Attachment 2 - DRAFT Performance Work Statement.pdf

Medical Surveillance

DRAFT Performance Work Statement

Attachment 2

Dobbins ARB, Georgia

29 December 2023

1. Introduction

1.1. Mission. Provides manpower to support the 94th Aeromedical Staging Squadron (94 ASTS) to assist with accomplishing Reserve Component Periodic Health Assessments (RCPHA) for ensuring the 94th Airlift Wing’s (94 AW) medical requirement for deployment is met.

1.2. Scope. This contract shall serve as a vehicle to provide certified physicians to perform

Annual Health and Occupational Physicals, and Medical Surveillances for a variety of duty specific career fields for employees and personnel assigned at Dobbins Air Reserve Base, GA.

Annual health physicals include all duty specific with specialties identified for Firefighters, Air

Traffic Controllers, and Security Forces personnel at Dobbins Air Reserve Base, GA. For the purpose of this contract Dobbins members include DOD Civilian employees, Active Guard

Reserve, and Traditional reservist.

1.3. Non-Personal Services. The services performed under this contract shall be non-personal services and are not inherently governmental. The prime contractor’s staff, including all teaming partners, subcontractors and their staff at the corporate level involved in the company’s or team’s administration of this contract will hereafter be referred to as “contractor management staff.” The prime contractor retains responsibility for any teaming partner or subcontractor and shall be accountable for their performance. The contractor management staff shall provide all equipment, tools, labor and materials required to recruit, qualify, train, place, manage and retain the medical support services supporting healthcare operations for the Air Force in accordance with the terms and conditions of this contract.

1.4. Definitions.

Authorized Agency are agencies point of contacts who authorized to make appointments with the contractor. Those agencies are:

94 ASTS/SGP 94th Aeromedical Staging Squadron

94 FSS/FSMC Civilian Personnel

94 SFS/SFO Security Forces Designated Operations Officer

94 OG/OGT Air Traffic Control

94 MSG/CEF Fire Department (HSO or Designated Representative)

Contractor is a term used in this contract which refers to the prime contractor.

Contracting Officer, while not all inclusive, is a person with authority to enter into, administer or terminate contracts, and make related determinations and findings on behalf of the

Government. Note: The only individual who can legally bind the Government.

Medical Surveillance Examinations are identified as pre-placement, periodic, special purpose, termination and fitness-for-duty examinations, Audiograms, Respirators and Reasonable

Accommodations that are determined by the 94 ASTS/SGP with assistance from 94 FSS/FSMC and federal directives. Examinations are to be performed to assess the health status of individuals as it relates to their workplace.

Pre-placement examinations are tests and examinations accomplished to establish and document baseline data for future use in the evaluation of occupational health hazards from the workplace.

Periodic Examinations are tests and physical examinations that are accomplished at intervals to evaluate and document the health of employees.

Special Purpose Examinations are physical examination given when an employee is exposed to a chemical or human body fluids during an incident or accident. This would include but is not limited to occupational exposures to blood borne pathogens.

Termination Examinations are tests and examinations that are accomplished to establish and document the health of employees at termination of employment.

Annual Second-Class Airman Medical Physicals are tests and examinations that are accomplished to establish fitness and document the health of employees within Air Traffic

Control positions.

Fitness-for-Duty Examinations are conducted to assess and provide a determination concerning the employee’s fitness for efficient performance of their assigned duties.

Reasonable Accommodation Examinations are conducted to assess and provide a determination concerning the employees who experience workplace barriers because of a medical disability.

1.5. Acronyms

AFCEC Air Force Civil Engineering Center

AFRC/SG Air Force Reserve Command/Surgeon General

AME Aviation Medical Examiner

ASTS Aeromedical Staging Squadron

BES Bioenvironmental Engineering Services

BLDG Building

CD Civilian Defender (Security Forces)

DAFI Department Air Force Instruction

DD Department Defense

DoD Department of Defense

FAA Federal Aviation Agency

FAR Federal Air Regulation

FEV Forced Expiratory Volume

FVC Forced Vital Capacity

HIPAA Health Insurance Portability and Accountability Act

NFPA National Fire Protection Agency

OH Occupational Health

PFT Pulmonary Function Test

PPE Personal Protective Equipment

PWS Performance Work Statement

RCPHA Reserve Component Periodic Health Assessment

SF Standard Form

Std Standard

STS Standard Threshold Shift

TIG Technical Implementation Guide

2. General Requirements

2.1. The contractor shall ensure that medical services are performed by a licensed mid-level provider (physician assistant or nurse practitioner) or licensed physician who has graduated from an accredited medical school and has completed a residency program approved by the Council on

Medical Education and Hospitals, American Medical Association, and be board certified in either occupational medicine or preventive medicine by the American Board of Preventive Medicine or

Osteopathic Council of Preventive Medicine. If a mid-level provider completes exams, they must be reviewed and co-signed by the licensed physician. The licensed physician must complete all clearance letters. All providers must possess a valid current license to practice medicine in Georgia.

