KSARNG OH PWS 20 Nov 23.pdf

PERFORMANCE WORK STATEMENT (PWS)

FOR

Kansas Army National Guard Occupational Health Medical Examination Services

1.0 General.

1.1 Scope. The contractor shall provide all labor, personnel, equipment, tools, materials, supervision, and quality control necessary, except as specified in Paragraph

3.0 as Government Furnished, to perform the service of testing and physical exam of each employee as defined in this PWS. This contract is for "Non-Personal Health Care Services", as defined in Federal Acquisition Regulation (FAR) 37.101. In accordance with (IAW) with FAR Part 37.4 the Government may enter into a non-personal health care services contract with physicians, dentists and other health care providers under authority of 10 U.S.C. 2304 and 41 U.S.C. 253. The Government shall evaluate the quality of professional and administrative services provided, while the Government retains no control over the medical, professional aspects of services rendered.

1.1.1 Objectives. The Kansas Army National Guard (KSARNG) Occupational Health Program encompasses providing job-related medical examinations. Exams are performed to identify any health ailments precluding an individual from performing the essential functions of their position, to prevent work-related health ailments by assessing the health status of individuals in relation to their work, and making medical recommendations regarding placement, accommodation, and exposure controls. The classification of medical examinations includes medical surveillance and medical qualification examinations.

1.1.1.1 Medical surveillance examinations are performed when workplace exposures may cause illness or injury and encompass hazard baseline, periodic, termination, and incidental evaluations.

1.1.1.2 Medical qualification examinations are performed atthe request of Human Resources (HR) personnel to determine if the employee can safely and efficiently perform the essential job functions of their position, and can include the following examinations: pre-placement, return-to-work, fitness for duty, functional capacity, and medical certification.

1.1.1.3 Test Requirements may be different for each classification of exam and will be identified at the time of exam scheduling. Therefore, cost quotes should be on a per test basis with the overall requirements and exam purpose being taken into consideration.

1.2 Background. The purpose of the Occupational Medicine (OM) Program is to provide occupational medical examinations for both medical surveillance and medical qualification to Kansas National Guard (KSNG) all DoD civilian employees, including non-appropriated fund (NAF) instrumentality employees, unless otherwise noted.

1.2.1 In accordance with (IAW) the Occupational Safety and Health Administration (OSHA), Title 29 Code of Federal Regulations (CFR) § 1910, Department of Defense Manual 6055.05, Occupational Medical Examinations: Medical Surveillance and Medical Qualification, Army Regulation (AR) 40-5 Army Public Health Program, AR 40-501 Standards of Medical Fitness and National Guard Regulation (NGR) 40-5, ARNG Occupational Health Program, employees must be monitored for the impacts of workplace exposures (known and potential) and provided medical surveillance evaluations based on job code and/or identified exposures. The medical surveillance program is a risk based medical screening and examination process intended to prevent or minimize adverse health effects through early recognition and prevention of occupational exposure. The program incorporates various elements that identifies employee workplace exposures to physical, chemical, biological, or radiological hazards, the effects for such exposure and directs measures to prevent occupational illnesses and injuries associated these exposures. Program requirements vary based on the individual's job code, the type of work performed, and the exposures at the worksite.

Industrial hygiene (IH) surveys are conducted to identify hazards and measure exposure levels of known hazards based on the individual and the task, separating potential exposure from actual exposures.

1.2.1.1 In accordance with the requirements of the office of personnel management (OPM) for specific job codes and data obtained from IH surveys, screening is required for employees exposed to potential health hazards in the workplace.

1.2.2 Medical qualifications are conducted IAW Part 339 of Title 5, CFR, civilian personnel authority, and at the request of KSNG Human Resource personnel.

1.3 Period of Performance (PoP). This Blanket Purchase Agreement (BPA) is for a period of five (5) years which includes one (1) base year and four(4) option years which may be exercised at the Government's sole discretion.

1.4 General Information:

1.4.1 Place and Performance of Services. The contractor shall provide services between their regular clinic hours of operation, Monday through Friday, except on recognized US holidays. Performance shall be at locations within Kansas where the capability to perform all required testing can be performed. The contractor shall at all times maintain an adequate work force for the uninterrupted performance of all tasks defined within this PWS within the time specified. When hiring personnel, the contractor shall keep in mind that the stability and continuity of the work force are essential.

