PWS - Medical Monitoring.pdf

Ver. October 2022

PERFORMANCE WORK STATEMENT (PWS)

FOR

MEDICAL SURVEILLANCE EXAMINATION SERVICES

1.0 General: The Performance Work Statement (PWS) supports the Florida Army National Guard (FLARNG) for Occupational Medical Surveillance Examination Program in accordance with the Occupation Safety and Health Association (OSHA) and other regulations. There are multiple locations that require this service. The estimated number of personnel to be examined is 175-275. The Government has the right to increase and/or decrease the number of employees/military personnel and the locations for service. The hours of operation will be based on the shops in that area, being tested due to time zone and traffic issues. MUST ENSURE COVID PROTOCAL/CDC

REGULATIONS

1.1 Scope: The Contractor will provide Board Certified Occupational Health Physician(s) / Physician’s Assistant, supervision, all labor, tools, materials, equipment, to include HIPPA and privacy statements and incidentals required to conduct the Medical Surveillance Examination / Occupational Health Services for the FLARNG. The contractor must be capable of conducting the Technician Occupational Medical Surveillance Examinations using mobile medical units (vans, trailers etc.)

1.1.1 Objectives MUST ENSURE COVID PROTOCAL/CDC REGULATIONS WHILE

PREFORMING ALL NEEDED TESTING FOR TECHICIANS IN HAZARDOUS WORK

ENVIRONMENTS.

1.2 Background: The purpose of the Occupational Medical Surveillance Examination Program is to provide job-related Medical Surveillance Examinations and Occupational Health Services to the technicians FLARNG full-time support (FTS) and/or temporary personnel who are or could potentially be exposed to health hazards in the work environment. The physicals will be given to technicians working in aviation and ground heavy equipment maintenance, mechanics, painters, welders, and any other employee exposed to a workplace hazard. 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, and the part-time traditional Soldiers.

1.3 Period of Performance (PoP): The Period of Performance shall be for a two (2) week period or 9 days performed during either one of the following periods based on the Government and Contractor availability.

1.3.1 Period 1: 27 March 2023 – 7 April 2023

1.3.1 Period 2: 10 April 2023 – 21 April 2023

1.4 General Information:

1.4.1 Place and Performance of Services: The contractor shall provide services per Technical Exhibit 3, between the hours of __0700 – 1700_ 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 per Technical Exhibit 3. 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.

1.4.1.1 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.

1.4.1.2 Unscheduled gate closures by the Security Police may occur at any time causing all personnel entering or exiting a closed installation to experience a delay. This cannot be predicted or prevented. Contractors are not compensated for unexpected closures or delays. Vehicles operated by contractor personnel are subject to search pursuant to applicable regulations. Any moving violation of any applicable motor vehicle regulation may result in the termination of the contractor employee’s installation driving privileges.

1.4.1.3 The contractor’s employees shall become familiar with and obey the regulations of the installation, including fire, traffic, safety and security regulations while on the installation. Contractor employees should only enter restricted areas when required to do so and only upon prior approval. All contractor employees shall always carry proper identification with them and shall be subject to such checks as may be deemed necessary. The contractor shall ensure compliance with all regulations and orders of the installation, which may affect performance. The Government reserves the right to direct the removal of an employee from Government property or revoke access to Government systems for misconduct, security reasons, or any overt evidence of communicable disease. Removal of contractor employees for reasons stated above does not relieve the Contractor from responsibility for total performance of this contract.

1.4.2 Recognized Holidays: N/A

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): N/A

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 Installation Access and Security Requirements. The contractor shall comply with all applicable installation/facility access and local security policies and procedures, which may be obtained from the COR. The contractor and all associated subcontractor employees shall 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 Department of Defense (DoD), Headquarters Department of Army (HQDA) and/or local policy (see PWS 6.0). Should the Force Protection Condition (FPCON) change, the Government may require changes in contractor security matters or processes.

