PWS Annual Surveilance FY 2020 updated 20200319 lmb.docx

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PERFORMANCE WORK STATEMENT (PWS)

FOR

OCCUPATIONAL HEALTH EXAM SERVICES

1.1 GENERAL

1.2 Scope: The Contractor will provide Board Certified Physician(s) with experience in Occupational Health, supervision, all labor, tools, materials, equipment, and incidentals required to conduct the Occupational Health Examinations / Medical Surveillance Services for the WIARNG. The Performance Work Statement (PWS) supports the Wisconsin Army National Guard (WIARNG) for Occupational Medical Surveillance Examination Program in accordance with the Occupation Safety and Health Association (OSHA) and other regulations. Annual Examinations are required for up to 50 WIARNG full time employees. Up to 125 Periodic examinations for newly hired, terminating or returning to service exams will also be required. The government reserves the right to increase and/or decrease the number of employees requiring examinations, during the contract period, based on the requirement. Places of Performance. Examinations will be in established permanent building clinics within the state of Wisconsin, within 1 hour of the following cities: Madison, Milwaukee, Eau Claire, Wausau, Oshkosh, Kenosha, Tomah, Wisconsin Rapids, and Hayward.

1.2.1 Background: The purpose of the Occupational Medical Surveillance Examination Program is to provide job-related Occupational Health Examinations and Medical Surveillance Services to the WIARNG full-time support (FTS) and/or temporary personnel who are exposed to OSHA level PEL health hazards in the work environment. The examination shall include personnel assigned to positions requiring specific standards of physical fitness. Personnel not included under these examinations are State Employees, civilian contractors, Active Guard Reserve, Active Duty for Operational Support (ADOS) and part-time traditional Soldiers.

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

1.4 General Information:

1.4.1 Quality Assurance (QA): The Government shall 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 must do to ensure that the contractor has performed in accordance with the performance standards. It defines how the performance standards will be applied, the frequency of surveillance, and acceptable quality level(s) (defect rate(s)). The Government will evaluate the quality of professional and administrative services provided, but retain no control over the medical professional aspects of services rendered such as testing procedures, etc.

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

New Year’s Day: January 1st Martin Luther King, Jr.’s Birthday President’s Day Memorial Day Independence Day: July 4th Labor Day Columbus Day Veteran’s Day: November 11th Thanksgiving Day Christmas Day

1.4.3 Place and Performance of Services: The contractor shall provide services between the hours of 0730-1630 on Monday through Friday, except on recognized US holidays or when the Government facility/installation is closed due to local or national emergencies, administrative closings, or similar Government-directed facility/installation closings. Performance shall be at established permanent building clinics within the state of Wisconsin, within 75 miles of the following cities: Madison, Milwaukee, Eau Claire, Wausau, Oshkosh, Kenosha, Tomah, Wisconsin Rapids, and Hayward. The contractor shall at all times maintain an adequate work force for the uninterrupted performance of all tasks defined within this PWS when the Government facility/installation is not closed for the above reasons. When hiring personnel, the contractor shall keep in mind that the stability and continuity of the work force are essential.

1.4.4 Security Requirements. The contractor shall comply with all applicable installation/facility access and local security policies and procedures, which may be obtained from the Contracting Officer’s Representative (COR). The contractor shall also provide all information required for background checks to meet installation access requirements to be accomplished by installation Provost Marshal Office, Director of Emergency Services or Security Office. The contractor shall ensure compliance with all personal identity verification requirements as directed by DOD, HQDA and/or local policy. Should the Force Protection Condition (FPCON) change, the Government may require changes in contractor security matters or processes.

1.4.4.1 COMSEC/IT Security. All communications with DOD organizations are subject to communications security (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 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.

1.4.4.2 Use of Government Information Systems (IS) and access to Government networks is a revocable privilege, not a right. Users are the foundation of the DoD strategy and their actions affect the most vulnerable portion of the AEI. Contractor employees shall have a favorable background investigation or hold a security clearance and access approvals commensurate with the level of information processed or available on the system. Contractor employees shall:

Comply with the command's Acceptable Use Policy (AUP) for Government owned IS and sign an AUP prior to or upon account activation.

