Attachment 2 - State of Work.docx

Solicitation 127EAY26Q0065 Lassen National Forest SCBA Physicals & Spirometry Testing

PROJECT

Medical: Physicals and Spirometry Testing

General Information

1.0 Scope of Work

The requirement is to provide SCBA Physicals and Spirometry testing on as needed basis at a local facility, and on-site visit from the medical provider to Susanville, CA 96130 at the Lassen National Forest.

2.0 Background

A medical evaluation to determine whether an employee can use a given respirator is an important element of an effective Respiratory Protection Program. It is necessary to prevent injuries, illnesses and even in rare cases, death from the physiological burden imposed by respirator use. OSHA regulation (29 CFR 1910.134(e) (1)) states that the Forest Service, as the employer, will provide medical evaluations before issuing breathing apparatus.

These physical examinations are and have been a requirement of the Region 5 Respiratory Protections Plan and Self-Contained Breathing Apparatus Operations Guide and are required for employees to utilize the SCBA equipment that is a regional requirement of their position on a Type 3 Engine in Region 5.

These examinations will be provided at the Lassen National Forest Headquarters at set intervals and/or at contractor provided medical facility as needed during the periods of performance.

Contractor Requirements

3.0 Technical Requirements / Tasks

Annual On-site SCBA Physicals and Health Screening and Spirometry Testing. Must meet OSHA Regulations (29 CFR 1919.134 (e)(1).

INSTRUCTIONS TO PHYSICIAN

U.S. Forest Service employees will be using self-contained breathing apparatus (SCBA). This protection will be worn when firefighters enter potentially hazardous atmospheric environments. This will consist of physically demanding work and wearing firefighter personal protective equipment (PPE) in high temperature environments.

Because the use of breathing apparatus increases the work of the heart and lungs, a medical assessment is requested to determine if the employee is physically capable of performing this work.

MEDICAL REQUIREMENTS – (ANSI Z88.6 – 2006)

OSHA regulation (29 CFR 1910.134(e) (1)); the Forest Service, as the employer, will provide medical evaluations before issuing breathing apparatus.

A spirometry test and/or an exercise stress testing (EST) may be used in addition to medical history and physical examination to establish a baseline record.

A Physician or other Licensed Health Care Professional (PLHCP) will determine what physical and psychological conditions are pertinent. The employee’s initial and follow up medical status pertaining to the use of respiratory equipment will be reviewed and documented by the PLHCP.

Medical Evaluation Components

• Physical examination

• Medical history

• Heart disease

• High blood pressure

• Lung disease (pulmonary disease) and sinus conditions

• Skin problems

• Seizures and substance abuse

• Claustrophobia and anxiety

• Eyeglasses and contacts

• Pulmonary testing *

• EKG *

*PLHCP discretion with approval from Unit SCBA Program Manager

Equipment and Conditions

• Self-Contained Open Circuit Breathing Apparatus weighing up to 35 lbs.

• The Employee will use SCBA/PPE for training and fire suppression purposes, no more than one to two hours in duration under normal circumstances.

• The expected physical work effort is heavy lifting 50 lbs. from floor to waist or shoulder, pulling fire hose, lifting tools, Heavy Physical exertion. (>5 mets.)

• If required by the local unit, full Structure Fire Ensemble, including Bunker Jacket and Pants, Boots, Helmet, and protective Nomex Hood.

• Temperature and humidity; High temperatures during fire suppression activities.

The PLHCP will recommend in writing the employee’s ability to wear SCBA/PPE with any use restrictions and periodicity of medical evaluations on the attached Appendix C Respirator Medical Evaluation Questionnaire.

The Physician or other Licensed Health Care Professional (PLHCP) will evaluate and grant written medical approval for each employee prior to respirator use. The PLHCP will use a medical questionnaire or conduct an initial medical examination that obtains the same information as the medical questionnaire (Appendix C). The questionnaire will be presented confidentially and in a manner that the employee can understand. The Forest Service will provide employees with an opportunity to discuss the questionnaire and exam results with the PLHCP.

The following information will be supplied by the Forest Service to the PLHCP prior to the professional’s recommendation concerning an employee’s ability to safely use respiratory protection (Appendix C; Medical Evaluation Questionnaire and Appendix B; Physician Instructions contain the following information).

1. The type and weight of the respirator to be used by the employee.

2. The duration and frequency of respirator use.

3. The expected physical work effort.

4. Additional protective clothing and equipment to be worn.

5. Temperature and humidity extremes that may be encountered.

Frequency of Evaluation According to the American National Standards Institute Z-88.6-2006 an initial medical evaluation shall be performed using a medical history (Respirator Medical Evaluation Questionnaire, Appendix C) or interview and examination that obtain the same information as the medical questionnaire. In addition, a follow-up questionnaire or interview should be used to identify medical conditions that develop after the initial evaluation. This questionnaire may be administered prior to an annual fit test. The frequency of this follow-up interval should be determined by the PLHCP.

Any information provided previously to the PLHCP does not need to be provided for a subsequent medical evaluation if the information and the PLHCP remain the same. The Forest Service will provide the PLHCP with a copy of this plan and the applicable regulatory requirements mandating this Plan (29 CFR 1910.134 (e) and Appendix C) if requested by the PLHCP.

Special Testing Spirometry or Exercise Stress Testing (EST) may be authorized if the PLHCP needs information in addition to a history and physical examination. Spirometry results do not in themselves indicate fitness or lack of fitness to safely use an SCBA. For accurate assessment, spirometry should be performed in accordance with the most recent recommendations of the American Thoracic Society. (Reference; ANSI Z88.6-2006, 10 Special Testing, 10.1).

4.0 Government Furnished – N/A

5.0 Deliverables / Schedule

1) Contractor will provide medical facility for exams for employees to travel to, on as needed bases during the period of performance and the facility must be within 300 miles of the Lassen National Forest, Susanville, CA 96130.

2) Provide documentation of test taken to government employees at time of service.

3)The written recommendation from the PLHCP regarding an employee’s ability to wear a respirator will provide only the following information:

6.0 Travel – N/A

7.0 Contractor’s Key Personnel

Qualified personnel to perform SCBA Physicals and Spirometry medical tests which meet 29 CFR 1910.134 (1) requirements

8.0 Security Requirements - N/A

9.0 Data Rights

Data to government should not include Personally Identifiable Information (PPI). Patients may receive their PPI Information.

All Data obtained from testing will remain confidential between PLHCP, examinees and Supervisors of examinees.

10.0 Section 508 – Electronic and Information Technology Standard - N/A