1.4.5.1 N/A

1.4.5.1.1 N/A

1.4.5.1.2 N/A

1.4.5.1.3 N/A

1.4.5.1.4 N/A

1.4.5.1.5 N/A

1.4.5.1.5.1 N/A

1.4.5.1.6 N/A

1.4.5.2 N/A).

1.4.5.2

1.4.5.3 Awareness Training (AT) Level 1: All contractor employees, including subcontractor employees, requiring access to Army installations, facilities, and controlled access areas shall complete AT Level 1 training within 30 calendar days after contract start date and within 30 calendar days of new employees commencing performance. The contractor shall submit certificates of completion for each affected contractor and subcontractor employee to the COR within 15 calendar days after completion of training by each employee or subcontractor personnel. AT Level 1 awareness training is available at the following website:

https://jko.jten.mil/courses/atl1/launch.html.

1.4.5.4 iWATCH Training: The contractor and all associated subcontractors with an area of performance within an Army-controlled installation, facilities or area shall brief all employees on the local iWATCH program (training standards provided by the requiring activity Antiterrorism Officer (ATO)). This local developed training shall be used to inform employees of the types of behavior to watch for and instruct employees to report suspicious activity to the COR or the KO. This training shall be completed within 30 calendar days of contract award and within 30 calendar days of new employees commencing performance. The contractor shall report completion for each contractor employee and subcontractor employee to the COR within 15 calendar days after completion of training.

1.4.5.5 N/A

1.4.5.6 N/A

1.4.5.6.1 N/A

1.4.5.6.2 N/A

1.4.5.6.3 N/A

1.4.5.6.4 N/A

1.4.5.6.5 N/A

1.4.5.7 N/A

1.4.5.8 N/A

1.4.5.9 N/A

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 (DFARS) 224.103 Personally Identifiable Information and Department of Defense Directive (DoDD) 5400.11, Department of https://jko.jten.mil/courses/atl1/launch.html

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 OPSEC Training: In accordance with AR 530-1, Operations Security, new contractor employees shall complete Level I OPSEC training within 30 calendar days of their reporting for duty and annually thereafter. The contractor shall submit certificates of completion for each contractor employee to the COR within 15 calendar days after completion of training. Level 1 OPSEC training is available at https://securityawareness.usalearning.gov/opsec/index.htm.

1.4.5.12 OPSEC SOP/Plan. N/A.

1.4.5.13 N/A

1.4.5.14 N/A

1.4.6 Physical Security. The contractor shall safeguard all Government property provided for contractor use. At the close of each work period, Government facilities, equipment and materials shall be secured.

1.4.6.1 Key Control. N/A

1.4.6.2 Lock Combinations: N/A

1.4.7 Special Qualifications: The contractor shall ensure all employees possess all required licenses for operating _equipment_ 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. (NOTE: 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.)

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 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.

1.4.9 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.

1.4.10 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. Contractor personnel shall wear identification badges distinguishing themselves as such. The badges shall have the company name, employee name and the word “contractor” displayed.

1.4.10.1 The contractor shall retrieve all identification media (including vehicle passes) from its employees who depart employment for any reason. The contractor shall return all identification media (i.e., badges and vehicles passes) to the KO within 14 days of an employee’s departure.

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 Contractor Travel

The contractor shall travel to each location during the performance of this contract to complete the exams at the pre-set sites in technical exhibit 3.

The contractor will be authorized travel expenses consistent with the substantive provisions of the Joint Travel Regulation (JTR) and the limitation of funds specified in this contract. All travel requires COR recommendation for approval and/or authorization by the KO prior to travel arrangements being made.

The contractor may be required to travel to off-site training locations and to ship training aids to these locations in the performance of this contract. The cost of shipping training aids shall be borne by the contractor. The contractor will not be reimbursed for the costs of shipping training aids in accordance with the JTR and limitation of funds in this contract.

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 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.

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 27 March 2023 – 7 April 2023 or 10 April 2023 – 21 April 2023 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 Defective Service: A service output that does not meet the standard of performance associated with the PWS.

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

2.1.4 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 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.

