OH Exams 2024 PWS_R1.docx

PERFORMANCE WORK STATEMENT (PWS)

FOR

Occupational Health Job Related Medical Examinations Services

1.0 General: Designated full-time support (FTS), both civilian, and uniformed federal technicians who are selected to be employees, or current employees who are potentially exposed to health hazards in the work environment are required to undergo job related Occupational Health exams. The Performance Work Statement (PWS) supports the Massachusetts Army National Guard (MA ARNG) Occupational Health Program in accordance with the Occupation Safety and Health Association (OSHA) and other regulations. The estimated number of personnel to be examined and tested is from a minimum of 10 to a maximum of 225 each year. The Government has the right to increase or decrease the number of personnel depending on employee population.

1.1 Description of Services: 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, screening, and physical exam of each employee as defined in this PWS.

1.2 Background: The Massachusetts Army National Guard (MAARNG) Occupational Health Program encompasses review of 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:

a. Medical Qualification

b. Medical Surveillance

c. Termination / Retirement

d. Fitness for duty

e. Audiologist evaluations.

Test Requirements may be different for each classification of exam and will be identified at the time of exam scheduling requests. Therefore, cost quotes should be on a per test or assessment basis.

1.3 Period of Performance (PoP): The Period of Performance shall be one Base Year of 12 months and four 12-month option years.

1.4 General Information:

1.4.1 Place and Performance of Services: The contractor shall provide services between the hours of 0700-1500 Monday through Friday, except on recognized US holidays. Performance shall be at locations within Massachusetts or within one hour travel time of an employee’s start point of travel. The location site must have the capability to perform all required testing and screening. 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. Telecommuting is not authorized.

1.4.1 Telework: The Government does not permit the contractor to telework in support of this requirement. In furtherance of Continuity of Operations Planning (COOP), a telework program may be enacted to ensure that the Government's mission-critical operations stay operational during times of national emergency or incidents of national significance. Telework shall be at no additional cost to the Government.

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

1.4.2.11Christmas 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).

1.4.4 Quality Assurance (QA): The Government will evaluate the contractor’s performance under this 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 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.

1.4.5.1 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 (DFARS) 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.

1.4.6 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 other Government personnel, as appropriate, may meet periodically with the contractor to review the contactor’s performance. At these 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.

1.4.7 Contract Manager (CM): The contactor shall designate a CM who shall ensure performance under this contract. The name of this person, and an alternate who shall 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.

1.4.8 Identification of Contractor Employees: All contractor personnel attending meetings, answering Government telephones and working in other situations where their contractor status is not obvious to third parties are required to identify themselves as such to avoid creating an impression that they are Government employees. The contractor shall ensure that all documents or reports produced by contractor personnel are suitably marked as contractor products or that contractor participation is appropriately disclosed. The contractor’s status as a “contractor” shall be predominantly displayed in all correspondence types (to include signature blocks on e-mail) and dealings with Government or non-Government entities.

1.4.9 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.

1.4.10 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.

1.4.11 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 OCIs, 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 event the 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.

2.1 Definitions:

2.1.1 Contractor. A supplier or vendor awarded a contract to provide specific supplies or services 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, 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 appointed by the contracting officer to administer the contract. 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 if 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 but may include non-manufactured things such as meeting minutes or reports.

2.1.6 Equipment: A tangible item that is functionally complete for its intended purpose, durable, nonexpendable, and needed for the performance of a contract. Equipment is not intended for sale and does not ordinarily lose its identity or become a component part of another article when put into use. Equipment does not include material, real property, special test equipment or special tooling.

2.1.7 Government Furnished Property: 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.

2.1.8 Government Property: All property owned or leased by the Government. Government property includes both Government-furnished property 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.

2.1.9 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. The prime contractor is responsible for performance of all subcontractors.

2.1.10 Loss of Government Property: Unintended, unforeseen, or accidental loss, damage, or destruction of Government property that reduces the Government’s expected economic benefits of the property. Loss of Government property does not include occurrences such as purposeful destructive testing, obsolescence, normal wear and tear, or manufacturing defects. Loss of Government property includes but is not limited to: Items that cannot be found after a reasonable search; Theft; Damage resulting in unexpected harm to property requiring repair to restore the item to usable condition; or Destruction resulting from incidents that render the item useless for its intended purpose or beyond economical repair.

