Attachment A - PWS.pdf

Ver. January 2021

PERFORMANCE WORK STATEMENT (PWS)

FOR

Medical Surveillance Services Explosive Ordnance Disposal (EOD) and Firefighter Physicals

1.0 General:

1.1 Scope: The contractor shall provide all personnel, equipment, tools, materials, supervision, and quality control necessary, except as specified in Paragraph 3.0 as Government Furnished, to perform EOD Firefighter Physicals, as defined in this PWS.

1.2 Background: The Michigan Army National Guard (MIARNG) requires support for Explosive Ordnance Disposal (EOD) and Firefighter Occupational Medical Surveillance Examination Program in accordance with the Occupation Safety and Health Association (OSHA) and other regulations. Due to the majority of personnel being spread out across the entire state of Michigan with some areas having distances of greater than 150 miles to an established facility, services should be provided in a mobile setting.

The purpose of the Occupational Medical Surveillance Examination Program is to provide job-related Medical Surveillance Examinations and Occupational Health Services to members of the MIARNG who are or could potentially be exposed to health hazards in the work environment in the commission of their duties as EOD Specialists and Firefighters. The examination shall include personnel assigned to positions requiring specific standards of physical fitness. Personnel not included under these examinations are State Employees, civilian contractors, and dual-status Title 32Technicians.

1.3 Period of Performance (PoP): The Period of Performance shall be 12 months.

1.4 General Information:

1.4.1 Place and Performance of Services: The contractor shall provide services between the hours of 0730-1730 on specified drill days or weekends agreed upon by the Government and the contractor except on recognized US holidays or when the Government facility/installation is closed due to local or national emergencies, administrative closings, or similar Government-directed facility/installation closings.

Performance shall be at Camp Grayling Training Center or other Government installation, specific location will be determined between the government and the contractor at the time of setting up services. The contractor shall at all times maintain an adequate work force for the uninterrupted performance of all tasks defined within this PWS when the Government facility/installation is not closed for the above reasons.

When hiring personnel, the contractor shall keep in mind that the stability and continuity of the work force are essential. Teleworking is not authorized.

W912JB-21-Q-0027 Attachment A Total Pages: 20

1.4.1.1 The nature of the service required, expect the contractor to be present on the Drill day in order to render the services. The Government does not permit the contractor to telework in support of this requirement. In furtherance of Continuity of Operations Planning (COOP), a telework program may be enacted to ensure that the Government's mission-critical operations stay operational during times of national emergency or incidents of national significance. Telework shall be at no additional cost to the Government.

1.4.1.2 Unscheduled gate closures by the Security Police may occur at any time causing all personnel entering or exiting a closed installation to experience a delay. This cannot be predicted or prevented. Contractors are not compensated for unexpected closures or delays. Vehicles operated by contractor personnel are subject to search pursuant to applicable regulations. Any moving violation of any applicable motor vehicle regulation may result in the termination of the contractor employee’s installation driving privileges.

1.4.1.3 The contractor’s employees shall become familiar with and obey the regulations of the installation; including fire, traffic, safety and security regulations while on the installation. Contractor employees should only enter restricted areas when required to do so and only upon prior approval. All contractor employees shall carry proper identification with them at all times, and shall be subject to such checks as may be deemed necessary. The contractor shall ensure compliance with all regulations and orders of the installation, which may affect performance. The Government reserves the right to direct the removal of an employee from Government property or revoke access to Government systems for misconduct, security reasons, or any overt evidence of communicable disease. Removal of contractor employees for reasons stated above does not relieve the Contractor from responsibility for total performance of this contract

1.4.2 Recognized Holidays: The following are recognized United States (US) holidays.

The contractor shall not perform services on these days:

1.4.2.1 New Year’s Day: January 1st

1.4.2.2 Martin Luther King, Jr.’s Birthday

1.4.2.3 President’s Day

1.4.2.4 Memorial Day

1.4.2.5 Independence Day: July 4th

1.4.2.6 Labor Day

1.4.2.7 Columbus Day

1.4.2.8 Veteran’s Day: November 11th

1.4.2.9 Thanksgiving Day

1.4.2.10 Christmas Day: December 25th

1.4.3 Quality Control (QC): The contractor shall develop and maintain an effective QC Plan (QCP) to ensure services are performed in accordance with this PWS. The contractor shall develop and implement procedures to identify, prevent, and ensure non-recurrence of defective services. The contractor’s QCP is the means by which it assures itself that its work complies with the requirements of the contract. As a minimum, the contractor shall develop QC procedures that address the areas identified in Technical Exhibit 2, Performance Requirements Summary (PRS).

1.4.4 Quality Assurance (QA): The Government will evaluate the contractor’s performance under this contract in accordance with the Quality Assurance Surveillance Plan (QASP). This plan is primarily focused on what the Government will do to ensure that the contractor has performed in accordance with the performance standards. It defines how the performance standards will be applied, the frequency of surveillance, and acceptable quality level(s) or defect rate(s).

