Attachment 3_NSWCPD (COVID) ENTRY SCREENING ASSESSMENT 30 NOV 2021 Rev 12.docx
DOCX document 85 KB Posted
- Solicitation number
- N6449822R4014
About this file
This solicitation requests engineering and technical support services for the design of test sites at the Naval Surface Warfare Center Philadelphia Division. The selected contractor(s) will provide design planning, engineering, and technical services to support test sites including the Hull, Mechanical, and Electrical systems engineering site and current and future test facilities. The Government intends to award an Indefinite Delivery, Indefinite Quantity, Cost-Plus-Fixed-Fee contract with the potential for Firm Fixed Price task orders. The period of performance is anticipated to be seventy-two months, consisting of a base period of sixty months and two option years. Task orders may be either level of effort or completion type. Multiple awards are anticipated. The solicitation will be awarded on a technically acceptable basis, with cost proposals evaluated at the task order level. The North American Industry Classification System code for this requirement is 541330.
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Other files
| File | Type | Posted |
|---|---|---|
| N6449822R4014 Amendment 0001.pdf | ||
| Attachment 2_ GFP LBES Test Site Design.xlsx | XLSX spreadsheet | |
| N6449822R4014.pdf | ||
| Exhibit A_CDRLs A001-A052.pdf | ||
| C6_Attachment 1 -NSWCPD SBPCD August 2018.xlsx | XLSX spreadsheet | |
| Exhibit B_DD 254 dated 07 March 2022.pdf |
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Text version
30 NOVEMBER 2021
Revision 12
NSWCPD COVID-19 SCREENING & SELF-ASSESSMENT QUESTIONNAIRE
| 1. Have you been fully immunized for COVID? |
| Fully Immunized is defined as an employee who has been immunized with both vaccine doses (single dose for J&J vaccine) and it has been greater than 14 days after final dose. |
If you answered YES proceed to question 4. YES or NO
2. Have you traveled INTERNATIONALLY (to include Canada) within the last 14 days? YES or NO
3. Have you traveled DOMESTICALLY (U.S.) outside of our authorized local travel radius in the past 14 days? (As a general rule the local travel radius is defined as 50 miles from the worksite. If the employee lives beyond 50 miles, then the local travel radius is extended for the normally used commute route. For non-swipe contractors/visitors, the NSWCPD POC shall be contacted for final disposition). YES or NO
4. Have you had close personal contact, as defined below, with anyone who has been diagnosed with COVID-19 (lab or clinical diagnosis) OR anyone who has any symptoms consistent with COVID-19? YES or NO
a. Within 6 feet for a cumulative of 15 minutes within a 24 hour period
b. In a confined space (car, small room, shared stateroom, berthing proximity, office, etc.)
c. Had direct contact with infectious secretions (been coughed, sneezed on, etc.)
5 Are you isolating or quarantining because you may have been exposed to a person with COVID-19 (within the last 72 hours for vaccinated employees) or are worried that you may be sick with COVID-19? YES or NO
6. Are you currently waiting on the results of a COVID-19 test due to suspected exposure to the virus or based on experiencing the symptoms below? YES or NO
7. In the last 14 days, have you experienced any of the following symptoms:
| Symptoms |
| Yes |
| No |
| Symptoms |
| Yes |
| No |
Fever or chills
Loss of taste or smell
Shortness of breath
Sore throat
Difficulty breathing
Congestion or runny nose
Fatigue
Nausea
Muscle or body aches
Vomiting
Headache
Diarrhea
Seek medical advice by calling your insurance provided health line number.If you have answered YES to Questions 2-7 or have tested positive for COVID-19 in the last 14 days, DO NOT ENTER the building and contact your direct supervisor/company for further direction.
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