2.1.11 Material: Property that may be consumed or expended during the performance of a contract, component parts of a higher assembly, or items that lose their individual identity through incorporation into an end-item. Material does not include equipment, special tooling, and special test equipment or real property.

2.1.12 Non-Personal Services: The personnel rendering the services 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. Non-personal service contracts are authorized by the government in accordance with FAR 37.012, under general contracting authority, and do not require specific statutory authorization.

2.1.13 Physical Security: Actions that prevent the loss or damage of Government property.

2.1.14 Property: All tangible property, both real and personal.

2.1.15 Property Administrator: 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.

2.1.16 Property Records: Records created and maintained by the contractor in support of its stewardship responsibilities for the management of Government property.

2.1.17 Quality Assurance: The government procedures to verify that services being performed by the Contractor are performed according to acceptable standards.

2.1.18 Quality Assurance Surveillance Plan: An organized document written by the government specifying the surveillance methodology used for surveillance of contractor performance.

2.1.19 Quality Control: All necessary measures taken by the Contractor to assure that the quality of a product or service shall meet contract requirements.

2.1.20 Sensitive Property: Property potentially dangerous to the public safety or security if stolen, lost, or misplaced, or that shall be subject to exceptional physical security, protection, control, and accountability. Examples include weapons, ammunition, explosives, controlled substances, radioactive materials, hazardous materials or wastes, or precious metals.

2.1.21 Subcontractor: One that enters a contract with a prime contractor. The Government does not have privity of contract with the subcontractor.

2.1.22 Wide Area Work Flow (WAWF): A secure web based system for electronic invoicing, receipt, and acceptance. WAWF allows government vendors to submit and track invoices and receipt/acceptance documents over the web and allows government personnel to process those invoices in a real-time, paperless environment.

2.1.23 Workday: The number of hours per day the Contractor provides services in accordance with the contract.

2.1.24 Work Week: Monday through Friday, unless specified otherwise.

2.2 Acronyms:

ACOR Alternate Contracting Officer’s Representative AFARS Army Federal Acquisition Regulation Supplement

CAP Contractor Acquired Property

COTS Commerical-Off-the-Shelf

HIPAA Health Insurance Portability and Accountability Act of 1996

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 Materials: The Government will furnish any agency specific forms necessary. Government will furnish specific criteria for testing.

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 indemnify the Government for any liability producing act or omission by the Contractor, its employees and agents occurring during contract performance. The Contractor shall maintain medical liability insurance, in a coverage amount acceptable to the Contracting Officer, which is not less than the amount normally prevailing within the local community for the medical specialty concerned. The Contractor is required to ensure that its subcontractors, if any, for provisions of health care services, contain the requirements of the clause at 52.237-7, Indemnification and Medical Liability Insurance, including the maintenance of medical liability insurance. 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 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.

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

5.1.2 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. Contractor shall provide a certified Audiologist to perform any audiology consultation requests.

5.1.3 Contractor shall ensure the right employee receives the right tests and examinations as requested by the MA AARNG Occupational Health Office (OHN) or Occupational Health Office representative. Each exam request will include individual employee by name and define the testing and exam required for that person based on the type of exam requested. All exam results will be organized and mailed, forwarded directly to the OHN by the contractor (hard copies, or encrypted downloads/email or other electronic media). Contractor will mail directly to each employee a hard copy of all exam results.

5.1.4 Contractor shall be able to provide all exam and testing requirements at the same location where employee is scheduled in one (1) day.

5.2 Exam and screening criteria may include any of the following:

5.2.1 Contractor shall provide vital signs to include height, weight, blood pressure, pulse and respirations.

5.2.2 Contractors shall provide physical exam assessment that includes, inguinal hernia screening for male employees, and back strength, flexibility and, range of motion for all employees. Note any abnormalities or symptoms and recommended lifting or other limitations if necessary.

5.2.3 Contractor shall ensure any requested Pulmonary Function Tests (PFTs) are Performed by a licensed physician, Certified Pulmonary Function Technologist, or Personnel certified through a program approved by the National Institute for Occupational Safety and Health (NIOSH) in accordance with 29 CFR 1910.1001.

a. 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, sex, race, age and a documented interpretation by a pulmonologist or certified Occupational Health physician.