Complete initial and/or annual Information Assurance (IA) training as defined in the IA Best Business Practices (BBP) training (https://informationassurance.us.army.mil).

Mark and safeguard files, output products, and storage media per classification level and disseminate them only to individuals authorized to receive them with a valid need to know.

Protect IS and IS peripherals located in their respective areas in accordance with physical security and data protection requirements.

Practice safe network and Internet operating principles and take no actions that threaten the integrity of the system or network.

1.4.4.3 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.

1.4.5 Post Award Conference/Periodic Progress Meetings: The contractor agrees to attend any post award conference convened by the KO in accordance with Federal Acquisition Regulations Subpart 42.5. The KO, Contracting Officer’s Representative (COR), and other Government personnel, as appropriate, may meet periodically with the contractor to review the contactor’s performance. At these meetings, the Contacting Officer 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.

1.4.6 Contract Manager (CM): The contactor shall provide 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, (or the KO if a COR is not assigned), to resolve issues, receive directions 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.

1.4.7 Identification of Contractor Employees: All contractor personnel attending meetings, 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.

1.4.8 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. Such actions may include, but are not limited to, removal from the contract, reduction in benefits, or termination of employment. 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.

2.0 Definitions and Acronyms:

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.

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.

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.

DEFECTIVE SERVICE. A service output that does not meet the standard of performance associated with the Performance Work Statement.

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

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.

PHYSICAL SECURITY. Actions that prevent the loss or damage of Government property.

QUALITY ASSURANCE. The government procedures to verify that services being performed by the Contractor are performed according to acceptable standards.

QUALITY ASSURANCE SURVEILLANCE PLAN (QASP). An organized written document specifying the surveillance methodology to be used for surveillance of contractor performance.

QUALITY CONTROL. All necessary measures taken by the Contractor to assure that the quality of an end product or service shall meet contract requirements.

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

WORK DAY. The number of hours per day the Contractor provides services in accordance with the contract.

WORK WEEK. Monday through Friday, unless specified otherwise.

2.2 ACRONYMS:

AEI

3. PROCEDURES and STANDARDS

3.1. This contract is for “Non Personal” Health Care “Services”, as defined in 37.101. In accordance 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.

3.2. 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.

3.3. 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.

3.4. Contractor shall provide a Board eligible or Certified Occupational Medicine Physician to conduct job-related medical surveillance physical examinations and occupational health specialty examinations.

3.5. Contractor shall arrange for the opportunity to consult with the Occupational Health Nurse (OHN) of the WIARNG by telephone to coordinate or resolve issues that might arise before, during, and after the testing period.

3.6. Contractor shall perform a comprehensive review and evaluation within 30-days following the conclusion of testing. The Contracting Officer’s Representative (COR) will contact and schedule a follow-up review and evaluation meeting to discuss positive and negative aspects of testing.

3.7. Contractor will use documentation provided by WIARNG to conduct and document the physicals and is responsible to ensure all equipment and personnel are available to complete specific exams requirements.

3.8. Contractor will provide a Job Functional Analysis or Kraus-Weber that includes back strength and flexibility if requested. Note any pain or recommended lifting limitations if less than 50 lbs.

3.9. Contractor shall ensure audiogram must be certified by the Council for Accreditation in Occupational Hearing Conservation (CAOHC) or the equivalent military Defense Occupational and Environmental Health Readiness System-Hearing Conservation (DOEHRS-HC) training in accordance with 29 CFR 1910.95. The estimated number of personnel to receive audiograms are up to 30.

Hearing screenings will be conducted on employees designated by the OHN to include all workers exposed to occupational noise > 85 dBA or 140 dBA impact noise as part of their job duties.

All hearing tests will be entered into DOEHRS-HC by the contractor.

An otoscopic exam will be conducted to ensure Test Only 500, 1000, 2000, 3000, 4000 and 6000.

Contractor must verify that worker has been noise free for at least 14 hours prior to screening.

g. All hearing screenings besides the baseline will be compared against the employee’s baseline to determine if there is a Significant Threshold Shift (STS) and retested immediately to verify results. Contractor will notify the Occupational Health Nurse within 10 days so that timely follow-up can be scheduled.

