PWS OSHA Examinations 4 AUG 23.pdf

Ver. October 2022

PERFORMANCE WORK STATEMENT (PWS)

FOR

Annual Medical Surveillance Examinations (OSHA)

4 August 2023

1.0 General:

1.1 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 annual Medical Surveillance also known as the Occupational Safety and Health Administration (OSHA) Examinations to the Virgin Islands National Guard (VIARNG) full-time and/or temporary support personnel as defined in this PWS.

1.1.1 Objectives: To support and perform Annual Medical Surveillance examinations as known as the Occupational Safety and Health Administration (OSHA) examinations to the Virgin Islands National Guard (VIARNG) full-time support and temporary support personnel in accordance with Department of Defense, OSHA and other state and federal regulations as defined in this

PWS.

1.2 Background: The contractor shall provide Annual Medical Surveillance (OSHA) Examinations for an estimated maximum of 20 personnel NG Technicians population, who fall under the VIARNG Occupational Health Program. The Government retains the right to increase and decrease the number of personnel tested and the locations of service due to military operations. These medical exams will determine any employee's work-related injury and illness or any hazardous exposure and note any finding of employee medical and work limitation. The medical surveillance exam reports once reviewed will give the employee medical determination, recommendations and clearance for the duties outlined in the provided job description (PD document).

1.3 Period of Performance (PoP): The Period of Performance shall be (1) Base Year of 12 months and 4 twelve 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 0800-1700 on Monday thru Friday except on recognized US holidays. Performance shall be in the geographical area of St. Croix, U.S. Virgin Islands. The contractor shall at all times maintain an adequate work force for the uninterrupted performance of all tasks defined within this PWS. 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: Teleworking is not authorized. The Government will NOT permit the contractor to telework in support of this requirement.

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: The following are recognized United States (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

1.4.2.11 Christmas 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). A final QCP shall be submitted to the Contracting Officer Representative (KO) NLT 10 days after contract award. After acceptance of the QCP, the contractor shall obtain the Contracting Officer’s (KO’s) acceptance in writing of any proposed changes to its QCP.

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 KO. 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 Communications Security/Information Technology (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.

1.4.6 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.

1.4.7 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 KO, 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. 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.

1.4.9 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.

2.0 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 DA Department of the Army 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 OHN Occupational Health Nurse OSHA Occupational Safety and Health Administration PII Personally Identifiable Information 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 VIARNG Virgin Islands Army National Guard

3.0 Not applicable to this contract. 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: Not applicable to this contract. 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: None.

3.3 Equipment: None.

3.4 Services: None.

3.5 Utilities: None.

4.0 Contractor Furnished Property, Materials, and Equipment (CFP/M/E): Not Applicable to this contract.

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. The Contractor will provide all labor, supervision, tools, materials, equipment, and incidentals required to conduct the Medical Surveillance Examinations/Occupational Health Services for the Government.

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.

4.11 Special Qualifications: The contractor shall ensure all employees possess all required licenses for being employed in their offices to include licenses for the; Physicians (MDs, D.O), Nurse Practitioners, Nurses, Medical Assistants, Certified Nursing Assistants, lab technicians etc., 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.)

5.0 Requirements: The contractor shall provide medical surveillance examinations and testing for a minimum of 20 personnel (NG Technicians Employees) population who fall under the VIARNG Occupational Health Program on the island of St Croix, U.S. Virgin Islands. The examinations shall include personnel assigned to positions requiring specific testing as required by OSHA job hazard exposures.

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.

5.1.2 The Contractor will provide licensed medical providers to administer medical surveillance screening/testing. The Contractor will ensure health care workers comply with the privacy requirements of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The Contractor will identify employees requiring counseling due to laboratory results and will document counseling performed by the examining provider. The Contractor will provide a copy of lab results to employees to review with their primary care physicians as needed counsel and provide feedback to any concerns or questions from the employee.

5.1.3 The Contractor will ensure personnel conducting Pulmonary Function Tests (PFTs) are certified by a NIOSH approved program and results are reviewed by a licensed physician, Certified Pulmonary Function Technologist, or Registered Respiratory Therapist in accordance with 29 CFR 1910.1001. PFTs will be performed only on those employees exposed to workplace respiratory hazards, who require the use of a respirator, and are identified as requiring a PFT by the State OHN. The test will include at a minimum, Forced Expiratory Volume in one second (FEV1), Forced Vital Capacity (FVC), and FEV1/FVC ratio, comparison with recognized standard results for the individual’s height and weight, and a documented interpretation by a pulmonologist or certified OH physician (MD/DO).

5.2 The contractors’ examinations to be provided are Occupational Health annual medical surveillance exams to include those listed below and as specified by the Occupational Health Nurse for each employee:

5.2.1 Field Annual Physical: (Physical Exam (Height & Weight, Vitals, Vision are standard inclusion of Physical Exams distant and near), Color, CBC, CMP/SMAC, Audio, EKG, Urinalysis, OSHA and Medical Forms)

5.2.2 Lead Test

5.2.3 Mercury Test

5.2.4 Cadmium Test: Blood or urine Cadmium

5.2.5 Pulmonary Function Test (PFT) with Quantitative fit testing Fit testing in accordance with 29 CFR 1910.134 appendix A

5.2.6 Chest X-Ray (2 View / PA & LAT

5.3 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 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.

