Attachment 5 Data Requirements Descriptions (DRD).pdf

Attachment 5 80AFRC20R0003 Data Requirements Descriptions

Neil A. Armstrong Flight Research Center (AFRC)

EDWARDS, CALIFORNIA 93523

FEBRUARY 28, 2020

OCCUPATIONAL HEALTH SERVICES

(OHS)

DATA REQUIREMENTS DESCRIPTIONS

(DRDS)

Attachment 5 80AFRC20R0003

AFRC DATA REQUIREMENTS DESCRIPTION (DRD)

1. DRD Title 2. Date of current version

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Item No.

RFP/Contract No. (Procurement completes)

AED Check Sheet and Bi-annual meeting M01

4. Use (Define need for, intended use of, and/or anticipated results of data) 5. DRD Category: (check one)

Establishes compliance for Contractors providing support to NASA

AFRC

______ Technical __X___ Administrative

______ SR & QA

6. References (Optional) 7. Interrelationships (e.g., with other DRDa) (Optional)

Performance Work Statement,

8. Preparation Information (Include complete instructions for document preparation)

a. Instructions:

AED check sheet shall be recorded each quarter. Any changes in between quarters will be updated and reported at the monthly OHM meeting.

Coordinate and participate in the AFRC- AED coordination mtg. per OCHMO audit request.

b. Content:

The Automated External Defibrillator (AED) Coordinator shall report in writing every quarter the following information:

(1) Location of each AED on site

(2) Point of Contact (Name and Extension)

(3) AED Identification Number (i.e., serial number)

(4) Lock Number

(5) Battery Expiration Date

(6) Battery Insert Date

(7) Battery Lot Number

(8) Pads Expiration Date

(9) Pads Lot Number

(10) Spare Pads Expiration Date

(11) Spare Pads Lot Number

(12) Date AED last checked

c. Format:

NASA-provided spreadsheet

d. Distribution:

1. Code 210 /Contracting Officer - (Electronic distribution in Microsoft Office or PDF format.)

2. Code 260 /Contracting Officer’s Representative - (Electronic distribution in Microsoft Office or

PDF format.)

3. I:\XV\Occupational Health\OHM3

4. OHM monthly meeting

e. Submission and Frequency:

1. Submission of checklist shall be Quarterly, by the 10th of that month (January, April, July and October).

2. Submission of update to OHM3 file shall be monthly

3. Reporting at OHM3 shall be done monthly

f. Maintenance: Revisions to this DRD shall be incorporated by page change or complete reissue.

Attachment 5 80AFRC20R0003 version

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Competency Assessments for Nursing Personnel

M02

4. Use (Define need for, intended use of, and/or anticipated results of data) 5. DRD Category: (check one)

Nursing skills performed at an adequate level need to be verified and documented annually.

_____ Technical __X__ Administrative

_____ SR & QA

6. References (Optional) 7. Interrelationships (e.g., with other DRDa) (Optional)

Contractor shall complete the NASA-provided spreadsheet addressing nursing skills required in the Health Unit.

b. Content:

The Contractor shall assess and score performance in the following categories for all Nursing Personnel:

(1) IV Insertion and Maintenance

(2) Universal Precautions

(3) Pulse Oximeter Application

(4) Spirometry

(5) Medication Administration

(6) 911 Call Response

(7) Phlebotomy

(8) Cerumen Management

(9) Audiometry

(10) Vision Screening

(11) Morning Equipment Checks and Calibrations

(12) Physical Exams (Vital Sign Assessments)

*The scoring is outlined in the NASA-provided Spreadsheet.

c. Format:

NASA-provided template.

d. Distribution:

1. Code 210/Contracting Officer - (Electronic distribution in Microsoft Office or PDF format.)

2. Code 260 /Contracting Officer’s Representative - (Electronic distribution in Microsoft Office or PDF format.)

3. Code 260/Chief Medical Officer - (Electronic distribution in Microsoft Office or PDF format).

4. I:\XV\Occupational Health\OHM3

5. OHM3 monthly meeting

e. Submission and Frequency:

30 days after contract award; Submission shall be annually (by the 10th of July).

f. Maintenance:

Revisions to this DRD shall be incorporated by page change or complete reissue.

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Exposure Assessment Status Report M03

4. Use (Define need for, intended use of, and/or anticipated results of data) 5. DRD Category: (check one)

To proactively identify and mitigate health risks in the work environment, exposure assessment will be accomplished on a continual basis

_____ Technical __X__ Administrative

The Contractor will accomplish approximately 30 exposure assessments throughout NASA AFRC and Building 703 in the course of the year.

b. Content:

NASA AFRC is broken up into different branches and within those branches, NASA has identified similar exposure groups (SEGs). These SEGs are listed in the first column of a NASA-provided spreadsheet, and the various IH programs are listed sequentially along the top row of the spreadsheet.

When the exposure assessment for a work-site is accomplished or updated, the status will be indicated appropriately in the spreadsheet. The spreadsheet will be updated continually as the exposure assessments are regularly performed.

c. Format:

NASA-Provided exposure assessment layout NASA-Provided spreadsheet

d. Distribution:

1. Code 210/Contracting Officer - (Electronic distribution in Microsoft Office or PDF format.)

2. Code 260/Contracting Officer’s Representative - (Electronic distribution in Microsoft Office or

PDF format.)