1.4.1.1 Telework. Not applicable.

1.4.2 Recognized Holidays. The following are recognized US holidays. The contractor shall not perform services on these days:

1.4.2.1 New Year's Day: January 1st

1.4.2.2 Martin Luther King, Jr.'s Birthday

1.4.2.3 President's Day

1.4.2.4 Memorial Day

1.4.2.5 Juneteenth National Independence Day: June 19th

1.4.2.6 Independence Day: July 4th

1.4.2.7 Labor Day

1.4.2.8 Columbus Day

1.4.2.9 Veteran's Day: November 11th

1.4.2.10 Thanksgiving Day

1.4.2.11 Christmas Day: December 25th

1.4.3 Quality Control (QC). The contractor shall develop and maintain an effective QC Plan (QCP) to ensure services are performed in accordance with this PWS. The contractor shall develop and implement procedures to identify, prevent, and ensure non recurrence of defective services. The contractor's QCP is the means by which it assures itself that its work complies with the requirements of the contract. As a minimum, the contractor shall develop QC procedures that address the areas identified in Technical Exhibit 1, Performance Requirements Summary (PRS). A final QCP shall be submitted to the Contracting Officer Representative (COR) NL T 10 days after contract award.

After acceptance of the QCP, the contractor shall obtain the Contracting Officer's (KO's) acceptance in writing of any proposed changes to its QCP. All test results will be provided directly to the employee and Occupational Health Nurse (OHN) by the vendor and will be checked for completeness and accuracy againstthe master roster of employees. Address and phone numberforthe OHN Government Technical Monitor (GTM) and Contracting Officer Representative (COR) are:

Kansas Army National Guard GTM ATTN: Olivia Kennedy 5920 SE Coyote Drive, BLDG 670 Topeka, KS 66619

(785) 646-0530

Kansas Army National Guard COR ATTN: Ross England 5920 SE Coyote Drive, BLDG 2005 Topeka, KS 66619

(785) 646-0103

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

1.4.5 Installation Access and Security Requirements. Not applicable.

1.4.5.1 Reserved

1.4.5.2 Reserved

1.4.5.3 Reserved

1.4.5.4 Reserved

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

1.4.5.6 Reserved

1.4.5.7 Reserved

1.4.5.8 Reserved

1.4.5.9 Reserved

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

1.4.5.11 OPS EC Training: Not applicable.

1.4.5.12 Reserved

1.4.5.13 Reserved

1.4.5.14 Reserved

1.4.6 Physical Security. Not applicable.

1.4.7 Special Qualifications.

1.4.7.1 The contractor shall provide a Board-eligible or -Certified Occupational Medicine Physician, or other Licensed Independent Practitioner (Nurse Practitioner or Physician Assistant), to conductjob-related medical surveillance physical examinations and occupational health consultation services. A Board-Certified Occupational Medicine Physician (Doctor of Medicine or Doctor of Osteopathic Medicine) must conduct medical reviews and final determinations for the medical surveillance examinations and Occupational Health services.

1.4.7.2 The contractor shall ensure all employees will operate under the supervision of a Board-Certified Occupational Health Physician (BCOHP) provided by the contractor and possess all required licenses and certifications for conducting occupational medical examinations, procedures, and occupational health services used in the performance of this contract. This does not include education or other qualifications for the position in which the contractor employee is performing, dress codes, or other information. The Government does not provide training to contractors. Contractors must ensure that any personnel performing under a contract are fully trained, licensed, certified, and otherwise qualified to provide services. License and certifications will be made available upon request.

1.4.7.3 Audiometric testing must be performed by contractor employees in accordance with 29 CFR 1910.95, and who are certified by the Council for Accreditation in Occupational Hearing Conservation (CAOHC) and able to perform an otoscopic examination IAW DA Pam 40-501. This certificate must be provided to verify training.

1.4.7.4 Contractor employees performing Pulmonary Function Tests (PFTs) must be a licensed physician, Certified Pulmonary Function Technologist, ora Registered Respiratory Therapist with spirometry certification every five (5) years. Contractor employees reviewing PFTs must be a Board-Certified Occupational Medicine Physician in accordance with 29 CFR 1910.1001. Personnel conducting pulmonary function testing will be certified through a program approved by the NIOSH and IAW 29 CFR § 1910.134.

1.4.7.5 Personnel will be appropriately trained and licensed to operate an x-ray machine. The x-ray equipment will be in excellent working conditions, appropriately maintained, calibrated, and licensed prior to use: see appendix E of part§ 1910.1001 of for chestX-Ray schedule and B-reader requirements.

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

1.4.7.6.1 Contractor employees performing laboratory testing must be certified under the American Society of Clinical Pathology.

1.4.7.6.2 Personnel performing blood draw and lab operations will be trained and skilled in the task of specimen collection.

1.4.7.7 Personnel conducting visual acuity test and vision screening will be trained and skilled in performance of task.

1.4.7.8 All contractor employees accessing patient records, data, or obtaining health information must complete annual Health Insurance Portability and Accountability Act (HIPM) training and must comply with the requirements stipulated in the Act of 1996.

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

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

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

1.4.9 Contract Manager (CM). The contactor shall designate a CM who shall ensure performance under th is con tract. The name of th is person, and an al tern ate who sh al I act for the contractor when the CM is absent, shall be designated in writing to the KO.

