Final Water Draft_Combine SOW_DHR and AFRD_v3.pdf

DRAFT

SCOPE OF SERVICES

PART A: HUMAN RESOURCES

Post Employment Offer Physicals and Drug Testing

The City of Atlanta (the “City”), Department of Human Resources (“DHR”) is seeking a qualified

Medical Services firm or firm(s) that provides 24-hours, 7 days per week Occupational Medical

Services which includes Post Employment Offer Examinations, Fitness for Duty Evaluations, and

Physical Ability/Agility Testing. The Medical Services provider shall provide physical examinations, Commercial Driver's License (CDL) medical certification and recertifications, Peace

Officer Safety Training (P.O.S.T Certification and Recertification's), post offer medical examinations, return to work examinations for safety sensitive positions; special examinations such as hazmat/respirator fit evaluations; COVID-19 testing, medical consultations/testimony;

drug and alcohol random-testing, post-accident (per U.S Department of Transportation regulations) reasonable suspicion, and post-employment services. The Physical Agility Testing shall administer a designed battery of tests to evaluate applicant's ability to perform essential job functions.

Services are defined as follows:

I. Physical Examinations - The specific procedures included in each type of physical examination are listed as follows:

A. Peace Officer Safety Training (P.O.S.T. Certification and Recertification) Sworn Police

Personnel.

1. Basic Physicals

a. Medical History including pulmonary, cardiac, and musculoskeletal.

b. Physical findings, including weight, height, blood pressure, pulse, and other vital signs.

c. Titus (vision) and audiogram tests.

d. Clinical Evaluation of the head, neck, thyroid, eyes, ears, nose, throat, chest, heart, lungs, breasts, abdomen, inguinal hernia, genitalia, rectum, prostrate, back, spine, bones, joints, extremities, skin, neurologic/emotional status, menstrual period, (LMP), and other parts of the body as deemed necessary.

2. Urinalysis

3. TB Tine

4. Serology

5. Hepatitis B

6. P A Chest X-ray

7. Agility Assessment

8. Hematocrit

9. SMAC

10. Physician's Affidavit - Recertification Application

II. Post Offer Physical Examinations – Examinations for safety sensitive positions which may require additional specific physical requirements determinations (i.e., static lift test, or comprehensive back evaluations).

A. Medical Certification Examinations - Commercial Driver's Licenses (CDL) - CDL holders meeting Federal Transit Administration (FTA) safety-sensitive definition. DOT

Examination (Program requirements following DOT regulation §391.41) with BMI/OSA

Assessment with Card and Drug/ Alcohol Tests.

B. Safety Sensitive Positions, including but not limited to, Parks Workers, Environmental

Service Workers, Facilities Maintenance, etc.:

1. Basic Physicals

a. Medical History including pulmonary, cardiac, and musculoskeletal.

b. Physical findings, including weight, height, blood pressure, pulse and other vital signs.

c. Titmus (vision) and audiogram tests.

d. Clinical Evaluation of the head, neck, thyroid, eyes, ears, nose, throat, chest, heart, lungs, breasts, abdomen, inguinal hernia, genitalia, rectum, prostrate, back, spine, bones, joints, extremities, skin, neurologic/emotional status, menstrual period, (LMP), and other parts of the body as deemed necessary.

2. Urinalysis

3. TB Tine

4. Drug Test (MRO Confirmation Section VIII and IX)

5. Breath Alcohol Test

C. Sworn Police Officers/Sworn Firefighters/Corrections Officers:

1. Basic Physicals-

a. Medical History-including pulmonary, cardiac, and musculoskeletal.

b. Physical findings, including weight, height, blood pressure, pulse, and other vital signs.

c. Titmus (vision) and audiogram tests.

d. Clinical Evaluation of the head, neck, thyroid, eyes, ears, nose, throat, chest, heart, lungs, breasts, abdomen, inguinal hernia, genitalia, rectum, prostrate, back, spine, bones, joints, extremities, skin, neurologic/emotional status, menstrual period, (LMP), and other parts of the body as deemed necessary.

2. Urinalysis

3. TB Tine

4. Drug Screen 10 Panel (MRO Confirmation Section VIII and IX)

5. Breath Alcohol Test

6. Hepatitis B

7. P A Chest X-ray

8. Agility Assessment

9. Hematocrit

10. SMAC

11. Drug Test

12. Alcohol Test

13. LAB Sickle Cell

14. LAB HIV -1 Antibodies

15. LAB CBC w/Differential

III. Special Requirements - Procedures based upon physical job requirements or risk factors for safety sensitive positions.