1.4.5. Installation Access and Security Requirements. The contractor shall comply with all applicable installation/facility access and local security policies and procedures, which may be obtained from the COR. The contractor and all associated subcontractor employees shall provide all information required for background checks to meet installation access requirements to be accomplished by installation Provost Marshal Office, Director of Emergency Services, or Security Office. The contractor shall ensure compliance with all personal identity verification requirements as directed by Department of Defense (DoD), Headquarters Department of Army (HQDA) and/or local policy (see PWS 6.0). Should the Force Protection Condition (FPCON) change, the Government may require changes in contractor security matters or processes.

1.4.5.1 RESERVED

1.4.5.1.1 RESERVED

1.4.5.1.2 RESERVED

1.4.5.1.3 RESERVED

1.4.5.1.4 RESERVED

1.4.5.1.5 RESERVED

1.4.5.1.5.1 RESERVED

1.4.5.1.6 RESERVED

1.4.5.2 For contractors that do not require a CAC, but require access to a DoD facility or installation: Contractor and all associated sub-contractors employees shall comply with adjudication standards and procedures using the National Crime Information Center Interstate Identification (NCIC-III) and Terrorist Screening Database (TSDB) (Army

Directive 2014-05), and applicable installation, facility and area commander installation/facility access, and local security policies and procedures (provided by a Government representative).

1.4.5.3 RESERVED

1.4.5.4 RESERVED

1.4.5.5 Communications Security/Information Technology (COMSEC/IT) Security. All communications with DoD organizations are subject to COMSEC review. All telephone communications networks are continually subject to intercept by unfriendly intelligence organizations. DoD has authorized the military departments to conduct COMSEC monitoring and recording of telephone calls originating from, or terminating at, DoD organizations. Therefore, the contractor is advised that any time contractor personnel place or receive a call they are subject to COMSEC procedures. The contractor shall ensure wide and frequent dissemination of the above information to all employees dealing with DoD information. The contractor shall abide by all Government regulations concerning the authorized use of the Government's computer network, including the restriction against using the network to recruit Government personnel or advertise job openings.

1.4.5.6 RESERVED

1.4.5.7 RESERVED

1.4.5.8 RESERVED

1.4.5.9 RESERVED

1.4.5.10 Protection of Personally Identifiable Information (PII). The contractor shall protect all PII encountered in the performance of services in accordance with Defense Federal Acquisition Regulation Supplement (DFARS) 224.103 Personally Identifiable Information and Department of Defense Directive (DoDD) 5400.11, Department of Defense Privacy Program, and DoD 5400.11-R. If a PII breach results from the contractor’s violation of the aforementioned policies, the contractor shall bear all notification costs, call-center support costs, and credit monitoring service costs for all individuals whose PII has been compromised.

1.4.5.11 RESERVED

1.4.5.12 RESREVED

1.4.5.13 RESERVED

1.4.5.14 RESERVED

1.4.6 Physical Security. The contractor shall safeguard all Government property provided for contractor use. At the close of each work period, Government facilities, equipment and materials shall be secured.

1.4.6.1 Key Control. NOTE: All references to keys include key cards. The contractor shall establish and implement methods of ensuring that no keys/key cards issued by the Government are lost or misplaced or are used by unauthorized persons. No keys issued by the Government shall be duplicated. Such procedures shall include turn-in of any issued keys by personnel who no longer require access to locked areas. The contractor shall include procedures covering key control in the QCP.

1.4.6.1.1 The contractor shall immediately report any occurrences of lost or duplicated keys/key cards to the COR.

1.4.6.1.2 In the event keys, other than master keys, are lost or duplicated, the contractor shall, upon direction by the KO, re-key or replace the affected lock or locks; however, the Government, at its option, may replace the affected lock or locks or perform re-keying. When the Government replaces or re-keys the locks, the Government will deduct the total cost of lock replacement or re-keying from the monthly payment due the contractor. In the event a master key is lost or duplicated, the Government will replace all locks and keys for that system, and will deduct the total cost from the monthly payment due the contractor.

1.4.6.1.3 The contactor shall prohibit the use of the Government issued keys/key cards by any persons other than the contractor’s employees. The contractor shall prohibit the opening of locked areas by contractor employees to permit entrance of persons other than contactor employees engaged in the performance of services in those areas, or personnel authorized entrance by the KO.

1.4.6.2 Lock Combinations: The contractor shall establish and implement methods of ensuring that no lock combinations are revealed to unauthorized persons. The contractor shall ensure that lock combinations are changed when personnel having access to the combinations no longer have a need to know such combinations. These procedures shall be included in the contractor’s QCP.

1.4.7 Special Qualifications: The contractor shall provide Board Certified Occupational Health Physician(s), supervision, all labor, tools, materials, equipment, and incidentals required to conduct the Medical Surveillance Examination / Occupational Health Services for the MIARNG. (NOTE: The Government does not provide training to contractors. Contractors must ensure that any personnel performing under a contract are fully trained, licensed, certified, and otherwise qualified to provide services.

1.4.8 Post Award Conference/Periodic Progress Meetings: The contractor agrees to attend any post award conference convened by the KO in accordance with FAR 42.5.

The KO, COR and other Government personnel, as appropriate, may meet periodically with the contractor to review the contactor’s performance. At these meetings, the KO will apprise the contractor of how the Government views the contractor’s performance and the contractor shall apprise the Government of problems, if any, being experienced.