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

1.4.10 Identification of Contractor Employees. Reserved

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

FAR 22.17.

1.4.12 Reserved

1.4.13 Data Rights. The Government has unlimited rights to all documents/materials produced under this contract. All documents and materials, to include the source codes of any software, produced under this contract shall be Government owned and are the property of the Government with all rights and privileges of ownership/copyright belonging exclusively to the Government. These documents and materials may not be used or sold by the contractor without written permission from the KO. All materials supplied to the Government shall be the sole property of the Government and may not be used for any other purpose. This right does not abrogate any other Government rights.

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

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

2.0 DEFINITIONS AND ACRONYMS

2.1 Definitions:

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

2.1.2 Contracting Officer (KO)-A person with 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.

2.1.3 Contracting Officer's Representative (COR) -An employee of the U.S.

Government designated by the KO to monitor contractor performance. Such appointment shall be in writing and shall state the scope of authority and limitations.

This individual has authority to provide technical direction to the Contractor as long as that direction is within the scope of the contract, does not constitute a change, and has no funding implications. This individual does NOT have authority to change the terms and conditions of the contract.

2.1.4 Defective Service -A service output that does not meet the standard of performance associated with the Performance Work Statement.

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

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

2.1.7 Physical Security-Actions that prevent the loss or damage of Government property.

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

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

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

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

2.2 Acronyms:

AAOHN

ABOEM

AEI

AKO

APHC

AR

AT/OPSEC

Bl

BP

American Association of Occupational Health Nurses American Board of Occupational and Environmental Medicine Army Enterprise lnfostructure Army Knowledge Online Army Public Health Center Army Regulation Antiterrorism/Operational Security Background Investigation Blood Pressure

BPA

CAC

CAOHC

CFR

CM

CMRA

COOP

COR

CXR

DA

DD254

DFARS

DO

DoD

DODM

DOEHRS-HC

DSCA

EKG

FAR

GFP/M/E/S

GTM

HIPM

HQDA

HSPD

IA

IS

JTR

KO

MD

NGB

NIOSH

OCI

OHN

OSHA

PFT

PII

PIPO

POC

POP

PPE

PRS

PWS

QA

QASP

QC

Blanket Purchase Agreement Common Access Card Council for Accreditation in Occupational Hearing Conservation Code of Federal Regulations Contract Manager Contractor Manpower Reporting Application Continuity of Operations Planning Contracting Officer Representative ChestX-Ray Department of the Army Department of Defense Contract Security Classification Specification Defense Federal Acquisition Regulation Supplement Doctor of Osteopathic Medicine Department of Defense Department of Defense Manual Defense Occupational and Environmental Health Readiness System Hearing Conservation Defense Counterintelligence and Security Agency Electrocardiogram Federal Acquisition Regulation Government Furnished Property/Material/Equipment/Services Government Technical Monitor Health Insurance Portability and Accountability Act Headquarters, Department of the Army Homeland Security Presidential Directive Information Assurance Information System(s) Joint Travel Regulation Contracting Officer Doctor of Medicine National Guard Bureau National Institute for Occupational Safety and Health Organizational Conflict of Interest Occupational Health Nurse Occupational Safety and Health Administration Pulmonary Function Test Personally Identifiable Information Phase In/Phase Out Point of Contact Period of Performance Personal Protective Equipment Performance Requirements Summary Performance Work Statement Quality Assurance Quality Assurance Surveillance Plan Quality Control

QCP

SCR

SSN

STS

TBD

TE

USD(I)

Quality Control Program Service Contract Reporting Social Security Number Significant Thresh old Shift To Be Determined Technical Exhibit Under Secretary of Defense for Intelligence

3.0 Government Furnished Property, Material, Equipment and Services (GFP/M/E/S). The Government will provide the property, material, equipment, and/or services listed below solely for the purpose of performance under this contract:

3.1 Property: None.

3.2 Materials: The Government will furnish any agency specific forms necessary.

Government wi II fu m ish specific criteria for testing.

3.3 Equipment: None.

3.4 Services: None.

3.5 Utilities: None.

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

4.1 General: Except for those items specifically stated to be Government-Furnished in Paragraph 3.0, the contractor shall furnish everything required to perform these services as indicated in Paragraph 1.1.

5.0 Requirements: The contractor shall:

5.1 General: The contractor shall indemnify the Government for any liability producing act or omission by the Contractor, its employees and agents occurring during contract performance. The contractor, upon request by the Contracting Officer, shall furnish prior to contract award evidence of its insurability concerning the medical liability insurance required by this clause.

5.1.1The contractor shall provide Occupational Health Medical Qualification and Medical Surveillance Examinations to include, but not limited to: Baseline, Periodic, Termination, Transfer, Return-to-Work, Functional Capacity Evaluation, Fit for Duty, Post-exposure, and medical certification. Other occupational health services shall be provided upon request.