IV. Special Examinations:

A. Hazardous Materials (HazMat)/Respirator Clearance - Annual HazMat/Respirator

Clearance examinations are required for employees working in specific maintenance operations (i.e., Watershed Maintenance Technician, Solid Waste Equipment Operator, Environmental Compliance Technician). The specific procedures included in the Hazardous

Materials (HazMat) examination are listed in Form 3 - Price Proposal.

1. Medical History-including pulmonary, cardiac, and musculoskeletal and compares current data and findings to previous years.

2. Physical Finding-including weight, height, blood pressure, pulse and other vital signs.

3. Clinical Evaluation of the head, neck, thyroid, eyes, ears, nose, throat, chest, heart, lungs, breasts, abdomen, inguinal hernia, genitalia, rectum, prostrate, back, spine, bones, joints, extremities, skin, neurologic/emotional status, menstrual period, (LMP), and other parts of the body as deemed necessary.

4. Spirometry

5. Chest X-ray

6. EKG

7. Extended Vision

8. OSHA Respirator Questionnaire

B. Fitness-For-Duty

1. Medical Fitness for Duty (FFD) Evaluations - A Fitness for Duty examination may require medical evaluations to assess the physical readiness of an employee to perform the essential functions of his/her job. Job descriptions will be provided on all Fitness for Duty evaluations. The employee's status will be addressed as fit or unfit with additional direction for further follow-up care/diagnostics at their own expense. All FFD examinations will be authorized by the Occupational Medical

Services staff and may include any services listed within this Statement of Work.

2. Psychological Fitness for Duty (FFD) Evaluations - A formal, specialized examination of the employee that results from (1) objective evidence that the employee may be unable to safely or effectively perform a defined job and (2) a reasonable basis for believing that the cause may be attributable to a psychological condition or impairment.

Ergonomic Assessment/Onsite Job Analysis - At the City’s discretion, other existing positions will undergo an ergonomic onsite job analysis to identify and document accurate physical demands of the job(s). The final reporting format will be agreed upon by the City and the Service Provider. Additionally, onsite job analysis may be requested in the development of the City’s task bank for the Modified and Transitional Duty Programs

(MDP/TEP). Service Provider shall provide a proven methodology which is legally defensive and meets Equal Employment Opportunity Commission (EEOC)/Americans with

Disabilities Act (ADA) guidelines.

V. Random Drug and Alcohol Tests – The City requires 24-hour, 7 days per week service for blood, breath alcohol and urine drug tests. The Service Provider must comply with and demonstrate a thorough and complete knowledge of the Department of Transportation's (DOT) rules, 49 CFR

Part 40 (Procedures for Transportation Workplace Drug and Alcohol Testing Programs), 49 CFR

Part 655 (Prevention of Alcohol Misuse and Prohibited Drug Use in Transit Operations), U.S.

Department of Transportation Lab Procedures and any future Federal requirements for alcohol and drug testing.

VI. Drug and Alcohol Tests:

A. 90-day Return to Work- excludes physical examination.

B. Post-Accidents as required by the rules and regulations referenced in Section V directly above.

C. Reasonable Suspicion.

VII. Medical Review Officer (MRO) Confirmatory - Reporting to Designated Employer

Representative (DER)/Drug & Alcohol Program Manager (DAPM) positive test results under

Department of Transportation's (DOT) rule, 49 CFR Part 40 (Procedures for Transportation

Workplace Drug and Alcohol Testing Programs).

VIII. Consultative/Medical Review/Testimony

A. The Service Provider must be available to consult with and advise the City’s management by telephone or in person as needed. Direct communication with the physician(s) is required on an as needed basis. The Service Provider must be available for quarterly partnership meeting at a mutually agreeable time and location.

B. The Service Provider assigned to perform the medical services of the Agreement shall have a thorough knowledge of laws governing occupational medicine for transportation, the Municipal

Code of Ordinances or the City of Atlanta provisions relating to drug testing and physical examinations, have an understanding of the physical and mental requirements to perform City's relevant jobs, be available to attend meetings, and be prepared to discuss and make recommendations to the City's designated staff on employees' fitness for work and reasonable issues.

C. The Service Provider shall be prepared to testify in administrative, legal, or arbitration proceedings on any claim or grievances arising out of injuries, illnesses, employment examinations or tests, or other similar matters.

D. The Service Provider may provide recommendations and participate in educational programs for the City’s employees. This may include Health Education Seminars with supporting materials.

IX. Documentation/Recordkeeping/Automated Transfer of Information

A. Service Provider shall maintain a detailed recordkeeping process, with detailed flowcharts of the medical records reporting and the City's access to available reports.

