Attachment A Statement of Work.pdf

UNCLASSIFIED

Sep 11, 2025, 07:46 PM UTC UNCLASSIFIED

Federal Bureau of Investigation

Human Resources Division I

FY26: FBI Medical Evaluations & Services

SHOP-PR-26-000039

Statement of Work

1.0 Background St a t em e n t

The Federal Bureau of Investigation’s (FBI) mission is to protect and defend the United States against terrorist and foreign intelligence threats, to uphold and enforce the criminal laws of the United States, and to provide leadership and criminal justice services to federal, state, municipal, and international agencies and partners. The FBI is responsive to the needs of the public and is faithful to the Constitution of the United States.

The purpose of this Indefinite Delivery Indefinite Quantity (IDIQ) contract is to acquire professional occupational health services through a nationwide patient physician network (PPN) that owns a series of clinics across the country (in each state, territory, district, etc.) to acquire medical examinations and related services for prospective and current FBI employees in support of the Federal Bureau of Investigation's (FBI) global mission.

This requirement is currently awarded to a large company and has numerous subcontracts.

This requirement for medical services and evaluations and will be procured as a full and open using FAR 15, for a firm fixed price award for a period of performance consisting of base plus four (4) option years.

2.0 Scope

Contract Type: Firm Fixed Price

2.1 Scope Statement

The FBI's HUMAN RESOURCES DIVISION requires Fitness/Wellness Exams to ensure that Potential and current employees can safely begin or continue work in specialty job functions.

This is a non-personal services contract. The Government shall not supervise or control contractor employees performing the services herein. Such contract service providers shall be accountable solely to the Contractor, who, in turn, is responsible to the Government. The cost of exams and provided services shall be fixed.

3.0 Objectives

3.1 Objective A – Administrative

3.1.1 Objective A - Task 1 Volume

The contractor shall perform employee fit for duty exams. Volume estimates are based on the current requirement for every four years and information known at this time. The FBI reserves the right to increase or decrease volumes over the life of this contract. Historically, these have been required as often as every year to as infrequent as every four years.

The table below shows the approximate minimum and maximum testing quantities that could be possible over the life of the contract.

The following estimates are provided for proposal pricing purposes and are subject to fluctuation over the life of this contract. Applicant exams for example, may fluctuate, or even cease during a hiring freeze. Testing requirements are also impacted by executive policies and availability of funding.

Estimated Exam Volume (based on historical data):

3.1.2 Objective A - Task 2 Start Up Call/Telecon

The contractor shall support a new Provider location "startup call / telecon" with FBI and any other key stakeholders as determined by the COR. The purpose of the call / telecon is to identify and understand FBI forms, training, Provider specific logistics, or criteria that will need to be addressed prior to scheduling any contract services at the new Provider location.

3.1.3 Objective A - Task 3 Outreach/Mobile Services

The contractor shall receive written approval from the COR prior to scheduling and completing outreach services if required by a specific location. Mobile services typically require the use of a mobile van. However, in some instances the FBI may consider a traveling practitioner(s) when space is available in a local FBI office and the service(s) requires minimal equipment (i.e. vaccinations).

3.1.4 Objective A - Task 4 Credentialing

The contractor shall manage all aspects of their PPN, including maintenance of credentialing files. The vetting process for individual PPN Provider credentialing shall cover the following, at a minimum:

Minimum Maximum Applicant Exam 1714 2748 Hazmat/OSHA Exam 380 410 Respiratory Exam 926 1198 DOS Travel 587 689 29 Days or Less Travel 355 731 Vaccines 2330 2927 Fit for Duty (FFD)

2 years 5766 6784 4 years 2883 3392

Medical license verification directly from an industry recognized primary source

Verification that the Provider is not excluded from working on federal contracts

HHS Office of the Inspector General Exclusions Database GSA System for Award Management Exclusion Database Verification of certification with DOT for any provider performing CDL and FAA exams Medical Doctors and Doctor of Osteopathic Medicine shall be board certified, or board eligible, in any of the following specialties:

cardiology, emergency medicine, internal medicine, physical medicine, family medicine, or preventive medicine (aerospace, occupational, or general preventive medicine or public health).

Exceptions to this requirement may be approved by COR on a case -by - case basis.

Nurse Practitioners shall be credentialed by American Nurses Credential Center (ANCC) or American Academy of Nurse Practitioners Certification Program (AANPCP).

Physicians Assistants shall be certified by the National Commission on Certification of Physician Assistants (NCCPA).

Audiologists shall be certified by the American Board of Audiology and are only authorized to complete Language Specialist examinations.

If there are any sanctions or censures discovered during this process that do not automatically exclude them from use, details of the sanction(s) shall be submitted to the COR for a final written decision prior to contracting.

All Providers shall be re - verified by the Contractor using the process above on an annual basis.

A list of all credentialed providers and / or any subcontractors shall be approved by the COR before any work/ service orders will be issued.

3.1.5 Objective A - Task 5 Medical Records/Documentation

The contractor shall store all medical records as the property of the Government and shall turn over or destroy at the Government's request. All medical record-keeping shall be in accordance with the Privacy Act of 1974 and destroyed ninety (9 0) calendar days after delivery.