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

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

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

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

2.1.9 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:

AEI Army Enterprise Infostructure AR Army Regulation AT/OPSEC Antiterrorism/Operational Security BI Background Investigation CM Contract Manager COR Contracting Officer Representative DA Department of the Army DD254 Department of Defense Contract Security Classification Specification DFARS Defense Federal Acquisition Regulation Supplement DoD Department of Defense DSCA Defense Counterintelligence and Security Agency FAR Federal Acquisition Regulation GFP/M/E/S Government Furnished Property/Material/Equipment/Services HQDA Headquarters, Department of the Army HSPD Homeland Security Presidential Directive IA Information Assurance IS Information System(s) KO Contracting Officer

NGB National Guard Bureau OCI Organizational Conflict of Interest PII Personally Identifiable Information PIPO Phase In/Phase Out POC Point of Contact PRS Performance Requirements Summary PWS Performance Work Statement QA Quality Assurance QASP Quality Assurance Surveillance Plan QC Quality Control QCP Quality Control Program SCR Service Contract Reporting SSN Social Security Number TE Technical Exhibit USD(I) 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: The Government will furnish the necessary workspace for the contractor to perform services outlined in this PWS to include desk space, telephones, computers and other items necessary to maintain an office environment.

3.2 Materials: N/A

3.3 Equipment: N/A

3.4 Services: N/A

3.5 Utilities: All utilities in the facility will be available for the contactor’s use in the performance of this contract. The contractor shall instruct employees in utilities conservation practices. The contractor shall operate under conditions that preclude the waste of utilities, which include turning off the water faucets or valves after using the required amount.

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

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.

4.2 Secret Facility Clearance: N/A

4.3 Contractor Security Clearance: N/A

5.0 Requirements: The contractor shall:

5.1 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. The Contractor will indemnify the Government for any liability producing act or omission by the Contractor, its employees and agents occurring during contract performance. The Contractor will 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.

5.1.1 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

5.1.2 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.

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

5.1.4 Contractor shall ensure that all hearing tests are done by the Defense Occupational and Environmental Health Readiness System- Hearing Conservation (DOEHRS-HC) through Benson hearing equipment at time of testing. NOT MANUALLY see hearing requirements in paragraph 3.3. and 5.2.3.

5.1.5 Contractor shall arrange for the opportunity to consult with the COR/POC by telephone to coordinate or resolve issues that might arise before, during, and after the testing period. The appointed COR/POC is the only one allowed to give authorization for testing and each individual will be accompanied by an authorization form prior to any testing.

5.1.6 Contractor shall conduct a daily test site status report update by telephone or in person to the COR/POC. This reporting will cover total number of test conducted, total number of no-shows, and the total number of uploaded hearing tests, and any other pertinent information regarding the performance of the testing.

5.1.7 Contractor shall perform a comprehensive review and evaluation within 30-days following the conclusion of testing. The COR/POC will contact and schedule a follow-up review and evaluation meeting to discuss positive and negative aspects of testing.

5.1.8 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 General Exam: Contractor will provide vital signs to include height, weight, blood pressure, pulse and respirations.

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

5.2.2 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.

1. Hearing screenings will be conducted only on employees exposed to occupational noise > 85 dBA or 140 dBA impact noise.

2. All hearing tests will be entered into DOEHRS-HC during testing.

3. Otoscopic Exam.

a. Test Only 500, 1000, 2000, 3000, 4000 and 6000.

b. Hearing aids must be removed.

c. Employee must be noise free for at least 14 hours prior to screening.

d. 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 and if there is still a STS notify the COR/POC within 10 days so that timely retesting can be scheduled.

5.2.3 DOEHRS Compatible Audiometer Testing: 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. Soldiers will be tested in a sound booth that meets the American National Standards Institute (ANSI) Maximum Permissible Ambient Noise Levels (MPANL) S3.1, 1999 (R 2008) as measured using a Type 1 Sound Level Meter (SLM) IAW DA Pam 40- 501 and will ensure that the USAPHC Audiometric Test Booth Certification Form is posted on the audiometric test booth(s). 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. The USAPHC Audiometric Test Booth Certification Form is available at:

http://phc.amedd.army.mil/PHC%20Resource%20Library/AudiometricTestBooth Certification.pdf.