4. I:\XV\Occupational Health\OHM3

5. OHM3 monthly meeting

e. Submission and Frequency:

Update will be provided at the OHM3 mtg monthly

Updated submission shall be monthly, on the 10th of the month

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Health Unit Staffing Report M04

4. Use (Define need for, intended use of, and/or anticipated results of data) 5. DRD Category: (check one)

To ensure Licensed Medical Providers (LMPs) are available to provide medical coverage, as well as respond to 911 calls.

_____ Technical __X__ Administrative

The Contractor shall provide medical coverage, to include 911 calls at AFRC main campus and 703.

1. The contractor shall provide two LMPs at all times available to attend any 911 call and any emergency or walk-ins at the main campus bldg. 4822 Health Unit. The contractor will provide a report of the schedules of the LMPs working under this contract for the hours 7:30 AM to 5:00 PM on normal workdays and 7:30AM to 4:00PM on alternate Fridays in the main Center campus at Edwards, CA.

2. The contractor shall provide two LMPs to support medical coverage, to include 911 calls and regular medical visit, once a week at AFRC bldg. 703, Palmdale, CA for the hours of 8:00 AM to 4:30 PM on normal workdays.

The Contractor shall provide report of schedule of LMPs working under this contract in support of 911 and medical coverage

b. Content:

The report shall include the days of the week each LMP is scheduled to work in the Health Unit located at AFRC Main campus and 703 campus for the upcoming month.

c. Format:

Contractor format is acceptable

d. Distribution:

1. Code 210/Contracting Officer - (Electronic distribution in Microsoft Office or PDF format.)

2. Code 260/Contracting Officer’s Representative - (Electronic distribution in Microsoft Office or

PDF format.)

3. Code 260/Chief Medical Officer- (Electronic distribution in Microsoft Office or PDF format.)

4. I:\XV\Occupational Health\OHM3

5. OHM3 monthly meeting

e. Submission and Frequency:

Submission shall be monthly, on the 10th of the month

Attachment 5 80AFRC20R0003

AFRC DATA REQUIREMENTS DESCRIPTION (DRD)

1. DRD Title 2. Date of current version

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Item No.

RFP/Contract No. (Procurement completes)

IH & OM Productivity Reports M05

4. Use (Define need for, intended use of, and/or anticipated results of data) 5. DRD Category: (check one)

The contractor shall track and record the productivity of the Environmental Health (EH) and Occupational Medicine (OM)

_____ Technical __X__ Administrative a.Instructions:

The Contractor will complete two NASA-provided spreadsheets on a monthly basis outlining the listed activities performed; one spreadsheet for EH and one for OM.

b.Content:

The EH productivity areas are:

1. Number and title of program/project Reviews/Permits

2. Number and program Evaluations/Assessments

3. Number and program Surveys (e.g. Number of Rf surveys, personnel sampling for OSHA-regulated chemicals, Indoor Air Quality surveys, etc.)

4. Number and type of Samples Taken

5. Number of Equipment Calibration Activities

6. Number and update on monthly schedule of Equipment Bump-testing/operation testing (e.g. #/all equipment tested for MONTH)

7. Training Events (e.g. Training campaigns/Training Title/Number of employees trained categorized between contractor/civil servant/JPL/other).

8. The OM productivity areas are the number of:

9. Equipment Calibration and Maintenance Activities

10. Medical Clearances/Clinic Visits

11. Fitness Center Usage

12. Training Events

c. Format:

Contractor format is acceptable/spreadsheets

d. Distribution:

1. Code 210/Contracting Officer - (Electronic distribution in Microsoft Office or PDF format.)

2. Code 260/Contracting Officer’s Representative - (Electronic distribution in Microsoft Office or

PDF format.)

3. I:\XV\Occupational Health\OHM3

4. OHM3 monthly meeting

e. Submission and Frequency:

Update will be provided at the OHM3 mtg monthly Submission shall be monthly, on the 10th of the month

f. Maintenance: Revisions to this DRD shall be incorporated by page change or complete reissue.

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Information Technology (IT) Security Management Plan

10/22/2014 M06 NND15531905Q /

NND15SA10C

4. Use (Define need for, intended use of, and/or anticipated results of data) 5. DRD Category: (check one)

Documents the processes and procedures that will be followed to ensure appropriate security of IT resources that are developed, processed or used under this contract.

_____ Technical __X__ Administrative

In accordance with NFS 1852.204-76, Security Requirements for Unclassified information Technology Resources, the Contractor shall develop and deliver an IT Security Management Plan.

b. Content:

This plan shall describe the processes and procedures that will be followed to ensure appropriate security of IT resources that are develop, processed, or used under this contract. The IT Security Management Plan shall address who the contractor will manage personnel and processes associated with IT Security on the instant contract. The plan shall also address how and when personnel requiring physical or logical access to NASA IT resources will complete NASA’s annual IT Security Awareness training. Refer to the IT Training Policy located in the IT Security Web site at https://itsecurity.nasa.gov/policies/index.html.

Use the attached NASA Information Technology Management Plan template

d. Distribution:

1. Code 210/Contracting Officer - (Electronic distribution in Microsoft Office or PDF format.)

2. Coode 260/Contracting Officer’s Representative - (Electronic distribution in Microsoft Office or

PDF format.)

e. Submission and Frequency:

30 days after contract award; One-time submission https://itsecurity.nasa.gov/policies/index.html

Attachment 5 80AFRC20R0003

Placeholder for “IT Security Management Plan”

(NOTE: Document is in PDF Format only, therefore not attached to this Word document)

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Monthly Accident Report M07

4. Use (Define need for, intended use of, and/or anticipated results of data) 5. DRD Category: (check one)

Documents monthly compliance for Contractors providing support to

NASA AFRC.