The service / work order shall list the required medical documentation needed for each service request. The Contractor shall have access to all required forms and documents. The Contractor shall be responsible for clerical costs necessary for printing, copying, and collating of all forms and documents used by its PPN Providers. As a mitigation in case an additional or replacement form is needed, blank forms can be electronically sent directly to PPN Providers by the Contractor. The original, populated 1126 shall be used as the standard.

The COR or delegated individual will provide alternative access to forms and other documents in the event electronic communication is interrupted and / or unavailable. Hard copies will be delivered via overnight delivery, if necessary.

3.1.6 Objective A - Task 6 Deliverables

The contractor shall use provided templates, policies, forms and other agency documents provided by FBI to comply with contract deliverables as appropriate.

The Contractor shall provide a monthly report to the government that includes a summary of exams by the type, program level issues, etc. A template will be provided upon award.

The Contractor shall provide a monthly cost report. This template shall also be provided.

The Contractor shall provide weekly statuses of Limited Access Request processing for the clinics. This shall be a highlight from the SharePoint site.

The Contractor shall support bi-weekly status meetings. The frequency of the meeting is subject to change depending on the current need of the requirement.

3.2 Objective B - Policies & Regulations

Follow applicable policies

3.2.1 Objective B - Task 1 National Standards

The contractor shall comply with national standards. These standards include, but are not limited to:

JCAHO standards http://jointcommission.org; American Medical Association (AMA) standards http://www.ama-assn.org; the American Association of Occupational Health Nurses

(MOHN) standards http://www.aaohn.org;American College of Occupational and Environmental Medicine (ACOEM) standards http://www.acoem.org/, Other standards recognized by relevant national medical specialty boards, established principles and ethics of related professions; and the standards of care in the state or locality where the services are provided.

http://jointcommission.org/

OSHA 1910.141, Sanitation Standards. Blood Borne Pathogens and Bio-Hazardous waste disposal regulations in accordance with OSHA

910. 1030.Privacy Act

ANSI Standards for Audiograms Any other national standards for provided medical exams National

Standards, etc.

3.2.2 Objective B - Task 2 Applicable Policies and Guidelines

The contractor shall comply with, but is not limited to, the following:

OCCUPATIONAL SAFETY AND HEALTH ADMINSTRAION (OSHA)

REGULATIONS AND HEALTH GUIDELINES: Occupational Safety and Health Administration (OSHA) 29CFR.19101910.141 Cleanliness of Health Care Facilities1910.1030

Blood Borne Pathogens Standard1910.95 Hearing Conservation Standard1910.120 Hazardous Materials Response Team Standard 1910.134Respiratory

Protection Standard American National Standards Association (ANSI) Prevention and Calibration of Medical Equipment

CDC Immunization Guidelines including safe handling and storage of vaccines. US Public Health Immunization Guidelines

Privacy Act of 1974 5 U.S.C § 552a5 CFR.339.301 Medical Qualifications Determinations for Federal Employees

Department of Transportation Omnibus Federal Employees Testing Act Department of State-

Medical Certification for Overseas Assignments World Health Organization Additional Required Regulations

/Guidelines

3.3 Objective C - Place of Performance/Locations

Various provider locations.

3.3.1 Objective C - Task 1 General

The contractor shall perform nationwide, per the individual service/ work orders and mileage requirements. The Provider shall make every attempt to complete all required services in one visit unless a purified protein derivative (PPD) was placed. In those cases, a second appointment is required for reading of the PPD.

3.3.2 Objective C - Task 2 Referrals

The contractor shall be responsible for all PPN referrals within the provided locations across the entire US.

3.3.3 Objective C - Task 3 Scheduling Efficiency

The contractor shall schedule all service appointments at a single Provider location for each examination to the greatest extent possible to minimize appointments for the examinee.

Every effort shall be made to ensure that all referred service/ work orders are scheduled to allow time for the medical laboratory results to be available to the provider at the time of the second medical examination.

Advance approval from the FBI COR or COR designated FBI personnel shall be obtained if services will be performed at more than one (1) location, or if additional appointments are needed due to a failure to complete all requested services during the examination appointment.

In areas where more than one (1) Provider location is available within the Contractor's PPN, the FBI may dictate which provider location is used. The FBI reserves the right to discontinue the use of Provider service locations that are unable to meet the quality standards set forth in the contract at any time.

The Contractor shall utilize mobile services where/when a fixed Provider location is unavailable. The mobile service shall meet all the requirements of the SOW for medical services to include having all necessary equipment, distance, single appointment, etc.

In such instances, FBI will not be responsible for any charges associated with the mobile van service, hourly outreach practitioner charges, or any charges other than the services provided. The Contractor shall obtain initial written approval from the COR prior to utilizing the mobile service Provider(s) prior to entering into any Provider agreement pertaining to this contract for service. A process will be initiated upon award to streamline approvals for mobile services if the Contractor is best able to meet the requirements of this contract in that manner

3.3.4 Objective C - Task 4 New provider locations

The contractor shall verify if the service / work order can be satisfied by an existing PPN or if a new Provider location will be required.