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.

Ventilation systems in audiometric test booths must provide adequate air exchange for patient comfort and acceptable sound levels for valid audiometric testing. The contractor shall conduct audiometry in accordance with AR 40-501 (RAR 003, 08/04/2011) for an undetermined number of Soldiers and in undetermined locations throughout the State. Hearing exams will be conducted using the DOEHRS-HC compatible audiometers (Benson) with DOEHRS software. Adherence to all requirements of OSHA, State & Federal Regulations is mandatory. Audiology evaluations and Speech Recognition in Noise Test (SPRINT) testing will be performed IAW all applicable Federal, DOD, MEDCOM, NGB, and State guidelines. SPRINT testing must be available at all events when requested and the results must be available immediately. The contractor shall check that member has DD Form 2215 (baseline Audiogram) recorded in the medical information system (DOERS-HC) and medical record; and if no DD Form 2215 is in the medical record, perform DOEHRS-HC approved audiograms, and all service members with a DD Form 2215 on file have a DD Form 2216 completed. Contractor shall provide a list of personnel who require audiograms.

Comprehensive Audio Evaluation (CAE) Testing for ARNG and USAR, the Contractor shall perform CAE testing and diagnostic audio testing, including Pure Tone Air and Pure Tone Bone Tests, and SPRINT testing as indicated by initial screening results and after appropriate unit authorization is obtained. These CAE services may include immittance testing, tympanometry, acoustic reflex, speech reception thresholds, word recognition testing, and otoacoustic emissions. The Contractor shall upload all pure tone audio test results into the DOEHRS-HC database within five (5) working days of completion and shall verify upload. IF

THE CONTRACTOR CANNOT OR DOES NOT HAVE ACCESS TO THE

DOERHS PROGRAM THEY NEED TO MAKE ARRANGEMENTS WITH THE

OHS MANAGER PRIOR TO CONDUCTING THE MEDICAL MONITORING AND

SOMETHING WILL BE WORKED OUT. BUT IT IS PREFERRED THAT THE

CONTRACTOR HAVE THEIR OWN PERSONNEL TO BE ABLE TO UPLOAD

TO THE DR PROGRAM.

5.2.4 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.

1. Screenings will only be conducted on employees exposed to respiratory hazards that will require a respirator to mitigate their hazards that are above the action level.

2. 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.

4. Follow NIOSH and ATS-ERS standard requirements:

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

b. 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.

c. 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.

d. 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.

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

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

g. No smoking within 1 hour prior.

h. No cold, flu or allergies within two weeks.

i. No inhaler use prior to test that would still be in the patient’s system.

j. 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.

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

5.2.5 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.

1. Visual acuity for distance and near.

2. Lateral phorias for distance and near.

3. Vertical phorias for distance and near.

4. Depth perception.

5. Color perception.

6. Peripheral vision.

5.2.6 Contractor shall ensure dermatological examinations are be performed by a physician and include an inspection of the entire integumentary system with emphasis on areas most likely to be affected by the employee's occupational (i.e. radiation) exposures. Documentation will include the presence of any dermatomes or lesions of the skin.

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

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

5.2.9 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, COR/POC and the Facility(ies).

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.

5.3 Personal Protective Equipment (PPE): 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.

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

5.4 Infectious Waste Disposal: 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.

5.4.1 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.

5.5 Mobile Unit Configuration: Medical Surveillance screening shall be accomplished via mobile unit designed to ensure complete individual privacy. Features of the unit shall include, but are not limed to, a climate-controlled atmosphere, patient waiting / holding area for registration, changing room, on board restroom, testing / phlebotomy station, individual audiometric testing booth, and physical examination area.

5.5.1 Mobile units shall be equipped with a self-contained power source. The Government shall not provide power to the contractor’s mobile unit unless other accommodations have been coordinated in writing.

