FY2026 Medical Surveillance PWS.pdf

PERFORMANCE WORK STATEMENT (PWS)

Medical Surveillance

Part 1 General Information

1. General: This is a non-personal service(s) contract under which the personnel rendering the service(s) are not subject, either by the contract’s terms or by the manner of its administration, to the supervision and control usually prevailing in relationships between the Government and its employees.

1.1 Description of Services/Introduction: Line of Effort Occupational Health Medical Surveillance (LOE OH Medical Surveillance) is identified to delignate Occupational Health Nurse for Medical Surveillance. The line of effort for Occupational Health (OH) Program collaborates to successfully execute preventative measures for federal technicians who work in a potential hazardous workplace environment.

1.2 Background: This mission of the Occupational Health Medical Surveillance Physical Examination in accordance with the Occupational Safety and Health Administration (OSHA), 5 CFR 339 medical standards, and other federal regulatory bodies are instituted to identify, assess, and mitigate occupational injury and illness threats by preventing or reducing work-related adverse health outcomes to protect workers from hazards in the workplace of the New Mexico Army National Guard (NMARNG) facilities. These programs and services are necessary to anticipate, identify, assess, communicate, and control occupational illness and injury by interpretation of the Industrial Hygiene Survey Reports collected in Field Maintenance Shops (FMS), Combined Surface Maintenance Support Facility (CSMS), Maneuver Area Training Equipment Sites (MATES), Armory, Army Aviation Support Facility (AASF), Army Aviation Operation Facility (AAOF), Headquarters (HQ) Administration Facility, United States Property and Fiscal Office (USP&FO) Administration Facility, USP&FO Warehouse, Three Ranges location in Santa Fe, Belen, and Stallion Range within the New Mexico Army National Guard (NMARNG) facilities.

1.3 Scope: Focused on Federal employees of the New Mexico Army National Guard, full-time support and personnel who are working in potential health hazards workplace environment. The number of personnel to be examined is 60.

1.4 Objectives: The purpose of the Occupational Medical Surveillance Examination Program is to provide job-related Medical Surveillance Examinations and Occupational Health Services to the New Mexico Army National Guard (NMARNG) full- time support (FTS) personnel who are or may be potentially exposed to health hazards in the work environment. The examination shall include personnel assigned to positions who are working in a potential hazardous exposed environment requiring specific standards of duties and responsibilities. Medical examinations include but are not limited to the following Standard Occupational Health exams: Pre-placement, baseline, annual, retirement, and termination of exposure medical exams. Personnel not included under these examinations are New Mexico State Employees, civilian contractors, and the NMARNG Inactive Duty Training (IDT) soldiers.

1.5 General Information:

1.5.1 The Contractor shall inform the Contracting Officer (KO) of issues or potential issues that might affect performance within 24 hours of identifying those issues. Verbal reports shall be followed by written reports to the KO within two (2) business days.

1.5.2 Quality Assurance: The NMARNG OHN shall evaluate the contractor’s performance under this contract in accordance with the Quality Assurance Surveillance Plan. This plan is primarily focused on what the NMARNG OHN must do to ensure that the contractor has performed in accordance with the performance standards. It defines how the performance standards will be applied, the frequency of surveillance, and the minimum acceptable defect rate(s) for OH Medical Surveillance.

1.5.3 Recognized Holidays: The following provides information on recognized holidays for the purpose of the PWS. If submittal of any documentation (e.g. deliverables, submittals, etc.) deadlines fall on a holiday, the closest workday prior to the holiday will apply as the deadline for submittal.

1.5.4 U.S. Holidays: Work shall not be performed on U.S. federally recognized holidays occurring during the normal workweek unless otherwise directed by the KO. When a U.S. holiday occurs on a Saturday or a Sunday, the holiday is observed on the preceding Friday or following Monday, respectively.

New Year’s Day January 1st M. L. King Memorial Day 3rd Monday in Jan Presidents Day 3rd Monday in February Memorial Day last Monday in May Juneteenth June 19th Independence Day July 4th Labor Day 1st Monday in September Columbus Day 2nd Monday in October Veteran’s Day November 11th Thanksgiving Day 4th Thursday in November Christmas Day December 25th

1.5.4 Operating Hours:

1.5.4.1 Government Facility Operating Hours: The Government facility operating hours are 0800 to 1700 Monday through Friday.