_____ Technical _____ Administrative

__X__ SR & QA

6. References (Optional) 7. Interrelationships (e.g., with other DRDa) (Optional)

AFRC Form 80034, Contractor Monthly Accident Report

a. Instructions Using AFRC Form 80034, Contractors will provide a Monthly Accident Report.

b. Content:

The following information will be provided on the Contractor Monthly Accident Report:

1. Average number of employees this month

2. Number of work hours worked this month

3. Number of injuries this month

4. Number of lost-time injuries this month

5. Lost-time days this month

6. Total work hours year-to-date

7. Total lost-time occurrences year-to-date

8. Total lost-time days year-to-date

AFRC Form 80034, Contractor Monthly Accident Report

d. Distribution:

1. Code 210/Contracting Officer - (Electronic distribution in Microsoft Office or PDF format.)

2. Code 260/Contracting Officer’s Representative - (Electronic distribution in Microsoft Office or

PDF format.)

3. Code 270/Safety and Environmental Quality Office– (Electronic distribution in Microsoft Office or PDF format)

e. Submission

30 days after contract award; Submission shall be monthly, on the 10th of the month

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Program reviews/self-audit/accomplishments and tri-annual audit prep

M08

4. Use (Define need for, intended use of, and/or anticipated results of data) 5. DRD Category: (check one)

To ensure that the Center’s EH and (OM) programs are operating in accordance with Fed and State Regs and NASA’s NPRs.

_____ Technical __X__ Administrative

Once yearly, the contractor will accomplish the following:

1. Program document reviews of all EH/OH AFRC program standard/procedure/plan (e.g.

ventilation, IAQ, asbestos and lead, laser, radiofrequency, ionizing radiation, ergonomics, etc.)

against federal and state regulation and NASA’s Procedural Requirements (NPR 1800.1).

2. Schedule for completion of EH program reviews.

3. Comprehensive Program review of the AFRC Radiation Program to include (Ionizing and Non-ionizing radiation) following format required by NASA’s OCHMO. In addition to NASA doc and NPR reviews this annual evaluation also includes source inventories for lasers, UV lamps, rf/em and ionizing radiation/training/calibration/surveys/leak tests/permits/aggregate dosimetry report/etc.

4. EH and OH Overall Program review utilizing NASA-provided self-audit checklists reviewing specific practices in various functional areas and/or EH and OH preparation of package (responding to audit questionnaire and checklists) for the tri-annual OCHMO audit.

5. Report review package will include all findings with reference, a proposed action plan, proposed new set of program metrics (e.g. # of ergonomic assessment performed a year, increase in the number of employees trained by 5% in the next year, etc.) and a draft copy of the proposed modification to the NASA AFRC policy/procedural/plan/instruction/checklist document.

6. EH and OH Overall Annual Accomplishments Summary report (e.g. increased the number of vaccinations by x% from last year without increase in budget by performing vaccination campaigns with local pharmacies; reduced potential overall cost of foreign travel vaccinations by x% by performing titrations; increased the number of employees trained in ergonomics by x % by performing three training campaigns, increase capability of the code to perform x, by internal/cross training, etc.)

b. Content:

(1) Occupational Medicine

(2) Flight Medicine (those aspects of OM dealing specifically with FAA and NASA flight physicals)

(3) Fitness Center Management

(4) Industrial Hygiene

(5) Health Physics (Radiation Safety Programs)

(6) Fitness and Wellness Campaigns

(7) Food Safety

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Program reviews/self-audit/accomplishments and tri-annual audit prep

M08

Continuation….

c. Format:

1) NASA-provided audit checklists

2) Radiation Safety Program Evaluation Report format will be provided by NASA

3) Other Review/Accomplishment Report format provided by contractor

3) NASA will provide editable copy of the Center docs

4) Spreadsheet of program review schedule provided by contractor

d. Distribution:

1. Code 210/Contracting Officer - (Electronic distribution in Microsoft Office or PDF format.)

2. Code 260/Contracting Officer’s Representative - (Electronic distribution in Microsoft Office or

PDF format.)

Update will be provided at the OHM3 mtg monthly.

Submission shall be annually, 30 days prior to the end of the calendar year, unless NASA Center policy is up for renewal. Then contractor will provide review 90 days prior to expiration date of document.

Attachment 5 80AFRC20R0003 version

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Organizational Conflict of Interest Mitigation Plan

M09

4. Use (Define need for, intended use of, and/or anticipated results of data) 5. DRD Category: (check one)

To Ensure that conflicts of interests are mitigated and that each contractor employee acknowledges and agrees to comply with the policy to protect sensitive information.

_____ Technical __X__ Administrative

_____ SR & QA

6. References (Optional) 7. Interrelationships (e.g., with other DRDa) (Optional)

NFS 1852.237-72 and NFS 1852.237-73

Contractor shall provide an Organizational Conflict of Interest Mitigation Plan

The Organizational Conflict of Interest Mitigation Plan shall discuss the following:

(1) Demonstrate an understanding of: 1) OCI principles, and 2) the full breadth of OCI issues and the types of harm that can result.

(2) Describe the actions the contractor intends to take to mitigate the OCIs identified the RFQ. I fusing a firewall, explain how these actions will operate to successfully address the conflict without adversely affecting performance of the contract. Additionally, identify any potential OCIs created by the requirements of the RFQ which the contractor intends to resolve using methods other than mitigation. Specific mitigation strategies shall be appended to the mitigation plan.