3.10. Contractor shall ensure Pulmonary Function Tests (PFTs) Performed by a licensed physician, Certified Pulmonary Function Technologist, or Registered Respiratory Therapist in accordance with 29 CFR 1910.1001. The estimated number of personnel to receive PFTs is up to 30.

Screenings will only be conducted on employees designated by the OHN to include all those exposed to respiratory hazards that will require a respirator to mitigate hazards identified as above the action level.

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

Follow NIOSH and ATS-ERS standard requirements:

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

Test results are acceptable with a minimum of three acceptable maneuvers that are free from a leak, obstructed mouthpiece, hesitation, false starts, cough, glottis closure, early termination, and have a good curve of at least 6 seconds duration.

Test results are reproducible in that they have the same result from the individual (two largest FVCs are within 0.150 L of each other and two largest FEV1's are within 0.150 L of each other) when the test is repeated several times. Testing is continued until criteria are met or 8 trials are attempted, or the employee being tested cannot or should not continue.

If three (3) acceptable and two (2) repeatable tests cannot be obtained, the technician performing the PFT must document the reason the standard could not be met.

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

Always indicate source of reference value on reports for adjusted predicted value No smoking within 1 hour prior No cold, flu or allergies within two weeks No inhaler use prior to test that would still be in the patient’s system 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.

Respirator clearance documented and a copy given to employee at time of visit.

3.11. 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 and will be documented on a form provided by WIARNG.

Visual acuity for distance and near.

Lateral phorias for distance and near.

Vertical phorias for distance and near.

Depth perception.

Color perception.

Peripheral vision.

3.12. Contractor shall ensure 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 employee instruction and equipment necessary for tests requiring special collection methods and/or containers. Document that employee has been counseled by examining provider about laboratory test results. Provide a copy of lab results to employee for their primary care physician.

3.13. Contractor shall ensure a review of systems on physical examinations must be performed by a physician with emphasis on areas most likely to be affected by the employee's occupational exposures or desired certification.

Contractor shall ensure that chest X-rays will be performed by a certified X-ray technician. The 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: The estimated number of personnel to receive chest X-rays are none, but services must be available if requested.

Chest X-rays are only performed for employees that have documented enrollment into an asbestos program or other medical surveillance program as required.

Chest X-ray will include posterior-anterior and left lateral view.

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

Contractor shall provide the COR with a Quality Assurance Medical Surveillance Plan listing the procedures or processes, which shall be utilized to meet the requirements discussed in the PWS.

4. PERSONAL PROTECTIVE EQUIPMENT (PPE)

4.1. Contractor shall furnish and assure healthcare workers are provided with the appropriate PPE such as, but not limited to: gloves, protective eyewear, and etc., where there is a potential for exposure to blood or other potentially infectious materials.

4.2. Contractor shall ensure each healthcare worker complies with the requirements of 29 CFR 1910.1030 Blood borne Pathogens Standard.

5. INFECTIOUS WASTE DISPOSAL

5.1. Disposal of all infectious waste shall be in accordance with local, state, and federal regulation and disposed of by the contractor unless other accommodations have been coordinated in writing.

5.2. Contractor shall ensure puncture resistant sharps containers are readily accessible to healthcare workers and located in all treatment areas where sharps could potentially be used.

6. MEDICAL REPORTS AND RECORDKEEPING

6.1. Contractors shall immediately contact the Occupational Health Nurse by telephone at 608-242-3342 if results of medical surveillance screening(s), which are questionable and / or of critical significance and / or require follow-up. Contractor shall ensure that all results to include all diagnostic tests, graphs, charts, reports, questionnaires, waivers, employee consent forms, physical findings, and examination results are made available to the Occupational Health Nurse within 30 working days of completion of testing. Any electronic access to records must be in printable format suitable to be filed in the employee’s medical record. Mailed documentation will be sent to the address listed below and the contractor is responsible for all postage fees.

6.2. Contractor shall identify all medical records with the employee’s full name, social security number, date of birth, job code, and the name of the employee’s work place or facility at a minimum. The contractor shall ensure work / health history forms and medical reports are complete and legible (typed / printed).

6.3. Contractor shall ensure that each employee signs the Privacy Act Statement (DD Form 2005) during the registration process.