B. The Service Provider shall document all examinations, tests, and findings, including but not limited to, using, and completing appropriate City forms, affidavits, and medical evaluation certificates, furnishing progress notes and correspondence as necessary. Documentation and recordkeeping will be in accordance with City policies and any State and/or Federal Requirements.

C. The Service Provider shall provide all examinations/testing results as defined under this

Statement of Work, including pending records, same day no less than the next business day from the date of service via electronic information systems. Alcohol test results shall be available same day. Results of all drug tests shall be available within one (1) business day. Final disposition of pending records due to lab results shall be reported within 1-3 business days of the date of service.

D. Service Provider's medical records system shall have a method of immediate electronic notification to the City's Benefits Staff when new records are available, or status updates occur.

E. Service Provider shall maintain a detailed description of its Internal Quality Assurance process to ensure correctable errors are identified prior to reporting exam or testing results.

F. The Service Provider shall immediately notify an Benefits staff when an employee is removed from work or not cleared to return to work due to disqualified/failed/unfit physical examination and has been referred to his or her personal physician for evaluation and/or treatment. Additionally, immediate notification is required when the medical status has been upgraded to qualified/passed/fit, allowing the employee to return to work.

G. The Service Provider shall advise the City's designated Occupational Medical Services staff on employees' physical/mental capacity to perform defined work, limitations in capacity, restrictions on environment or assignment, disability, etc., in order to determine matters of fitness and reasonable accommodations.

H. Service Provider shall provide all completed, original Custody and Control Forms (CCF) and

Alcohol Test Forms (ATF), at a minimum, on a weekly basis. All incoming Custody and Control

Forms (CCF) and Alcohol Test Forms (ATF) will be reviewed by the City's Designated Employer

Representative (DER) for quality assurance purposes.

I. The Service Provider shall require the City employees reporting for drug and alcohol tests to present a picture I.D. to confirm identity. Absent of a picture I.D., the Service Provider shall take a digital picture of the employee and notify the City OMS staff to confirm identity following the test.

J. The Service Provider shall document on the Random Test Notification Cards, the date and time employees arrive and depart with an electronic date/time stamp. The City's "Late" arrival notification protocol must be incorporated into the Service Provider's workflow and fully adhered

to. Late notification protocol includes:

1. Contemporaneous, verbal communication with the City’s Designated Employer

Representative (DER) to report any employee arriving greater than one (1) hour from the time of notification;

2. Verbal approval by the DER to proceed with testing;

3. Receipt of a written, signed statement from the employee;

4. Proceed with requested testing; and

5. Transmission of the written statement via fax or e-mail to the Designated Employer

Representative (DER).

K. The Service Provider shall provide the employees, in writing, of any results/findings requiring further medical evaluation.

L. The Federal Transit Administration (FTA) establishes a records retention under 69 C.F.R

655.71. However, the City maintains a best practice records retention of a minimum of five (5) years. All employee records established under this Statement of Work, for this Agreement, will be retained for a minimum of five (5) years.

M. Upon termination of the Agreement, all employee records established under the Statement of

Work for this Agreement will be electronically transferred to the City for archival. All records must be transmitted prior to payment of the final invoice (See Section XI, Systems Requirements) below.

X. Service Requirements:

A. The Service Provider shall comply with all guidelines under Department of Transportation's

(DOT) regulation, 49 CFR Part 40 (Procedures for Transportation Workplace Drug and Alcohol

Testing Programs), which sets standards for the collection and testing of blood, urine and breath specimens.

B. The Service Provider shall agree not to render service to any employee for services without proper written authorization. If services are rendered without proper written authorization, the City reserves the right to withhold payment for that service. Except in cases where afterhours are coordinated by the City's Occupational Medical Services Staff only, verbal authorization will be accepted, i.e., post-accidents (under U.S DOT regulations, Officer involved incident and reasonable suspicion0.

C. The Service Provider must be available for 24-hours, 7 days per week for blood, alcohol, and urine drug tests, including on-site screenings. The Service Provider shall be available to provide random, post- accident (under DOT regulations) or reasonable suspicion drug/alcohol/blood testing 24-hours, 7 days per week, including on-site screenings. Random Test schedules including on-site screenings will be set by the City's Designated Human Resources Representative and session information will be provided to the Service Provider.

D. The Service Provider shall assume sole responsibility for afterhours, weekends, and holidays coordination of their staff, including on-site screenings and visits, to meet the City's existing procedures for blood, drug & alcohol testing. The City will not be responsible for contact and/or coordinating the Service Provider's staff or any of their third party contracted vendors for services in these circumstances.

E. The Service Provider must provide Breath Alcohol Technician and Collectors to conduct on-site post- accident Department of Transportation (DOT) blood/drug/alcohol testing for emergency room/hospitalized employees involved in vehicle accidents and/or Officer involved incident For

Emergency Room (ER)/hospitalized employees, coordination and collection by the Service

Provider must occur within two (2) hours of the accident.