(3) Require the reporting of all potential or actual OCs during performance of the contract. An OCI report shall include: 1) a description of the conflict, 2) the plan for resolving the conflict, and 3) the benefits and risks vis-à-vis contract performance associated with plan approval and acceptance.

(4) Include a requirement to update this plan as necessary to address specific OCs. All updates to the plan must be approved by the Contracting Officer and the updates / changes must be incorporated in the contract to be effective.

(5) Define company roles, responsibilities and procedures for screening (i.e., identifying, analyzing, resolving and reporting existing as well as new business opportunities for actual and potential OCIs.

(6) Identify any affiliated companies / entities (e.g., a parent company or a whole-owned subsidiary) and procedures for coordinating OCIs with such affiliated companies or entities.

(7) Explain how the contractor will flow down the provisions of this mitigation plan to any subcontractor that may have a conflict with regard to performing the requirements of this contract.

Discuss affected subcontractors’ OCI program as it relates to this contract and specifically explain how affected subcontractor will identify, resolve, and report OCIs associated with this contract.

(8) Establish and require entrance training for new employees, refresher training for existing employees, and exit training for departing employees.

(9) Define organizational and employee sanctions for violations of established OCI procedures, requirements and guidelines.

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Organizational Conflict of Interest Mitigation Plan

M09

Continuation…

(10) Require periodic self-audits to ensure compliance with established OCI procedures, requirements and guidelines.

(11) Define records related to the OCI plan (e.g., training and audit records) that will be made available to the Government upon request.

Contractor Format

d. Distribution:

1. Code 210/Contracting Officer - (Electronic distribution in Microsoft Office or PDF format.)

2. Code 260/Contracting Officer’s Representative - (Electronic distribution in Microsoft Office or

PDF format.)

e. Submission and Frequency:

Upon Contract Award (Needs NASA Approval); to be updated as required thereafter.

Attachment 5 80AFRC20R0003 version

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Staffing Plan & Key Personnel M10

4. Use (Define need for, intended use of, and/or anticipated results of data) 5. DRD Category: (check one)

Provide staffing plan and qualifications of contractor employed key personnel responsible for leading or managing specific contract functions

_____ Technical _X__ Administrative

6. References (Optional)

7. Interrelationships (e.g., with other DRDa) (Optional)

NFS 1852.235-71, Key Personnel and Facilities

NASA Contractor Financial Management Reporting (NF533)

The Contractor shall provide résumés to include qualification, education, training, performance references and applicability of related experience of proposed key personnel responsible for leading or managing specific contract functions. The Contracting Officer will approve key personnel employed on a permanent (more than 90 days) basis. Changes in key personnel require approval by the Contracting Officer.

b. Content:

The Contractor shall provide résumés of key personnel (key personnel are identified by the Quoter).

c. Format:

Contractor Format

d. Distribution:

1. Code 210/Contracting Officer (Electronic distribution in Microsoft Office or PDF format.)

2. Code 260/Contracting Officer’s Representative (Electronic distribution in Microsoft Office or

PDF format.)

e. Submission:

1. Initial: due with proposal

2. Final and Approval: Contract start + 30 calendar days.

4. Update Frequency: As required.

Revisions to this DRD shall be incorporated by page change or complete reissuance.

Attachment 5 80AFRC20R0003

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Staff Licenses and Certifications M11

4. Use (Define need for, intended use of, and/or anticipated results of data) 5. DRD Category: (check one)

To validate essential credentials for key personnel on the contract for whom licensures and certifications are required.

__X__ Technical _____ Administrative

The contractor shall provide copies of required licenses and certifications for all personnel requiring such credentials.

b. Content:

Certification and licensure requirements, and the personnel specified, are detailed in the

Certifications and Training Requirements attachment.

c. Format:

Contractor Format

d. Distribution:

1. Code 210/Contracting Officer - (Electronic distribution in Microsoft Office or PDF format.)

2. Code 260/Contracting Officer’s Technical Representative - (Electronic distribution in Microsoft

Office or PDF format.)

e. Submission Submission shall be with Quote.

Updates reported during OHM3 as modifications occur

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Standard Threshold Shift Reports M12

4. Use (Define need for, intended use of, and/or anticipated results of data) 5. DRD Category: (check one)

STS report is assembled from data derived from the NASA-provided electronic health record database. STS report from mishap investigations

__X__ Administrative

The OM contractor shall extract relevant data from the NASA-provided electronic health record database regarding audiometry results for those individuals in the Hearing Conservation Program.

The EH contractor shall perform an IH investigation for all STS and TTS and provide feedback to the NMIS mishap report.

b. Content:

OM STS report- The STS Report lists the total number of audiograms and the total number of ears tested for a given time-frame, as well as the number presenting with an initial Standard Threshold Shift (as defined by OSHA), the number of re-tests performed, the number NOT persisting on re-test, the number persisting on re-test, as well as the number persisting by default (i.e. failure of follow-up). The number of STSs persisting—whether by re-test or by default—divided by the total number of ears tested for that reporting time-frame (multiplied by 100) is the STS RATE, and will be reported quarterly. Furthermore, this report will record the number of pending baseline revisions, and the number of baselines revised, during the reporting time-frame. Finally, this report will record the number of OSHA-Reportable Shifts (ORSs) for the reporting time-frame.