5.1.2 Contractor shall ensure all procedures are conducted in accordance with applicable American Board of Occupational and Environmental Medicine (ABOEM), American Association of Occupational Health Nurses (AAOHN), U.S. Department of

Labor, Occupational Safety and Health Administration (OSHA), and the National Institute for Occupational Safety and Health (NIOSH) Standards.

5.1.3 Contractor shall provide a Board eligible or Certified Occupational Medicine Physician to conduct or provide oversight of physician assistants or nurse practitioners with appropriate qualifications, training, licensing, and experience in occupational health performing physical examinations and occupational health consultation services.

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

5.2 Examination, Screening, and Testing Services:

5.2.1 Physical Exam:

5.2.1.1 The contractor shall provide a Board-eligible or-certified Occupational Medicine Physician, or other Licensed Independent Practitioner (e.g. Nurse Practitioner or Physician Assistant), to conductjob-related medical surveillance physical examinations, and occupational health consultation services. A Board-certified Occupational Medicine Physician (MD or DO) must review and sign-off on all KSARNG Occupational Health exams. In addition to examination requirements, the contracted physician, or Licensed Independent Practitioner, shall review with examinees the results of tests known at the time of an examination, and as appropriate, recommend follow-up services with private/personal healthcare providers. Written documentation of the contracted physician or Licensed Independent Practitioner reviewing exam results and follow-up procedures with KSARNG examinees shall be included in every KSARNG examinees' exam report.

5.2.1.2 The contractor shall perform musculoskeletal assessments and will include the Kraus-Weber Back Strength and Flexibility Rating. Any pain or recommended lifting limitations if less than 50 lbs. will be noted. Further, contractors will provide physical exam assessment that includes, inguinal hernia screening for male employees.

5.2.1.3 Dermatological examinations when indicated must include an inspection of the entire integumentary system with emphasis on areas most likely to be affected by the employee's occupational exposures. Documentation will include a body map of the presence of any dermatoses or lesions of the skin.

5.2.1.4 If a dermatological referral is recommended, it can only be to certified dermatologists or Occupational Health physicians. Prior coordination with this office is required before referrals are scheduled.

5.2.2 Vital Signs:

5.2.2.1 The contractor shall measure vital signs to include height, weight, temperature, blood pressure (BP), pulse and respirations, for each KSARNG employee examined.

5.2.2.2 When determining "normal" BP readings, the contractor shall follow the American Heart Association's guidance in the below table:

SYSTOLIC mm Hg DIASTOLIC mm Hg BLOOD PRESSURE CATEGORY (upper number) and/or (lower number)

NORMAL

ELEVATED

HIGH BLOOD PRESSURE

(HYPERTENSION) STAGE 1

LESS THAN 120

120-129 130-139 and LESS THAN 80 and LESS THAN 80 or 80-89

HIGH BLOOD PRESSURE 140 OR HIGHER or 90 OR HIGHER

(HYPERTENSION) STAGE 2

HYPERTENSIVE CRISIS HIGHER THAN 180 and/or HIGHER THAN 120

5.2.2.2.1 If BP is greater than 140/90 mm Hg, repeat two times, record, counsel the KSARNG examinee about follow-up measures with a personal healthcare provider, and document in the examination report.

5.2.2.2.2 Hypertensive BP readings on just one visit will not be used as a basis for medicals disqualification.

5.2.2.2.3. When measuring blood pressure, the National Institutes of Health (NIH) guidelines will be followed, which indicates that employees are to have their BP measured while seated, with back supported, and the upper arm supported at heart level.

5.2.2.2.4 Before measuring an employee's BP, the contractor shall ensure that the patient has been resting for 5 minutes.

5.2.2.2.5 The contractor shall use a BP cuff that is of a sufficient size in relation to an examinee's arm circumference.

5.2.2.3 Determinations of "not medically qualified" for cardiovascular reasons shall be made in the following situations:

5.2.2.3.1 New onset chest pain which has not been adequately evaluated.

5.2.2.3.2 Unstable angina.

5.2.2.3.3 Evidence of congestive heart failure.

5.2.2.3.4 Ectopy (either atrial or ventricular) which has produced syncope or near syncope.

5.2.2.3.5 Ventricular ectopy (symptomatic or not) which has not been evaluated by a cardiologist.

5.2.2.3.6 Recurrent atrial fibrillation or su praventricu lar tachycardia.

5.2.2.3.7 Stage 3 hypertension.

5.2.3 Vision:

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

5.2.3.1.1 Visual acuity for distance and near.

5.2.3.1.2 Lateral phorias for distance and near.

5.2.3.1.3 Vertical phorias for distance and near.

5.2.3.1.4 Depth perception.

5.2.3.1.5 Color perception.

5.2.3.1.6 Peripheral vision.

5.2.4 Audiogram: See Technical Exhibit#4.

5.2.5 Laboratory:

5.2.5.1 Contractor shall ensure all clinical laboratory services are processed by a certified clinical laboratory licensed through the U.S. Department of Health and Human Services (DHHS), Health Care Financing Administration pursuant to the terms of the Clinical Laboratories Improvement Act of 1967 (42 U.S.C. 263a) and the College of American Pathologies and performed by personnel certified underthe American Society of Clinical Pathology. Tests may include any or all of the following:

