LRN Medical Surveillance Performance Work Statement.pdf

Medical Examination Performance Work Statement (LRN Nashville District)

1. Purpose. This agreement establishes a means for the contractor to provide requested occupational health services and tasks for any of the available services noted below.

2. Delivery Areas:

Metro LRN Nashville Area.

Cheatham Dam Cheatham Lock Old Hickory Dam

Old Hickory Resource Office J. Percy Priest Lake Resource Office

Western Kentucky Area.

Kentucky Lock Barkley Lock Lake Barkley Natural Resource Barkley Powerhouse

Mid-Tennessee River Area.

Pickwick Lock Wheeler Lock Wilson Lock Guntersville Lock

East-Tennessee River Area

Chickamauga Lock Watts Bar Lock Fort Loudon/Melton Hill Lock Nickajack Lock

Mid-Cumberland Area

Center Hill Powerhouse Cordell Hull Powerhouse Dale Hollow Powerhouse

Center Hill Resource office

Eastern Kentucky Area

Wolf Creek/Laurel Power

Lake Cumberland Resource Office

Medical Examination Performance Work Statement (Nashville District)

The point of contact for invoicing is the LRN District Safety Office Floyd Payne, floyd.a.payne@usace.army.mil (Primary Contact 615-736-7182 or Paul Burress (Secondary Contact) 615-736-2165.

3. Maximum authorized travel distance from facility to clinic shall be no more than 75 miles.

However, if it is more advantageous for the employee to travel a greater distance that would be permissible.

a. All locations for treatment shall be brick and mortar facilities.

b. Mobile clinics will not be considered.

4. Reference Documents.

a. AR 40-5, Army Health Program, HQDA, 12 May 2020

b. ER 385-1-40, Safety – Occupational Health Program; HQUSACE, 10 September 2021

c. ER 385-1-86, U.S. Army Corps of Engineers Dive Program, HQUSACE, 23 November

2021.

d. ER 385-1-89, Hearing Conservation Program, HQUSACE, 15 October 2012.

e. ER 385-1-90, Respiratory Protection Program, HQUSACE, 30 April 2020.

f. ER 385-1-91, Training, Testing and Licensing of Motorboat Operators, HQUSACE, 1

September 2019.

g. ER 385-1-92, Safety and Occupational Health Requirements for Environmental Cleanup

Projects, HQUSACE, 1 November 2018.

h. 29 CFR 1910.120, Labor Occupational Safety and Health Administration, as current.

i. 29 CFR 1910.1020, Labor Occupational Safety and Health Administration, as current.

j. The cited references can be found at https://armypubs.army.mil

Code of Regulations can be accessed at:

eCFR :: 29 CFR Part 1910 -- Occupational Safety and Health Standards Official Publications of the Headquarters, U.S. Army Corps of Engineers https://www.publications.usace.army.mil

5. Establishing Medical Exam Appointments.

a. The contractor shall name an account manager or other person as the singular point of contact for all matters related to the execution of this contract.

b. The LRN Nashville District Safety Office shall provide the account manager with the name(s), contact information to include phone number and e-mail address, type of exam required, and reason for exam request.

c. The account manager or designated person shall advise the LRN Nashville District Safety Office of the proper procedures for establishing a medical exam appointment.

d. Individual LRN Nashville District Employees shall be responsible for contacting the contractor to establish a medical exam appointment.

e. LRN Nashville District Employees shall be responsible for following contractor instructions related to the establishment and performance of medical exams.

https://armypubs.army.mil/ https://www.ecfr.gov/current/title-29/subtitle-B/chapter-XVII/part-1910 https://www.publications.usace.army.mil/ https://www.publications.usace.army.mil/

f. The contractor shall provide e-mail confirmation to the employee of the time, date and location of the examination.

6. Determination of Medical Exam Scope.

a. Upon arrival at the medical exam location, the LRN Nashville District employee shall present the following forms as they apply to the employee’s examination: DOT Physical.