All forms shall be signed by designated signatures on stated forms in this PWS.

2.2. Validation of qualifications, licensor, and certification (as applicable). The contractor shall provide written verification (and photocopies where necessary) showing licensor, board certification, hospital affiliation, and provide a secure email or certified mail of the report of health examinations to the 94 ASTS/SGP via email to the full-time staff within 21 calendar days of any changes and prior to performing any services under this contract for the Prime or subcontractor.

2.3. HIPAA. All contracted management staff performing services for the Air Force have been trained and/or familiar with HIPAA Privacy & Security Rule and will be held accountable for complying with health information privacy and security policies and procedures. Reference

Section H, Special Contract Clauses, for detailed HIPAA language.

3. Description of Services

3.1 The contractor shall provide all personnel, equipment, materials, necessary to perform chest x-rays and physical examinations.

3.1.1 Contractor may perform the services at their facilities, affiliate or qualified subcontractor facilities. The facilities shall be located within 20-miles of zip code 30069 and meet Government standards of health and safety guidelines.

3.1.2. Physical examinations may be performed on Government-Owned property. When services are performed on Government-Owned property; contractor is also responsible for removal of all waste.

3.2 Medical Surveillance Examinations

3.2.1. Contractor shall conduct physical examinations and tests under this contract between the hours of 7:00 am and 5:00 pm EST, Monday through Friday. All federal holidays are excluded.

3.2.2 Contractor shall perform any medical surveillance examinations as identified in paragraph 1.4. Any additional examinations may be provided but only if identified by the physician and coordinated with 94 ASTS/SGP, 94 FSS/FSMC and coordinated with the

Contracting Officer. No additional examinations maybe performed if not identified in this contract.

3.2.3 All examinations and tests shall be performed in accordance with requirements which have been established and approved by 94 ASTS/SGP and documented on any of the following forms (or any official revision or replacement thereof):

AFI 32-2001 Fire and Emergency Services Program

AFI 1753 Hearing Conservation Examination

AF2766 Clinical Occupational Health Exam Requirements

DD2216 Hearing Conservation data

FAA 8500-8

Application for Airman Medical Certificate or Airman Medical

& Student Pilot Certificate

FAA 8500-9 White Certificate (provided to the employee)

OF78/OF178 Certificate of Medical Examination

SF 88 Report of Medical Examination

Local Form Medical Evaluation of Department of the Air Force Civilian

Police Series

SF600 Standard Form 600

3.2.4 Physical examination techniques must comply or be equal to the examination requirements prescribed by any of the following directives (or any official revision or replacement thereof):

3.2.5 Medical Surveillance examinations shall be conducted within 30-calendar days from receipt of after the request from 94 ASTS/SGP or authorized agency.

3.2.6 The contractor shall determine if the government employee meets existing physical requirements and medical standards. NOTE: When non-occupational medical problem is identified, the patient will be informed of the abnormality and advised to seek proper medical care (private physician). If a non-occupational abnormality is remedial (e.g., otosclerosis) or is likely to be temporary (e.g., external otitis), but may interfere with the ability of the person to wear PPE such as hearing protection and/or respiratory protection, or unable to perform their job, etc., appropriate temporary duty restrictions shall be recommended. The physician’s determination as to whether the employee meets physical requirements and medical standards shall be documented on any form identified under paragraph 3.3.3 of this PWS. by the contractor.

3.3 Pre-placement, Special Purpose, Termination Examinations

3.3.1 Pre-placement physical examinations shall be performed within five (5) working days after receipt of verbal request for appointment from 94 ASTS/SGP.

AFI 31-118 Security Forces Standards and Procedures

AFI48-123 Medical Examinations and Standards

AFI 48-145 Occupational and Environmental Health Program

AFI 48-127 Occupational Noise and Hearing Conservation Program

Title 14 Part 67

Subpart C Part

Second-Class Airman Medical Certificate

NFPA 1851

Standard on Selection, Care, and Maintenance of protective ensembles for Structural Fire Fighting and Proximity Fire

Fighting

NFPA1582

Standard Comprehensive Occupational Medical Program for

Fire Department

NFPA1581

Standard on Fire Department Infection Control Program

NFPA 1500

Standard on Fire Department Occupational Safety, Health, and

Wellness Program

NFPS 1500-

TIG

Standard on Fire Department Occupational Safety, Health, and

Wellness Program-TIG

QSH Qualifications Standards Handbook

USAF TIG

1582-03

Technical Implementation Guide 1582-03 for NFPA Std 1582

DoD

6055.05M

Occupational Medical Examinations and Surveillance Manual

3.3.2 Examination requirements which include a PFT shall include a FVC and FEV, when required. Firefighter physicals must obtain physical examinations IAW current edition of

NFPA 1582 as amended by AFCEC 1582 TIG.