5.2.5.1.1 Biliru bin, total.

5.2.5.1.2 Blood urea nitrogen (BUN).

5.2.5.1.3 Complete Blood Count (CBC) including differential and blood platelet counts (actual).

5.2.5.1.4 Creatinine, serum.

5.2.5.1.5 Eosinoph ii count.

5.2.5.1.6 Hemoglobin and hematocrit.

5.2.5.1.7 Peripheral smear morphology.

5.2.5.1.8 Red cell indices.

5.2.5.1.9 Reticulocyte count.

5.2.5.1.10 Triglycerides, Total Cholesterol to include HDL and LDL.

5.2.5.1.11 Urinalysis (UA), screening and microscopic.

5.2.5.1.12 Alkaline phosphatase (Alk PO4), Gamma Glutamyl Transpeptidase (GGTP), Serum Glutamic Oxalacetic Transaminase (SGOT), and Serum Glutamic Pyruvic Transaminase (SGPT) either individually or as part of a Liver Profile.

5.2.5.1.13 Zinc Protoporphyrin (ZPP) and Serum Lead must be processed by a laboratory meeting standards set forth in 29 CFR 1910.1025. Only on selected individuals

5.2.5.1.14 Heavy Metals to include chromium and cadmium (urine and blood levels).

Only on selected individuals.

5.2.5.2 Note: Other labs may be required based on exposure, i.e. chromium, copper, formaldehyde, benzene, etc.

5.2.6 Pulmonary Function Testing I Respirator Evaluation and Clearance:

5.2.6.1 Pulmonary Function Tests will meet the following criteria:

5.2.6.1.1 Performed by a licensed physician, Certified Pulmonary Function Technologist, Registered Respiratory Therapist, or Spirometry Certified every five (5) years and reviewed by a Board-Certified Occupational Medicine Physician in accordance with 29 CFR 1910.1001.

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

5.2.6.1.3 Emphasize updated ATS-ERS standard requirements:

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

5.2.6.1.5 Always use measured height not reported height by the nearest half inch without footwear.

5.2.6.1.6 Always indicate source of reference value on reports for adjusted predicted value.

5.2.6.1.7 No smoking within 1 hourprior.

5.2.6.1.8 No cold, influenza or allergies within two weeks.

5.2.6.1.9 No inhaler use prior to testthatwould still be in the patient's system.

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

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

5.2.6.1.11 Respirator clearance documented and provided to employee.

5.2.7 Radiology:

5.2.7.1 Chestx-rays (CXR) will be performed by a certified X-ray technician and will include a posterior-anterior and left lateral view as indicated by workplace exposure and/or requested by the KSARNG Occupational Health office.

5.2.7.2 Interpretation and classification will be performed by a B-reader, or a board eligible or certified radiologist meeting the requirements of 29 CFR 1910.1001 Appendix E.

5.2.7.3. Contractor will perform ChestX Rays for 8-Read and EKGs when requested as testing to be included in exam.

5.3 Scheduling:

5.3.1 The contractor shall consult with the KSARNG Occupational Health Nurse (OHN) by telephone and/or email to coordinate or resolve issues that may arise before, during, and after the examination period. If the KSARNG representative is unreachable by telephone, the contractor is authorized to leave a message, as telephones listed for the KSARNG OHN representative are secure.

5.3.2 The contractor shall work directly with the KSARNG's OHN to schedule examinations. If there is a question about examination requirements or specifications, the contractor shall first consult the KSARNG OHN for approval priorto conducting the procedure(s).

5.3.3 Coordination of scheduling shall be a joint effort between the KSARNG's OHN and the contractor. In most cases, the KSARNG OHN will submit an exam request to the contractor, notify the employee and supervisor of the exam request, and then have the employee or supervisor call the contractor directly to schedule the exam. Once an exam is scheduled, the contractor shall call or email the KSARNG OHN to notify the OHN of the scheduled exam date and time. KSARNG employees may be scheduled for their examinations on a routine and/or as needed basis, to be determined by the KSARNG OHN, over a 12-month period. Each employee's occupational exposures, both real and potential, are different, components of these exams will be determined on a case-by-case basis and communicated by the KSARNG's OHN to the contractor prior to appointment scheduling.

