive and restrictive patterns.

Pattern of obstruction FEV‐1

Mild obstruction <LLN but >= 70% of predicted

Moderate obstruction <70% and >= 60% of predicted

Moderately severe obstruction <60% and >= 50% of predicted

Severe obstruction <50% and >= 34% of predicted

Pattern of restriction FVC

Mild restriction <LLN but >= 70% of predicted

Moderate restriction <70% and >= 60% of predicted

Moderately severe restriction <60% and >= 50% of predicted

Severe restriction <50% and >= 34% of predicted

A change over 1 year in FEV‐1 and FVC that exceeds 15 percent should be considered meaningful and should prompt further evaluation.

Attachment 3

Example 1 of an exam list and generated fit for duty form

Example 2 of an exam list and generated fit for duty form

Attachment 4

Applicable references

- NFPA 1582 – Standard on comprehensive occupational medical program for fire Departments, (http://apps.suffolkva.us/bids/files/2281_RFP_19083_Attachment_2_NFPA_1582.pdf)

- NFPA 1582‐18 Technical implementation Guide (TIG) 2018

- 29 Code of Federal Regulations (CFR) 1910 ‐ Occupational Safety and Health Administration

(OSHA)

(https://www.osha.gov/laws‐regs/regulations/standardnumber/1910)

- 5 CFR 339 OSHA Medical qualification determinations

(https://www.law.cornell.edu/cfr/text/5/part‐339)

- AFI 48‐123 ‐ Medical Examinations and standards (5 November 2013)

(https://static.e‐publishing.af.mil/production/1/af_sg/publication/afi48‐123/afi48‐123.pdf)

- AFI 48‐127 ‐ Occupational noise and Hearing conservation program. (26 Feb 2016)

(https://static.e‐publishing.af.mil/production/1/af_sg/publication/afi48‐127/afi48‐127.pdf)

- AFI 48‐137 – Respiratory Protection Program (12 Sep 2018)

(https://static.e‐publishing.af.mil/production/1/af_sg/publication/afi48‐137/afi48‐137.pdf)

- AFI 48‐145 ‐ Occupational and Environmental Health Program (11 July 2018)

(https://static.e‐publishing.af.mil/production/1/af_sg/publication/afi48‐145/afi48‐145.pdf)

- AFMAN 48‐146 ‐ Occupational and Environmental Health Program Management (15 October

2018)

(https://static.e‐publishing.af.mil/production/1/af_sg/publication/afman48‐146/afman48‐146.pdf)

- DoDM 6055.5 M ‐ Occupational Health Surveillance Manual (2 May 2007 incorporating change 3, August 31, 2018)

(https://www.esd.whs.mil/Portals/54/Documents/DD/issuances/dodm/605505mp.pdf?ver=2017‐08‐14‐ 111314‐123)

- DoDI 6055.12 – Hearing Conservation Plan (14 August 2019)

(https://www.esd.whs.mil/Portals/54/Documents/DD/issuances/dodi/605512p.pdf?ver=2017‐10‐25‐ 110159‐777)