3.3.3 The equipment must be of an approved type, as recommended by the American Thoracic

Society, and be properly calibrated.

3.3.4 Persons, other than licensed physicians, who administer the PFT shall have completed a training course in spirometry sponsored by an appropriate academic or professional institution and be supervised by a physician.

3.3.5 The professional medical staff shall evaluate and make appropriate recommendations based on findings and indicate whether a Dobbin’s member is physically able to perform their work while wearing the prescribed respiratory protection.

3.3.6 The contractor shall deliver all medical documentation IAW guidelines identified under section four (4) of this PWS.

3.4 Periodic Examinations.

3.4.1. Periodic examinations shall be performed within five (5) working days after receipt of verbal request for appointment from 94 ASTS/SGP or authorized agency.

3.4.2. Firefighters physicals must obtain physical examinations IAW NFPA 1582 as amended by AFCEC 1582 TIG.

3.4.2.1.1. NFPA 1582 Standard on Comprehensive Occupational Medical Program for

Fire Departments. Firefighter examinations shall be performed by a licensed mid-level provider (physician assistant or nurse practitioner) or licensed physician who is board certified in either occupational medicine or preventive medicine by the American Board of

Preventive Medicine or Osteopathic Council of Preventive Medicine. If a mid-level provider completes exams, they shall be reviewed and co-signed by the licensed physician. The licensed physician must complete all clearance letters.

3.4.2.2 Air Traffic Controllers must obtain a Second-Class Medical examinations IAW Title

14 Part 67 Subpart C and contractor shall provide member with FAA 8500-9.

3.4.2.3. Examination requirements will require certified physicians Aviation Medical

Examiners (AME) to perform specialty examinations for Air Traffic Controllers.

3.4.2.4. Civilian Defender medical valuations will:

a. Certify the individual is medically fit to perform the essential job functions, with or without reasonable accommodation, without positing a direct threat to the health or safety of themselves or others.

b. Identify any health condition that may be substantially aggravated by the job.

c. Evaluate an individual’s health and fitness to safely initiate or maintain a regular exercise program and take the Physical Fitness Test: identify individual cardiovascular risk factors and provide advice and assistance in controlling risk factors, including referral to the individual’s personal physician. Individuals shall be assessed medically for their suitability to conduct the following standards:

i. Perform a 16.5” vertical jump

ii. Complete the Illinois Agility Run in 18.1 seconds or less

iii. Run 300 meters in 66 seconds or less

iv. Perform 32 push-ups (no time limit)

v. Run 1.5 mils in 16 minutes, 17 seconds or less (16:17)

d. Serve as a baseline for tracking occupational health trends

3.4.3. The contractor shall deliver all medical documentation IAW guidelines identified under

3.5. Fitness-for-Duty Examinations.

3.5.1. The Fitness-for-Duty exam is scheduled by the 94 ASTS/SGP and/or 94 FSS/FSMC. All requirements for the physical will be listed on OF 78/178.

3.5.2. The physical shall be accomplished within five (5) working days.

3.5.3. In cases where there is a question about physical fitness-for-duty, the Government has an immediate need to determine whether to remove the employee from the duty area; therefore, the physical exam shall be accomplished as soon as possible.

3.5.4. The physician shall contact 94 ASTS/SGP & 94 FSS/FSMC not later than (NLT) the morning of the next workday to provide diagnosis. OF 78/178 will delivered to the 94 ASTS/SGP and/or 94 FSS/FSMC, electronically.

3.5.5. Fire Department Performance Requirements for Yearly Physicals:

a. Medical History

b. Physical Examination:

(1) Vital signs [temperature, pulse, and respiratory rate, and blood pressure (BP)] BP shall be measured according to the recommendations of the Seventh Report of the Joint National Committee on

Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC

(2) Head, eyes, ears, nose, and throat (HEENT)

(3) Neck

(4) Cardiovascular

(5) Pulmonary

(6) Breast

(7) Gastrointestinal with digital rectal exam as clinically indicated

(8) Genitourinary as clinically indicated

(9) Hernia

(10) Lymph nodes

(11) Neurological

(12) Musculoskeletal

(13) Skin (includes screening for cancers)

(14) Vision

c. Ancillary Testing:

i. Blood Test: Blood tests shall be performed annually and shall include the following:

(1) CBC with differential, RBC indices and morphology, and platelet count

(2) Electrolytes (Na, K, Cl, HCO3, or CO2)

(3) Renal function (BUN, creatinine)

(4) Glucose

(5) Liver function tests (ALT, AST, direct and indirect bilirubin, alkaline phosphatase)