5.3.4 Prior to scheduling exams, the KSARNG OHN will generate all necessary non contractor exam paperwork for the corresponding exam type. For medical qualification examinations, the individual's Position Description, and Optional Form (OF) 178. For medical surveillance examinations an exposure data summary will be provided. The KSARNG OHN will send all paperwork to the contractor via secured/encrypted email with all attachments.

5.3.5 The contractor shall email the KSARNG OHN a schedule of examination appointments (with employee's name, date, time and location of examination) within 10 business days from when a written request is made by the KSARNG OHN.

5.3.6 If coordination of exams is done over the phone, a follow-up email to confirm the information discussed telephonically will be sent by the KSARNG's OHN to the contractor by close of business that day.

5.3.7 In the event of an equipment failure in the contracted clinic, or a missed or incorrect examination procedure, specific testing and/or parts of examinations that are not completed during the testing period shall be completed, at no cost to the KSARNG, at a later scheduled time that is mutually convenientforthe employee and the contractor. The new schedule will be communicated to the KSARNG's OHN via email or phone within 48 hours.

5.3.8 If an KSARNG employee is a "No Show" to a scheduled appointment, the contractor shall contact the employee, or employee's supervisor, within 24 hours via telephone to reschedule. The contractor shall also provide a follow-up email notification (within 48 hours of a missed appointment)to the KSARNG's OHN, indicating the missed appointment and appointment reschedule date(s).

5.3.9 The contractor shall schedule appointments to allow a patient thirty (30) minutes prior to the physical exam to complete medical forms. All examination procedures and testing components shall be completed in one (1) day. Exceptions shall be approved by the COR.

5.4 Documentation and Reports:

5.4.1 The contractor shall ensure that each employee signs the Privacy Act Statement (DD Form 2005) during the examination registration process. The contractor's release of information will also be read and signed by the examinee PRIOR to the performance of any examination.

5.4.2 The contractor shall provide hard copies of medical examination results to include all diagnostic tests, graphs, charts, reports, questionnaires, waivers, employee consent forms, clearance letters, and physical findings within 30 days of examination completion via trackable shipping method. Within thirty (30) working days upon completion of testing services the contractor shall ensure two copies of the employee's examination findings are furnished. One copy shall be mailed directly to the individual employee's home of record and one copy shall be sent to the KSARNG OHN address provided in section 1.4.3.

5.4.3 The contractor shall send examination reports and results according to the listed steps:

5.4.3.1 The cover letter and original medical report packet addressed to the KSARNG's

OHN.

5.4.3.2 The outside of the interior envelope (containing exam documentation) shall be marked: "CONFIDENTIAL-TO BE OPENED BY ADDRESSEE ONLY."

5.4.4 Copies provided (sent) in bulk to the KSARNG OHN shall be sent in appropriately secured, correctly sized individual envelops not folded. If stapling is required;

documents will be stapled in the upper left-hand corner.

5.4.5 Under no circumstances shall written results be given to the employee's supervisor, or any other KSARNG employees, other than the examined employee and the KSARN G OH N, in accordance with the Privacy Act of 197 4.

5.4.6 The contractor shall ensure that all tests and forms are complete, as specified, through a QA process. This includes processing time related to review, determination, QA, and exam letters/reports mailed.

5.4.7 In the case of Initial Medical Qualification exams for new hires, the KSARNG's OHN may contact, via phone and/or email, the contractorwithin this time frame-30 business days from date of examination completion-to determine, either verbally or in writing, exam determination results for prospective new hires.

5.4.8 Original employee medical records will be maintained by the KSARNG OHN, with possible temporary transfer to the contractor for the duration of an employee's ''work-up" when specifically requested by the contractor.

5.4.8.1 Transfer of medical records (in blue Standard Form SF 66D) will be coordinated by KSARNG OHN at least 14 days prior to a scheduled exam.

5.4.8.2 The contractor will be responsible for returning records to the KSARNG OHN upon completion of an examination.

5.5 Notification of Abnormal Results and Findings:

5.5.1 Contractors shall immediately report to the OHN by telephone or encrypted electronic method if results of tests and exams which are questionable, of critical significance, or require follow-up.

5.5.2 For urgent, follow-up, exam-related findings that are not work related, the contractor shall contact the employee directly within 48 hours of examination and provide follow-up instructions.

5.5.3 For all examinations, any critical items, abnormalities, work restrictions, or referrals to other medical specialists identified by the contractor shall be communicated, first via telephone, followed by a secure encrypted email, to the KSARNG OHN within seven (7) business days of a completed exam to ensure continuity of care.

5.5.4 Contractor shall send all results to include all diagnostic tests, graphs, charts, reports, questionnaires, waivers, employee consent forms, physical findings, and examination results to the OHN within 15 working days of completion of testing to address provided in section 1.4.3.

5.5.5 All results will be provided to the employee with layman term explanations to include if they should follow-up with their primary care provider in accordance with current guidelines. Contractor shall provide results via mail to the patient's home of record or in-person du ring the examination visit.