EH STS report- The EH STS report shall identify locations the employee works around, the equipment the employee uses, noise levels/dosimetry for these areas and equipment, duration these noisy activities occur, warning signage, types of hearing protection devices used and their respective attenuation rating, their personal attenuation rating (only for earplugs), employee’s practices when using hearing protection, identify exposures to ototoxin chemicals, and any additional employee input. The EH STS report will be completed within 30 days of the date the STS was reported to

NMIS.

c. Format:

NASA-provided spreadsheet.

d. Distribution:

1. Code 210/Contracting Officer - (Electronic distribution in Microsoft Office or PDF format.)

2. Code 260/Contracting Officer’s Representative - (Electronic distribution in Microsoft Office or

PDF format.)

e. Submission and Frequency:

Update will be provided at the OHM3 mtg monthly Submission shall be monthly, by the 10th of the month

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Standing Orders and Protocols M13

4. Use (Define need for, intended use of, and/or anticipated results of data) 5. DRD Category: (check one)

To ensure there is consistent medical practice meeting the Standard of Care, even when a clinician is absent, the contractor shall provide written standing order and protocols addressing: 1) Chest Pain, 2) Anaphylactoid Reaction and 3) Initial Emergency Response

_____ Technical __X__ Administrative

These standing orders and protocols shall be written and signed by the Contractor’s physician (i.e.

Medical Director), and must receive the written concurrence of the AFRC Chief Medical Officer prior to implementation.

The Contractor shall Develop specific, written standing orders and protocols for the contract Health Unit staff (to include the Nurse Practitioner and the Registered Nurses) to address, at a minimum, the following THREE conditions:

(1) Chest pain;

(2) Anaphylactoid reaction;

(3) Initial steps of Emergency Response beyond Basic Life Support (e.g. placing an intravenous line, administering oxygen, applying a cardiac monitor, etc.).

c. Format:

NASA-provided templates for each of the three conditions listed above. NOTE: These templates are to be used a guide ONLY.

d. Distribution:

1. Code 210/Contracting Officer - (Electronic distribution in Microsoft Office or PDF format.)

2. Code 260/Contracting Officer’s Representative - (Electronic distribution in Microsoft Office or

PDF

format.)

e. Submission and Frequency:

Upon Contract Award and updated when modifications occur

Attachment 5 80AFRC20R0003

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Management Plan M14

4. Use (Define need for, intended use of, and/or anticipated results of data) 5. DRD Category: (check one)

To provide a description of the contractor’s overall management system and organization for accomplishing the requirements set forth in the contract.

______ Technical __X___ Administrative

______ SR & QA

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Risk Management Plan M15

4. Use (Define need for, intended use of, and/or anticipated results of data) 5. DRD Category: (check one)

To provide the Government insight to the contractor’s ability to mitigate risks during contract performance.

_____ Technical __X__ Administrative

_____ SR & QA

NPG 7120.5

Prepare a Risk Management Plan that describes the processes for identifying and mitigating performance risk.

The plan shall include, at a minimum, the following:

• Project organization, roles, and responsibilities

• Risk Management activities and practices

• Procedures regarding on-going risk mitigation efforts

• Risk management documentation

• Risk management assumptions, technical considerations and constraints.

Contractor format is acceptable

d. Distribution:

1. code 210/Contracting Officer - (Electronic distribution in Microsoft Office or PDF format.)

2. code 260/Contracting Officer’s Representative - (Electronic distribution in Microsoft Office or

PDF format.)

e. Submission and Frequency:

Upon Contract Award and when significant modifications occur

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Medical Emergency Response Vehicle (MERV) Mileage Report

M16

4. Use (Define need for, intended use of, and/or anticipated results of data) 5. DRD Category: (check one)

Establishes monthly compliance for a mileage report submission on the

MERV.

_____ Technical __X__ Administrative

Mileage reporting on the MERV shall be reported each month.

b. Content:

An email shall be submitted to the Transportation Officer, located in Code F-Facilities, Engineering and Asset Management Office, detailing the following:

1) The Vehicle identified

2) The odometer reading

3) The date the reading occurred

Email

d. Distribution:

1. Code 210/Contracting Officer – (Email)

2. Code 230/Transportation Officer – (Email)

e. Submission and Frequency:

Submission shall be monthly, on the 10th of the month Update will be provided at the OHM3 mtg monthly

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911 Emergency Response Quality Assurance Review Sheet

Q01

4. Use (Define need for, intended use of, and/or anticipated results of data) 5. DRD Category: (check one)

This is a checklist used for recording performance data during Emergencies

_____ Technical __X__ Administrative

_____ SR & QA

6. References (Optional) 7. Interrelationships (e.g., with other DRDa) (Optional)

AFRC 10870, 911 Call Review

The contractor shall complete AFRC 10870 after every emergency occurrence.

The 911 Call Review checklist consists of:

(1) Twenty-one yes/no questions;

(2) Summary of Response narrative;

(3) Corrective Action Recommendations.

Government-provided AFRC Form 10870

d. Distribution:

1. Code 210/Contracting Officer - (Electronic distribution in Microsoft Office or PDF format.)

2. Code 260/Contracting Officer’s Representative - (Electronic distribution in Microsoft Office or PDF format.)

Per occurrence; Submission shall be monthly, by the 10th of the month Update will be provided at the OHM3 mtg monthly.

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Performance Improvement Report Q02

4. Use (Define need for, intended use of, and/or anticipated results of data) 5. DRD Category: (check one)

To ensure performance improvement goals are met, a report of the performance Improvement Activities accomplished will be submitted quarterly.

_____ Technical __X__ Administrative

The AFRC Form 10868 is used by AFRC to address performance improvement activities. This form covers four different areas:

1) Plan; Establish the objectives and processes necessary to deliver results in accordance with the expected output.

2) Do; Implement the new processes on a small scale if possible to test possible effects.