New locations may also be initiated by the FBI if the need for a new location is identified. In that case, the FBI will notify the Contractor of the requested location. The Contractor shall add new Provider locations within the assigned region at no additional cost to the Government. The need to adjust the quantity or locations of the providers shall be included in the proposed contract cost.

If a requested location is not covered by the Contractor's existing PPN, the Contractor shall establish a new Provider location within ninety (90) calendar days of notification from the COR.

Failure to establish a new Provider location within the required ninety (90) calendar days may result in a disincentive of $25.00 for each calendar day beyond the ninety (90) calendar days until a new Provider location is available for service scheduling. This disincentive shall not exceed $500.00 per new Provider location request. The monthly invoice and report shall detail this, and the amount of the monthly invoice be reduced by the sum of these days. The Contractor shall not be penalized for timeline delays for which the FBI is responsible (e.g., site visit availability, startup call/ telecon availability, etc.).

3.3.5 Objective C - Task 5 Distance Requirements

The contractor shall offer provider locations within a specific distance of the FBI employee' s home/applicant's processing office based on the population in that area. All population data for the basis of calculating shall be based upon the most recent the most recent United States Census Bureau's Population Estimate Tool at https://www.census.gov/quickfacts/facUtable/US#. Population ranges and required mileage are noted in the table below.

The distance requirements may be waived on a case -by - case basis, with written COR approval. The Contractor shall email the COR details on their actions to locate a Provider location within the specified distance requirement, and detailed information on the closest available Provider location. The COR may assess a disincentive of up to ten percent (10%) of the total cost of all service/ work orders per Employee/ Applicant referral for any service(s) performed outside the distance requirements without prior written COR approval.

Minimum Population

Maximum Population

Distance of provider location from

Less than 50,000 250 miles 50,000 100,000 25 miles Over 100,000 10 miles http://www.census.gov/quickfacts http://www.census.gov/quickfacts

3.4 Objective D - Medical Services

Medical Services

3.4.1 Objective D - Task 1 General Medical Services

The contractor shall perform the quantity and types of testing required to determine an individual’s ability to safely perform their FBI job functions is subject to change over the life of this contract. Additional tests may be requested by the FBI at varying frequencies or via a different testing method. If an existing or new FBI role is given a fitness for duty requirement during the life of this contract, then the associated exams/services shall be considered in scope. As testing methods evolve, current tests or testing methods may also evolve and they shall be within the scope of this SOW.

As long as the intent of the medical services/ exam or test is for the purpose of assessing the individual's ability to safely perform their FBI job then it shall be considered in the scope of this contract.

The Contractor's reporting methods, timing, and notification procedures shall also be subject to change over the life of this contract.

The Contractor shall maintain a PPN of medical provider locations that can perform requested medical services within the SOW distance requirements. The Contractor shall discontinue the use of any single Provider, a member of their staff, and/or the use of a Provider service location that is unable to meet the quality standards set forth in the contract at any time. The Contractor and PPNs shall be compliant with all HIPPA laws.

The Contractor shall designate a qualified, full time Contractor program manager (CPM) to be responsible for all Contractor operations. This position shall be key. The individual shall have a clinical background. The FBI defers to the Contractor on other staffing needs to successfully meet contract requirements. All costs shall be included in the overhead. The FBI shall review the Contractor's approach to providing this management level support to ensure quality as part of the solicitation process. The CPM shall be the FBI COR’s primary point of contact.

The Contractor shall review all service/ work order results and associated documentation for QA prior to submission to FBI.

Clinic and provider staff tracking

The Contractor shall maintain a “living” SharePoint site that keeps a running list of every individual ever performing work on this contract. The site shall be updated at least twice per week. Daily during the first four months of the program. The site shall allow access to FBI staff. A list shall be provided. The site shall allow the FBI staff to export data into excel, pdf, and Power BI. Mandatory fields shall include:

• First name, last name, middle name(s), suffixes. Separate cells for each and if no middle name the cell shall indicate “NMN”

• Name of FBI Office(s) serviced

• Location’s Physical Address (Street, City, State, Zip)

• Two points of contact for the office (names, phone, fax, and email)

• Clinic name

• Individual’s function (nurse, admin, physician, etc.). Shall have defined list of options

• FBI Office that is supported (Office name)

• FBI Office’s physical address

• Date name is added

• Date starting on program

• Date LAR paperwork submitted

• Date LAR is Approved/denied

• LAR expiration date

• Date fingerprinted

• Date departed the program

• Status (Active, Departed, or Pending)

• Prime Contractor owned Clinic (Yes/No)

• Mobile Clinic (Yes/No)

• Office Hours

• Automated field to reflect the latest date any type of update was made for that individual

• Automated notifications to at least two designated FBI staff of when changes are made to the site to which line/individual

• Entering a new name shall trigger a notification to designated FBI staff that someone new has started and will need to be processed. Other notifications: departures, LAR expiration, etc. It is also suggested that some type of tickler be set for the LAR expiration dates. If possible, the notification shall contain the FBI Office’s name in the subject (if automated option)

Other details as needed/upon request

The Contractor shall update the site daily. The FBI shall designate FBI email addresses to receive notifications. The FBI COR and other FBI designees shall have access. One to two shall be able to enter VAR/LAR approval dates/expiration dates. The FBI individuals shall be able to export the data into excel or pdf for reporting purposes. The SharePoint site may also be used for deliverables as approved by the FBI. It shall be approved via FBI protocols, etc. before it can hold other FBI data.