5.6 Medical Reports and Recordkeeping: Contractor shall immediately contact the COR by telephone if results of medical surveillance screening(s), which are questionable and/or of critical significance and/or require follow-up. 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 Occupational Health Manager within 30 working days of completion of testing to:

Florida Army National Guard ATTN: OHS Manager Tammy Peters

5629 St Rd 16 W Building 2127 Starke, FL 32091

5.6.1 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 workplace or facility at a minimum. The contractor shall ensure work / health history forms and medical reports are complete and legible (typed / printed).

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

5.6.3 Summary Report: The Contractor will provide a comprehensive data processed analytical end report in both electronic and hardcopy format. Electronic format shall be on CD-R and hardcopy shall be placed in an Acco Presstex Grip Punchless Binder (Blue) or equal product, with tabs containing the below data:

1. Tab # 1 - Classification Summary to include:

Colum # 1 - Employee Name, Colum # 2 – SSN, Colum # 3 - D.O.B., Colum # 4 –Blood Pressure (B/P) - N = normal, A = abnormal, Colum # 5 – AUDIO – N= normal, A = abnormal, Colum # 6 – PFT - N = normal, A = abnormal, Colum # 7 – Vision - N = normal, A = abnormal,

2. Tab # 2 – Employee Listing with Hearing Classifications to include:

Colum # 1 Employee Names, Colum # 2 SSN, Colum # 3 Date, Colum # 4 Speech Frequencies, and Colum # 5 – High Frequencies – Normal, Mild Hearing Loss, Moderate Hearing Loss, Moderate Severe Hearing Loss, and Profound Hearing Loss

3. Tab # 3 – Employee Listing with All Hearing Tests

4. Tab # 4 – Hearing Summary Report – Bar Graph indicating total numbers related to Total Number of employees tested, break outs will be total # of Males tested, total # of Females tested. Number of Normal Hearing, Number of Mild Loss, Number of Moderate Loss, Number of Moderate Severe Loss, Number of Severe Loss, Number of Profound Loss, Number of Standard Threshold Shift and Number of OSHA Recordable Shift if any.

5. Tab # 5 – Employee Listing with Most Recent PFT – Colum # 1 Employee Names, Colum # 2 – Date test conducted, and Colum # 3 - Classification – Normal, Mild Obstructive, Borderline Obstructive, Moderate Obstructive and Significant Obstructive as the test indicates

6. Tab # 6 – Employee Listing with most Recent PFT Results –

Colum # 1 Employee Names, Colum # 2 Date test conducted, Colum # 3 – FVC, Colum # 4 - FEV1, Colum # 5 – FEV1/FVC and other information as tested.

7. Tab # 7 - Pulmonary Summary Report – Analytical Breakdown to include –

Total number of employees, Number of Employee Tested, Number with Normal Screening.

8. Number with Mild Restriction, Number with Moderate Restriction, Number with Severe Restriction, Number with Borderline Obstruction, Number with Mild Obstruction, Number with Moderate Obstruction, Number with Severe Obstruction, and Number with Superimposed Restriction.

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

Publication (Chapter/Page)

Date of Publication

Mandatory or Advisory

Website

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

Defense Federal Acquisition Regulation Supplement http://www.acq.osd.mil/dpap/dars/dfarspgi/current/in dex.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-

Personal Identity Verification (PIV) of Federal Employees and Contractors

(paragraph 9)

August 2013 http://nvlpubs.nist.gov/nistpubs/FIPS/NIST.FIPS.201 -2.pdf

DoDM 5200.2 Procedures for the DoD Personnel Security Program

(PSP)