(6) Total cholesterol, HDL, LDL, clinically useful lipid ratios (e.g., percent LDL), and triglycerides

ii. Colon Cancer Screening. Fecal occult blood testing shall be provided annually to all members above the age of 40 or earlier if clinically indicated.

iii. Prostate Cancer. Due to increased cancer risk, the fire department shall provide all male fire fighters with prostate-specific antigen (PSA) testing beginning at age 50 and annually thereafter. Those with a family history or African-American heritage, who are at a higher risk for prostate cancer, shall be provided with testing beginning at age

40 and annually thereafter.

iv. Urine Laboratory Tests. The urine laboratory tests shall be performed annually and shall include the following:

(1) Dipstick analysis for glucose, ketones, leukocyte esterase, protein, blood, and bilirubin

(2) Microscopic analysis for RBC, WBC, casts, and crystals if indicated by results of dipstick analysis

(3) Analysis for occupational chemical exposure if indicated

d. Audiology. Hearing thresholds shall be assessed annually in each ear at each of the following frequencies:

(1) 500 Hz

(2) 1000 Hz

(3) 2000 Hz

(4) 3000 Hz

(5) 4000 Hz

(6) 6000 Hz

(7) 8000 Hz

e. Spirometry. Pulmonary function testing (spirometry) shall be conducted annually to measure the member’s forced vital capacity. (FVC), forced expiratory volume in 1 second (FEV1), and the absolute FEV1/FVC ratio.

f. Chest Radiographs. Chest x-rays shall include an initial baseline and shall be repeated every 5 years or as medically indicated.

g. Electrocardiograms (ECGs). A resting ECG shall be performed as part of the baseline medical evaluation and shall be performed annually thereafter.

h. Immunizations and Infectious Disease Screening. The following infectious disease immunizations or infectious disease screenings shall be provided, as indicated:

(1) Tuberculosis (TB) screening by either tuberculin skin testing using the tuberculin purified protein derivative (PPD) or the tuberculin blood test (interferon gamma release assay) shall be performed at baseline. Subsequent tuberculosis screening shall be performed annually or at a frequency according to CDC guidelines unless the member has a history of positive tuberculin screening test, in which case CDC guidelines for management and subsequent chest radiographic surveillance shall be followed

(2) Hepatitis C virus screen — baseline and following occupational exposure

(3) Hepatitis B virus vaccinations and titers—as specified in CDC guidelines

(4) Tetanus/diphtheria vaccine — booster every 10 years

(5) Measles, mumps, rubella vaccine (MMR) — one dose of MMR vaccine to members born after 1957 without prior immunization and/or evidence of immunity as outlined in the Morbidity and Mortality Weekly Report article “Measles, Mumps, and Rubella — Vaccine Use and Strategies for Elimination of Measles, Rubella, and Congenital Rubella Syndrome and Control of Mumps: Recommendations of the Advisory Committee on Immunization Practices (ACIP).”

(6) Polio vaccine — as indicated (a single booster of IPV for members traveling to endemic areas in the line of duty, or as outlined in the Morbidity and Mortality

Weekly Report article “Poliomyelitis Prevention in the United States: Updated

Recommendations of the Advisory Committee on Immunization Practices (ACIP).

(7) Hepatitis A vaccine

(8) Varicella vaccine—offered to all non-immune personnel

(9) Influenza vaccine (seasonal and novel) — offered to all personnel annually

(10) HIV screening — available to all personnel

i. Post-Exposure Bloodborne Pathogen Testing. Physicians who care for members shall follow current CDC recommendations for post-exposure prophylaxis (PEP) for bloodborne pathogen (BBP) exposures.

j. HIV Testing. HIV testing shall be offered on a confidential basis as part of post-exposure protocols and as requested by the fire department physician or member.

k. Heavy Metal Evaluation. Baseline testing for heavy metals shall be required when indicated by known exposure or substantial risk.

l. Health Care Provider Visit.

m. Height/Weight/BMI.

n. Respirator Fit Test. (Contractor will provide a respirator questionnaire to each employee.

Once medically cleared Base Bio will conduct the Respirator Fit Test by the Fire Dept.)