5.5.6 A copy of employees' examination results will be delivered to each employee, highlighting any abnormalities that require follow-up with a primary care provider, when the abnormality is not linked to an occupational exposure.

5.5.7 All retesting, not due to technical error will be pre-approved by the Occupational Health Nurse.

5.5.8 Any abnormal clinical finding due to technical error will be repeated at no additional charge.

5.6 Invoice and Pricing:

5.6.1 Contractor shall provide the Contracting Officer's Representative with a Quality Assurance Surveillance Plan listing the procedures or processes, which shall be utilized to assess if the contractor is meeting the requirements of the PWS

5.6.2 The contractor shall only charge per test, staff level, and set up for quantity of services rendered.

5.7 Infection Control: Reserved

5.8. Conduct: Reserved

5.9. Malpractice insurance. Reserved.

5.10. Complete disclosure. Reserved

5.11. Unacceptable skills. Reserved

5.12. Misconduct/Disruption of Services. Reserved

5.13. Litigation. Reserved

5.14. Confidentiality. The contractor shall abide by Army Regulation (AR) 40-66 concerning the nature of limited privileged communication between patient and provider for security and personnel reliability programs. The contractor shall abide by AR 40-66 concerning confidentiality of patient records, as embodied in federal statues including the Privacy Act of 1974 and the Drug and Alcohol Act, Public Law 92-129.

5.15. Conflict of Interest:

5.15.1. The contractor shall not introduce any new services without prior approval of the COR. In disagreements or deviations from established protocols, COR will be the deciding authority.

5.15.2. The contractor shall not use services rendered pursuant to this agreement as part of a study, research grant, or publication without the prior written consent of the

KO.

5.15.3. The contractor shall not bill the patient, an insurer, or anyone else for services rendered. The only compensation the contractor is entitled to for performance of the contract is payment as specified by this contract. The contractor and staff are not prohibited, under this contract, from conducting private medical practice if there is no conflict with the performance of duties under this contract and the contractor and staff does not use KSARNG facilities or other KSARNG property in connection therewith.

5.15.4. The contractor and staff shall not be an employee of the United States government if the employment wou Id create a conflict of interest.

5.16. Reserved

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

Publication Date of Mandatory Website (Chapter/Page) Publication / Advisory

Federal Acquisition Regulation FAR 37.101, Federal Acquisition Regulation; htt12s://www.acguisition.gov/?g=browsefar FAR 52.204-2, Security Requirements;

DFARS 224.103, Defense Federal Acquisition Regulation Supplement.

Title 29, Code of Federal Regulations, Part 1910: Occupational Safety and Mandatory Health Standards U.S. Department of Labor, Code of Federal Regulations 29 (CFR) 1910.120 (b) (5), (f), Mandatory Medical Surveillance Title 29, Code of Federal Regulations, Part 1960: Safety and Health Mandatory Provisions for Federal Employees American Society for Testing and Materials, ASTM F3387-19 Advisory Standard Practice for Respiratory Protection Threshold Lim it Values and Biological Exposure Indices (TL Vs), American Conference

Advisory of Governmental Industrial Hygienists (ACGIH), Cincinnati, Ohio DoDI 5400.11 01/29/2019 htt12s://www.esd.whs.mil/Directives/issuan Department of Defense Privacy and Civil ces/dodi/ Liberties Programs

DoD 5400.11-R 05/14/2007 htt12s://www.esd.whs.mil/Directives/issuan Department of Defense Privacy Program ces/dodm/

Department of Defense 6055.05M, Occupational Medical Examinations: Medical 27 July 2022 Mandatory Surveillance and Medical Qualification AR 11-34 The Army Respiratory Protection

25 Jul 2013 Mandatory Pro11ram AR 40-5 Army Public Health Pro11ram 12 May 2020 Mandatory AR 40-66 Medical Record Administration and 17 Jun 2008 Healthcare Documentation AR 40-501 Standards of Medical Fitness 27 Jun 2019 AR 381-12 Threat Awareness and Reporting 01 Jun 2016 httQ ://a rm yQu bs.arm y.m ii/Prod uctMa !:!§/Pu Program,(Section 11, Para. 2-4.b) bForm/AR.asnx AR 385-10 The Army Safety Program 27 Nov 2013

AR 525-13 Antiterrorism 03 Dec2019 httQ ://a rm yQu bs.arm y.m ii/Prod uctMa !:!§/Pu bForm/AR.aSQX

AR 530-1 Operations Security 26 Sep 2014 httQ ://a rm yQu bs.a rm y.m ii/Prod uctMa !:!§/Pu bForm/AR.asox

Headquarters, Department of the 08 January

Army Pamphlet (DA PAM) 40-501, Army Hearing Program 2015

Headquarters, Department of the Army Pamphlet (DA PAM) 40-506, 15 July 2009 Mandatory The Army Vision Conservation and Readiness Program Headquarters, Department of the Army Pamphlet(DA PAM) 385-10, 24 July 2023 Army Safety and Occupational Health Program Procedures Department of the Army Technical Bulletin Medical (TB MED) 509, Spirometry in 25 Feb 2016 Occupational Health Surveillance NGR 40-5 ARNG Occuoational Health Proaram 15Feb2013

TECHNICAL EXHIBIT 1

Performance Requirements Summary

This Performance Requirements Summary includes performance standards. The Government will use these standards to determine contractor performance and will compare contractor performance to the Acceptable Quality Level (AQL).