The contractor shall resolve outstanding issues raised by the Government. Contractor attendance at these meetings shall be at no additional cost to the Government.

1.4.9 Contract Manager (CM): The contactor shall designate a CM who shall ensure performance under this contract. The name of this person, and an alternate who shall act for the contractor when the CM is absent, shall be designated in writing to the KO.

The CM or alternate shall have full authority to act for the contractor on all contract matters relating to daily operation of this contract. The CM shall work through the COR, to resolve issues, receive technical instructions, and ensure adequate performance of services. The CM shall ensure that contractor employees do not perform any services outside the scope of the contract without an official modification issued by the KO. The CM shall ensure contractor employees understand that services performed outside the scope of the contract are performed wholly at the expense of the contractor.

1.4.10 Identification of Contractor Employees. Contractor personnel shall wear identification badges distinguishing themselves as such. The badges shall have the company name, employee name and the word “contractor” displayed.

1.4.10.1 The contractor shall retrieve all identification media (including vehicle passes) from its employees who depart employment for any reason. The contractor shall return all identification media (i.e., badges and vehicles passes) to the KO within 14 days of an employee’s departure.

1.4.11. Combating Trafficking in Persons: The United States Government has adopted a zero tolerance policy regarding trafficking in persons. Contractors and contractor employees shall not engage in severe forms of trafficking in persons during the period of performance of the contract; procure commercial sex acts during the period of performance of the contract; or use forced labor in the performance of the contract. The Contractor shall notify its employees of the United States Government’s zero tolerance policy, the actions that will be taken against employees for violations of this policy. The contractor shall take appropriate action, up to and including termination, against employees or subcontractors that violate the US Government policy as described at

FAR 22.17.

1.4.12 Contractor Travel: The contractor shall travel to locations as state in the PWS during the performance of this contract to facilitate performance of this contract. The contractor may be required to travel to off-site training locations and to ship training aids to these locations in the performance of this contract. The cost of shipping training aids shall be borne by “the contractor”. Data Rights: The Government has unlimited rights to all documents/materials produced under this contract. All documents and materials, to include the source codes of any software, produced under this contract shall be Government owned and are the property of the Government with all rights and privileges of ownership/copyright belonging exclusively to the Government. These documents and materials may not be used or sold by the contractor without written permission from the KO. All materials supplied to the Government shall be the sole property of the Government and may not be used for any other purpose. This right does not abrogate any other Government rights.

1.4.14 Organizational Conflicts of Interest (OCI): The contractor and subcontractor personnel performing services under this contract may receive, have access to or participate in the development of proprietary or source selection information (e.g., cost or pricing information, budget information or analyses, specifications or work statements, etc.) or perform evaluation services which may create a current or subsequent OCIs, as defined in FAR Subpart 9.5. The contractor shall notify the KO immediately whenever it becomes aware that such access or participation may result in any actual or potential OCI and shall promptly submit a plan to the KO to avoid or mitigate any such OCI. The contractor’s mitigation plan will be determined to be acceptable solely at the discretion of the KO. In the event the KO unilaterally determines that any such OCI cannot be satisfactorily avoided or mitigated, the KO may impose other remedies as he or she deems necessary, including prohibiting the contractor from participation in subsequent contracted requirements which may be affected by the OCI.

1.4.15 Phase In / Phase Out Periods: To minimize any decreases in productivity and to prevent possible negative impacts on additional services, the contractor shall have personnel on board, during the 60 days phase in/ phase out periods. During the phase in period, the contractor shall become familiar with performance requirements in order to commence full performance of services on the contract start date.

2.0 Definitions and Acronyms

2.1 Definitions:

2.1.1 Contractor: A supplier or vendor awarded a contract to provide specific supplies or service to the Government. The term used in this contract refers to the prime.

2.1.2 Defective Service: A service output that does not meet the standard of performance associated with the PWS.

2.1.3 Deliverable: Anything that can be physically delivered and includes non-manufactured things such as meeting minutes or reports.

2.1.4 Key Personnel: Contractor personnel that are evaluated in a source selection process and that may be required to be used in the performance of a contract by the PWS. When key personnel are used as an evaluation factor in best value procurement, an offer can be rejected if it does not have a firm commitment from the persons that are listed in the proposal.

2.1.5 Physical Security: Actions that prevent the loss or damage of Government property.

2.1.6 Quality Assurance: The Government procedures to verify that services being performed by the Contractor are performed according to acceptable standards.

2.1.7 Quality Assurance Surveillance Plan (QASP): An organized written document specifying the surveillance methodology to be used for surveillance of contractor performance.

2.1.8 Quality Control: All necessary measures taken by the Contractor to ensure that the quality of an end product or service shall meet contract requirements.

2.1.9 Subcontractor: One that enters into a contract with a prime contractor. The Government does not have privity of contract with the subcontractor.