3.5.6. Civilian Defender Medical Examination requirements

a. Medical Examination: The medical exam will focus on the eyes, ears, nose, and throat, the respiratory, musculoskeletal, and neurological systems. Attention will be paid to signs and symptoms suggestive of inability to maintain mental alertness and control of voluntary motor functions. Acuity of the senses, range of motion, and motor strength required to perform essential job functions will be considered. Document the examination on OF 178, or equivalent.

b. Cardiovascular Risk Factors: Civilian Defenders have to respond to emergency situations that may impose significant physical and psychological stress. Such stress may trigger sudden death or myocardial infarction in the presence of underlying heart disease. For this reason, cardiac risk evaluation is most appropriate.

i. The Framingham 10-year risk calculator is probably the most useful single tool to characterize the risk to a Civilian Defender of a cardiac event. The Framingham

Risk score uses independent risk factors (age, gender, total cholesterol, HDL cholesterol, systolic blood pressure, treatment of hypertension, and cigarette smoking) to assess an individual’s absolute risk for developing a cardiac event, such as MI or new onset angina.

ii. Generally, those individuals with a high 10-year risk, and those with coronary artery disease or coronary artery disease equivalent (peripheral arterial disease, abdominal aortic aneurysm, symptomatic carotid artery disease, diabetes) are candidates for additional testing (usually a treadmill stress test, stress thallium, or stress echo). The medical review officer will consider temporarily disqualifying these individuals from strenuous duties and/or duties that require wearing a respirator (except a mask for escape purposes only), pending the results of evaluation by the workers’ private physician.

c. Diabetes: Fasting blood sugar will be obtained because diabetes mellitus frequently can interfere with safe performance of essential Civilian Defender functions, such patients will be carefully evaluated. The examinee will have a history of being under excellent control for an extended period of time, with a glycosylated hemoglobin less than 8.0. The examinee will have a history of an absence of end organ damage (nephropathy, neuropathy, and proliferative retinopathy), an absence of uncontrolled hypertension, and no history of ketoacidosis, hyperosmolar nonketotic coma, nor severe hypoglycemia in the previous year.

d. Lipids: Serum cholesterol, high-density lipoprotein, low-density lipoprotein, and triglycerides will be evaluated for cardiovascular risk and referral to the individual’s private physician when intervention is indicated.

e. Arrhythmias: Arrhythmias that predispose to or have a risk of cerebral hypoperfusion and impaired consciousness are generally not compatible with safe performance of the duties of Civilian Defenders. Security Force personnel with pacemakers may be qualified if the underlying disease does not pose a significant risk; they will be evaluated on a case-by-case basis. Implanted defibrillators are generally not compatible with safe performance of the duties of Civilian Defenders. The pre-placement exam will include a resting electrocardiogram for initial evaluation and then as clinically indicated thereafter.

f. Hypertension: Blood pressure (the average of at least two independent measurements taken after 15 minutes of rest) will be used in evaluating cardiovascular risk. Refer the individual to their private physician when intervention is indicated.

g. Hearing:

i. Civilian Defenders require a pre-placement audiogram to determine if they can safely perform their duties. Audiometry testing is conducted using audiometers (manual or microprocessor) calibrated to the current ANSI S3.6 standards. Pure tone unaided air conduction hearing threshold levels will not exceed 30 dB hearing loss (HL) on average for each ear at 500, 1000, and 2000 Hz, with no level greater than 35 dB HL at these frequencies; and thresholds will not exceed 55 dB at 4000 Hz in each ear. If the hearing is worse than these thresholds, it is questionable whether or not that individual can function as a Civilian Defender. If one ear is deaf or has extremely poor hearing, it is likely the individual would be unable to safely perform Civilian Defender duties.

ii. Field “use” tests are neither as reliable nor valid as the speech-in-noise test used by the audiologist. Speech-based “use” tests invoke a large number of variables such as the content of the message, context, accent, background noise, and so forth. The speech-in-noise test controls for these factors. The "Whispered Voice Test" is no longer valid and will not be accepted by medical professionals.

iii. Civilian Defender personnel identified as being occupationally exposed to noise levels requiring placement in the Hearing Conservation Program, will undergo initial, annual, and termination audiometric evaluation in accordance with AFI 48-127, Occupational

Noise and Hearing Conservation Program.

h. Vision:

i. Screening may be performed by the examining physician if they have the capability to perform these tests; optometry referral is not required unless indicated by poor vision or an inability to properly assess the vision. When an examinee’s vision is worse than indicated below, it is likely the individual may not be able to safely perform the essential job functions; the examining physician will consider this in his/her assessment.

Determine individual limitations on a case-by-case basis.

ii. Using the individual’s best optical correction, distance vision will be at least 20/30 in one eye and 20/100 in the other, or 20/40 in one eye and 20/70 in the other, and near vision will be correctable to 20/40 binocularly (both eyes open). Uncorrected binocular visual acuity will be at least 20/100. Do not limit successful soft contact lens wearers to any uncorrected distance standard as long as they can be corrected to the standards listed above. Personnel wearing soft contact lenses will provide evidence from their eye care professional affirming their successful use of soft contact lenses.

iii. Individuals will be able to discriminate vivid red/green color.

iv. Individuals will have normal muscle balance, defined as the lack of strabismus (greater than 15 diopters), nystagmus, and diplopia.

v. Additionally, individuals will have at least a total horizontal visual field of 120 degrees and at least a total vertical visual field of 40 degrees (20 above the horizontal meridian and 20 below the horizontal meridian) in each eye.

vi. Individuals will not have a history of abnormal night vision.

i. Respirators: Units must medically clear individuals who need to wear/use a respirator.