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

a. Visual acuity for distance and near.

b. Lateral phorias for distance and near.

c. Vertical phorias for distance and near.

d. Depth perception.

e. Color perception.

f. Peripheral vision.

5.2.5 Contractor shall ensure laboratory tests will be processed by certified clinical laboratories and performed by personnel certified under the American Society of Clinical Pathology. Serum Lead must be processed by a laboratory meeting standards set forth in 29 CFR 1910.1025. Laboratory tests may include any or all of the following:

a. Bilirubin, total.

b. Blood urea nitrogen (BUN).

c. Complete Blood Count (CBC) including differential and blood platelets (actual).

d. Creatinine, serum.

e. Eosinophil count.

f. Hemoglobin and hematocrit.

g. Peripheral smear morphology.

h. Red cell indices.

i. Reticulocyte count.

j. Triglycerides, Total Cholesterol to include HDL and LDL.

k. Urinalysis (UA), screening and microscopic.

l. Liver Profile ensymes

m. Zinc Protoporphyrin (ZPP)

n. Heavy Metals to include chromium and cadmium (urine and blood levels) Note: Other labs may be required based on exposure, i.e. chromium, copper, formaldehyde, benzene, etc.

5.2.6 Audiograms must be performed in accordance with Standard Testing Procedures for Army Hearing Conservation and Hearing Readiness in accordance with Technical Exhibit 4 and will include a record of the threshold of audibility of each ear for pure tone test frequencies 500, 1000, 2000, 3000, 4000, and 6000 Hertz.

5.2.7 Contractor shall ensure dermatological examinations must include an inspection of the integumentary system with emphasis on areas most likely to be affected by the employee's occupational (i.e. radiation or chemical) exposures. Documentation shall include the presence of any dermatomes or lesions of the skin.

5.2.8 Contractor shall perform Chest X Rays for B-Read and EKGs when requested as testing to be included in exam.

5.2.9 Contractor shall provide the Contracting Officer’s Representative with a Quality Assurance Service Plan listing the procedures or processes, which shall be utilized to meet the requirements discussed in the PWS.

5.2.10 Contractor will notify of abnormal findings; any abnormal findings may be confirmed by repeat analysis. Confirmed results will be reported immediately to the OHN. If abnormal findings are due to vendor contractor error, tests will be repeated at no additional charge to the government.

5.3 MEDICAL REPORTS AND RECORDKEEPING

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

5.3.2 Contractor shall organize and send all exam results and recommendations, forms, and supportive documentation to the OHN (hard copies, or encrypted downloads/email or other electronic media) within 10 working days of completion of exam.

5.3.3 Contractor shall mail directly to each employee a hard copy of all testing results within 15 working days of completion of exam.

5.4 Examination Scheduling and Processing

5.4.1 Coordination of scheduling shall be a joint effort between the SOH Office and the Contractor. A representative of the SOH Office will contact the contractor to schedule each individual employee. At that time, the type of exam / testing will be identified and verified with the contractor. An appointment shall be available within 10 working days of the scheduling request.

5.4.2 In the event of a Contractor equipment failure, specific testing and / or parts of examinations that are not completed during the testing period shall be completed at a scheduled time mutually convenient for the Contractor, the OHN, and the employee. Unfinished testing / examinations by fault of the Contractor will be completed at no additional cost to the Government. The option to re-schedule physicals not completed due to equipment failure shall be done at no additional cost to the Government. The Contractor shall be directly responsible to cover costs for completing these make-up screenings.

5.4.3 Privacy and Security. The Contractor shall ensure that all findings are clearly recorded on Government or other approved / agreed forms, and are protected by Privacy Act of 1974 and Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandated safeguards to ensure confidentiality of health information.

5.4.4 The contractor shall only charge per test or other itemized services for quantity of services rendered.

5.4.5 Contractor shall arrange for the opportunity to consult with the Occupational Health Nurse of the MAARNG to coordinate or resolve issues that might arise before, during, and after exams.