The Contractor shall deliver occupational health services to include, but not limited to the following:

Immunizations as appropriate for current FBI employees (NOTE:

Immunizations are not authorized as part of an applicant medical exam) lab work, Fitness for Duty (FFD) exams, OSHA and NOAA mandated medical surveillance exams, official short-term travel reviews, provision of travel medications, and Department of State (DOS) medical exams Commercial Driver's License (CDL) medical clearance exams (where licensed), and Federal Aviation Administration (FAA) medical clearance evaluations.

Other medical services/exams as requirements evolve as long as the intent is related to the individual’s ability to perform an FBI function.

Locations capable of performing CDL and FM evaluations shall be specifically identified in writing and provided to the Contracting Officer' s Representative (COR).

Chest x-rays, Spirometry, or other services as requested

The service authorization for an individual shall be initiated via a service/work order on the FBI General Authorization form. The Contractor shall use this to assign the provider(s), schedule patients, perform examinations, collect results, submit required medical records, perform QA reviews of the performed services and results for completeness, and transmit completed medical record reports to the location(s) designated by

FBI.

All work on this contract shall be initiated/authorized on the FBI General Authorization form or electronic list provided by the COR delegated FBI point of contact (POC). Exams completed without proper authorization shall not be billable to the government.

The FBI currently operates via a paper process. The intent is to migrate to a more electronic process. The Contractor shall support either paper or electronic. Service results, forms, and other information shall be transmitted to FBI via overnight. For paper results, shipping to the destination address shall be provided on the work order. Tracking numbers should be recorded for all packages. Any lost packets shall be considered and treated as a security risk. It shall be reported immediately to the FBI COR or COR designated POC via email.

All current processes are paper-based, and the vendor shall comply with all processes. The FBI intends to transition to electronic processes and handling of information. The FBI prefers that the awarded contractor have a FEDRAMP certification (or something similar) at the time of contract award.

Preference/selection may or may not be given to a vendor that does have the certification.

If this transition occurs during the life of this contract, the Contractor shall support this transition and adhere to all applicable privacy, information technology system and data security requirements to include data retention, access, transmission, disposition of any equipment, etc. The FBI shall not be responsible for any electronic devices or associated maintenance/network charges.

Service/ work order requirements may be performed at any qualified PPN provider facility such as: hospitals, occupational health clinics, general medical clinics, specialty clinics, urgent care facilities, etc. Outreach services may also be conducted using mobile van service and / or traveling medical staff.

The Contractor shall distribute all service/ work order required forms, documents, and supplies to the PPN provider responsible for performing services. All required forms shall be specified in the service/ work orders and made available to the Contractor in advance of service requests. The Contractor shall receive, and process completed documentation from the provider(s). This shall include reviewing all materials for completeness, adequacy of testing, and accuracy according to component and instructions of the service / work orders. All testing and services shall meet the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) standards for Ambulatory Care.

The Contractor shall assist the FBI in assessing and improving the quality, timeliness, and accuracy of services in meeting JCAHO standards as well as recommending innovative continuous quality improvement techniques .Service / work orders shall be completed by licensed health care practitioner(s) whose knowledge, skills, and abilities are commensurate with the scope of practice per the state or territory requirements in which the service is performed.

All tests and services shall be performed utilizing accurate, properly calibrated and maintained testing equipment, and properly trained and credentialed personnel familiar with the required occupational health standards for testing and services.

Tests and services enable providers to assess fitness for duty, ensuring the applicant or employee can perform the essential functions of a position and can safely deploy outside the continental united states (OCONUS). This includes an evaluation for any condition that could cause sudden incapacitation, restrict, or prohibit participation in defensive tactics and dangerous assignments that might entail the use of firearms or potential exposure to hazardous substances.

The records of calibration shall be available for review during site visits and/or upon request. At a minimum. the following equipment shall be calibrated and have annual preventative maintenance (PM) at all service locations: Titmus machines, EKG, Audiometric Screening equipment, Hearing Booth audiometer, vaccine refrigerators, and Spirometer to adhere to American National Standards Institute (ANSI) and Occupational Safety and Health Administration (OSHA) standards.

Documentation of Preventative Maintenance (PM) in accordance with original equipment manufacturer (OEM) specifications shall be current and prominently displayed on the equipment and / or available for review during site visits. This information shall also be posted on the contract's SharePoint site.

Contract services shall be quality checked by the FBI and documentation reviewed for accuracy, legibility, and completeness. The Contractor shall provide a monthly, quality check report to the FBI COR with every invoice. The FBI reserves the right to request calibration and maintenance documentation from the Contractor for any service provider location or mobile provider - this documentation shall be provided to the COR within five (5) calendar days of the request.