Ensure medical clearance for respirator use is in accordance with current applicable guidance on the AFI 48-137, Respiratory Protection Program.

j. Immunizations: Agencies may establish periodic immunization programs by written policies or directives to safeguard the health of employees whose work may subject them or others to significant health or safety risks due to occupational or environmental exposure or demands. Make a review of Civilian Defender immunization status to ensure personnel have received tetanus, purified protein derivative, hepatitis B, and other appropriate immunizations.

k. Psychiatric:

i. A history or diagnosis of a psychiatric disorder, which could affect safe and efficient job performance, require additional evaluation to determine whether the individual is able to safely and successfully perform the essential job functions. The presence of any of the following specific psychiatric disorders, or a history of such, warrants further evaluation by a psychologist or psychiatrist before a Civilian Defender is deemed fit for duty. Other psychiatric disorders not listed here also may warrant further evaluation. A particular diagnosis need not necessarily have previously been made; rather if there appears to be signs associated with any of the listed diagnoses, this may warrant further evaluation:

ii. Delirium, dementia, and amnestic and other cognitive disorders

iii. Major depressive disorder

iv. Manic-depressive disorder (bipolar)

v. Dissociative disorders

vi. Kleptomania

vii. Panic disorder and other anxiety disorders (depending upon etiology, duration and severity of clinical expression)

viii. Pyromania

ix. Schizophrenia and other psychotic disorders

x. Personality disorders

xi. Alcohol or drug dependence

xii. Neurological: A history of chronic headaches, head trauma, cranial defects, and epilepsy are among the neurological disorders that can interfere with Civilian Defender functioning. Since epilepsy can be particularly dangerous, ensure the likelihood of an on-the-job seizure is assessed. To evaluate this risk, the recommended method is described in the Medical Screening Manual for California Law Enforcement located on the California Police Officer Standards and Training website. In such cases, the physician will assess non-seizure related impairments, such as interictal electroencephalogram discharges (which can cause transient cognitive impairment) or anti-epileptic drug side effects (about 30% of patients may experience moderate to severe side effects to include cognitive impairment, visual effects, and ataxia).

3.6. Audiograms.

3.6.1. The contractor shall be responsible to review and conduct audiograms IAW AFI Std 48-

127 accomplished in accordance with the standard for all DoD civilians and military members identified on a DD 2216.

3.6.2. The completed DD 2216 shall serve as written notification of audiogram results. However, this does not preclude the contractor from providing other written patient disposition when warranted to describe the patient’s medical disposition.

3.6.3. Whenever a threshold shift has been verified by the second follow-up through audiometric testing, the Contractor or Personnel performing the test will provide audiogram documented results. The contractor will perform an examination of the patient and then using the criteria found in AFI 48-127, shall determine whether a physiological problem caused the threshold shift.

If so, notify 94 ASTS/SGP.

3.6.4. A clinical examination of the ears, nose and throat will be performed by the examining practitioner on all employees getting a reference audiogram check, those with STS, those required to be examined based on history and those undergoing a fitness and risk evaluation.

3.6.5. During the examination the practitioner must note:

a. Cerumen plugging the ear canals

b. Otitis externa

c. Condition of the tympanic membranes

d. Any middle ear disease

e. Eustachian tube function

f. Any other ENT disease or condition, which might adversely affect the audiogram results

g. Any condition that may interfere with the wearing of hearing protection (permanently or temporarily)

3.6.6. The contractor shall deliver all medical documentation IAW guidelines identified under

3.7. Respirators.

3.7.1. Contractor shall review OSHA respirator questionnaire, evaluate and make appropriate recommendations based on findings and indicate whether an employee is physically able to perform their work while wearing the prescribed respiratory protection. If additional testing is required, notify 94 ASTS/SGP.

3.7.2. The contractor shall deliver all medical documentation IAW guidelines identified under

3.8. Final Assessment and Disposition.

3.8.1. A physician shall review all examination results and histories to make a final determination if the individual is at an increased risk due to his/her health from any occupational exposures to which he/she is potentially exposed.

3.8.2. All assessments and dispositions shall be documented on any form identified under paragraph 3.4.3 of this PWS and any other accompanying documentation shall be delivered as identified under section four (4) of this PWS.

3.8.3. The contractor shall verify physical examination findings through verification of the original tests or any additional testing as prescribed by the attending contract physician and after telephone coordination with the 94 ASTS/SGP. Further coordination/consultation shall be acquired from the 94 FSS/FSMC concerning pre-placement and fitness-for-duty examinations.