5.4.6 Contractor shall perform a comprehensive review and written evaluation within 30-days following the conclusion of the service contract. The Occupational Health Nurse may contact and schedule a periodic review and evaluation meeting to discuss positive and negative aspects of testing as necessary.

5.4.7 Contractor shall ensure licensed medical technicians will perform the medical examination screening/testing elements. The person(s) conducting the audiogram must be certified by the Council for Accreditation in Occupational Hearing Conservation (CAOHC). Personnel conducting Spirometry shall be certified through a program approved by the National Institute for Occupational Safety and Health (NIOSH).

5.4.8 Instrumentation must meet or exceed appropriate performance standards and calibration accuracy must be verified IAW current Occupational Medicine Certification standards.

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

Publication (Chapter/Page)

Federal Acquisition Regulation https://www.acquisition.gov/?q=browsefar

Defense Federal Acquisition Regulation Supplement http://www.acq.osd.mil/dpap/dars/dfarspgi/current/index.html or https://www.acquisition.gov/dfars

Joint Travel Regulation (JTR) https://www.defensetravel.dod.mil/site/travelreg.cfm

DoDM 1000.13-M-V1 DoD Identification (ID) Cards (Enclosure 2, paragraph 3.b) 01/23/2014 (Change 1: 07/28/2020) http://www.esd.whs.mil/Directives/issuances/dodm

Federal Information Processing Standards (FIPS) Publication 201-2 Personal Identity Verification (PIV) of Federal Employees and Contractors (paragraph 9) August 2013 http://nvlpubs.nist.gov/nistpubs/FIPS/NIST.FIPS.201-2.pdf

https://www.esd.whs.mil/Directives/issuances/dodm/

DoDI 5200.46 DoD Investigative and Adjudicative Guidance for Issuing the Common Access Card (CAC) 09/09/14 (Change 1: 05/04/2018) https://www.esd.whs.mil/Directives/issuances/dodi/

Homeland Security Presidential Directive (HSPD)-12 Policy for a Common Identification Standard for Federal Employees and Contractors 08/27/2004 https://www.dhs.gov/homeland-security-presidential-directive-12

DoDI 5400.11 Department of Defense Privacy and Civil Liberties Programs 01/29/2019 https://www.esd.whs.mil/Directives/issuances/dodi/

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

DoDD 8140.01 Cyberspace Workforce Management

10/05/2020 https://www.esd.whs.mil/Directives/issuances/dodd/

DoD 8570.01-M Information Assurance Workforce Improvement Program 12/19/2005 (Change 4: 11/10/2015) https://www.esd.whs.mil/Directives/issuances/dodm/

DoD 5220.22-M National Industrial Security Program Operating Manual (NISPOM) 02/28/2006 (Change 2: 05/18/2016) https://www.esd.whs.mil/Directives/issuances/dodm/

Army Directive 2014-05 Policy and Implementation Procedures for Common Access Card Credentialing and Installation Access for Uncleared Contractors 03/07/2014 https://armypubs.army.mil/ProductMaps/PubForm/ArmyDir.aspx

AR 25-2

Information Assurance 04/04/2019 http://armypubs.army.mil/ProductMaps/PubForm/AR.aspx

AR 530-1

Operations Security 09/26/2014 http://armypubs.army.mil/ProductMaps/PubForm/AR.aspx

AR 525-13

Antiterrorism 12/09/2019 http://armypubs.army.mil/ProductMaps/PubForm/AR.aspx

AR 381-12

Threat Awareness and Reporting Program (TARP) (Section II, ¶ 2-4.b) 06/01/2016 http://armypubs.army.mil/ProductMaps/PubForm/AR.aspx

Title 29, Code of Federal Regulations, Part 1910: Occupational Safety and Health Standards.

Mandatory

Title 29, Code of Federal Regulations, Part 1960: Safety and Health Provisions for Federal Employees.

Mandatory

American National Standards Institute (ANSI) 288.6-1884, American National Standard for Respiratory Protection, Respirator Use, Physical Qualifications for Personnel.

Advisory

Threshold Limit Values and Biological Exposure Indices (TLVs), American Conference of Governmental Industrial Hygienists (ACGIH), Cincinnati, Ohio.