The Contractor shall be responsible for ensuring that all necessary training and instructions are provided to all PPN personnel dealing directly with FBI related exams, including but not limited to penalties for late exams, missing items, and improper billing.

The service / work order may request individual services or services included as part of a customized physical exam. All service/ work orders shall be initiated by FBI. All records and results shall be maintained, stored, and submitted by the Contractor within ten (10) business days after the services are performed. All hard copy and/or electronic medical records associated with the Contractor's PPN shall remain the property of FBI. No paper originals or copies are to be permanently stored with the Contractor or at any provider locations.

The use of electronic medical records at a Contractor's PPN location shall be approved by FBI COR or COR delegated individual.

The Contractor shall report any critical service results directly to the Technical Point of Contact (TPOC) within twenty- four (24) hours of receiving the results. If the result is life threatening, for example, a critical EKG, the contractor is expected to utilize medical discretion to include sending the examinee to the emergency department and notify the TPOC immediately.

The Contractor shall factor in the LAR/fingerprinting processing time when adding new PPNs to ensure the availability to promptly fulfill work orders. The Contractor shall provide travel medications, vaccines, or prescriptions at the appointment location for travelers. Time related to LAR completion and fingerprinting is not directly billable to the FBI.

3.4.2 Objective D - Task 2 Specialized Services

The contractor shall perform specialized customer services work order requirements. These include, but are not limited to:

• tailored operational process flows,

• scheduling process,

• timing,

• specialized services or examinations,

• agency specific forms,

• Practitioner credentials and certifications,

• and / or other specialized requirements.

Further clarification beyond the service / work order requirements may be obtained from the FBI upon request.

3.4.3 Objective D - Task 3 Management of the Patient Physician Network

The contractor shall maintain a PPN and provide FBI with a comprehensive list of all active Provider locations with associated Practitioners and service capabilities identified. (See SharePoint requirements).

The initial report shall be provided to the COR at the time of award and any time upon request.

The Contractor shall schedule all services identified at a single provider location, unless otherwise noted within the service/ work order requirements. The CPM shall participate in a monthly telecon with COR and/ or COR authorized designees regarding the PPN and contract efforts.

The Contractor's PPN Providers and Practitioners shall conduct themselves in an appropriate and professional manner. This includes patient interaction, equipment quality, facility cleanliness, and more. The Contractor shall monitor and manage PPN performance. Providers that fail to complete the requirements of the referral adequately may be requested by FBI to complete a Complaint Resolution Plan. The Contractor shall also review all complaints regarding inappropriate or unprofessional performance at a provider location. The Contractor shall present all complaints to the COR via email with a plan for resolution within seven (7) calendar days of notification. Failure to present or resolve the complaints may necessitate discontinuation of Contractor's Provider location performing services on this contract.

The FBI reserves the right to perform site visits to any provider location, as FBI or agency needs may require. The COR, or COR designated POC, shall contact the CPM to schedule site visits and determine FBI designee(s) for such visits. Site visits may include a detailed evaluation of the provider's facility by FBI designated personnel. At any time during the life of the contract, the COR may direct discontinuation of Contractor's Provider location(s) performing services on this contract.

3.4.4 Objective D - Task 4 Emergency / Surge Services

The contractor shall be required to provide emergency / surge services beyond the estimated volume. Under emergency/ surge circumstances, the COR will notify the Contractor of the specific service(s) required. The Contractor shall have emergency/ surge capability in place to accommodate such requirements. When emergency / surge services are invoked, the Contractor shall meet service requirements in accordance with existing best practices. The FBI recognizes that while the Contractor would be expected to perform as quickly as possible, they reserve the right to wave any associated disincentive for the Contractor.

NOTE: This section is only applicable when the CO issues a contract modification.

3.4.5 Objective D - Task 5 Contact with Employee

The contractor shall ensure that the Provider works directly with employees/ applicants to schedule appointments, as designated only by an FBI work order. Providers shall provide a list of scheduled exams to the designated FBI POC upon request.

The Contractor must attempt direct contact with employees/applicants within 24 hours of work receipt and then every 24 hours thereafter until contact is made and EE/Applicant is scheduled.

The Contractor shall make at least three (3) attempts via phone or email to contact the Employee/ Applicant. Attempts shall be at least 24 hours apart.

If the attempt is successful and the employee/applicant requests time to check their calendar and respond, the next attempt at contact shall not be less than one (1) week. The Provider shall document all communication attempts. The Contractor shall be mindful of time zones and the hours that they are making calls. Calls shall only be made Monday-Friday during the hours of 8:00 A.M. and 7:00 P.M. for the time zone being called. If attempts to communicate with the requester are successful, the Contractor shall provide the employee/ applicant with an appointment confirmation notice via email immediately after scheduling. The FBI POC shall be copied on the order form.

The appointment confirmation shall include, but is not limited to:

information on the provider, provider's physical address location, practitioner name, any special instructions, etc.

Content and structure of the appointment confirmation notice email may be changed by the COR at any time. Centralized, online, scheduling is the preferred method for scheduling appointments.