7. SUMMARY REPORT:

The Contractor will provide a comprehensive report as follows:

7.1 Reports will be provided every six months directly to shops that were supported. Addresses and a point of contact for each shop will be provided. Each report will include a summary of shops employees by name and the date and type of physical(s) performed and indicate qualified or not qualified for each type and expiration. Documentation of these qualifications with expirations will be provided as a certification card for each worker examined and copies of these cards will be included in the report. All information contained within the report must be sufficient for the supervisor to refer to during an inspection without violating HIPAA. A duplicate report will be sent to the Occupational Health Nurse via electronic format.

8. EXAMINATION SCHEDULING

8.1. Coordination of scheduling shall be a joint effort between the Facility Supervisor, the technician and the Contractor. The employee technician must be able to schedule directly with the contractor or medical provider.

8.2. 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, Occupational Health Nurse and the Shops and the techinician. Unfinished testing / examinations will be completed at no additional cost to the Government. The option to schedule physicals not completed due to equipment failure, through a local occupational medical facility shall be done at no cost to the Government. The Contractor shall be directly responsible to cover costs for completing these make-up screenings.

9. Contractor Manpower Reporting Application (CMRA):

9.1 The contractor shall report ALL contractor labor hours (including subcontractor labor hours) required for performance of services provided under this contract for the Wisconsin Army National Guard via a secure data collection site.

9.2 Contractor shall completely fill in all required data fields using the following web address: http://www.ecmra.mil/. Reporting inputs shall be for the labor executed during the period of performance during each Government fiscal year (FY), which runs October 1 through September 30. While inputs may be reported any time during the FY, all data shall be reported no later than October 31 of each calendar year, beginning with 2013. Contractors may direct questions to the help desk at http://www.ecmra.mil.

10. DESCRIPTION OF SERVICES

Examinations are determined based upon job codes and identified occupational hazard exposure. The Occupational Health Nurse will provide Written Orders for each exam.

10.1 The following standard services are to be provided under this PWS:

10.1.1 Lab Services

10.1.1.2 - Frequently Used Labs Units Schedule Unit Occ Health Profile (Bundle: CBC, liver function test, BUN, Creatinine, Urinalysis) Each CBC (HGB, HCT, WBC, MCV, MCH, MCHC) with diff Each CBC (HGB, HCT, WBC, MCV, MCH, MCHC) without diff Each Liver Function Test (AST, ALT, ALB, ALK PHOS, dBil, TBil, Protein) Each BUN /Creatinine Each Urinalysis with Micro Each Urinalysis without Micro Each Blood Glucose Each

10.1.1.3 - Infrequently Used Labs Units Schedule Unit Price Cadmium Profile (Per Lab Corp) Human Chorionic Gonadotropin HCG beta Chromium (Blood) Lead, industrial whole blood ZPP, Blood Protoporphyrins, zinc

10.1.2 Procedures

Audiometry B-Reading Chest X-Ray (PA & Lat View) Spirometry Comprehensive Vision Vital Signs / Body Ht and Wt. (no charge with exam) Each Venipuncture and Specimen Handling Each

10.1.3 Exams Units Schedule Unit Price

Comprehensive Exam (Medical Surveillance) Billing Terms OHC Terms Units Schedule Unit Price Record Processing services as related to Exams or Clearances Record Processing (Mailing of X-rays) Missed Work-up or missed procedure Missed Exam

15. Applicable Publications:

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

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

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

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

15.5. Army Regulation 40-5, Preventive Medicine

15.6. Department of Defense 6055.05M, Occupational Medical Surveillance Manual

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

15.8. Army Regulation 11-34, The Army Respiratory Protection Program

15.9. Headquarters, Department of the Army Pamphlet (DA PAM) 40-501 Hearing Conservation

15.10. Headquarters, Department of the Army Pamphlet (DA PAM) 40-506 Vision Conservation

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).

10.0

TECHNICAL EXHIBIT 2

Deliverables Schedule

Copies

TECHNICAL EXHIBIT 3

Estimated Workload Data

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

ITEM

NAME

ANNUAL ESTIMATED QUANTITY

Annual Examinations

Periodic examinations for newly hired, terminating or returning to service