PERFORMANCE WORK STATEMENT Pre-Hire Exams.pdf

PERFORMANCEWORK STATEMENT (PWS) FOR

Occupational Health Pre-Hire Medical Exams 22-27

1.1 General:

1.2 Scope: The contractor shall provide all personnel, equipment, tools, materials, supervision, and quality control necessary, except as specified in Paragraph 3.0 as Government Furnished, to perform Occupational Health Pre-Hire Medical Exams.

1.3 Background: The purpose of the Mississippi Army National Guard (MSARNG) Occupational Health Pre-Hire Medical Exams is to provide baseline, job specific medical examinations for MSARNG federal technician pre hire candidates for one year (12 months). The number of projected technician candidates to be examined may change due to the technician staffing requirements. This statement of work does not cover State employees, emergency hires, or civilian vendors. The number of projected technicians to be examined may change due to the current technician staffing levels. The vendor will only charge for exams performed. The vendor will provide all labor, tools, supervision and supplies to conduct periodic medical examinations for the MSARNG. The clinic will be within a twenty-five mile radius of the Jackson, MS metro area.

1.4 Period of Performance (PoP): The Period of Performance shall be for one year (12 months).

1.4.1 Scheduling: Occupational Health Pre-Hire Medical Exams scheduling will vary depending upon MSARNG demand and ability.

** All notifications of any abnormal results will be made immediately to technician and documented in the medical record.

**All exam results, including lab results, will be completed, assessed by contractor’s licensed medical practitioner, reviewed by contractor and mailed to ARNG Staff Element Joint Force 1410 Riverside Dr. Jackson, MS ATTN: Veronica Boyd, using U.S. postal mail service or securely digitally emailed to the OHN at veronica.r.boyd2.mil@mail.mil within 30 days of last day of event.

1.5 General Information:

1.51 SCOPE OF TASKS: The following tests/examinations will be required to be performed by the vendor and/or its agents for technicians within one year and must meet the criteria specified:

1.5.1. Basic exams will consist of the following elements:

a. Head to toe functional capacity exam on designated employees, to include lifting capacity, range of motion and identifying any physical limitations.

b. Audiogram 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.

mailto:veronica.r.boyd2.mil@mail.mil

c. Vision screening will detect the possible need for visual correction. Parameters surveyed will include far and near visual acuity, both eyes, left eye, right eye, stereo depth, vertical phoria, lateral phoria, color vision, and peripheral vision. And Nondestructive Inspection and Testing (NDI) vision screenings per FAA. The exam documentation will reflect, and the technician notified, of any abnormal findings per the TG 006. Any additional tests are NOT billable to MSARNG.

d. Vital Statistics to include blood pressure, pulse, height, and weight.

1.5.2. The following individual elements may be required based on job-related hazard exposures:

a. Laboratory tests will be processed by certified clinical laboratories and performed by personnel certified under the American Society of Clinical Pathology. The supporting laboratory will provide, at no additional cost, employee instruction and equipment necessary for tests requiring special collection methods and/or containers (i.e., 24-hour urine collection, fasting, etc.). Tests may include any or all the following:

1. Lead/ZPP analysis

2. Chromium level analysis

3. Cadmium level analysis

4. Benzene level analysis

5. Lipid panel

6. CMP

7. Comprehensive Profile (Lipid Panel, BUN, Creat, Sodium, Potassium, Chloride, Carbon Dioxide, Calcium, Total Protein, Albumin, Total Bilirubin, Alkaline Phosphatase, AST, ALT, CBC (includes Diff with white blood cell count, red blood cell count, hemoglobin, hematocrit, MCV, MCH MCHC, RDW, and Platelet count)

9. Urinalysis (POCS) (includes color, appearance, specific gravity, PH, glucose, bilirubin, ketones, occult blood, protein, nitrite, leukocyte esterase

b. Pulmonary Function Tests will meet the following criteria:

1. Performed by a licensed physician, Certified Pulmonary Function Technologist, or Registered Respiratory Therapist in accordance with 29 CFR 1910.1001. Reports will include respirator use clearance.