3.4.6 Objective D- Task 6 Scheduling and Completion of Services

If attempts to communicate with the requestor/applicant is unsuccessful, the Contractor shall reach out to the FBI Regional Program Manager for that area. The provider (and every sub contact clinic) shall draw labs and send samples to the preferred center. The lab results shall be provided as follows:

• Blood Lead with exact value (no range)

• Complete Blood Count with Differential

• Complete Metabolic Panel with ALT

• Glucose-6-phosphate-dehydrogenase (G6PD)

• Hemoglobin

• A1c

• Hepatitis B Surface Antigen

• Hepatitis C Antibody

• HIV I/ HIV III

• GRA

• Lipid Panel

• Plasma and

• RBC Cholinesterase level (One Draw)

• Rapid Plasma Reagin (Syphilis)

• Zinc Protoporphyrin (ZPP) with exact value (no range)

The Contractor shall submit a listing of all service/ work order requirements that could not be scheduled due to Employee / Applicant availability on their Monthly Self - Assessment Report (MSAR).

If all three (3) attempts to communicate with the Employee/ Applicant are unsuccessful, the Contractor shall email the FBI point of contact to have the FBI reach the employee/applicant and request a new work order. The referral shall be returned to the FBI.

Rescheduled appointments or additional appointments needed to complete all service/ work order requirements shall be documented within the MSAR.

This shall include all Employee / Applicant missed appointment(s) which are considered as 'no-show' appointment(s) to include cancellations within twenty-four (24) hours.

This shall also include missed appointments due to Provider/Contractor failure to complete scheduled appointment. The Contractor shall collect an unlimited number of work orders daily and prioritize them according to (1) applicant exams, (2) Travel visits, and (3) Employee fitness for duty exams.

The Contractor shall target scheduling at least 1100 appointments per month as supported by the volume of service/ work orders and available funding. This target is subject to change based upon the current need of the

FBI.

It is preferred that "block" scheduling be available in high volume locations.

"Block" scheduling requires the examining facility provide standardized days and times for FBI exams to meet the volume needs of the specific location.

The PPN practitioner shall schedule and complete all service/ work order requirements within the following schedule:

• Official Foreign Travel Reviews, including DoS examinations ten

(10) business days from the date of receiving examinee availability.

Applicant Medical Assessments fifteen (15) business days from the date of receiving examinee availability.

• Routine Periodic Fitness for Duty Assessments and Medical

Surveillance Exams thirty (30) business days from the date of receiving examinee availability.

Failure to schedule and complete all services within the required days from work order date received shall result in a disincentive of $25.00 for each business day beyond the designated days up to 50% of the price of the service.

3.4.7 Objective D - Task 7 Expedited Referral Service Completion

The PPN practitioner shall schedule and complete all "Expedited" orders within two (2) business days of work order receipt. FBI will clearly mark the work order as "Expedited". Failure to schedule and complete all expedited work orders within two (2) business days from receipt will result in forfeiture of the Expedited Service Fee and the Standard Referral Service Completion requirements shall apply.

3.4.8 Objective D - Task 8 Standard Referral Report Submission

The contractor shall complete Normal Operations.

Once all requirements listed on the service/ work order are completed, the PPN practitioner shall compile the information (e.g., test results, procedures, completed forms, exam summary, etc.) and pair it with the appropriate work order, perform quality assurance, and submit the completed order to FBI within ten (10) business days. Failure to submit the completed work order to the FBI queue within ten (10) business days from the final appointment date will result in a disincentive of $25.00 for each business day beyond the ten

(10) business day requirement up to 50% of the price of the service.

FBI designated TPOCs may contact the Contractor, who shall support and facilitate direct communication within all PPN agreements.

Expedited Referral Report Submission

Once all requirements listed on the expedited service / work order are completed, the PPN Practitioner shall:

• compile the information (e.g., test results, procedures, completed forms, etc.) and pair it with the work order,

• perform a quality check, and

• submit the completed referral back to FBI within two (2) business days. Failure to submit the referral back to the FBI queue within two (2) business days from the final appointment date will result in forfeiture of the Expedited Service Fee. The Standard Referral Report Submission (C.20) requirements would then apply. This Expedited Service Fee shall not be applicable if late submission is due to incomplete/ insufficient work orders sent on behalf of the FBI.

3.4.9 Objective D - Task 9 Missing Items

A missing item may include, but is not limited to, a missing service, missing signature, incomplete documents, etc. An exam submitted to FBI as "final" discovered to contain one (1) or more missing items shall be considered incomplete. An FBI COR designated POC may reach out to Contractor to obtain missing items. Applicable timeframe(s) annotated in this SOW shall resume, including any associated disincentives. Submission of an exam containing missing items shall result in a disincentive of $10.00 per missing item not to exceed more than 50% of the price of the service and shall be reported in the monthly quality assurance report.

3.4.10 Objective D - Task 10 Examination Services

The Contractor shall perform all requested occupational health exam services in accordance with the contract requirements. Practitioners shall conduct -in person evaluations for all exam types. None shall be virtual or telephonic.