1. Service Provider shall maintain a methodology for securely and confidentially reporting positive Breath Alcohol tests to its employee.

F. The Service Provider shall provide a list of facilities in the metropolitan area which will offer services under this Statement of Work. Additionally, the Service Provider shall demonstrate the facilities accessibility to the rail and bus lines.

G. Validated parking vouchers or adequate free parking will be provided for the City’s employees visiting the Service Provider's facility.

H. The Service Provider shall have facilities, equipment, personnel, and resources to provide the complete Statement of Work required under this Agreement.

I. Service Provider shall maintain a detailed process for appointment scheduling to support an efficient high-volume clinic, with clearly defined check-in/out procedures.

J. The Service Provider shall maintain a current training and/or re-training plan for key staff. The training plan shall include at a minimum the type and frequency of training.

K. Physician(s) assigned to the City's Agreement is/are required to have recent occupational medicine experience and a comprehensive knowledge of Federal Transit Regulations, Family

Medical Leave Act, the Americans with Disability Act, the terms of this Agreement, the physician requirements to perform the City jobs relevant to this Agreement and related the City policies and procedures.

L. The City reserves the right to review the credentials, interview the physician(s) and key medical personnel prior to their assignment to the City's Agreement. The City reserves the right of approval of physicians(s) or key personnel assigned to this Agreement. The City also reserves the right to approve drug and alcohol testing laboratories.

M. The Service Provider must provide a back-up licensed medical doctor, certified medical examiner/Department of Transportation (DOT) and certified Medical Review Officer (MRO) that is familiar with all aspects of the Occupational Medicine Services Agreement. The Service

Provider must receive prior approval from the City's Benefits Director.

N. The Service Provider shall provide the City with a chart detailing its organizational structure and a written policy on the communication workflow between the Service Provider and the City.

O. The Service Provider's physician(s) must be available to provide expert testimony for grievances, depositions, arbitrations, and litigations at the contracted fee, based upon the

City's need. Whenever possible, the City will give a 48-hour notice.

P. The Service Provider must be available for walk-in appointments as necessary.

Q. The Service Provider shall provide the City's Benefits Director and Designated Employer

Representative (DER) with agreed upon access 24-7 to the employee records for services rendered within this Statement of Work.

R. In case of computer system/server malfunction on the part of the Service Provider, the Service

Provider shall:

1. Notify the City's designated Occupational Medical Services (OMS) staff immediately, by phone, of the system's issues; and

2. Provide hard copies of all alcohol, drug, and physical examination results on a daily basis via courier service until the electronic data exchange is corrected and fully functioning.

S. Notification of positive drug and alcohol test results will adhere to Department of

Transportation's (DOT) rule, 49 CFR Part 40 (Procedures for Transportation Workplace Drug and

Alcohol Testing Programs.

T. Service Provider shall have in place a protocol for communicating sensitive exam and testing results which shall be made available upon request by the City's Drug and Alcohol Program

Manager (DAPM).

XI. Systems Requirements:

The Service Provider must ensure that all systems used for storing and processing post-offer employment physical data comply with applicable data privacy laws, including HIPAA and any other relevant regulations. Systems must include measures to protect against unauthorized access, data breaches, and cyberattacks, including:

Encryption of data at rest and in transit.

Multi-factor authentication for system access.

Role-based access control to restrict access to sensitive data.

All data collected or generated as part of the Agreement must remain the property of the City of

Atlanta.

XII. The City Employees Authorized to Request Services:

The employees in the following positions shall be authorized to request the specified services for the City. All results will be sent to the designated HR Staff.

Benefits Director

Benefits Director Designated

Medical Leave Manager

Full Statement of Work

Occupational Medical Services Supervisor Senior Occupational Medical Services & Occupational

Medical Services Specialists Designated Employer Representative (DER)/ Drug & Alcohol

Program Manager (DAPM).

Post-offer physicals, Return to work exams, Medical recertification exams, DOT/Non-DOT Drug

& Alcohol tests, special procedures (i.e., comprehensive back evaluations, static lift, etc.).

Post-accidents DOT, Reasonable suspicion. Medical recertification exams

Fitness for Duty evaluations.

Post-accidents DOT, Drug & Alcohol, Reasonable suspicion, Medical recertification exams

Fitness for Duty evaluations.

All physicals & examinations defined under the Statement of Work; Random, Post-Accident DOT, Reasonable Suspicion drug & alcohol results as well as Non-DOT follow up testing, if necessary

All Specialty examinations requested.