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

3. Specifications regarding equipment guidelines and calibration test administration, and test interpretation must meet applicable OSHA and ANSI standards. Supporting documentation will be provided to the Occupational Health Manager upon request.

c. Respirator Clearance: The Vendor must provide technician with a Respirator Clearance questionnaire and the medical provider will review the Respirator Clearance Questionnaire and make a recommendation for or against medical clearance for technicians whose position may require respirators. The Vendor will provide clearance, in writing, to wear respirators, type, and any restrictions to the technician. This information will also be documented in the exam paperwork.

d. Respirator Fit Testing. The vendor must have quantitative and qualitative respirator fit testing capabilities. The results must be documented in the medical record and a copy of results provided to the technicians for their records.

1.5.3. Physical Examination by a certified Occupational Health Physician (MD, OD or PA) only with appropriate qualifications, training, licensing, and experience in occupational health. The physician will verbally counsel patients on findings and wellness education.

1.5.4. Abnormal Findings. Any abnormal findings that indicate the possibility of a present danger to the employee will be confirmed by repeat analysis at no additional charge. Confirmed results will be reported immediately to the technician and documented in the exam paperwork. If these findings affect the functional capacity or physical performance abilities of the technician, the medical provider must so indicate in the conclusions. If abnormal findings are due to vendor (or vendor’s agent) error, e.g.

artifacts on chest x-rays, test will be repeated at no additional charge.

1.5.2 In the event of vendor equipment or staffing failure, specific testing and/or parts of examinations which are not completed during the testing period are to be completed at an alternate location and scheduled time mutually convenient to the Vendor and the technician.

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

1.5.4.1 New Year’s Day: January 1st

1.5.4.2 Martin Luther King, Jr.’s Birthday

1.5.4.3 President’s Day

1.5.4.4 Memorial Day

1.5.4.5 Juneteenth National Independence Day

1.5.4.6 Independence Day: July 4th

1.5.4.7 Labor Day

1.5.4.8 Columbus Day

1.5.4.9 Veteran’s Day: November 11th

1.5.4.10 Thanksgiving Day

1.5.4.11 Christmas Day

1.4.5.3 Protection of Personally Identifiable Information (PII). The contractor shall protect all Personally Identifiable Information (PII) encountered in the performance of services in accordance with DFARS 224.103 and 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 who’s PII has been compromised.

5.0 Requirements: The contractor shall furnish all items necessary to meet the requirements of this contract. The vendor will provide their own medical supplies, office supplies and equipment needed for all testing and exams. The vendor will ensure that the licensed medical practitioner will have a private exam area with table and supplies available to conduct a thorough fit for duty, functional capacity assessment exam per job description and functional capacity exam. Vendors will provide documented proof of current required technician certification/license and equipment calibration with their proposal. The vendor will notify the technician immediately of any serious or life threatening medical abnormality, and document such event on the technician’s medical form.

5-1. The Contractor must NOT bill any authorized MSARNG Technician for services rendered. Any additional testing needed for a technician’s medical exam that is not indicated in the authorization must be authorized by the Occupational Health Nurse in writing.

5-2. The Contractor’s medical provider will review the technicians’ completed Respirator Clearance Questionnaire and make a recommendation for or against clearance for technicians whose position requires respirators. The Contractor will provide clearance to wear respirators, type and any restrictions directly to the technician and the OHN. This information will also be documented in the exam paperwork.

5.X Contractor Manpower Reporting Application (CMRA): N/A

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

**The Vendor will be familiar with all given references to understand the MSARNG overall expectation of health of Periodic technicians, and to ensure that all technicians are tested and assessed in accordance with the given references.

6-1. 29 CFR 1910: Occupational Safety & Health Standards

6-2. 29 CFR 1960: Program Elements for Federal Employee Occupational Safety & Health Programs

6-3. DA Pam 40-501: Hearing Conservation 6-4. DA Pam 40-506: The Army Vision Conservation and Readiness Program, 15 Jul 2009

6-5. Technical Guide (TG)-006: Vision and Safety eyewear Guide for U.S. Army Civilian & Military Job Series, Oct. 2010

6-6. NGR 40-5: The Army National Guard Preventive Medicine Program, Feb. 2013