2.2 Acronyms:

ABOEM American Board of Occupational and Environmental Medicine AEI Army Enterprise Info structure AR Army Regulation AT Awareness Training ATCTS Army Training Certification Tracking System ATO Antiterrorism Officer AT/OPSEC Antiterrorism/Operational Security AUP Acceptable Use Policy BBP Best Business Practices BI Background Investigation CAC Common Access Card CAOHC Occupational Hearing Conservation CFP/M/E Contractor Furnished Property, Materials, and Equipment CM Contract Manager COMSEC/IT Communications Security/Information Technology COR Contracting Officer Representative COOP Continuity of Operations Planning DA Department of the Army DD254 Department of Defense Contract Security Classification Specification DEERS Defense Enrollment Eligibility Reporting System DFARS Defense Federal Acquisition Regulation Supplement DHHS Department of Health and Human Services DoD Department of Defense DODD Department of Defense Directive DOEHRS-HC Defense Occupational and Environmental Health Readiness System-

Hearing Conservation EOD Explosive Ordnance Disposal e-QUIP Electronic Questionnaires for Investigations Processing FAR Federal Acquisition Regulation FEV1 Forced Expiratory Volume in one second FPCON Force Protection Condition

FVC Forced Vital Capacity FSO Corporate Facility Security Officer GFP/M/E/S Government Furnished Property/Material/Equipment/Services GSA General Services Administration HQDA Headquarters, Department of the Army HSPD Homeland Security Presidential Directive HQDA Headquarters Department of Army IA Information Assurance IS Information System(s) IT Information Technology JTR Joint Travel Regulation KO Contracting Officer MIARNG Michigan Army National Guard NCIC-III National Crime Information Center Interstate Identification NGB National Guard Bureau NIOSH National Institute for Occupational Safety and Health OCI Organizational Conflict of Interest OSHA Occupation Safety and Health Association PFTs Pulmonary Function Tests PII Personally Identifiable Information PIPO Phase In/Phase Out PIV Personal Identity Verification POC Point of Contact PoP Period of Performance PPE Personal Protective Equipment PRS Performance Requirements Summary PSIP Personnel Security Investigation Portal PWS Performance Work Statement QA Quality Assurance QASP Quality Assurance Surveillance Plan QC Quality Control QCP Quality Control Program RAPIDS Real-Time Automated Personnel ID System SCR Service Contract Reporting SOP Standard Operating Procedure SSN Social Security Number TA Trusted Agent TARP Threat Awareness and Reporting Program TASS Trusted Associate Sponsorship System TE Technical Exhibit TSDB Terrorist Screening Database USD(I) Under Secretary of Defense for Intelligence

3.0 Government Furnished Property, Material, Equipment and Services (GFP/M/E/S):

The Government will not provide property, material, equipment, and/or services.

4.0 Contractor Furnished Property, Materials, and Equipment (CFP/M/E):

4.1 General: The contractor shall furnish everything required to perform these services as indicated in Paragraph 1.1.

5.0 Requirements: The contractor shall

5.1. Contractor shall maintain medical liability insurance, no less than $1,000,000 which is the normal prevailing within the local community for the medical specialty concerned.

5.1.1 Contractor shall ensure that its subcontractors, if any, for provisions of health care services, contain the requirements of the clause at 52.237-7, Indemnification and Medical Liability Insurance, including the maintenance of medical liability insurance.

5.1.2 The contractor shall abide by Privacy Act and HIPAA regulations and guidelines.

5.2 Contractor shall ensure all procedures are conducted in accordance with applicable American Board of Occupational and Environmental Medicine (ABOEM), American Association of Occupational Health Nurses (AAOHN), U.S. Department of Labor, Occupational Safety and Health Administration (OSHA), and the National Institute for Occupational Safety and Health (NIOSH) Standards.

5.3. Contractor shall ensure all clinical laboratory services are performed by a laboratory licensed through the U.S. Department of Health and Human Services (DHHS), Health Care Financing Administration pursuant to the terms of the Clinical Laboratories Improvement Act of 1967 (42 U.S.C. 263a) and the College of American Pathologies.

5.4 Contractor shall provide a Board eligible or Certified Occupational Medicine Physician to conduct job-related medical surveillance physical examinations and occupational health consultation services.

5.5 Contractor shall arrange for the opportunity to consult with an Occupational Health Manager of the MIARNG by telephone to coordinate or resolve issues that might arise before, during, and after the testing period.

5.6 Contractor shall perform a comprehensive review and evaluation within 30-days following the conclusion of testing. The Contracting Officer’s Representative will contact and schedule a follow-up review and evaluation meeting to discuss positive and negative aspects of testing.

5.7 Contractor shall provide vital signs to include height, weight, blood pressure, pulse and respirations.

5.8 Contractor shall provide a Job Functional Analysis or Kraus-Weber that includes back strength and flexibility. Note any pain or recommended lifting limitations if less than 50 lbs.

5.9 Contractor shall ensure audiogram must be certified by the Council for Accreditation in Occupational Hearing Conservation (CAOHC) or the equivalent military Defense Occupational and Environmental Health Readiness System-Hearing Conservation (DOEHRS-HC) training in accordance with 29 CFR 1910.95. The estimated number of personnel to receive audiograms are no more than 400.

5.9.1 Hearing screenings shall be conducted only on employees exposed to occupational noise > 85 dBA or 140 dBA impact noise.