04/03/2017 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 01/29/2019 https://www.esd.whs.mil/Directives/issuances/dodi/ https://www.acquisition.gov/?q=browsefar http://www.acq.osd.mil/dpap/dars/dfarspgi/current/index.html http://www.acq.osd.mil/dpap/dars/dfarspgi/current/index.html https://www.acquisition.gov/dfars http://www.esd.whs.mil/Directives/issuances/dodm http://nvlpubs.nist.gov/nistpubs/FIPS/NIST.FIPS.201-2.pdf http://nvlpubs.nist.gov/nistpubs/FIPS/NIST.FIPS.201-2.pdf https://www.esd.whs.mil/Directives/issuances/dodm/ https://www.esd.whs.mil/Directives/issuances/dodi/ https://www.dhs.gov/homeland-security-presidential-directive-12 https://www.dhs.gov/homeland-security-presidential-directive-12 https://www.esd.whs.mil/Directives/issuances/dodi/

Department of Defense Privacy and Civil Liberties Programs

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)

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/A rmyDir.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

6.1 Applicable Forms: Forms applicable to the PWS are listed below:

Form Date Website

DD 1172-2

Application for Identification

Card/DEERS Enrollment

Mar 2017 http://www.dtic.mil/whs/directives/forms/index.htm

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

Aug 2000 https://www.esd.whs.mil/Directives/forms/dd0001_0499/ https://www.esd.whs.mil/Directives/issuances/dodd/ https://www.esd.whs.mil/Directives/issuances/dodm/ http://armypubs.army.mil/ProductMaps/PubForm/AR.aspx http://armypubs.army.mil/ProductMaps/PubForm/AR.aspx http://armypubs.army.mil/ProductMaps/PubForm/AR.aspx http://armypubs.army.mil/ProductMaps/PubForm/AR.aspx http://armypubs.army.mil/ProductMaps/PubForm/AR.aspx http://armypubs.army.mil/ProductMaps/PubForm/AR.aspx http://armypubs.army.mil/ProductMaps/PubForm/AR.aspx http://armypubs.army.mil/ProductMaps/PubForm/AR.aspx http://www.dtic.mil/whs/directives/forms/forminfo/forminfopage2479.html http://www.dtic.mil/whs/directives/forms/forminfo/forminfopage2479.html http://www.dtic.mil/whs/directives/forms/index.htm https://www.uscis.gov/sites/default/files/files/form/i-9.pdf http://www.dtic.mil/whs/directives/forms/dd/ddforms0001-0499.htm http://www.dtic.mil/whs/directives/forms/dd/ddforms0001-0499.htm https://www.esd.whs.mil/Directives/forms/dd0001_0499/

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).

Performance Objective

Performance Standard Acceptable Quality Levels (AQL)

Surveillance Method / By Whom

5.2.2 PRS # 1:

Audiogram

(DOERHS)

All hearing tests must be uploaded into DOEHRS system within 12 hours of test being conducted at each site.

Zero deviation from standard

Periodic inspection by

COR/POC

5.2.5 PRS # 2:

Vision screening

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.

Zero deviation from standard

Periodic inspection by COR/POC

5.2.4 PRS # 3:

Spirometry

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.

Zero deviation from standard

Periodic inspection by COR/POC

5.6 PRS # 4:

The contractor shall perform required tests each day

All technicians who did not attend the event will be removed by the Contractor so the there are no inconsistency in the rosters or report ran after the event.

Zero deviation from standard

Periodic inspection by COR/POC

5.2.8 - 5.2.9 PRS # 5:

Daily Status Report

Contractor contacts COR/POC daily either by telephone or in person.

Zero deviation from standard

Periodic inspection by COR/POC

TECHNICAL EXHIBIT 2

Deliverables Schedule

PWS Reference / Deliverable Title

Frequency Number of Copies

Medium/Format Submit To

5.6.3 Contractor will

provide at the conclusion of the services a summary report of Medical records.

Completed reports will be generated the conclusion of all testing sites and after all services have been reviewed by a

DR/PA.

1 copy of the report will be created for the Occupational

Health Specialist.

Both Digital and Paper

Copy (Binder)

All copies and records will be sent to the

COR/POC

5.6.3 Contractor will

provide, at the conclusion of the services a report summary of all services provided on each individual

Completed reports will be generated the conclusion of all testing sites and after all services have been reviewed by a DR/PA.