3.8.4. The case shall be coordinated with 94 ASTS/SGP if a determination cannot be conclusively determined if an individual is/is not physically able to perform their job.

3.8.5. An individual may be recommended for temporary removal from his/her work area or limitations recommended from specific working conditions or exposures until the specific nature of their medical condition can be determined through verification or additional testing.

The contractor shall verbally notify and follow up with a written notification via email to the

94 FSS/FSMC immediately at (678) 655-5036 and coordinated with 94 ASTS/SGP (678) 655-

7005, but no later than one (1) workday after the determination that a limiting condition exists or that removal from the work area is recommended.

3.9. Relationship of Parties.

3.9.1. It is expressly agreed and understood that the services rendered by the contractor and its employees are rendered in the capacity of an independent contractor. Although the government may evaluate the quality of both professional and administrative services for purposes of contract inspection and acceptance, it retains no control over the services rendered, including, but not limited to; professional judgments, diagnosis, or specific treatments.

3.9.2. The contractor shall be solely responsible for any and all liability caused by the acts or commissions of its agents or employees.

3.10. Indemnification.

3.10.1. The contractor expressly agrees to indemnity, hold harmless, and to defend the government of the United States for all of its employees and agents acting officially or otherwise, from any and all liability, claims, demands, actions, debts, and attorney fees arising out of, claimed on account of, or in any manner predicated on loss or damage to the property of the injuries to, or death of any person whatsoever, which may occur as a result of or in connection with the services being provided under this contract.

4. Deliverables

4.1. The contractor shall provide to the 94 ASTS/SGP a current copy of any standards, guidelines and/or reference ranges used to interpret laboratory test results. Provide each time it is changed.

4.2. Contract physicians shall complete required form(s) and/or documentation in accordance with the corresponding Air Force instructions, directives and policies identified under section

3.4.3 & 3.4.4 of this PWS.

4.3. Reporting of Examination Result

DELIVERABLES SCHEDULE

DOCUMENT

Organization delivered to Time period Submit To

Pre-Placement

Fitness for Duty

94 ASTS/SGP

94 FSS/FSMC

Within 3-work days after completed exam

94 ASTS POC

94asts.medical@us.af.mil

-Periodic

-Special Purpose

-Termination

-Audiograms

-Respirators

-Additional Services

-Reasonable

Accommodation exams

94 ASTS/SGP

Within 3-work days after completed exam

94 ASTS POC

94asts.medical@us.af.mil

Firefighter Annual

Physicals PHA/OHA

Yearly/Annual

(Clearance Letter)

94 ASTS/SGP

94 MSG/CEF

Fire

Department

Within 3-work days after completed exam

94 ASTS POC

94asts.medical@us.af.mil

Firefighter Annual

Physicals PHA/OHA

Yearly/Annual

94 ASTS/SGP

94 MSG/CEF

Fire

Department

Within 3-work days after completed exam

94 ASTS POC

94asts.medical@us.af.mil

Civilian Defender

Medical Evaluation for

Annual Physical

Agility Test (PAT)

94 ASTS/SGP

94 SFS/SFO

Within 3-work days after completed exam

94 ASTS POC

94asts.medical@us.af.mil

Military Security

Forces Medical

Evaluation for Annual

Physical

94 ASTS/SGP

Within 3-work days after completed exam

94 ASTS POC

94asts.medical@us.af.mil

Civilian Defender

Medical Evaluation for

Initial Physical Agility

Test (PAT)

94 ASTS/SGP

94 SFS/SFO

Within 3-work days after completed exam

94 ASTS POC

94asts.medical@us.af.mil

Air Traffic Control

Annual – Class II

Medical Examination

(FAA 8500-9 Airman

Medical Certificate)

94 ASTS/SGP

Individual Air

Traffic Control

Specialist

Within 3-work days after completed exam

94 ASTS POC

94asts.medical@us.af.mil

4.3.1. All physical examination results that medically disqualify employees and /or abnormal laboratory results must be telephoned to the responsible office at (678) 655-7005/9609/9667 and email 94asts.medical@us.af.mil immediately after receipt.

4.3.2. The contractor will note the date, time and person contacted.

mailto:94asts.medical@us.af.mil mailto:94asts.medical@us.af.mil mailto:94asts.medical@us.af.mil mailto:94asts.medical@us.af.mil mailto:94asts.medical@us.af.mil mailto:94asts.medical@us.af.mil

4.3.3. The 94 ASTS/SGP will note the date, time and name of person reporting the abnormal data, and name of provider notified with date and time.

4.3.4. Telephone notification is not normally necessary for normal examination results;

however, it must be provided for fitness-for duty examinations (see section 3.7), when an individual is recommended temporary removal from his/her duties (see paragraph 3.10.5) and/or if requested by 94 ASTS/SGP and/or 94 FSS/FSMC.