Upon Request, results of any and all medical services may be reported to the Commissioner of

Human Resources or Human Resources Benefits Director/Manager.

XIII. Reporting:

A. The Service Provider shall provide a monthly and yearly service report documenting service usage as outlined in the Statement of Work, including but not limited to exam/test type by category, total number of tests conducted, test/exam type outcome, i.e., qualified, disqualified, positive, negative, 2-year Department of Transportation (DOT) cards, etc. In addition, wait time, in/out time times must be included.

B. The Service Provider shall grant access to the designated Occupational Medical Services (OMS) staff ad hoc privilege to generate reports as needed for analysis and trending of exams and testing data on an as needed basis. If access cannot be granted to designated Occupational Medical

Services (OMS) staff, the Service Provider, within 48 hours of the request, will generate all ad hoc reports at no additional costs to the City.

XIV. Invoicing/Billing:

An itemized bill for all services and related costs including but not limited to medical exams and drug/alcohol screening shall be prepared by the 5th of the following month and emailed to the

Department of Human Resources, 68 Mitchell Street, S.W., Suite 2120, Atlanta, Georgia 30303-

0306. The itemized bill shall include the applicant’s name, date of exam, and a list of each charge and the particular test/screening provided.

CITY OF ATLANTA

FIRE – RESCUE DEPARTMENT

ANDRE DICKENS 226 Peachtree St., SW RODERICK M. SMITH MAYOR Atlanta, GA 30303-3749 FIRE CHIEF

PHONE (404) 546-7000

ICHIEFS ID – ATLFDHQ

Fire and EMS Medical Evaluation Scope of Services Annual Member Physicals for Atlanta Fire Rescue Department

1) The AFRD is seeking a Professional Services Agreement with a company (“Contractor”) that can provide comprehensive medical evaluations for AFRD sworn personnel.

a) The Contractor shall provide annual physical examinations with appropriate blood tests, chest radiographs, ultrasounds for approximately 1000 employed AFRD personnel (hereinafter referred to as “member”).

b) The Contractor shall provide a board-certified physician and/or mid-level healthcare provider defined as a certified nurse practitioner or physician’s assistant and will heretofore referred to as “provider.”

c) The title of physician shall be defined as either a Doctor of Medicine (MD) and/or Doctor of Osteopathic Medicine (DO) and both are considered equally qualified to support the scope of services provided.

d) Provider Board certification shall include one or more of the following levels of training:

i) Family Medicine

ii) Internal Medicine

iii) Occupational Medicine

e) Provider shall have these desirable qualifications:

i) Experience in fields relevant to the fire service such as occupational toxicology.

Industrial hygiene, epidemiology, infectious disease, pulmonary disease, cardiology, orthopedics, psychiatry, and emergency medical care.

ii) Experience/familiarity with job tasks of a firefighter including physical demands, psychological stressors, chemical, biological, and physical exposures and the effects of medical conditions on jobs tasks.

Part B: AFRD

iii) Knowledgeable in local, state, and federal laws related to health and safety of the firefighter.

iv) Knowledgeable of trends related to firefighter injuries and illnesses.

f) The Contractor shall be able to provide all services, within this agreement, at an AFRD designated City of Atlanta facility for year-round exams.

i) Ability to conduct exams/tests within ±15 business days of a member’s birthday.

ii) Ability to process at least 25 members per week or 100 members a month.

iii) Ability to provide a minimum of 42 weeks of service per year.

g) The Contractor shall evaluate members to identify medical conditions that could affect their ability to safely respond to and participate in emergency operations.

h) The Contractor shall report the results of the medical evaluation to the member, including any medical condition(s) identified during the medical evaluation, and the recommendation as to whether the current member is medically certified to safely perform the essential job tasks.

i) Any abnormal findings shall be addressed directly with the member with specific recommendations to control or remedy the abnormality, and with recommendations for follow-up or referral.

j) The Contractor shall forward copies of any abnormal results along with instructions regarding primary care follow-up to a member who was instructed to seek (as appropriate) medical follow-up to address any medical conditions or lab/tests abnormalities identified during the medical evaluation.

k) The Contractor shall provide for transfer of all medical records to a new service provider upon contract expiration or termination.

2) The physical examinations conducted by the contractor must adhere to the following standards as a minimum:

a) The United States Occupational Safety and Health Administration (OSHA) Regulations (Standards 29 CFR).

i) 1910.5 (Applicability Standards)

ii) 1910.120 (Hazardous Waste Operations and Emergency Response)

iii) 1910.134 (Respiratory Protection)

iv) 1910.156 (Fire Brigades)

v) 1910.1030 (Bloodborne Pathogens)

b) The National Fire Protection Agency (NFPA) 1582 – 2022 Edition (effective April 8, 2021), Standard on Comprehensive Occupational Medical Program for Fire Departments which contains minimal standards for release to work.