2 hardcopies of the report will be created. One for the individuals tested and one for each medical record on the technician

Paper Copies Mailed to the FLARNG Occupational Health

Specialist office within 30 calendar days of completion of testing.

1.4.5.3 AT Level 1

Awareness Training

Certificates

Provide within 15 calendar days after employee completes training.

1 Electronic Submission

COR

1.4.5.3 AT Level 1

Awareness Training

Certificates.

Provide within 15 calendar days after employee completes training.

1 Electronic Submission

COR

1.4.5.11 OPSEC

Training Certificates

Provide within 15 calendar days after employee completes training.

1 Electronic Submission

COR

TECHNICAL EXHIBIT 3

Estimated Workload Data

Location

Testing

Site Shop

Soldier

# Dates Total Schedule 6/hr Contacts

AASF #1 AASF 1 FMS 11 3/27/2023 Tues. - 8:00a-12:00p; 13:00p-16:00p Jacksonville, FL

13650 Aerospace Way AASF 1 FMS 9 3/28/2023 Wed. - 8:00a-12:00p; 13:00p-16:00p Supervisor Mrs. Theresa Schirbock

Jacksonville, FL 32221 AASF 1 AASF #1 4/10/2023 drive 50 miles 904-573-2300 x 1001

4/11/2023 theresa.l.schirbock.civ@mail.mil

CSMS CSMS FMS 12 3/29/2023 Thurs. -8:00a-12:00p; 13:00p-16:00p Starke, CBJTC, FL

5629 SR 16 W., Bldg 4100 CSMS USPFO 3/30/2023 Fri. - 7:00a-11:30a POC TBD

Example Draft FLARNG Medical Monitoring Schedule 2023

CBJTC Starke, FL 32091 CSMS FMS 10 904-682-3345 (office)

CSMS MATES 4/12/2023 (cell)

CSMS CSMS 4/13/2023 drive 295 miles

FMS # 1 FMS 1 FMS 2 3/31/2023 Mon. - 09:00a - 13:30p Miami, FL

700 NW 28th Street FMS 1 FMS 1 POC SFC Jean Guerrier

Miami, FL 33127 drive 165 miles 305-542-5772 (cell)

4/14/2023 jean.guerrier.mil@army.mil

FMS # 6 FMS 6 UTES 4/4/2023 Tues. - 8:00a-12:00p; 13:00p-16:00p Haines City, FL

111 Commerce Ave. FMS 6 FMS 5 POC CW4 Jason.L.Beihl

Haines City, FL 33844 FMS 6 FMS 16 863-559-0286 (cell)

FMS 6 FMS 6 jason.l.beihl.mil@army.mil

FMS 6 FMS 7 4/18/2023 drive 60 miles

FMS # 4 FMS 4 FMS 4 4/5/2023 Wed. - 7:00a - 14:00p Tampa, FL

2316 W. Lemon Street FMS 4 FMS 3 POC CW2 Nicholas Hunt

Tampa, FL 33609 FMS4 drive 50 miles 801-300-2151 (cell); 813-267-9820 (Shop cell)

4/19/2023 nicholas.d.hunt8.mil@army.mil

AASF #2 AASF 2 FMS 8 4/6/2023 Thurs. - 7:00a-14:00p Brooksville, FL

16388 Helicopter Dr. AASF 2 AASF # 2 POC SFC Edmund Unutoa

Brooksville, FL 34604 drive 300 miles (Thurs p/ Friday a) 727-798-6170 (cell)

4/20/2023 edmund.a.unutoa.civ@mail.mil

FMS # 14 FMS 14 FMS 14 4/7/2023 Fri. -11:00a -14:00p Bonifay. FL

307 W. Montana Ave FMS 14 FMS 13 Supervisor WO1 William C Reid

Bonifay, FL 32425 FMS 14 FMS 15 This day is subject 850-258-0586 (cell)

4/21/2023 to change to afternoon testing william.c.reid43.mil@mail.mil

Total numbers are an estimate

******Number of soldiers can change depending on AT, leave, and mission requirements!!!