1.5.4.2 Contractor Support Hours: The Contractor shall provide support between the hours of 0800-1600 on Tuesday, August 18th; 0800-1600 on Thursday, August 20th.

1.5.4.3 Period of Performance Tuesday August 18, 2026, and Thursday August 20, 2026

1.5.5 Place of Performance: The work to be performed under this contract will be performed at:

1.5.5.1 249 Armory Rd, Las Cruces, NM on August 18, 2026.

15.5.5.2 47 Bataan Blvd, Santa Fe, NM on August 20, 2026.

1.6 Security & Access Requirements:

1.6.1 Installation Access: Access to Santa Fe complex is limited to personnel who meet security criteria. The Contractor is responsible for coordinating with the Contracting Officer Representative (COR) to obtain temporary visitor passes for their medical personnel prior to the start of the medical surveillance event.

1.6.2 Physical Security & OPSEC: The Contractor shall safeguard all Government equipment and property provided for their temporary use during the medical services event. Contractor personnel shall adhere to facility security policies and immediately report any suspicious activities to security personnel, the COR, or the KO.

1.7 Post Award Communications: The COR or KO, will hold a brief post-award meeting (via phone or in-person) prior to the event to finalize logistics, base access, and facility setup.

1.8 Key Personnel: The Contractor shall designate someone who shall be responsible for the performance of the work and act as the primary point of contact for the Government during the medical surveillance event.

1.9 Identification of Contractor Employees: Contractor personnel must identify themselves as contractors to avoid creating an impression that they are Government officials. During the medical services event, contractors wear company-branded apparel or easily readable identification badges displaying their name and company affiliation.

1.10 Contractor Travel: All travel, lodging, and per diem costs required for the Contractor to execute this 2-day medical services event at Santa Fe and Las Cruces shall be included in the Contractor's total Firm-Fixed-Price contract. The Government will not reimburse travel separately.

1.11 Protection of Government Information: The Contractor shall not cite any information, take unauthorized photographs, or use locations obtained through this contract on any digital marketing tools or company websites without written permission from the KO.

1.12 Required Training (AT Level I, OPSEC, iWATCH): Due to the short duration of this contract (2 days) and lack of IT access, formal online certification for Anti-Terrorism (AT) Level 1, OPSEC, and iWATCH is not required prior to arrival. Instead, the Government will provide a verbal (phone) AT/OPSEC/iWATCH local threat briefing to the Contractor personnel prior to the performance of the contract.

PART 2

DEFINITIONS & ACRONYMS

2 Definitions and Acronyms

2.1 Definitions: Although not inclusive of every term used within this PWS, the following provides a list of definitions used throughout this PWS and commonly used in the acquisition field.

Contracting Officer (KO) – means a person with the authority to enter into, administer, and/or terminate contracts and make related determinations and findings on behalf of the Government. Note: The only individual who can legally bind the Government.

Contracting Officer's Representative (COR) – As defined in DFARS 202.101, means an individual designated and authorized in writing by the Contracting Officer to perform specific technical or administrative functions. DoD Instruction (DoDI) 5000.72, Part II Definitions states the following when defining a COR: “Defined in subpart 202.101 of Reference (f). Any individual delegated responsibilities pursuant to subpart 1.602-2 of Reference (e), regardless of local terminology, must be certified in accordance with this instruction. For example, local terminology can be COR, Contracting Officer’s technical representative, technical point of contact, technical representative, alternate COR, administrative COR, assistant COR, line item manager, task order manager, quality assurance personnel, quality assurance evaluator, or COR management.” In addition, Army Regulation 70-13, Chapter 2, paragraph 2-2g, states, in part, the following when providing other surveillance support personnel to assist the COR when needed, “…These other surveillance support personnel may serve as on-site representatives of the COR in performance of actual contract surveillance if they meet all COR requirements and have been appointed by the Contracting Officer as alternate CORs.”

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

Contractor-acquired Property - means property acquired, fabricated, or otherwise provided by the Contractor for performing a contract and to which the Government has title.

Day – means, unless otherwise specified, a calendar day.

Defective Service – means a service output that does not meet the standard of performance associated with the Performance Work Statement.

Deliverable – means anything that can be physically delivered but may include non-manufactured things such as meeting minutes or reports.