3) Check; Measure the new processes and compare results with expected results to ascertain any differences.

4) Act; Analyze the differences to determine cause. Determine where to apply changes that will include improvement.

Using the AFRC Form 10868 the contractor shall accomplish on-going performance improvement activities (as communicated with the COR) in the “Plan-Do-Check-Act” format.

A report summarizing the on-going activities shall be submitted on a quarterly basis. (NOTE: The AFRC Form 10868 itself is not required to be reported; only the summary report is required.

However, completed AFRC Form 10868s may be reviewed as part of the evaluation process by the

COR).

b. Content:

The performance Improvement Report itself will only list the Title of the performance Improvement Activity, its assigned number, the responsible party, the date the activity was last reviewed, and the status as to whether it is closed or open (i.e. on-going).

c. Format:

AFRC Form 10868

d. Distribution:

1. Code 210/Contracting Officer - (Electronic distribution in Microsoft Office or PDF format.)

2. Code 260/Contracting Officer’s Representative - (Electronic distribution in Microsoft Office or

PDF format.)

e. Submission and Frequency:

30 days after contract award; Submission of Summary Reports shall be quarterly, on the 10th of that month (January, April, July and October)

Attachment 5 80AFRC20R0003 version

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RFP/Contract No. (Procurement completes)

Office Safety Surveys (3 sites) S01

4. Use (Define need for, intended use of, and/or anticipated results of data) 5. DRD Category: (check one)

The AFRC Form 80260c is an office safety walk-through checklist _____ Technical __X__ Administrative

_____ SR & QA

6. References (Optional) 7. Interrelationships (e.g., with other DRDa) (Optional)

AFRC 80260c

The AFRC Form shall be used for three sites: B4877- Fitness Facility, B4822- Occupational Health

Unit and B703/N234-Medical Office

The AFRC 80260c consists of 14 questions addressing the following areas:

(1) Housekeeping, Egress, Walking Surfaces;

(2) Earthquake Safety;

(3) Electrical Safety;

(4) Fire Protection.

AFRC Form 80260c

d. Distribution:

1. Code 210/Contracting Officer - (Electronic distribution in Microsoft Office or PDF format.)

2. Code 260/Contracting Officer’s Representative - (Electronic distribution in Microsoft Office or PDF format.)

e. Submission and Frequency:

Submission shall be monthly, on the 10th of the month

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RFP/Contract No. (Procurement completes)

EH Program Improvements XXXX

4. Use (Define need for, intended use of, and/or anticipated results of data) 5. DRD Category: (check one)

To strengthen and develop Environmental Health Programs. _____ Technical __X__ Administrative

b. Instructions:

At least yearly, review the NASA provided “Recognize Assess Control (RAC) file” and update the ranking for identified hazards/programs.

For each Fiscal year: Contractor will develop action plans for the top four Hazards/programs (with the greatest risk score) on the RAC file. Submit the action plan for NASA review and approval. Upon approval, complete the action plans within the same fiscal year.

Action plans will identify what risk score element (e.g. program effectiveness or uncertainty [e.g.

data gathering required]) it will address and the proposed activities.

NASA RAC Spreadsheet. Action plan is added to the NASA RAC spreadsheet.

Spreadsheet NASA approval through email

d. Distribution:

1. Code 210/Contracting Officer - (Electronic distribution in Microsoft Office or PDF format.)

2. Code 260/Contracting Officer’s Representative - (Electronic distribution in Microsoft Office or PDF format.)

e. Submission and Frequency:

Action Plan progress status will be provided at the OHM3 meetings (January, March, May, July, September, November).

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Ergonomic Program Metrics XXXX

4. Use (Define need for, intended use of, and/or anticipated results of data) 5. DRD Category: (check one)

To document the efficacy of the ergonomics program. _____ Technical __X__ Administrative

c. Instructions:

Center ergonomic programs shall be re-evaluated at least annually and changes implemented to ensure coverage of all potential ergonomics hazards. Metrics that document the efficacy of the ergonomics program shall be maintained and used to improve the program and further reduce MSD risks. Develop an action plan (set new metric goals) based upon the evaluation. Action plans shall be approved by NASA. Complete the action plan.

Overview of the Ergonomic program.

Metrics for Office/workstation evaluations.

Metrics for industrial process evaluations.

Metrics for teaching/promoting ergonomic practices.

Recommended Action plan/ metric goals.

Report with each of the sections listed in the content.

d. Distribution:

1. Code 210/Contracting Officer - (Electronic distribution in Microsoft Office or PDF format.)

2. Code 260/Contracting Officer’s Representative - (Electronic distribution in Microsoft Office or

PDF format.)

e. Submission and Frequency:

Action Plan progress status will be provided at the OHM3 meetings (February, April, June, August, October, December).

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RFP/Contract No. (Procurement completes)

Tri-annual audit Preparation XXXX

4. Use (Define need for, intended use of, and/or anticipated results of data) 5. DRD Category: (check one)

Coordinate the logistics for the tri-annual audit (anticipated Calendar Year 2022).

_____ Technical __X__ Administrative

d. Instructions:

Coordinate the logistics for the audit team.

b. Content:

Schedule room location for audit team to use.

Coordinate in brief and out brief meetings.

Provide the information requested by the lead auditor regarding the logistics of the audit.

(Examples of information to gather may include the follows:

• A map of the Center/Facility showing building names/numbers and where possible, room numbers.

• The latest Center/Facility organizational chart showing the management hierarchy from the Center Director to the Occupational Health staff; both NASA and Contractor.