Crane Operators Physical, OSHA Respirator Questionnaire. Forms documenting the physical used by the servicing provider may be used, provided they contain the same level of documentation.

b. If necessary, the contractor shall seek additional medical history, exposure history, and occupational history information from the employee.

c. The contractor shall refer to the regulations listed above to determine whether the employee is subject to specific medical examination requirements under any or all of those regulations.

d. Upon review of all pertinent documentation, the contractor shall determine and deliver a regimen of appropriate tests and examination procedures.

7. Analysis and Interpretation. All examination results and lab data shall be delivered by the contractor to a board-certified occupational health physician for review and determination of fitness.

8. Reports of Findings and Recommendations.

a. The employer may authorize additional tests to be performed to allow completion of an annual wellness exam, when desired by the employee and agreed to by the supervisor.

The additional cost must not exceed 30% of the required occupational examination. The contract occupational health physician shall deliver his/her laboratory and examination findings and recommendations to:

i. The affected employee. (ANY TESTING DONE BEYOND THAT REQUIRED

FOR THE WELLNESS HEALTH EXAMINATION SHALL ONLY BE SHARED

WITH THE EMPLOYEE AND THEIR PERSONAL PHYSICIAN, IF

REQUESTED. THIS INFORMATION SHALL NOT BE INCLUDED IN THE

OCCUPATIONAL HEALTH RECORDS OR REVIEWS.)

b. The affected employee’s personal physician (if requested).

c. The contractor’s medical records manager.

d. If the employee is found fit for clearance, the occupational health physician shall issue a memorandum of medical clearance via secure email to the employee and the LRN Nashville District Safety Office.

e. In the event that the employee is found unfit, the occupational health physician shall counsel the employee regarding the findings and any recommended follow-up actions.

9. Record Retention and Storage.

a. The contractor shall retain and store all medical documentation in accordance with the Health Insurance Portability and Accountability Act (HIPAA) and OPM/GOVT-10 Employee Medical File System Records

b. In the event of contract termination or business interruption, the contractor shall ensure the secure transfer of all records in its care to an entity designated by the LRN Nashville District Safety Office.

c. The contractor shall establish and maintain a system that allows LRN Nashville District employees to access their medical records in accordance with 29 CFR 1910.1020.

10. Schedule of Fees for Service. The contractor shall submit a schedule of fees for service for all anticipated activities included, but not limited to the following:

a. Comprehensive Medical Exam (Medical Surveillance/HAZMAT)

b. Reproductive Cancer Screening (Female)

c. Audiometry

d. B-Reading

e. Chest X-Ray P/A

f. Colorectal Cancer Screening

g. Electrocardiogram

h. Spirometry

i. Best Vision

j. Comprehensive Vision

k. Tonometry

l. Vital Signs, Height/Weight

m. Scheduling

n. Venipuncture

o. Physician – Occupational Medicine Consultant (per hour)

p. Record Review – Physician (per hour)

q. Medical Review Officer (per hour)

r. Audiology Review (per record)

s. Record Processing (per hour)

t. Missed Appointment Fees (per occurrence)

u. Blood Type & Rh

v. Cholinesterase RBC and Plasma

w. SMA 20

x. Lead – Industrial whole blood

y. PCBs

z. PSA

aa. ZPP, Blood Protoporphyrins, zinc

bb. Chlorinated Hydrocarbons, Quant (B); Dichloromethane, 1-1-1 Trichloroethane, Trichloroethylene, Tetrachloroethylene, Dichlorobenzene, Chloroform

cc. Glucose 6 Phosphate Dehydrogenase

dd. Hepatitis B Surface Antibody (QL)

ee. Lyme’s Disease AB Screen

ff. Hepatitis A Vaccination #1

gg. Hepatitis A Vaccination #2

hh. Hepatitis B Vaccination #1

ii. Hepatitis B Vaccination #2

jj. Hepatitis B Vaccination #3

kk. Hepatitis A/B Combination #1

ll. Hepatitis A/B Combination #2

mm. Hepatitis A/B Combination #3

nn. Influenza Vaccination

oo. Tetanus Diphtheria Vaccination

pp. Tuberculosis Skin Test