Advisory

Mandatory

U.S. Department of Labor, Code of Federal Regulations 29 (CFR) 1910.120 (b) (5), (f), Medical Surveillance

Mandatory

6.1 Applicable Forms: Forms applicable to the PWS are listed below (additional forms may be applicable based on exams performed):

DD 1172-2

Application for Identification Card/DEERS Enrollment

I-9 Employment Eligibility Verification 10/21/2019 https://www.uscis.gov/sites/default/files/files/form/i-9.pdf

DD 441

Department of Defense Security Agreement Feb 2020 http://www.dtic.mil/whs/directives/forms/dd/ddforms0001-0499.htm

DD 250

Material Inspection and Receiving Report

TECHNICAL EXHIBIT 1

Performance Requirements Summary (PRS)

This PRS includes performance objectives the Government will use to determine contractor performance and will compare contractor performance to the Acceptable Quality Level (AQL).

5.1.4 Location and timeframe for completing exam components

Examination scheduling timeline

Contractor shall ensure an exam date is available within 10 working days of request

TECHNICAL EXHIBIT 2

Deliverables Schedule

5.3.2 Exam results packet

TECHNICAL EXHIBIT 3

Estimated Workload Data

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

TECHNICAL EXHIBIT 4

STANDARD

TESTING PROCEDURES FOR ARMY

HEARING CONSERVATION AND HEARING READINESS

IAW 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.

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

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

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

D. 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.

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

F. 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.

2. EQUIPMENT

A. Hearing Conservation and Hearing Readiness testing will be completed using the approved DOEHRS-HC audiometer. The current version of the DOEHRS-HC software must be utilized. IAW AR 40-501, Chapter 11g.(1) “The Defense Occupational Environmental Hearing Readiness Application – Hearing Conservation (DOEHRS-HC) audiometer is the only authorized audiometer for conducting and recording DD Form 2215 (Reference Audiogram) and DD Form 2216 (Hearing conservation Data).” The current DoD approved DOEHRS-HC audiometer is the Benson CCA-200mini.

B. An audiometer must have an annual, comprehensive electro-acoustical calibration to ensure it is functioning properly and IAW the American National Standards Institute (ANSI) Standard S3.6.

C. Audiometers must pass a daily calibration and functional check. Daily calibration check results must be recorded on a DD Form 2217, Biological Audiometer Calibration Check.

D. Earphone cushions must be clean and in good condition.

E. Headbands must be in good condition and provide proper tension.

F. Earphone cords must be in good condition with no cracks or breaks in the insulation or shorts in the wires.

3. TEST ENVIRONMENT

A. Hearing Conservation and Hearing Readiness tests must be completed in a sound booth. The noise levels within the hearing test environment must not exceed those shown in DA PAM 40-501, Table 7-1. Stationary audiometric test booths must be evaluated on an annual basis using sound level meter equipment conforming to:

a. At least the Type 1 requirements of the ANSI Standard S1.4-1983 (R 1997) and S1.4A-1985 Amendment (or latest approved standard).

b. The band filter sets shall conform to requirements for Order 3, Type 3-D, extended range as specified by the latest ANSI Standard S1.11.

B. Noise level measurements must be recorded on the U. S. Army Public Health Command Audiometric Test Booth Certification Form with a copy furnished to the Hearing Program Manager or their representative upon request. The USAPHC Audiometric Test Booth Certification Form is available at: http://phc.amedd.army.mil/PHC%20Resource%20Library/AudiometricTestBoothCertification.pdf

C. Noise level measurements for mobile audiometric test booths must be evaluated each time they are moved to a new location or at a minimum, annually, if they are never moved and are used as stationary audiometric test booths.

D. Ventilation systems in audiometric test booths must provide adequate air exchange for patient comfort and acceptable sound levels for valid audiometric testing.

E. The standard for testing maximum permissible ambient noise levels (MPANL) within DoD is the ANSI S3.1, 1999 (R 2008) standard which requires sound measurements with a Type 1 sound level meter. The OSHA standard which allows measurements with a Type 2 sound level meter and allows much higher MPANL is not applicable for testing within DoD.