• Current Statements of Work for any contracts associated with Occupational Health (EAP, Fitness Center, Medical Clinic, Industrial Hygiene, Food Safety, Health Physics, and/or Childcare Center).

• Any Occupational Health, Safety or Environmental Compliance related internal and external surveys, audits, assessments and reviews over the past year.

• A list of all contractors and tenants’ onsite and an explanation regarding how and to what extent the NASA OH policies apply to them.

• Instructions for dialing (1) local numbers; (2) local off-Center numbers; and (3) long distance numbers. Instructions for wireless Internet connection.)

c. Format:

Electronic files will be placed in share drive folders.

d. Distribution:

1. Code 210/Contracting Officer - (Electronic distribution in Microsoft Office or PDF format.)

2. Code 260/Contracting Officer’s Representative - (Electronic distribution in Microsoft Office or PDF format.)

e. Submission and Frequency:

NASA Headquarters Audit team will provide approximately 45 day notice of when information needs to be submitted. Frequency is once every 3 years.

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RFP/Contract No. (Procurement completes)

EH Program Orientation Handbook XXXX

4. Use (Define need for, intended use of, and/or anticipated results of data) 5. DRD Category: (check one)

To help new EH contract personnel understand the different elements of the AFRC EH Programs.

_____ Technical __X__ Administrative

e. Instructions:

Develop an Orientation handbook that will be used by future new EH contract personnel.

• AFRC Organization Tree

• Useful websites (e.g. SATERN, CORITY, Odie, NPR, etc.)

• Useful AFRC phone numbers (e.g. IT, Health Unit, EAP, Help Desk Facilities, Security, Safety, etc.)

• AFRC Processes to obtain keys, computer, facility access ( e.g. ID MAX elements required to perform jobs)

• AFRC EH Program overviews

• List of DRDs, Required Reports and deadlines (e.g. OHM meeting reports, etc.)

• Copy of the PWS and breakdown of responsibilities and how tasks are issued from NASA.

• Work Schedule and Calendar schedule of tasks. (e.g. Program reviews, audits, calibration, surveys, permitting, training, etc.)

• List of equipment and associated standard operating procedure (SOP) on how to operate the equipment.

• Edwards Site Map

• List of AFRC trainings needed to perform specific functions and use of government equipment (e.g. computer, flight line drivers, HIPAA, etc.)

• Record Management requirements

• And any other information deemed necessary to facility the orientation process.

Electronic files will be placed in share drive folders.

d. Distribution:

1. Code 210/Contracting Officer - (Electronic distribution in Microsoft Office or PDF format.)

2. Code 260/Contracting Officer’s Representative - (Electronic distribution in Microsoft Office or

PDF format.)

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EH Program Orientation Handbook XXXX

Continuation…

e. Submission and Frequency:

Submission of handbook draft is due one month after start of contract. Updates as needed.

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4. RFP/Contract No. (Procurement completes):

Safety, health and Environmental Management Plan (SHEMP)

S02

5. Use (Define need for, intended use of, and/or anticipated results of data) 6. DRD Category: (check one)

Establishes Safety, Health and Environmental Management Plan Compliance

_____ Administrative

__X__ SR & QA

7. References (Optional) 8. Due Date:

Attachments A, B and C Submit SHEMP with proposal. Complete any modification required by NASA AFRC within 30 days after contract start-date

9. Preparation Information (Include complete instructions for document preparation)

The Contractor shall submit a Safety, Health, and Environmental Management Plan.

Contractor format is acceptable. The contents of the proposed safety and health plan shall follow the outline listed in Appendix E of NPR 8715.3D.

• The plan shall address the elements contained in Attachment A.

• The plan shall address the requirements listed in Attachment B that are applicable to the tasks described in the Statement of Work.

• The Contractor must complete and submit the Safety, Health, and Environmental Questionnaire contained in Attachment C.

• The contractor is required to follow all applicable United States Department of Labor OSHA regulations, applicable State of California Division of Occupational Safety and Health (DOSH) [better known as Cal/OSHA] regulations, NASA Occupational Health Program Procedures NPR 1800.1, NASA Occupational Safety and Health Programs NPR 8715.1, NASA General Safety Program Requirements NPR 8715.3, and applicable Armstrong Flight Research Center Occupational Health Programs including:

NASA Occupational Health Program Procedures NPR 1800.1 NASA Occupational Safety and Health Programs NPR 8715.1 NASA General Safety Program Requirements NPR 8715.3 Niton XLp-300A X-Ray Fluorescence Analyzer Usage AFEI-260-001 Bloodborne Pathogens AFOP-1800.1-003 Radiofrequency and Microwave Radiation Protection AFOP-1800.1-005 Fatigue Risk Management AFOP-7900.3-025 Armstrong Smoking Policy AFPD-8719.1-001 Heat Stress Measurement, Notification, & Response AFPL-1800.1-001 Reproductive and Developmental Heath Plan AFPL-1800.1-002 Ergonomics Program Plan AFPL-1800.1-006 Laser Safety Plan AFPL-1800.1-007 Ionizing Radiation Safety AFST-1800.1-001 Hearing Conservation AFST-1800.1-003 Cryogen Safety AFST-8715.3-003 Respiratory Protection Program AFST-8715.3-004

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Safety, health and Environmental Management Plan (SHEMP)

S02

Continuation…

During the execution of the contract, the Contractor will accomplish the following tasks to ensure a safe and healthy work environment for their employees.

1. Make all employees aware of their roles and responsibilities under the SHEMP.

2. Resident contractors must submit form AFRC 80034 by the 10th of each month to the AFRC

Contracting Officer (M/S 4811/140) and the AFRC Safety, Health, and Environmental Office (MS 4850) relative to on-site Contractor personnel.

