PWS.pdf

Attachment A

WAPA

DESERT SOUTHWEST REGION

PERFORMANCE WORK STATEMENT For

OCCUPATIONAL MEDICAL EXAMINATION SERVICES

1. GENERAL INFORMATION

1.1 SCOPE OF WORK

The Contractor shall provide all necessary facilities, staff, materials and equipment to provide periodic occupational health examinations, as well as exit medical examinations, and fit for duty in this Performance Work Statement (PWS), for employees of the Western Area Power Administration, Desert Southwest Region (WAPA), located in and around Arizona and Nevada. The scope of work is outlined in each specific exam packet that is located in Attachment B (WAPA Order 340.1).

1.2 LOCATION OF PERFORMANCE

Performance under this contract shall primarily occur at the DSW Regional Office located at 615 S. 43rd Avenue, Phoenix, Arizona. The Contractor must also be able to provide service to employees located in the following locations Yuma, AZ, Flagstaff, AZ, Phoenix, AZ, and Henderson, NV. The Contractor must have facility within a 30 mile radius of the locations previously identified.

1.3 PERIOD OF PERFORMANCE

This contract shall be awarded with a base year and with four option years.

1.4 GOVERNMENT PERSONNEL

The Contracting Officer (CO) is the individual executing this contract on behalf of the Government and is responsible for the overall administration of the contract. The CO is the only person authorized to make any changes in the prices, terms, or other conditions of the contract.

Krystall Valencia, G0700 DSW Safety and Occupational Health Specialist G0700, is designated as the Desert Southwest Region (DSW WAPA), Point of Contact (POC) for this contract. Sandy Akin, DSW Safety and Occupational Health Specialist, is the local secondary contact if the Clinic Staff require urgent assistance and cannot communicate directly with the main POC Safety and Occupational Health Specialist. The WAPA POC is responsible for giving the Contractor any special instructions or guidance necessary to complete the work; however, the WAPA POC has no authority to alter the terms and/or conditions of the contract. The contact information for the WAPA’s POC will be provided at the pre-performance meeting.

1.5 CONTRACTOR PERSONNEL

Physicians must be qualified in occupational health and assisted by licensed nurses or physician’s assistants qualified in the occupational field. Each Certified Medical Examiner must be licensed to practice in the state in which they reside. Staff must include certified medical examiners listed on the National Registry of Certified Medical Examiners in accordance with Title 49, C.F.R. §391.41-49.

1.6 INSURANCE REQUIREMENTS

The Contractor shall obtain and carry in full force during the period of this contract such permits, licenses, bonds and insurance required by state, municipal and federal law pertaining to the scope of professional practice described herein. Proof of insurance shall be provided to the Contracting Officer in accordance with contract clause FAR 52.237-7, within 10 days AFTER contract award.

1.7 OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION REGULATIONS

The Contractor shall comply with the latest effective standards promulgated by the Department of Labor, Occupational Safety and Health Administration, Safety and Health Standards, 29 CFR 1910 and 29 CFR 1926.

1.8 PRE-PERFORMANCE MEETING

The CO will schedule a pre-performance meeting with the Contractor and the WAPA POC, within 10 days AFTER contract award to discuss contract requirements.

1.9 PAYMENT

The Contractor shall submit invoices listing each employee’s examination, itemizing in detail all charges (including any tests, lab work or other services provided by other medical entities), to the address specified in the Contract. Separate invoices shall be submitted w ithin 30 calendar days of the last service rendered in a month, to include all services done in that particular month indicating what services were rendered.

Invoice example:

Date of Physical Employee Name Charge Description

Charge Amount Payments

01/01/2017 WAPA Employee Audiogram $$ DOT Recertification $$

Balance Due: $$

All invoices will be sent to:

WPSC-CFO@wapa.gov

WAPA

Accounts Payable

PO BOX 281111

Lakewood, CO 80228-8111

Upon receipt of invoice, and after all deliverables required (under Parts 2.3 and 3.1 of this PWS) have been completed in accordance with this Performance Work Statement, the CO will approve payment only for those services and tests required and authorized by the Contract. Invoices that have not met all of the deliverables required will be rejected and sent back to the Contractor.