PWS Paragraph Task Performance Acceptable Surveillance Standard Quality Levels Method/ By Whom

(AQL)

1.4.4 Contractor The contractor Employee will On Site Inspection -shall be able to performs all not need to Government provide all exams and report to more representative and exam and testing at the than one site employee feedback testing scheduled site for exam and requirements at on the same day testing. All the location testing will be where conducted in employee is one (1) day scheduled in one (1) day

5.1.3 Contractor 99%of 1 % failure rate Periodic Inspection

shall ensure personnel of personnel - OHN will review that each identified as not receiving resu Its of medical employee needing testing the testing and exams and testing.

receives the and screening examination as correct testing receive the requested and correct testing examination as scheduled for identified them during scheduling

5.4 Contractor The contractor Exams Periodic Inspection

shall schedule shall schedule scheduled - COR and OHN will the employee no later than 15 within 15 examine and cross for an exam working days working days of check results and within from scheduling request service records request designated timeframe

PWS Reference / Deliverable Title

1.4.1 QC Plan

5.3.1 resu Its to include all diagnostic tests, graphs, charts, reports, questionnaires, waivers, employee consent forms, physical findings, and examination results

TECHNICAL EXHIBIT 2

Deliverables Schedule

Frequency Number of Medium/Format Copies

Within 30 days of 1 Electronic or contract award Hard Copy

Provide within 15 2 Electronic and working days after Hard Copy testing and examinations completed

Submit To

KO

1 hard copy directly to employee and one hard or electronic copy to OHN

TECHNICAL EXHIBIT 3

Estimated Workload Data

(This information is provided for historical background only. It is not a guarantee of workload quantities.)

ITEM NAME ESTIMATED QUANTllY

1 Pre-Placement Exams 25

2 Periodic/ Medical Surveillance Exam 12

3 Fit For Duty Evaluation 5

4 Termination / Retirement Exam 7

5 Audiology Consultation 12

TECHNICAL EXHIBIT 4

STANDARD

TESTING PROCEDURES FOR ARMY

HEARING CONSERVATION AND HEARING READINESS

/AW DoDI 6055.12, AR 40-501 & DA PAM 40-501

1. EXAMINER: The following are the requirements for certified hearing technician examiners performing hearing testing for Army Hearing Conservation and Readiness.

Hearing testing must be completed by a physician, audiologist or certified hearing technician.

Hearing technicians must administer audiometric tests under the supervision of a physician or audiologist.

Hearing technicians must have Council for Accreditation in Occupational Hearing Conservation (CAOH C) or equivalent mi I itary certification. Hearing technicians trained and certified at a military course will have the appropriate DoD certification number assigned at the time of their course.

Hearing technicians certified at a civilian CAOHC course must obtain a DoD certification number that is compatible with the Defense Occupational and Environmental Health Readiness System - Hearing Conservation (DOEHRS-HC) software from the U.S. Army Public Health Command, Army Hearing Program. Requests for DoD numbers should be submitted to usarmy.apg.medcom-aphc.mbx.army-hearing-program@mail.mil by the installation Hearing Program Manager, Deputy State Surgeon or Occupational Health Nurse or other government POC. The request should include a scanned copy of the CAOHC certificate, HIPAA training certificate, IA training certificate, the hearing technician's name, complete address, phone number and e-mail address.

Hearing technicians shall be trained for otoscopic examination and earplug fitting.

The Defense Occupational and Environmental Health Readiness System - Hearing Conservation (DOEHRS-HC) is a Department of Defense (DoD) Military Health System (MHS) Information System (IS) that contains Personally Identifiable Information (PII) and Protected Health Information (PHI). End users of the DOEHRS-HC system are required to complete annual Health Insurance Portability and Accountability Act (HIPAA) training and Information Assurance (IA) training. Joint Knowledge Online is the training system sanctioned by the Department of Defense (DoD) and is the official HIPAA training site for the DoD. DOEHRS-HC users must complete annual HIPAA training through https://jkodirect.jten .mil/Atlas2/faces/page/login/Login .seam and provide proof of certification upon request.

DOEHRS-HC users must also complete the DoD CyberAwareness Challenge and provide proof of certification upon request.