Government-furnished Property – As reflected in FAR 52.245-1, Government-furnished Property “means property in the possession of, or directly acquired by, the Government and subsequently furnished to the Contractor for performance of a contract. Government-furnished property includes, but is not limited to, spares and property furnished for repair, maintenance, overhaul, or modification. Government-furnished property also includes contractor-acquired property if the contractor-acquired property is a deliverable under a cost contract when accepted by the Government for continued use under the contract

Government Property - means all property owned or leased by the Government.

Government property includes both Government-furnished and Contractor-acquired property.

Government property includes material, equipment, special tooling, special test equipment, and real property. Government property does not include intellectual property and software.

Property Administrator - means an authorized representative of the KO appointed in accordance with agency procedures, responsible for administering the contract requirements and obligations relating to Government property in the possession of a Contractor.

High Level Objective (HLO) – means a key overarching result-based objective for a project necessary to achieve the project’s vision. HLOs are similar to Level 2 in a Work Breakdown Structure. Each HLO may contain several statements to flesh out the areas necessary to meet the objective.

Physical Security – means that part of security concerned with physical measures designed to safeguard personnel; to prevent unauthorized access to equipment, installations, material, and documents; and to safeguard against espionage, sabotage, damage, and theft.

Quality Assurance – (or Government contract quality assurance) means the various functions, including, inspection, performed by the Government to determine whether a Contractor has fulfilled the contract obligations pertaining to quality and quantity.

Quality Assurance Surveillance Plan (QASP) – means the key Government-developed surveillance process document and is applied to Performance-Based Service Contracting (PBSC). The QASP is used for managing Contractor performance assessment by ensuring that systematic quality assurance methods validate that Contractor quality control efforts are timely, effective, and are delivering the results specified in the contract or task order. The QASP directly corresponds to the performance objectives and standards (i.e., quality, quantity, timeliness) specified in the Performance Work Statement (PWS). It provides specific details on how the Government will survey, observe, test, sample, evaluate, and document Contractor performance results to determine if the Contractor has met the required standards for each objective in the PWS. The QASP, with very few if any exceptions, is an internal to Government document.

Quality Control – means all necessary measures taken by the Contractor to assure that the quality of an end product or service shall meet contract requirements.

Statement – means the specific results-based activities required to satisfy HLOs. A statement contains a result, the context of the statement, and the required action(s). Statements focus on “what” is to be accomplished; however they are not prescriptive in describing “how” the outcome is to be achieved. Each HLO may have several statements to flesh out the areas necessary to meet the objective. Statements are similar to Level 3 in a Work Breakdown Structure.

Subcontractor – means one that enters into a contract with a prime Contractor. The Government does not have privity of contract with the subcontractor.

Work Day - The number of hours per day the Contractor provides services in accordance with the contract.

Work Week - Monday through Friday, unless otherwise specified.

2.2 Acronyms: Although not inclusive of every term used within this PWS, or that may be included in an acquisition, the following provides a list of acronyms commonly used in the acquisition field.

ACOR Alternate Contracting Officer's Representative AE Army in Europe AFARS Army Federal Acquisition Regulation Supplement AHA Activity Hazard Analysis AOR Area of Responsibility AR Army Regulation AT Anti-terrorism ATCTS Army Training Certification Tracking System CAC Common Access Card CCE Contracting Center of Excellence CFE Conventional Forces Europe CFR Code of Federal Regulations CONUS Continental United States (excludes Alaska and Hawaii) COR Contracting Officer’s Representative COTS Commercial-Off-the-Shelf DA Department of the Army DD250 Department of Defense Form 250 (Receiving Report) DD254 Department of Defense Contract Security Requirement List DFARS Defense Federal Acquisition Regulation Supplement DMDC Defense Manpower Data Center DoD Department of Defense FAR Federal Acquisition Regulation FRG Federal Republic of Germany GFP Government Furnished Property HLO High Level Objective HIPAA Health Insurance Portability and Accountability Act of 1996 IA Information Awareness IAC Installation Access Control IACO Installation Access Control Office ID Identification IGCE Independent Government Cost Estimate IT Information Technology JTR Joint Travel Regulation JPAS Joint Personnel Adjudication System KO Contracting Officer OCI Organizational Conflict of Interest OCONUS Outside Continental United States (includes Alaska and Hawaii) ODC Other Direct Costs OPSEC Operations Security PA Property Administrator PII Personally Identifiable Information PIPO Phase In/Phase Out POC Point of Contact PRS Performance Requirements Summary PWS Performance Work Statement QA Quality Assurance

QAP Quality Assurance Program QASP Quality Assurance Surveillance Plan QC Quality Control QCP Quality Control Program RA Requiring Activity RCO Regional Contracting Office SIGE Safety and Health Protection Plan TE Technical Exhibit USAG United States Army Garrison USAREUR United States Army Europe UOM Unit of Measure

PART 3

GOVERNMENT PROPERTY (GP) AND SERVICES

3 Government Property and Services

3.1 The New Mexico Army National Guard will furnish up to two classrooms, five tables and twenty chairs for contractor use during the performance of this contract. The contractor is responsible for proper use and care of all government- furnished facilities and property and shall return them in condition received, excluding normal wear and tear.