2. DESCRIPTION OF SERVICES TO BE PERFORMED

2.1 GENERAL

The Contractor shall provide periodic occupational health and exit examinations for WAPA employees and shall provide the required documentation during the scheduled physical examination, all in accordance with Attachment B (WAPA Order 340.1). The occupational health examinations shall be conducted by or under the direction of a qualified and licensed occupational health physician. The purpose of the exam is to determine fitness for duty according to the requirements of the employee’s position. Any deficiencies must be identified and documented, especially in connection with hearing, respiratory, mailto:WPSC-CFO@wapa.gov lifting, and other adverse environmental conditions and hazardous or arduous duties. The examining physician must report these deficiencies to the employee and the WAPA POC, HR, in a written analysis (see Part 2.3 below).

2.2 PERIODIC PHYSICAL EXAMS / EXIT EXAMINATIONS

Employees being examined will provide the examining physician a medical packet containing all required forms and information at the time of examination.

The requirements for pre-employment, annual and exit examinations are listed in (Attachment 3 of) WAPA Order 340.1.

The components of the examinations are dependent upon the employee’s position and are broken out in such a manner in position description exam packet.

2.3 DETAILED REQUIREMENTS FOR ALL MEDICAL EXAMS

For each medical examination, the examining physician must:

a) Become familiar with the employee’s physical duty requirements.

b) Ensure medical equipment is adequate in terms of present day accepted standards of medical practice, maintained in good working order, and properly calibrated.

c) Complete Parts B & C of the applicable OF 178, Certificate of Medical Examination (U.S. Office of Personnel Management (Attachment 6 of WAPA Order 340.1).

d) Complete Part B of WAPA F 5400.31, Medical Examination Form (complete all parts of the position specific exam packet).

e) Compare previous physical examination data with current results for all periodic exams. (When available WAPA will provide a copy of prior year examination data via confidential mail if such records are not on file in physician’s office.)

f) Review and discuss the abnormal examination results with the employee at the time of the examination.

g) Physician will obtain employee’s signature on the Medical Release Form, authorizing the physician to provide the examination results to WAPA.

h) (This section required only for Commercial Driver Fitness Determinations) Complete the Medical Examination

Report for Commercial Driver Fitness Determination (649-F 6045) and the Medical Examiner’s Certificate (650-FS-L2 6046), when provided in the examination packets (if necessary). These are Department of Transportation requirements for employees who operate commercial vehicles over 26,000 pounds. Form 650-FS-

L2 and a copy of 649-F (6045) shall be returned to the employee with the written analysis described in Part 3.1 below. A copy of these forms shall be provided to the WAPA POC with the employer copy of the analysis described below. The remaining individuals not required to obtain the aforementioned certificates (CDL) will receive a physical exam within guidelines in Attachment B (WAPA Order 340.1).

i) Medical History: The Genetic Information Non-Discrimination Act of 2008 prohibits WAPA from acquiring or using information about an employee or applicant's genetic information, including family medical history. The Contractor, physician or physician-designee are not to inquire about an individual's family medical history or other genetic information. I f such information is disclosed to the Contractor, the physician or the physician-designee, the information must be redacted and/ or w ithheld from any findings reported to WAPA.

3. REPORTING REQUIREMENTS

3.1 WRITTEN EXAMINATION ANALYSIS, TEST RESULTS AND DOCUMENTATION

The examining physician shall provide a written analysis (cover sheet) clearly describing all test results and documentation as required in Part 2.3 (of this PWS), to the employee, at the employee’s home address, within 45 calendar days of the examination. A copy of the analysis and test results shall also be sent to the attention of the WAPA POC, in the self-addressed stamped envelope, marked confidential.