The Contractor shall send all required forms listed in the service/ work order directly to the FBI COR designated POC. The FBI requires that all service results, lab results, forms, and any other required information be submitted on paper at this time and electronically if contract is modified.

Certain examination components (e.g., lab work, immunizations, etc.) may require additional appointment(s). This shall not delay the Contractor from submitting the completed primary examination results and / or the results of other completed testing in accordance with timeframes identified. Written notification regarding any pending results shall accompany the medical record that is submitted.

All exceptions to the stated timeframes shall be documented and provided to the COR via email for review. Justification shall include the reasons for the delay and the expected delivery date. Failure to justify a valid reason for the delay shall result in a penalty of $10.00 for each business day a report I document/ result is late beyond the stated timeframe requirements described in this section.

The examining Provider shall review and evaluate all medical examinations, tests, and findings for completeness, accuracy, and indicate the need for any additional follow- up to determine the Employee or Applicant's ability to meet the essential duties of the position. The Contractor shall conduct a quality review of completed examinations prior to submitting to the FBI.

The Provider shall discuss the examination results with the Employee at the conclusion of the exam. The Provider shall not address abnormal values, with the Applicant, except for critical values or findings deemed by the examining Practitioner as life threatening or emergent.

In the event a form request is made, and the original request is omitted from the applicant packet, then upon completion of an applicant exam, the contractor shall submit a Supplemental Form Fee for Applicant Exams, pending COR approval.

3.4.11 Objective D - Task 11 Same Sex Observer

The Contractor shall provide a same sex observer if requested by any FBI examinee.

3.5 Objective E - Specific Exams

3.5.1 Objective E Task 1: Fitness for Duty

The contractor shall conduct these examinations on a periodic basis, as determined by FBI, for employees in designated positions with medical requirements. The Provider shall refer to the FD- 1126 and complete items authorized by the ordering FBI POC. The network Provider shall ensure that forms FD- 1065 and FD-1093 (or FD- 1093A) are completed in their entirety.

Incomplete forms shall be returned for correction.

Distant Vision - If corrective lenses are used, the evaluation shall be accomplished with and without correction. Results for both readings shall be given in Snellen equivalents and shall be recorded for both left and right eyes. The reading provided for each eye shall indicate the acuity level at which the line is read without error by the examinee.

Distant vision shall be 20/20 in one eye and no worse than 20/40 in the other eye (Corrected or uncorrected). If these standards not met, retest using the Snellen wall chart.

Near Vision - If corrective lenses are used, the evaluation shall be accomplished with and without correction. Results for both readings shall be given in Snellen equivalents and recorded for both left and right eyes. The reading provided for each eye shall indicate the acuity level at which the line is read without error by the examinee.

Field of Vision - Shall be completed full of confrontation.

Resting Electrocardiogram (12-lead EKG) - The Contractor shall include the original test or submit an electronic copy of the EKG with interpretation by the evaluating Provider. It shall be signed by the evaluating Provider.

Additional tests

(The following tests are not part of the routine FFD exam, but rather ad hoc orders requested on the 1126 on an as needed basis).

• Chest X-ray

• Spirometry / Pulmonary Function Screening- Documentation of results shall include graphs and written interpretation.

Blood Group and Type G6PDLead and Zinc Protoporphyrin (ZPP) Hepatitis B Antigen / Antibody Hepatitis C Antibody Glycosylated Hemoglobin (A1C) HIV I and HIV II RBC and Plasma Cholinesteraselnterferon Gamma Release Assay (IGRA)

Immunization History-The Contractor shall update vaccines as required for foreign travel by the destination country for entry or exit, as well as providing any vaccines ordered by the FBI which may include, but are not limited to:

`Hepatitis A Series Hepatitis B Series Combination Hepatitis A /B series in lieu of individual Hepatitis A and

Hepatitis B series Influenza Measles / Mumps / Rubella (MMR) - (two doses) Meningitis Polio (four (4) childhood doses and one (1) booster after the age of 18 years)

Tetanus / Diphtheria/Pertussis OR Tetanus/ Diphtheria (Only if Pertussis allergy)

Varicella or proof of disease history

The Provider shall document any administered vaccines in the INTERNATIONAL CERTIFICATE OF VACCINES (CDC 731, Yellow Card) and shall include documentation of all administered vaccines in the completed exam package.

3.5.2 Objective E – Task 2: Specific Fitness for Duty Exams

The contractor shall refer to FD-1126, FD-1065 (Report of Medical History Form), FD-1093A (Medical Evaluation Form -Applicants), FD-967 (New Agent Activity Form.

Screening audiometric test - Prior to the test, the examining Practitioner shall assess both ear canals and follow Occupational Safety and Health Administration (OSHA) 5CFR1910.95 guidelines for both left and right ears.

Test shall be performed in HZ levels: 500, 1000, 2000, 3000, 4000, 6000, and 8000. The graphical print out from the audiometer shall accompany the results documented on the FD-1093.

Spirometry / Pulmonary Function Screening - Documentation of results shall include graphs and written interpretation.