PART 4

CONTRACTOR FURNISHED ITEMS AND SERVICES

4 Contractor Furnished Property and Services

4.1 General: The Contractor shall furnish all clinical personnel, medical supplies, administrative materials, travel, transportation, and supervision necessary to conduct the medical surveillance event, except for the physical examination rooms which will be provided by the Government. The Contractor shall furnish everything required to perform the Occupational Medical Surveillance examinations and services in accordance with federal, state, and local regulations.

4.2 Materials: The Contractor shall provide certified and licensed personnel, all labor, tools, diagnostic materials, medical equipment, and incidentals required to conduct the Medical Surveillance Examination / Occupational Health Services for the NMARNG. The Contractor shall provide a complete set of examination forms and questionnaires to the NMARNG Occupational Health Nurse (OHN) prior to the event for review and to ensure they meet the specific surveillance needs of the NMARNG, the publications are listed in paragraph 6.1 of this PWS.

4.3 Vehicles and Equipment: The Contractor is responsible for all transportation to and from the designated facilities in Santa Fe and Las Cruces, NM. The Contractor is explicitly required to provide and transport their own hearing test equipment to both locations to perform audiometric testing. The equipment must be fully equipped, calibrated, and compliant with OSHA standards.

PART 5

SPECIFIC TASKS

5.1 Basic Services: The Contractor shall provide all labor, medical/diagnostic equipment, materials, clinical oversight, licensing, and comprehensive administrative support necessary to perform standard Occupational Health Medical Surveillance Examinations. The Contractor is strictly required to handle all administrative duties associated with the medical surveillance events. This includes, but is not limited to, patient check-in, distribution and collection of medical questionnaires, data entry, tracking completion, and secure records management.

The exams shall include pre-placement, baseline, annual, retirement, and termination-of-exposure medical exams for New Mexico Army National Guard (NMARNG) federal technicians.

The Contractor shall deliver these services on-site on August 18th (0800–1600) in Las Cruces, NM, and on August 20th (0800–1600) in Santa Fe, NM. The Contractor shall deliver finalized, physician-reviewed medical reports and recommendations for all examined personnel.

The Government’s estimated budget range for the successful execution of this requirement is between $40,000.00 and $50,000.00. Offerors should design their performance approach to maximize value and clinical efficiency within this cost parameter.

5.2 Tasks: LOE OH Medical Surveillance Duties and Responsibilities

5.2.1 Service Delivery Method (On-Site Mobile Clinic): The Contractor shall perform all medical examinations exclusively via an on-site mobile clinic approach. The Contractor shall utilize temporary classroom spaces provided by the Government at the NMARNG facilities in Las Cruces and Santa Fe to conduct the indoor portions of the examinations as outlined in section 3 of the PWS. The Contractor is required to bring all portable medical equipment, administrative supplies, and administer hearing tests to these locations to execute the requirement. No off-site or alternative clinic locations are authorized under this contract.

5.2.2 Examination Performance Standards: All examinations must be performed by licensed independent practitioners (LIP) to include Medical Doctors (MD), Doctor of Osteopathic Medicine (DO), Nurse Practitioners (NP), or Physician Assistants (PA). A Board- Certified Occupational Health Physician must perform the final clinical review of all examination results, questionnaires, and laboratory data, and must sign off on the final fitness-for-duty recommendations (see Technical Exhibit B).

5.2.3 Scheduling and Coordination: The Contractor shall coordinate directly with the NMARNG Occupational Health Manager (OHM) starting immediately at post-award.

5.2.3.1 The NMARNG point of contact (POC) will provide the roster of 60 federal technicians scheduled for examinations at least two (2) weeks prior to the first day of performance.

5.2.3.2 The Contractor shall build and confirm the daily appointment schedule via email to the OHM at least one (1) week prior to the event to minimize technician downtime during the duty day.