The AFRC Form 80034 will be provided upon contract award.

3. Report mishaps and close calls within 1 hour to the Safety, Health, and Environmental Office, Building 4850.

4. Assess and document employee training requirements specific to the tasks they are expected to perform. Provide these records to NASA AFRC when requested.

5. Provide required training to employees and provide evidence of training to NASA AFRC when requested.

Attachment 5 80AFRC20R0003

Attachment A

Safety, Health, and Environmental Management Plan Elements

1.0 MANAGEMENT LEADERSHIP & EMPLOYEE PARTICIPATION

1.1 Provide the contractor's safety, health, and environmental (SHE) policy statement.

Compare the contractor's policy statement with AFRC and OSHA and discuss any differences.

1.2 Describe and discuss specific goals and objectives of your SHE plan using the framework of the four elements of OSHA’s VPP Safety and Health Management System (Management Leadership & Employee Involvement, Worksite Analysis, Hazard Prevention & Control, and Safety & Health Training).

1.3 Describe the process and procedures for implementing management commitment to safety and health through visible activities and initiatives including the exercise of controls to ensure workplace safety and health. Include a statement from the project manager or designated safety official indicating the plan will be implemented as approved and that the project manager will take personal responsibility for the implementation.

1.4 Describe how your employees are involved in safety and health program development, implementation, and decision-making process.

1.5 Describe the line and staff responsibilities for SHE program implementation. Identify any other personnel or organizations that provide safety services or exercises any form of control or assurance in these areas. As a minimum, identify the following:

a. Safety Representative - individual responsible for the Contractor’s adherence to Center-wide safety, health, environmental and fire protection concerns and goals and will participate in meetings related to Center’s SHE Program.

b. Company Physician – provide the identification of a company physician to facilitate communication of medical data to the head of the AFRC clinic. The contractor shall identify the point of contact by name, address, and telephone number to the AFRC center clinic.

c. Building Fire Warden - each building occupied by the contractor will have an assigned individual to facilitate the Center’s fire safety program. Identify the assigned contractor's Building Fire Warden.

d. Designated Safety Official – Identify the individual responsible for implementing the proposed Safety and Health Plan.

1.6 Compare the provisions & procedures in the proposed SHE plan with applicable AFRC requirements and contractual directions, and applicable Federal, State, and local regulations. Identify the lines of authority and responsibility for each requirement and regulation. Discuss how the subsequent contractor’s SHE will be controlled to maintain the identified lines of authority and responsibility for the life of the contract.

1.7 Describe the procedures for ensuring that management and employees will be held accountable for implementing their tasks in a safe and healthful manner. Include discipline, motivational techniques, or any other techniques that ensure accountability.

1.8 Describe the method to be used for internal program reviews & evaluations. Program reviews may consist of either (1) participation in OSHA VPP surveys at the request of the Government or (2) description in a written report that documents the methods & procedures for determining the existence and criticality of the hazardous operations.

Attachment 5 80AFRC20R0003

1.9 Describe the approach taken to document the contractor SHE program performance to provide necessary visibility and insight. Identify what records will be made available to the Government in accordance with OSHA’s VPP criteria as implemented at AFRC. As a minimum, the following will be provided:

a. Roster of Terminated Employees - list of terminated employees reported sent to the Center Occupational Health Program Office no later than 30 days after the end of each contract year or at the end of the contract.

b. Material Safety Data - description of the procedure to be used to prepare Material Safety Data for hazardous materials brought onto Government property or including in products delivered to the Government. (OSHA 29 CFR Part 1910.1200)

c. Hazardous Materials Inventory - compile and report inventory of all hazardous materials within the scope of 29 CFR Part 1910.1200, and their location on Government property.

1.10 The contractor shall recognize in its plan that it will be expected to make all safety and health documentation (including relevant personnel records) available for inspection or audit at the Government's request.

1.11 The contractor may be requested to participate in the review and modification of safety requirements that are to be implemented by the Government including any referenced documents therein. This review activity will be implemented at the direction of the AFRC Contracting Officer’s Technical Representative in accordance with established AFRC directives and procedures.

1.12 Identify procedures used to assure that the contractor's procurements are reviewed for safety and environmental considerations and that those specifications contain appropriate criteria and instructions.

2.0 WORKPLACE ANALYSIS

Describe the method and techniques the contractor will use to systematically identify the hazards within the workplace for the duration of the contract. All hazards identified on AFRC property that is immediately dangerous to life or health should be reported immediately to the AFRC safety office and to the Contractor’s President/Program Manager in order to ensure that proper attention and correction is given to these hazards.

2.1 Describe the procedures and techniques to be used to compile an inventory of hazards associated with the work to be performed on this contract. Specific techniques to be considered include:

a. Comprehensive Survey - wall-to-wall engineering assessment of the work site.

b. Change Analysis - addresses modifications in facilities, equipment, processes, and materials (including waste).

c. Hazard Analysis - Addresses facilities, systems, operations, processes, materials

(including waste), and specific tasks or jobs.

2.2 Includes the procedures and frequency for regular inspections and evaluations of work areas' hazards and who will be accountable for implementing of corrective measures.

(inspection program or monthly report)

2.3 The contractor will identify the methods to be used to encourage employees to report hazardous conditions (e.g., close calls) and analyze/abate hazards. The contractor will describe steps to be taken to create reprisal-free employee reporting with emphasis on management support for employees and describe methods to be used to…