5.9.2 All hearing tests shall be entered into DOEHRS-HC.

5.9.3 Otoscopic Exam.

5.9.4 Test Only 500, 1000, 2000, 3000, 4000 and 6000.

5.9.5 Hearing aids must be removed.

5.9.6 Employee must be noise free for at least 14 hours prior to screening.

5.9.7 All hearing screenings besides the baseline will be compared against the employee’s baseline to determine if there is a Significant Threshold Shift (STS) and retested immediately and if there is still a STS notify the Occupational Health Manager within 10 days so that timely retesting can be scheduled.

5.10 Contractor shall ensure Pulmonary Function Tests (PFTs) Performed by a licensed physician, Certified Pulmonary Function Technologist, or Registered Respiratory Therapist in accordance with 29 CFR 1910.1001. The estimated number of personnel to receive PFTs are no more than 200.

5.10.1 Screenings shall only be conducted on employees exposed to respiratory hazards that will require a respirator to mitigate their hazards that are above the action level.

5.10.2 Test shall include as a minimum Forced Expiratory Volume in one second (FEV1), Forced Vital Capacity (FVC), comparison with recognized normal range for the individual's height and weight, sex, race, age and a documented interpretation by a pulmonologist or certified Occupational Health physician.

5.10.2.1 Follow NIOSH and ATS-ERS standard requirements:

5.10.2.2 Continue testing individual when the patient is improving until improvement is <30ml.

5.10.2.3 Test results are acceptable with a minimum of three acceptable maneuvers that are free from a leak, obstructed mouthpiece, hesitation, false starts, cough, glottis closure, early termination, and have a good curve of at least 6 seconds duration.

5.10.2.4 Test results are reproducible in that they have the same result from the individual (two largest FVCs are within 0.150 L of each other and two largest FEV1's are within 0.150 L of each other) when the test is repeated several times. Testing is continued until criteria are met or 8 trials are attempted, or the employee being tested cannot or should not continue.

5.10.2.5 If three (3) acceptable and two (2) repeatable tests cannot be obtained, the technician performing the PFT must document the reason the standard could not be met.

5.10.2.6 Use measured height not reported height by the nearest half inch without footwear.

5.10.2.7 Indicate source of reference value on reports for adjusted predicted value.

5.10.2.8 Ensure test is given when patient has abstained from smoking for 1 hour prior.

5.10.2.9 Ensure the patient has not had cold, flu or allergies within two weeks of the test.

5.10.2.10 Ensure the patient has not used an inhaler prior to test that could still be in the patient’s system.

5.10.3 Specifications regarding equipment guidelines and calibration, test administration, and test interpretation must meet applicable OSHA and ANSI standards.

Supporting documentation shall be provided to this office daily or annually depending on manufacturing guidelines of spirometer.

5.10.4 Respirator clearance shall be documented and a copy given to employee at time of visit.

5.11 Contractor shall provide quantitative fit testing in accordance with 29 CFR 1910.

134 appendix A. The estimated number of personnel to receive fit testing is no more than 200.

5.12 Contractor shall ensure that vision screenings are in accordance with DA PAM 40- 506 using multiphasic vision screening equipment to measure the following primary visual skills.

5.12.1 Visual acuity for distance and near.

5.12.2 Lateral phorias for distance and near.

5.12.3 Vertical phorias for distance andnear.

5.12.4 Depth perception.

5.12.5 Color perception.

5.12.6 Peripheral vision.

5.13 Contractor shall ensure laboratory tests are processed by certified clinical laboratories and performed by personnel certified under the American Society of Clinical Pathology. The supporting laboratory will provide employee instruction and equipment necessary for tests requiring special collection methods and/or containers. Document that employee has been counseled by examining provider about laboratory test results.

Provide a copy of lab results to employee for their primary care physician. Tests include:

5.13.1 Blood Chemistries (serum) with H&H, BUN and Creatinine. Estimated quantity:

400.

5.13.2 Liver Function to include AP and if abnormal include GGTP. Estimated quantity:

400.

5.14 Contractor shall ensure dermatological examinations must be performed by a physician and include an inspection of the entire integumentary system with emphasis on areas most likely to be affected by the employee's occupational (i.e. radiation) exposures. Documentation will include the presence of any dermatomes or lesions of the skin.

5.15 Contractors shall ensure that chest X-rays will be performed by a certified X-ray technician. The interpretation and classification will be performed by a B-reader, or a board eligible or certified radiologist meeting the requirements of 29 CFR 1910.1001 Appendix E: The estimated number of personnel to receive chest X-rays are no more than 200.

5.15.1 Chest X-rays are only performed for asbestos exposed employees.

5.15.2 Be a posterior-anterior and left lateralview.

5.16 Contractor shall ensure instrumentation must meet or exceed appropriate performance standards, and accuracy must be verified in accordance with current Occupational Medicine Certificationstandards.

5.17 Reserved.

5.18 Reserved.

5.19 Personal Protective Equipment (PPE)

5.19.1 Contractor shall furnish and assure healthcare workers are provided with the appropriate PPE such as, but not limited to: gloves, protective eyewear, and etc., where there is a potential for exposure to blood or other potentially infectious materials.

5.19.2 Contractor shall ensure each healthcare worker complies with the requirements of 29 CFR 1910.1030 Blood borne Pathogens Standard.

5.20 Infectious Waste Disposal

5.20.1 Disposal of all infectious waste shall be in accordance with local, state, and federal regulation and disposed of by the contractor unless other accommodations have been coordinated in writing.