3) The contractor shall work with the AFRD Health & Safety Officer or designee to ensure that all requirements of the agreement are met in a timely manner.

a) Agree to the overall and daily scheduling for annual physicals and make-up exams.

b) Agree with the AFRD duty schedule to maintain continuous service to the community.

4) Medical Record Keeping

a) All medical record keeping shall comply with the requirements of 29 CFR 1910.1020, “Access to employee exposure and medical records,” and other applicable regulations and laws.

b) Medical records shall include any follow up or additional fitness and/or specific medical testing performed outside of these guidelines.

c) The confidential information shall be maintained as part of an individual’s comprehensive medical record.

d) The Contractor shall be responsible for archiving these additional records as a part of each member’s confidential medical file.

5) Reporting and Contractor Responsibilities

a) The Contractor shall provide each member a copy of the information gathered during their annual physical, including interpretive data.

b) The Contractor shall provide to AFRD a medical “Clearance Letter” for each member on an annual basis.

c) These letters shall be classified as:

i) Fully Cleared for SCBA respirator use/essential firefighter duties as defined in the NFPA 1582 and OSHA 1910.156 and 1910.134.

ii) Temporarily Cleared with written expiration date to comply with additional medical information.

iii) Not Medically Cleared to preform essential firefighter duties as defined in the NFPA 1582 and OSHA 1910.156 and 1910.134.

d) The Contractor shall provide AFRD an aggregate report on the data collected during the calendar year. This report shall describe the overall “health” of the fire department.

i) The Department aggregate data for the annual report should include at a minimum the following data set:

(1) Avg age (low and high range)

(2) Avg weight (low and high range)

(3) Avg Blood pressure (low and high range)

(4) Avg Percentage body fat (low and high range)

(5) Avg BMI (low and high range)

(6) Avg Hemoglobin A1c (low and high range)

(7) Avg Blood sugar (low and high range)

(8) Avg total cholesterol (low and high range)

(9) Avg total cholesterol (low and high range)

(10) Avg HDL (low and high range)

(11) Avg LDL (low and high range)

ii) Specific age group statistics shall at a minimum include those data indicated within the following bands:

(1) 18-29

(2) 30-39

(3) 40-49

(4) 50+

(5) Members designated “rookie” or by graduating class.

iii) Include total number of follow-up referrals and may include, but not limited to:

(1) Abnormal EKG

(2) Abnormal Pulmonary test

(3) Recommended stress test

(4) Diabetes (newly discovered)

(5) High Cholesterol

(6) Elevated hemoglobin A1c and fasting blood sugar

(7) Abnormal urinalysis

(8) Abnormal thyroid

(9) Elevated liver enzymes

(10) Elevated PSA

(11) Elevated C125

(12) Abnormal iron

(13) Abnormal kidney function

(14) Abnormal blood count

(15) Abnormal ultrasound (cardiac/aortic/abdomen)

(16) Abnormal Ca Scan

(17) Abnormal Vitamin D level

(18) Abnormal Hearing Test

(19) Abnormal Vision Screen

iv) Include total number of condition specific recommendations and may include, but not limited to:

(1) Weight loss

(a) Total department pounds

(b) Avg lbs./member

(2) Smoking/nicotine cessation

(3) Alcohol cessation

(4) Nutrition

(5) Sleep disturbance referral

(6) Stress awareness referral

6) Each member’s annual physical shall consist of components listed in NFPA 1582 Section 7.5 through Section 7.7 and serve as the bases of the annual medical evaluation.

7) Physical Exam and Consultation - The annual physical examination shall include each of the following elements:

a) Vital signs

b) Head, eyes, ears, nose, and throat (including oral cancer screening)

c) Neck

d) Cardiovascular

e) Pulmonary

f) Breast

g) GI

h) Genitourinary

i) Hernia

j) Lymph nodes

k) Neurological

l) Musculoskeletal

m) Skin (including cancer screening).

n) Vision

8) Blood Testing – Blood tests shall be performed annually and shall include ALL the following for each member:

a) CBC with differential, RBC indices and morphology and platelet count.

b) Electrolytes (N, K, Cl, HCO3 or CO2). (3) Renal function (BUN, creatinine).

c) Glucose - fasting

d) Liver function tests (ALT, AST, direct and indirect bilirubin, alkaline phosphatase).

e) Total cholesterol, HDL, LDL, and clinically useful lipid ratios (e.g., percent LDL) and triglycerides

f) Iron (TIBC)

g) Thyroid function; TSH & free T4.