WAPA

Human Resources – A7200

PO BOX 281111

Lakewood, CO 80228-8111

A cover letter, noting the type of exam given (e.g., annual/periodic, fitness-for-duty, or exit) and clearly describing overall findings with emphasis on potential health concerns, hearing, CDL and respirator conditions, must accompany the results provided to the employee and to the WAPA POC.

WAPA

Safety – G0702 PO Box 6457 Phoenix, AZ 85005

4. SCHEDULING OF TESTS

4.1 GENERAL

The WAPA POC will identify individuals who are required to receive an examination. This information will be provided to the Contractor at the pre-performance meeting.

If the facility is unable to conduct specific tests, the Contractor shall be responsible for designating a specific testing facility and scheduling an appointment on behalf of the employee. The Contractor shall pay for any such approved tests provided by other medical subcontractors and bill WAPA for those tests.

If appointments are canceled/rescheduled WAPA will not incur any of the charges.

4.2 ADDITIONAL DIAGNOSTIC TESTS OR SPECIAL EXAMS

Any diagnostic test or special examination which the examining physician deems necessary, but not specifically required by the Order or this Contract, must be approved by the WAPA POC prior to conducting such test or examination. Any tests or services requested by the employee, which are not approved by the WAPA POC, are not authorized and are specifically excluded from this Contract. The physician should refer the individual to their private health care provider.

Immunizations (Hepatitis B, Tetanus) [that are specially mentioned in Attachment B (WAPA Order 340.1)] are authorized under this Contract, and shall appear on the invoice as a separate line item.

5. QUALITY ASSURANCE

5.1 GENERAL

The Contractor shall perform all services hereunder in compliance with the Government’s Performance Standards outlined below, with the requirements of the Contract, and in accordance with any quality assurance program normally used by the Contractor. The Contractor’s quality assurance program should include procedures to identify, prevent, and ensure non-recurrence of defective services.

5.2 PERFORMANCE STANDARDS

1. The Contractor shall only invoice for services and/or tests required by this Performance Work Statement and approved by the WAPA POC. Invoices shall be submitted w ithin 30 calendar days of the last service rendered in a month, to include all services done in that particular month.

2. Invoices shall be itemized, detailed and clear as to which services and tests were performed, and for which employee, on which date. All invoices shall be sent to:

WAPA

Accounts Payable - A8210 P.O. Box 281111 Lakewood, CO 80228-8111

3. Lab results shall be accurate. Re-testing required due to Contractor/lab error or loss, shall be minimal and immediate, and shall be performed at no additional cost to WAPA.

4. To the maximum extent possible, the examinations, services and tests shall be accomplished within a two (2) hour timeframe, for each employee. The employee shall be given ample time with the examining physician to discuss health concerns.

5.3 ASSESSMENT

The WAPA POC will monitor the Contractor’s performance to ensure compliance with this Performance Work Statement and with any other Contract specifications and requirements. The Government may use various methods to monitor performance such as random inspections, complaints received from WAPA employees, improper or inaccurate invoicing, etc.

When deficiencies are observed, the WAPA POC, Krystall Valencia – Safety and Occupational Health Specialist, will meet with the Contractor’s on-site representative to review the deficiency and ensure the Contractor has an understanding of the deficiencies. The preferred method to resolve deficiencies is to allow re-performance to correct the deficiencies at no additional cost to WAPA. The Contractor shall be provided an opportunity to correct any deficiencies within a reasonable timeframe (but in no case more than 30 days) depending on the type of deficiency. In the event the deficiencies are not corrected in a timely manner or there are more than three deficiencies in any one month, the Contracting Officer may: (1) have the work (services/tests) accomplished by other means and the cost deducted from the associated invoice payment, or

(2) (for administrative deficiencies such as invoicing issues, etc…) have 10% deducted from the invoice payment, or (3) terminate the contract for failure to perform.