5.20.2 Contractor shall ensure puncture resistant sharps containers are readily accessible to healthcare workers and located in all treatment areas where sharps could potentially be used.

5.21 Medical Reports and Recordkeeping

5.21.1 Contractors shall immediately notify the Occupational Health Manager by telephone if results of medical surveillance screening(s), which are questionable and / or of critical significance and / or require follow-up. Contractor shall send all results to include all diagnostic tests, graphs, charts, reports, questionnaires, waivers, employee consent forms, physical findings, and examination results to the Occupational Health Manager within 30 working days of completion of testing to:

Michigan Army National Guard Attn: MAJ Kristin Schulte 3411 N. Martin Luther King Jr. Blvd Lansing, MI 48906

5.21.2 Contractor shall identify all medical records with the employee’s full name, social security number, date of birth, job code, and the name of the employee’s work place or facility at a minimum. The contractor shall ensure work / health history forms and medical reports are complete and legible (typed / printed).

5.21.3 Contractor shall ensure that each employee signs the Privacy Act Statement (DD Form 2005) during the registration process.

5.22 Examination Scheduling

5.22.1 Coordination of scheduling shall be a joint effort between the Occupational Health Manager and the Contractor, a draft copy of the schedule will be initiated by the Occupational Health Manager and sent to the Contractor for review and any needed adjustments. One patient/employee per 15 minute intervals.

5.22.2 In the event of a Contractor equipment failure, specific testing and / or parts of examinations that are not completed during the testing period shall be completed at a scheduled time mutually convenient for the Contractor, Occupational Health Manager and the Facility(ies). Unfinished testing / examinations will be completed at no additional cost to the Government. The option to schedule physicals not completed due to equipment failure, through a local occupational medical facility shall be done at no cost to the Government. The Contractor shall be directly responsible to cover costs for completing these make-up screenings.

5.22.3 Service Contract Reporting:

5.23.1 RESERVED

6.0 Applicable Publications: Publications applicable to this PWS are listed below:

Publication

(Chapter/Page) Date of

Publication Mandator y or Website

Occupational Safety and Health Standards.

Title 29, Code of Federal Regulations, Part 1910

22 Mar 1999

Mandatory https://www.osha.gov/laws -regs/federalregister/1999- 03-22

Safety and Health Provisions for Federal Employees

Title 29, Code of Federal Regulations, Part 1960

26 Nov 2004 Mandatory https://www.osha.gov/laws regs/regulations/standardn umber/1960

Threshold Limit Values and Biological Exposure Indices (TLVs), American Conference of Governmental Industrial Hygienists (ACGIH), Cincinnati, Ohio.

31 Dec 2005 Advisory https://www.acgih.org/science /tlv-bei-guidelines/

Army Regulation 40-5, Preventive Medicine

12 May 2020 Mandatory https://armypubs.army.mil/Produ ctMaps/PubForm/AR.aspx

Department of Defense 6055.05M, Occupational Medical Surveillance Manual

11 Nov 2008 Mandatory https://www.esd.whs.mil/Directiv es/issuances/dodi/

Army Regulation 11-34, The Army Respiratory Protection Program

25 Jul 2015 Mandatory https://armypubs.army.mil/Produc tMaps/PubForm/AR.aspx#

Headquarters, Department of 12 Oct 2017 Mandatory https://armypubs.army.mil/Produ ctMaps/PubForm/Details.aspx?

PUB_ID=1005919

https://www.osha.gov/laws-regs/federalregister/1999-03-22 https://www.osha.gov/laws-regs/federalregister/1999-03-22 https://www.osha.gov/laws-regs/federalregister/1999-03-22 https://www.osha.gov/laws-regs/regulations/standardnumber/1960 https://www.osha.gov/laws-regs/regulations/standardnumber/1960 https://www.osha.gov/laws-regs/regulations/standardnumber/1960 https://www.osha.gov/laws-regs/regulations/standardnumber/1960 https://www.acgih.org/science/tlv-bei-guidelines/ https://www.acgih.org/science/tlv-bei-guidelines/ https://armypubs.army.mil/ProductMaps/PubForm/AR.aspx https://armypubs.army.mil/ProductMaps/PubForm/AR.aspx https://www.esd.whs.mil/Directives/issuances/dodi/ https://www.esd.whs.mil/Directives/issuances/dodi/ https://armypubs.army.mil/ProductMaps/PubForm/AR.aspx https://armypubs.army.mil/ProductMaps/PubForm/AR.aspx https://armypubs.army.mil/ProductMaps/PubForm/Details.aspx?PUB_ID=1005919 https://armypubs.army.mil/ProductMaps/PubForm/Details.aspx?PUB_ID=1005919 https://armypubs.army.mil/ProductMaps/PubForm/Details.aspx?PUB_ID=1005919 the Army Pamphlet SAFETY

AND OCCUPATIONAL HEALTH

PROGRAM

Federal Acquisition Regulation Mandatory https://www.acquisition.gov/?q=b rowsefar

Defense Federal Acquisition Regulation Supplement

Mandatory http://www.acq.osd.mil/dpap/dar s/dfarspgi/current/index.html or https://www.acquisition.gov/dfars