5.4 Contractor shall perform a comprehensive review and evaluation within 10-days following the conclusion of testing.

The Contracting Officer’s Representative will contact and schedule a follow-up review and evaluation meeting to discuss positive and negative aspects of testing.

5.5 Contractors shall immediately contact the Occupational Health Nurse by telephone or email if results of medical surveillance screening(s), are questionable and are of critical significance and require follow-up. Deviations outside of the accepted, normal range for any test results will be reported. Contractor shall have all results available for pick up or submission to include all diagnostic tests, graphs, charts, reports, questionnaires, waivers, employee consent forms, physical findings, and examination results to the Occupational Health Nurse within 10 working days of completion.

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

Publication (Chapter/Page)

Date of Publication

Mandatory or Advisory

Website

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

27 June 1974 15 March 2023(updated)

Mandatory www.osha.gov/laws-regs/regualtions/standardnumber/19

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

27 June 1974 15 March 2023(updated)

Mandatory www.osha.gov/laws-regs/regualtions/standardnumber/19

Army Regulation 40-5, Preventive Medicine

25 May 2007 Advisory

Department of Defense 6055.05M, Occupational Medical Surveillance Manual

27 July 2022 Mandatory https://www.esd.whs.mil/Portals/54/ Documents/DD/issuances/dodm/605 505m.PDF?ver=3u-UoR7v7wydz- RIKQkI_Q%3D%3D

U.S. Department of Labor, Code of Federal Regulations 29 (CFR) 1910.120

(b) (5), (f), Medical Surveillance

03/15/2023

Mandatory https://www.ecfr.gov/current/title- 29/subtitle-B/chapter-XVII/part- 1910?toc=1

DOD Directive 4715.1E, Environment, Safety, and Occupational Health (ESOH), March 19, Advisory

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

Mandatory https://ansi.org/

Federal Acquisition Regulation 03/01/2023 Advisory https://www.acquisition.gov/?q=bro wsefar

Defense Federal Acquisition Regulation Supplement (DFARS)

03/01/2023 Advisory http://www.acq.osd.mil/dpap/dars/df arspgi/current/index.html or https://www.acquisition.gov/dfars

DoDI 5400.11 Department of Defense Privacy and Civil Liberties Programs

01/29/2019

Advisory https://www.esd.whs.mil/Directives/ issuances/dodi/

DoD 5400.11-R Department of Defense Privacy Program

05/14/2007 Advisory https://www.esd.whs.mil/Directives/ issuances/dodm/

DoDI 8140.01 Cyberspace Workforce Management

10/05/2020 issuances/dodd/

DoD 8570.01-M Information Assurance Workforce Improvement Program

12/19/2005 (Change 4:

11/10/2015) issuances/dodm/

DoD 5220.22-M National Industrial Security Program Operating Manual (NISPOM)

02/28/2006 (Change 2:

05/18/2016) issuances/dodm/

AR 25-2

Information Assurance

04/04/2019

Advisory http://armypubs.army.mil/ProductM aps/PubForm/AR.aspx

AR 530-1

Operations Security

09/26/2014 Advisory http://armypubs.army.mil/ProductM aps/PubForm/AR.aspx

AR 525-13

Antiterrorism

12/09/2019 Mandatory http://armypubs.army.mil/ProductM aps/PubForm/AR.aspx

AR 381-12

Threat Awareness and Reporting Program (TARP) (Section II, ¶ 2-4. b)

06/01/2016 Advisory http://armypubs.army.mil/ProductM aps/PubForm/AR.aspx

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

Form Date Website

Appendix C to of 29 CFR § 1910.134 OSHA Respirator Medical Evaluation Questionnaire

27 June 1974 https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.134AppC

1926.1101 App D - Medical

Questionnaires Pt. 1 & Pt. 2 Mandatory/ Periodic

May 14, 2019 https://www.osha.gov/laws-regs/regulations/standardnumber/1926/1926.1101AppD

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

5.1 Maintains professional standards

for all testing and reporting requirements

Ensures all procedures, tests are conducted in accordance with applicable state and federal boards, laws, and regulations

100% Random monitoring, which shall be performed by the KO designated inspector.

4.11

Providers Licenses and Certifications

All employees who are required to be licensed and certified to perform procedures, testing and examinations are current.

100% Random monitoring, which shall be performed

5.4 Comprehensive review and evaluation within 10-days

following the conclusion of testing.

Contractor provides completed and signed evaluation documentation within 10 days of completion

100%

Random monitoring, which shall be performed

5.5 Timely Reporting of results

Immediate notification of critical and abnormal results

Timely submission of completed examination results

95%

Random monitoring, which shall be performed

TECHNICAL EXHIBIT 2

Deliverables Schedule

PWS Reference / Deliverable Title

Frequency Number of Copies

Medium/Format Submit To

1.4.3 Quality Control (QC)

Within 10 calendar days of contract award

1 Electronic Submission

KO

1.4.7 Contract Manager

Provide within 10 calendar days after employee completes training.

1 Electronic Submission

KO

1.9 Combating of trafficking of persons

http://combat-trafficking.army.mil/training.htm

Provide within 10 days of contract award

Electronic Submission

KO

5.1.2

Copies of license and certification of contractor and business

Provide within 10 days of contract award

1 Electronic or Hard copy submission

KO