5.2.4 Contractor Professional Responsibilities:

5.2.4.1 Medical Liability Insurance: The Contractor shall maintain medical liability insurance in an amount acceptable to $1 million, and not less than the prevailing local standard for the medical specialties involved.

5.2.4.2 Clinical Supervision: The NMARNG OHM may monitor and evaluate the quality of the administrative and professional services rendered under this contract but will retain no direct control over the professional medical decisions, clinical testing procedures, or physician-patient relationships.

5.2.5 Laboratory Standards: The Contractor shall ensure that all clinical laboratory and blood analysis services are performed by a laboratory licensed through the U.S. Department of Health and Human Services (DHHS) and the Healthcare Financing Administration, pursuant to the Clinical Laboratories Improvement Act (CLIA) of 1967 (42 U.S.C. 263a), and accredited by the College of American Pathologists (CAP).

PART 6

APPLICABLE PUBLICATIONS

6. Applicable Publications (Current Editions): The following publications, manuals, regulations, etc. are mentioned in this PWS and are listed below.

6.1 Publications:

6.1.1 29 CFR Part 1910,AR 40-5

6.1.2 DA PAM 40-11

6.1.3 AR 40-66

6.1.4 DA PAM 40-501.

PART 7

ATTACHMENT AND TECHNICAL EXHIBIT LISTING

6. Attachment and Technical Exhibit List

6.1 Technical Exhibit A – Performance Requirements Summary

6.2 Technical Exhibit B – Exam summary

TECHNICAL EXHIBIT A

Performance Requirements Summary (PRS)

PERFORMANCE

OBJECTIVE

STANDARD PERFORMANCE

THRESHOLD

ACCEPTABLE

QUALITY

LEVELS (AQLs)

METHOD OF

SURVEILLANCE

PRS#1: Timely Execution of Mobile Clinics (PWS 5.1 & 5.2.1)

Contractor executes the on-site clinics, complete with a hearing test, at Las Cruces (Aug 18) and Santa Fe (Aug 20) between 0800–1600.

99% compliance. Minor deviations (up to 1 hour delay) due to unforeseen travel/traffic are acceptable provided all scheduled FTS personnel are seen that day.

100% Direct Observation by OH Manager or designated representative / On-site Sign-in Rosters.

PRS#2:

Administrative & Event Management

(PWS 5.1 & 5.2.3)

Contractor independently handles all administrative duties (patient check-in, questionnaire distribution, schedule flow, and data entry).

99% compliance. Zero instances of Government personnel being required to step in and perform contractor administrative duties.

Direct Observation and Feedback from OH Manager.

PRS#3: Qualified Medical Personnel & Lab Standards (PWS

5.2.2 & 5.2.5)

Examinations are performed by licensed NPs/PAs/MDs/DOs.

Labs are CLIA/CAP accredited. Final reviews are conducted by a Board-Certified Occupational Health Physician.

99% compliance. No uncertified/unlicense d personnel may perform examinations or reviews. No unaccredited labs may be used.

Periodic Inspection of credentials and lab accreditations prior to event execution.

PRS #4: Delivery of Final Medical Reports (PWS 5.1 & 5.2.2)

Finalized, physician-reviewed medical reports, labs, and fitness-for-duty recommendations are delivered securely to the NMARNG Occupational Health Manager.

95% of all final reports are delivered within 14 business days of the examination date. Zero PII/HIPAA breaches.

100% Inspection of reports delivered by the OH Manager.

TECHNICAL EXHIBIT B

Exam Summary

WELDER, PAINTER, CONFINED SPACE, MACHINIST, ALLIED TRADES, AIRCRAFT

MECHANIC, AIRCRAFT SHEET METAL MECHANIC

REQUIRED DATA COLLECTION & TEST

STANDARDS

Flow Rate of Medical Exams One patient every 15 minutes Clinic as scheduled per appointment.

Special Forms as Required: Physician Examination Record Hearing Conservation Program Attendance Records Hearing Test Case History Benzene Physical Examination Record and Clearance Respirator Fit Test Record Respiratory OSHA questionnaire Fit Test Qualification Form Fit Test Card

Noise Exposure/Ear Protection Hearing protection questions on the hearing test case history

Respiratory history Standard, Respiratory questionnaire and examination record, Spirometry. Pulmonary Function Test(upon request-baseline) Chest X-ray (upon request-baseline or physician recommendation) Documentation of Respirator Clearance.