Joint Travel Regulation (JTR) Mandatory https://www.defensetravel.dod.m il/site/travelreg.cfm

DoDM 1000.13-M-V1 DoD Identification (ID) Cards (Enclosure 2, paragraph 3.b)

01/23/2014 (Change 1:

07/28/2020)

Mandatory http://www.esd.whs.mil/Directive s/issuances/dodm

DoDM 5200.2 Procedures for the DoD Personnel Security Program

(PSP)

04/03/2017 Mandatory https://www.esd.whs.mil/Directiv es/issuances/dodm/

DoDI 5200.46 DoD Investigative and Adjudicative Guidance for Issuing the Common Access Card (CAC)

09/09/14 (Change 1:

05/04/2018)

Mandatory https://www.esd.whs.mil/Directiv es/issuances/dodi/

Homeland Security Presidential Directive (HSPD)-12 Policy for a Common Identification Standard for Federal Employees and Contractors

08/27/2004 Mandatory https://www.dhs.gov/homeland-security-presidential-directive-12

DoDI 5400.11 Department of Defense Privacy and Civil Liberties Programs

01/29/2019 Mandatory https://www.esd.whs.mil/Directiv es/issuances/dodi/

DoD 5400.11-R Department of Defense Privacy Program

05/14/2007 Mandatory https://www.esd.whs.mil/Directiv es/issuances/dodm/

DoDD 8140.01 Cyberspace Workforce Management

10/05/2020

Mandatory https://www.esd.whs.mil/Directiv es/issuances/dodd/

DoD 8570.01-M Information Assurance Workforce Improvement Program

12/19/2005 (Change 4:

11/10/2015)

Mandatory https://www.esd.whs.mil/Directiv es/issuances/dodm/

DoD 5220.22-M National Industrial Security Program Operating Manual

(NISPOM)

02/28/2006 (Change 2:

05/18/2016)

Mandatory https://www.esd.whs.mil/Directiv es/issuances/dodm/ https://www.acquisition.gov/?q=browsefar https://www.acquisition.gov/?q=browsefar http://www.acq.osd.mil/dpap/dars/dfarspgi/current/index.html http://www.acq.osd.mil/dpap/dars/dfarspgi/current/index.html https://www.acquisition.gov/dfars https://www.defensetravel.dod.mil/site/travelreg.cfm https://www.defensetravel.dod.mil/site/travelreg.cfm http://www.esd.whs.mil/Directives/issuances/dodm http://www.esd.whs.mil/Directives/issuances/dodm https://www.esd.whs.mil/Directives/issuances/dodm/ https://www.esd.whs.mil/Directives/issuances/dodm/ https://www.esd.whs.mil/Directives/issuances/dodi/ https://www.esd.whs.mil/Directives/issuances/dodi/ https://www.dhs.gov/homeland-security-presidential-directive-12 https://www.dhs.gov/homeland-security-presidential-directive-12 https://www.esd.whs.mil/Directives/issuances/dodi/ https://www.esd.whs.mil/Directives/issuances/dodi/ https://www.esd.whs.mil/Directives/issuances/dodm/ https://www.esd.whs.mil/Directives/issuances/dodm/ https://www.esd.whs.mil/Directives/issuances/dodd/ https://www.esd.whs.mil/Directives/issuances/dodd/ https://www.esd.whs.mil/Directives/issuances/dodm/ https://www.esd.whs.mil/Directives/issuances/dodm/ https://www.esd.whs.mil/Directives/issuances/dodm/ https://www.esd.whs.mil/Directives/issuances/dodm/

Army Directive 2014-05 Policy and Implementation Procedures for Common Access Card Credentialing and Installation Access

03/07/2014 Mandatory https://armypubs.army.mil/Produ ctMaps/PubForm/ArmyDir.aspx

AR 25-2

Information Assurance

04/04/2019 Mandatory http://armypubs.army.mil/Produc tMaps/PubForm/AR.aspx

AR 530-1

Operations Security

09/26/2014 Mandatory http://armypubs.army.mil/Produc tMaps/PubForm/AR.aspx

AR 525-13

Antiterrorism

12/09/2019 Mandatory http://armypubs.army.mil/Produc tMaps/PubForm/AR.aspx

AR 381-12

Threat Awareness and Reporting Program (TARP) (Section II, 2-4.b)

06/01/2016 Mandatory http://armypubs.army.mil/Produc tMaps/PubForm/AR.aspx

(DA PAM) 40-501

Hearing Conservation

08 Jan 2015 Mandatory https://armypubs.army.mil/Produ ctMaps/PubForm/PAM.aspx

Headquarters, Department of the Army Pamphlet (DA PAM) 40- 506 Vision

15 Jul 2009 Mandatory https://phc.amedd.army.mil/topic s/workplacehealth.vcr/Pag

Federal Information Processing Standards (FIPS) Publication 201-2 Personal Identity Verification (PIV) of Federal Employees and Contractors (paragraph 9)