h) Additional labs (as requested by AFRD)

i) Heavy Metals (HAZMAT Duties): Lead, Aluminum, Antimony, Bismuth, Cadmium, Chromium, Copper, Nickel, Zinc, Organophosphates (Cholinesterase, RBC), Polychlorinated Biphenyls.

ii) Prostate specific antigen (PSA) for all men 40 years and older.

iii) C125 Ovarian Cancer Marker for all women 30 years and older.

iv) Hemoglobin A1c

v) Vitamin D

vi) CRP (C-reactive protein)

9) Urine Laboratory Testing – Urine lab tests required shall be performed annually and include the following:

a) Dipstick analysis for glucose, ketones, leukocyte esterase, protein, blood, and bilirubin.

b) Microscopic analysis for RBC, WBC, casts, and crystals if indicated by dipstick analysis results.

c) Analysis for occupational chemical exposure if assigned to HAZMAT Duties: Heavy metals: Arsenic and Mercury.

10) Audiology Testing

a) Audiology testing shall compare audiogram results obtained during the evaluations with baseline and subsequent test results. Standard threshold shifts shall be corrected for age as permitted by OSHA.

b) Hearing thresholds shall be assessed annually in each ear at each of the following frequencies:

i) 500 Hz

ii) 1000 Hz

iii) 2000 Hz

iv) 3000 Hz

v) 4000 Hz

vi) 6000 Hz

vii) 8000 Hz

11) Vision Screening.

a) Has distant visual acuity of at least 20/40 (Snellen) in each eye without corrective lenses or visual acuity separately corrected to 20/40 (Snellen) or better with corrective lenses.

b) Distant binocular acuity of at least 20/40 (Snellen) in both eyes with or without corrective lenses, field of vision of at least 70 degrees in the horizontal meridian in each eye.

c) The ability of member to recognize the colors of traffic signals and devices showing standard red, green, and amber.

12) Spirometry - Pulmonary function testing shall be conducted annually to measure the following components:

a) Forced vital capacity (FVC).

b) Forced expiratory volume in 1.0 seconds (FEV1).

c) FVC and FEV1 ratio.

d) FEV1 and FVC results shall be expressed as the absolute value and as percent predicted adjusted for gender, age, height, and ethnicity using NHANES III normative equations.

13) Chest Radiograph

a) Chest x-rays shall include an initial baseline and shall be repeated every 5 years or as medically indicated.

b) Contractor shall compare any chest radiographs with baseline and subsequent radiographs.

14) Electrocardiograms (ECGs)

a) A resting 12-lead ECG shall be performed as part of the baseline medical evaluation and shall be performed annually for all members.

b) Evaluations shall compare baseline to subsequent ECGs.

15) Risk Stratification - Cardiovascular

a) The Contractor shall annually assess asymptomatic members 40 years of age or older with no known atherosclerotic cardiovascular disease (ASCVD) for the 2-year and 10-year risk of ASCVD.

b) Asymptomatic members younger than 40 years of age known to be high risk for ASCVD shall be assessed for coronary artery disease.

c) Intermediate Risk

i) Assessed 2 to 4% ASCVD over the next 2 years or 10% to <20% risk of ASCVD over the next 10 years.

ii) Members assessed as being at intermediate risk of ASCVD shall be further evaluated using symptom-limiting exercise stress testing (EST) with or without imaging.

iii) Positive EST shall be referred to a cardiologist for further evaluation and treatment.

iv) Negative ESTs shall be repeated at least every 2-5 years or as clinically indicated, and positive tests shall be referred to a cardiologist for further evaluation and treatment.

d) High Risk

i) Assessed as being at 4% risk of ASCVD over the next 2 years.

ii) Members assessed as being at high risk of ASCVD shall be referred to a cardiologist for further evaluation and treatment.

16) Mammography

a) The Contractor shall inform the female member of the benefits, limitations, and potential harms linked to breast cancer screening.

b) The Contractor shall recommend annual mammography to any female member who 40 to 54 years old and every 2 years for female members who are 55 years and older, or such intervals as clinically indicated.