F. Hearing technicians will ensure that tests are completed in a sound booth that meets the DoD and Army Maximum Permissible Ambient Noise Levels (MPANL) IAW ANSI standards for MPANL and will ensure that the USAPHC Audiometric Test Booth Certification Form is posted on the audiometric test booth(s).

4. AUDIOMETRIC EVALUATION REQUIREMENTS

A. Hearing technicians will accurately enter their examiner information into the DOEHRS-HC system. Sharing of Common Access Cards (CAC), training certification numbers, usernames and passwords is prohibited. Incidents of falsified or shared examiner information shall be immediately reported to the USAPHC, Army Hearing Program, usarmy.apg.mdcom-aphc.mbx.army-hearing-program@mail.mil

B. Hearing technicians will complete the daily functional checks and daily calibration on their DOEHRS-HC audiometers at the beginning of each test day with results recorded on a DD Form 2217, Biological Audiometer Calibration Check. The hearing technician will, upon request, provide the Hearing Program Manager, Case Manager or their representative a copy of the DD Form 2217.

C. The hearing technician will ensure all Army National Guard Soldiers have their Major Command identified as NGB in the DOEHRS-HC system and that the correct state or territory is selected for the Soldier being tested. Contractor hearing technicians will ensure that when they test on site for Army National Guard contracts their DOEHRS-HC examiner information lists the state or territory where they are testing.

D. The hearing technician shall ensure that all demographic information for personnel tested is entered correctly and accurately at the time of the test. Hearing technicians will not enter noise data unless there is specific noise exposure information available for the individual being tested. Hearing technicians will ensure that Unit Identification Code (UIC) information is entered correctly.

E. Otoscopic examinations will be performed prior to the hearing test.

F. Hearing technicians will ensure hearing aids and any other objects that may interfere with testing (glasses, earrings, gum, etc.) are removed prior to administering any monitoring audiometry hearing tests.

G. DD Form 2215 and DD Form 2216 Audiograms will be completed using the DOEHRS-HC system. Thresholds will be recorded at 500 Hz, 1000 Hz, 2000 Hz, 3000 Hz, 4000 Hz and 6000 Hz using the CCA-200mini audiometer, Standard Test Configuration, Modified Hughson-Westlake threshold procedure, and DoD Significant Threshold Shift method.

H. The hearing technician shall ensure that all DD Form 2215 and DD Form 2216 audiograms are printed immediately following the completion of the test.

I. Hearing test results will be explained to the individuals being tested.

J. DOEHRS-HC automatically generates recommendations for referral when specific criteria are met. The hearing technician will inform both the individual and the Hearing Program Manager, Case Manager or their representative of the need for a referral at the time of the test.

K. The hearing technician shall ensure that all consult referral forms are printed and saved immediately following the completion of the test.

L. In the event of a negative significant threshold shift (STS), hearing technicians will ensure that the follow-up test is conducted immediately. If a negative STS is confirmed, a new baseline will be re-established at the time of testing.

M. In the event of a positive STS, hearing technicians will ensure the individual signs the DD Form 2216 to acknowledge that the test results and required follow-up steps were explained to the individual.

N. In the event of a positive STS, the Hearing Program Manager, the Case Manager or their representative will be notified on the day of testing so the follow-up hearing test(s) can be completed within 30-days (Civilian) or 90-days (Military) of the periodic test.

O. The hearing technician will ensure that positive STS follow-up tests are performed after at least fourteen noise free hours. If necessary, hearing technicians will complete follow-up two immediately after completing follow-up one. Hearing technicians will ensure that a new baseline is established when the positive STS is confirmed after completing follow-up two.

P. All DOEHRS-HC data must be uploaded to the DOEHRS-HC Data Repository at the end of each test day, at a minimum.

Q. The hearing technician will, upon request, provide the Hearing Program Manager, Case Manager or their representative, requested DOEHRS-HC reports at the end of each test day. The profile report, daily report logs, STS reports and test summary are standard reports available in the DOEHRS-HC system.

5. DHA STANDARD CONTRACT LANGUAGE REQUIREMENTS

A. DHA Standard Contract Language will be used for all contracts; Personal Identifiable Information (PII), Protected Health Information (PHI) and Federal Information requirements (Revised 2 April 2014): http://www.tricare.mil/tma/privacy/contractlanguage.aspx