4.3.5. All examination results will be reported on any forms identified under paragraph 3.4.3.

(with additional documents as necessary) and distributed with original file in the employee’s medical folder and three (3) copies emailed to the following recipients:

a. 94 ASTS/SGP

b. Employee (preferred at time of examination)

c. 94 FSS/FSMC

4.4. Monthly Lists/Reports.

4.4.1. The contractor shall provide 94 ASTS/SGP with a monthly list of all personnel tested included with the invoice in WAWF.

4.4.2. List shall be itemized of all tests administered to include the date and cost of each test per individual.

4.4.3. The contractor shall annotate the monthly examination roster as follows:

Status Disposition

Completed Date Completed

No-Show Date and reason, if any, if the individual failed to meet their scheduled appointment

4.4.4. The contractor’s medical personnel shall provide technical review of all examination data to ensure the highest level of quality control and accuracy of the completed medical surveillance examination. In addition, the contractor’s physician, nurse or technician shall sign any form identified under paragraph 3.4.3. of this PWS provided by the member at time of appointment as having provided a medical examination. The copies of the completed forms shall be delivered under section four (4) of this PWS.

5. Service Summary

5.1 This Service Summary (SS) identifies critical success requirements for the contract. The absence of any contract requirement from the SS shall not detract from its enforceability nor limit the rights or remedies of the Government.

Performance Requirements Summary

Performance

Objective

PWS

Reference Standard

Performance

Threshold

Method of

Surveillance

PRS # 1

The contractor shall provide qualified personnel that meet all the requirements identified in section 3 of the PWS.

3.6.2. The Contractor shall be

responsible for employing qualified technical personnel proficient and current in their skill sets and able to perform all tasks identified in this contract.

The contractor provided at minimum personnel that have verified and identifiable experience conducting at least

100% of the task outlined in the PWS.

(PA may be acceptable if approved)

Qualified AME shall perform ATC exams.

The AME or designated

Representative will conduct random sampling to determine if employee received all required sections of the OHA/PHA.

PRS # 2

Quality of work of required deliverables identified in section 3

3.6.2.2. All procedures and test

are performed and delivered in a professional manner. No corners were cut.

Deviations are coordinated and approved by Air Traffic

Controller Point of

Contact, AME and

Flight Doctor.

Deliverables are at least

100% accurate. All task are performed IAW section 3.6.2.2

The AME or designated

Representative will conduct random sampling to determine if employee received all required sections of the OHA/PHA.

PRS # 3

The contractor shall provide qualified personnel that meet all the requirements identified in section 3

3.7.5

The Contractor shall be responsible for employing qualified technical personnel proficient and current in their skill sets and able to perform all tasks identified in this contract.

The contractor provided at minimum personnel that have verified and identifiable experience conducting at least

100% of the task outlined in the PWS.

(PA may be acceptable if approved)

Qualified AME shall perform ATC exams.

The Fire Dept. HSO or designated

Representative will conduct random sampling to determine if employee received all parts of the

OHA/PHA.

PRS # 4

Quality of work of required deliverables identified in section 3

3.7.5

All procedures and test are performed and delivered in a professional manner. No corners were cut.

Deviations are coordinated and approved by Fire Dept.

and Flight Doctor.

Deliverables are at least

100% accurate. All task are performed IAW section 3.7.5.

The Fire Dept. HSO or designated

Representative will conduct random sampling to determine if employee received all required sections of the OHA/PHA.

PRS # 5

Medical Clearance and Physical Fitness clearance letter submitted as identified in section 4 of this PWS.

4.3 All deliverables are sent

to the fire dept. HSO or representative. All personnel should have a clearance letter submitted for them.

Within 3 days after completion of exam.

100% inspection of clearance letters by the HSO or fire dept.

representative.

PRS # 6

Medical Clearance and Physical Fitness clearance letter submitted as identified in section 4 of this PWS.

4.3 All deliverables are sent

to the SFS representative. All personnel should have a clearance letter submitted for them.

Within 3 days after completion of exam.

100% inspection of clearance letters by the SFS representative.

PRS # 7

Medical Clearance and Physical Fitness clearance letter submitted as identified in section 4 of this PWS.

4.3 Qualified AME shall

perform ATC exams.

Within 3 days after completion of exam.

100% inspection of clearance letters by the AME or designated

Representative

PRS # 8

Medical Clearance, Exams, and Physical

Fitness clearance letter submitted as identified in section 4 of this PWS.

4.3 Qualified AME shall

perform exams and deliver results to

94ASTS.Medical@us.af

.mil

Within 3 days after completion of exam.

100% inspection of clearance letters by the AME or designated

Representative mailto:94ASTS.Medical@us.af.mil mailto:94ASTS.Medical@us.af.mil