August 2013 Mandatory http://nvlpubs.nist.gov/nistpubs/F IPS/NIST.FIPS.201-2.pdf

6.1 Applicable Forms: Forms applicable to the PWS are listed below:

Form Date Website

DD 1172-2

Application for Identification Card/DEERS Enrollment

Mar 2017 http://www.dtic.mil/whs/directives/forms/index.htm

I-9 Employment Eligibility Verification

10/21/201 https://www.uscis.gov/sites/default/files/files/form/i- 9.pdf

DD 441

Department of Defense Security Agreement

Feb 2020 http://www.dtic.mil/whs/directives/forms/dd/ddforms 0001-0499.htm

DD 250

Material Inspection and Receiving Report

Aug 2000 https://www.esd.whs.mil/Directives/forms/dd0001_0 499/ https://armypubs.army.mil/ProductMaps/PubForm/ArmyDir.aspx https://armypubs.army.mil/ProductMaps/PubForm/ArmyDir.aspx http://armypubs.army.mil/ProductMaps/PubForm/AR.aspx http://armypubs.army.mil/ProductMaps/PubForm/AR.aspx http://armypubs.army.mil/ProductMaps/PubForm/AR.aspx http://armypubs.army.mil/ProductMaps/PubForm/AR.aspx http://armypubs.army.mil/ProductMaps/PubForm/AR.aspx http://armypubs.army.mil/ProductMaps/PubForm/AR.aspx http://armypubs.army.mil/ProductMaps/PubForm/AR.aspx http://armypubs.army.mil/ProductMaps/PubForm/AR.aspx https://armypubs.army.mil/ProductMaps/PubForm/PAM.aspx https://armypubs.army.mil/ProductMaps/PubForm/PAM.aspx https://phc.amedd.army.mil/topics/workplacehealth.vcr/Pag https://phc.amedd.army.mil/topics/workplacehealth.vcr/Pag http://nvlpubs.nist.gov/nistpubs/FIPS/NIST.FIPS.201-2.pdf http://nvlpubs.nist.gov/nistpubs/FIPS/NIST.FIPS.201-2.pdf http://www.dtic.mil/whs/directives/forms/forminfo/forminfopage2479.html http://www.dtic.mil/whs/directives/forms/forminfo/forminfopage2479.html http://www.dtic.mil/whs/directives/forms/index.htm https://www.uscis.gov/sites/default/files/files/form/i-9.pdf https://www.uscis.gov/sites/default/files/files/form/i-9.pdf http://www.dtic.mil/whs/directives/forms/dd/ddforms0001-0499.htm http://www.dtic.mil/whs/directives/forms/dd/ddforms0001-0499.htm https://www.esd.whs.mil/Directives/forms/dd0001_0499/ https://www.esd.whs.mil/Directives/forms/dd0001_0499/

TECHNICAL EXHIBIT 1

Deliverables Schedule

PWS Reference / Deliverable Title

Frequency Number of Copies

Medium/Form at

Submit To

5.1 Insurance & Licensed

and/or certified staff for all physicians and technicians

At each scheduled event

1 Electronic Submission

COR

5.10 Equipment Certification At each scheduled

event

Original(s) Electronic Submission

COR

5.21 Medical Reports and

Recordkeeping

Provided to the COR 30 Days after scheduled event

As needed Electronic Submission

COR

TECHNICAL EXHIBIT 2

Estimated Workload Data

The estimated number of personnel to be examined is 150. The Government has the right to increase and/or decrease the number of employees/military personnel and the locations for service.

TECHNICAL EXHIBIT 3

Performance Requirements

Summary

Performance Objective Performance Standard

Acceptable Quality Levels

(AQL)

Surveillan ce Method

/ By Whom

5.4 Provide qualified personnel

Insurance and Licenses for staff are maintained 100% of the time

0% allowed to be uninsured or not licensed

100% Surveillance/COR

5.16

Equipment Certification

Equipment shall be certified 100% of the time; Provide certificates timely 95% of the time

0% allowed use of uncertified equipment; 5% certifications provided late

100% Surveillance/COR

5.7-5.15 Medical Surveillance

95% timely surveillance

5% surveillance provided untimely

Periodic Inspection/COR

5.20 Infectious Waste Disposal

100% compliant with handling of infectious waste

0% non-compliance

100% Surveillance/CO

R 5.21

Medical Reports and Recordkeeping

Reports submitted timely 95% of the time

5% reports submitted late

Periodic Inspection/COR

Description of Required Service Testing

Physical Exam Components:

Physical Exam performed per Michigan Army National Guard OSHA Respirator Questionnaire Review and Determination Audiogram by Certified Hearing Conservationist Physician Vision: Titmus Test and Amisier Grid Fecal Occult Blood (for patients over 40 yrs)

Chest Xray (PA/LAT VIEWS)

Pulmonary Function Testing (Spirometry) performed by licensed Quantitative Fit Testing - Army National Guard to supply mask

Laboratory Testing (If not done with physical exam, a $25.00 Office Visit will apply):

Urine Specific Gravity (Microscopic Urine) Heavy Metals (Blood) - Cadmium, Arsenic, Mercury, Lead Heavy Metals (Urine) - Cadmium, Arsenic, Mercury, Lead Comprehensive Panel Lipid Profile CBC with Differential Beta 2 Microglobulin Liver Panel (Alk PO4, SGOT, SGPT and GGTP) Benzene (Blood) Lead/ZPP