17) Infectious Disease Screening and Immunizations

a) Tuberculosis (TB) screening

i) Baseline, by either tuberculin skin testing using the tuberculin purified protein derivative (PPD) or the tuberculin blood test (interferon gamma release assay).

ii) Subsequent tuberculosis screening may be performed annually or at a frequency according to CDC guidelines unless the member has a history of positive tuberculin screening test, in which case CDC guidelines for management and subsequent chest radiographic surveillance apply.

iii) QuantiFERON-TB Gold shall be offered as an alternate test if the member has a history of PPD sensitivity and/or TB (BCG) vaccination.

b) Immunizations and Titers:

i) If the member choses to decline a vaccination, there shall be a signed/dated record of declination.

ii) Any declination in a series of vaccinations shall be offered at the member’s next annual physical and if declined again, a new declination shall be updated accordingly.

iii) Hepatitis C virus screening & antibody test – baseline and following occupational exposure (as requested by AFRD).

iv) Hepatitis B virus vaccinations and titers – laboratory confirmation of immunity to be tested 1-2 months after completion of the vaccination 3 dose series or as specified in CDC guidelines

v) Tetanus/diphtheria/pertussis (Tdap) vaccine – can be given once to replace the Td booster every 10 years or the 5-year wound management Td dose or as specified in CDC guidelines.

vi) Measles, Mumps and Rubella (MMR) vaccine and titers– in absence of documented immunity, two doses of MMR to be administered or as specified in CDC guidelines.

vii) Hepatitis A vaccine offered to high-risk personnel [HAZMAT, USAR and SCUBA/Water Rescue] and other members with frequent exposure to contaminated water.

viii) Varicella vaccine and titers– offered to all non-immune members.

ix) Influenza vaccine – offered to all members annually (as requested by AFRD).

x) HIV screening – to all members upon their request.

18) Heavy Metal Evaluation

a) Baseline testing and annually thereafter for heavy metals shall be required for a member who is assigned to HAZMAT duties.

b) Evaluations shall be performed following for recurrent exposures or where required under federal or state regulations.

19) Colon Cancer Screenings

a) The Contractor shall provide Fecal Occult Blood testing to all members aged 30 years and older.

b) The Contractor shall recommend visual exams (e.g., colonoscopy, CT colonoscopy, or flexible sigmoidoscopy) to all members age of 45 and earlier if clinically indicated.

20) Prostate Cancer

a) Contractor shall discuss the risks and benefits of prostate cancer screening, including prostate-specific antigen (PSA) testing, with all male members 40 years and older.

b) The Contractor shall discuss the risks and benefits of prostate cancer screening, including PSA testing for members who are at a higher risk for prostate cancer (e.g., African Americans or where one or more first-degree relatives have been diagnosed with prostate cancer at an early age).

21) Lung Cancer Screening

a) The Contractor shall offer low-dose computed tomography (LDCT) annually to members who are 50 years and older with at least a 20-pack-per-year smoking history and currently smoke or have quit within the past 15 years.

b) Screening shall be discontinued once a member has not smoked cigarettes for 15 years or determined to be of no clinical benefit.

22) Cervical Cancer Screening

Contractor shall discuss the risks and benefits of screening for cervical cancer with cytology (i.e., Pap smear) every 3 years from ages 21 to 65 or screen for combination of cytology and human papillomavirus (HPV) every 5 years.

23) Sleep Disturbance Screening

a) Contractor shall annually screen for sleep disorders using a validated questionnaire, such as the Berlin Questionnaire or Epworth Sleepiness Scale.

b) For members with a high index of suspicion for a sleep disorder based on questionnaires or biometric data, the Contractor shall discuss the risks and benefits of testing and treatment.

24) Cancer and Cardiovascular Disease Risk Reduction

a) Contractor shall annually inform members of the heightened risks of cardiovascular disease and various types of cancer associated with firefighting.

b) Contractor shall offer the following ultrasound imaging studies (as requested by AFRD):

i) Carotid arteries

ii) Echocardiogram (heart with function)

iii) Aorta and aortic valves

iv) Thyroid

v) (Abdominal Organs): liver, pancreas, gall bladder, kidneys and spleen and Bladder

c) The Contractor shall offer a Cardiac Calcium Scan for any member 45 years and older who does not have a prior documented scan in the past 5 years (as requested by AFRD).

25) Occupational Stress Awareness Consultation

a) The Contractor shall during the annual physical, inform the member of, and assess for the heightened risk of, stress associated with occupational exposures related to fire fighting.

b) The Contractor shall make the member aware of common adverse signs and symptoms of occupational stress, inform members of practices that limit the damaging effects of occupational stress, and provide the member with referral to licensed behavioral health specialists trained to recognize and treat stress-related disorders in first responders, as indicated. AFRD currently has a Public Safety Behavioral Health Wellness Unit (BHWU).

Vendor will be expected to collaborate and/or consult with the BHWU Chief Psychologist in the event an AFRD employee endorses items during their physical that would be indicative of mental health concerns. Vendor would be expected to refer employees to BHWU for their annual wellness visit or follow up consultation.

26) Hormone Imbalance Awareness Consultation

The Contractor shall inform the member of the heightened risks of certain hormone therapy, such as testosterone therapy in male members, that can have adverse effects on a member’s health.