Color vision - Documentation of results shall be provided in the following format:

type of test used; number of plates correct/ number of plates used. Ishihara 14 plate is preferred required. Include the Ishihara results document. Alternatives to Ishihara 14 shall be approved by FBI COR. Provider shall also document the plate number(s) of any plate(s) that are missed by the examinee. If applicant does not pass all 14 plates of the Ishihara, Farnsworth test should be administered.

The FBI is still finalizing the process for color vision testing and moving toward computerized exams. Scoring will mimic the FAA scoring, and that information will be provided. At the time of solicitation preparation, the process is defined as follows.

Computerized Color Vision Testing

The Contractor shall utilize just one of the following validated computerized tests for color vision testing: Waggonner CCTV, Rabin or Color Assessment and Diagnosis (CAD) test. The Contractor shall state which exam they shall use and use that same exam at every clinic/every exam.

FBI Applicants shall take the computer-based color vision test. If the examinee fails, they shall re-test immediately during that same visit. If they fail the second one, they shall repeat with the clinic 7 days later. If the examinees fail this third attempt and want to pursue the application process, they shall trave to the FBI Headquarters, Washington D.C. for a virtualized test.

Other:

The Provider shall not address abnormal values, with the Applicant, except for critical values or findings deemed by the examining Provider as life threatening or emergent.

If the Applicant does not return to the facility for TB skin test reading within seventy - two (72) hours, the Provider shall mark the paperwork as "did not return" and submit the completed exam to the FBI.

Immunization History-Applicants shall provide copies of all immunization records at the time of their exam. The Provider shall receive and include immunization documents in their exam package to the FBI POC.

Immunizations shall not be given during an Applicant exam. The provider shall note on the exam if the individual did not provide immunization records.

Applicant's and existing Employees are not eligible for FBI-funded immunizations during the applicant process.

The FBI will provide the Contractor with the Special Agent Essential Task List.

Please note that this information is proprietary and shall not be shared outside of FBI business.

3.5.3 Objective E - Task 3 Department of State Exams

The contractor shall order exams per the Fitness for Duty Periodic Exam Forms (FD-1065 and FD- 1093), FD- 1126 and DoS Form DS-6561. Any other forms shall be provided. All DOS forms shall be the most current version available from the DoS web site. If the employee fails to provide forms, Provider can obtain them from eforms.state.gov.

The Provider shall complete OS form 6561 pages 3 and 4 legibly and in its entirety. The Contractor shall ensure that the form is signed and dated by the examining Provider.

The Provider shall comment on all positive responses by examinee.

Employees Deploying to Department of State Identified War Zones: Refer to Department of State Forms DS-6570 (ESCAPE Post Pre-Deployment Physical Exam Acknowledgement Form). Examiner shall read, sign and date DS-6570 form.

3.5.4 Objective E- Task 4 OSHA Exams

The contractor shall perform these exams for employees assigned to jobs or job tasks that require medical surveillance for compliance with OSHA CFR 1910. In addition to the Routine Examination, OSHA exams may include:

Evaluation Questionnaire, OSHA 900FBI Respiratory Clearance and Hazardous Materials

Response Medical Report, FD 899 Form RBC and Plasma Cholinesterase with each exam only if indicated in the Ad Hoc section of the FD-1126, Blood Lead and ZPP

The contractor shall provide ordered immunizations, unless medically contraindicated.

3.5.5 Objective E - Task 5 Federal Aviation Administration (FAA) Examinations

The contractor shall provide ordered immunizations, unless medically contraindicated.

A Provider certified as an Aviation Medical Examiner (AME) shall perform Class 1, Class 2 and Class 3 Federal Aviation Administration (FAA) examinations which typically consist of a physical evaluation and specific laboratory and testing requirements. The examination price shall include all required forms and any specimen collection / handling.

3.5.6 Objective E - Task 6 Commercial Driver License Examinations

The contractor shall perform CDL examinations to determine commercial driver physical fitness and shall be performed by a COL Certified Medical Examiner. CDL examinations typically consist of a physical evaluation and specific laboratory and testing requirements. All components of the examination and testing shall be as prescribed by 49 CFR parts 350, 383, 390, and 391 and meet certifications as required by the Federal Motor Carrier Safety Administration physical qualifications and standard and guidelines.

3.5.7 Objective E - Task 7 Diver’s Examinations

The contractor shall perform FBI Divers exams. These shall be guided by National Oceanic and Atmospheric Administration (NOAA) standards. All assessment exams shall include in addition to the normal Fitness for Duty examination to include a completed FD-1065a, FD-899 and FD- 900.

Pulmonary Function Test (PFT) shall be done with the initial examination and every exam after if the individual is a smoker. A posterior and anterior (PA), and lateral (LAT) chest X-ray shall be completed with the initial examination only.

3.5.8 Objective E - Task 8 HAZMAT Examinations

The contractor shall perform All HAZMAT examinations in addition to all the components of a Periodic Fitness for Duty examination (see Section on these exams) shall include a completed FD-899 and FD-900. RBC and Plasma Cholinesterase blood draw (one draw) shall only be drawn if indicated in the Ad Hoc section of the FD-1126.