Respiratory Fit Test Upon request by Occupational Health Nurse for Qualitative fit test and Quantitative fit test.

MD Exam Hands on physical by a board eligible or board-certified physician.

Employee ID First, Middle, Last Name, Company name and area, Social Security number and Date of Birth.

Personnel Must be Fasting History Confidential Work Health Questionnaire that includes respiratory history for P.P.E. (Mask) wearers.

Blood Pressure Standard, Right and/or left arm, use manual BP for SP < =80, >=140/DP <=50 >=90 record results on physician examination record.

Resting pulse rate Standard, Record results on physician examination record.

Temperature and Respirations Standard, Record result on physician examination record.

Urinalysis Dipstick; One (1) 10 ml Acid Washed Urine Container for urine Chromium.

Height/Weight Record result on physician examination record.

Vision Near and Far Acuity, color and vertical/lateral phorias and record results on comparative data form.

Otoscopic Exam Standard Audiometry Test only (500,1000, 2000, 3000, 4000, 6000 + 8000 Hz) on

DD form 2216 Laboratory Specimens One (1) Lavender Top Tube for Complete blood count (CBC);

One (1) Tiger Top Tube for Comprehensive Metabolic Panel (CMP), Liver Function Test (LFT)

MAINTENANCE MECHANIC, SMALL ARMS REPAIRER, AND RANGE OPERATION

SPECIALIST

Flow Rate of Medical Exams One patient every 15 minutes (Mobile) Clinic as scheduled per appointment.

Special Forms as Required: Physician Examination Record Hearing Conservation Program Attendance Records Hearing Test Case History Benzene Physical Examination Record

Noise Exposure/Ear Protection Hearing protection questions on the hearing test case history

Respiratory history (Upon Request by Occupational Health Nurse)

Standard, Respiratory questionnaire and examination record, Spirometry. Pulmonary Function Test(upon request-baseline) Chest X-ray (upon request-baseline or physician recommendation) Documentation of Respirator Clearance.

Respiratory Fit Test (Upon Request by Occupational Health Nurse)

Qualitative fit test or Quantitative fit test.

MD Exam Hands on physical by a board eligible or board certified physician/physician assistant.

Employee ID First, Middle, Last Name, Company name and area, Social Security number and Date of Birth.

Personnel Must be Fasting History Confidential Work Health Questionnaire that includes if any respiratory history for P.P.E. (Mask) wearers.

Blood Pressure Standard, Right and/or left arm, use manual BP for

SP < =80, >=140/DP <=50 >=90 record results on physician examination record.

Resting pulse rate Standard, Record results on physician examination record.

Temperature and Respirations Standard, Record result on physician examination record.

Urinalysis Dipstick Height/Weight Record result on physician examination record.

Vision Near and Far Acuity, color and vertical/lateral phorias and record results on comparative data form.

Otoscopic Exam Standard Audiometry Test only (500,1000, 2000, 3000, 4000, 6000 + 8000

Hz) on DD form 2216 Laboratory Specimens (Upon Request by Occupational Health Nurse)

One (1) Lavender Top Tube for Complete blood count (CBC); One (1) Tiger Top Tube for Comprehensive Metabolic Panel (CMP), Liver Function Test (LFT)

TITLE 5 TECHNICIANS, USP&FO WAREHOUSE

Flow Rate of Medical Exams One patient every 15 minutes Clinic as scheduled per appointment.

Special Forms as Required: Physician Examination Record.

Hearing Conservation Program Attendance Records.

MD Exam Hands on physical by a board eligible or board certified physician/physician assistant.

Employee ID First, Middle, Last Name, Company name and area, Social Security number and Date of Birth.

Personnel Must be Fasting History Confidential Work Health Questionnaire

Blood Pressure Standard, Right and/or left arm, use manual BP for SP < =80, >=140/DP <=50 >=90 record results on physician examination record.

Resting pulse rate Standard, Record results on physician examination record.

Temperature and Respirations Standard, Record result on physician examination record.

Urinalysis Dipstick Height/Weight Record result on physician examination record.

Vision Near and Far Acuity, color and vertical/lateral phorias and record results on comparative data form.

Laboratory Specimens One (1) Lavender Top Tube for Complete blood count (CBC); One (1) Tiger Top Tube for Comprehensive Metabolic Panel (CMP), Liver Function Test (LFT)