PPPL_Statement_of_Work_OMO_2018_(draft).pdf

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STATEMENT OF WORK (SOW)

For Operation of the

Occupational Medicine Office March 16, 2018

1.0 BACKGROUND

Princeton Plasma Physics Laboratory (PPPL) is operated by Princeton University on behalf of the Department of Energy (DOE). PPPL is the largest center for the scientific research and development of magnetic fusion and plasma sciences in the United States.

2.0 SCOPE

The Occupational Medicine Office (OMO) provides a comprehensive worker protection program that shall be designed to protect and promote the health of individual workers and the workforce as a whole. This program shall be administered in a manner that ensures the delivery of high-quality health services. The Subcontractor shall provide these services in accordance with the principles of professional practice and ethical conduct, and with concern for the costs of care and for improving the health status of workers. The Subcontractor shall comply with applicable federal, state, and local laws with emphasis on prevention, early recognition, and treatment of occupational related illness or injury. The Subcontractor shall provide open communications and informed consent to the workers that it serves.

3.0 OBJECTIVES

3.1 The Subcontractor shall:

3.1.1 Perform day-to-day operations of the Occupational Medicine Office in accordance with the PPPL Personal Practices Manual (Benefits Section), under the direction of the Executive Director of Human Resources and Organizational Development.

3.1.2 Conduct Pre-placement, Fire Fighter (Pre-employment and Annual Physicals), Fitness for Duty, Worker Qualification/Re-qualification, Return to Work, Wellness, and Terminations Physicals.

3.1.3 Administer the Random Drug Screening Program following the PPPL Drug Policy for selected work groups. The program includes the conduct and analysis of employee urine samples.

Samples shall be handled in accordance with established Chain of Custody protocol. Positive test results require the immediate notification to the Executive Director of Human Resources and Organizational Development.

3.1.4 As clinically indicated, conduct or have conducted specialized testing, (e.g., Cardiac Stress Testing).

3.1.5 Provide Emergency/Urgent medical care for employees, subcontractors and visitors, as required.

3.1.6 Diagnose and treat non-occupation illness. Examples include upper respiratory infection, sinusitis, conjunctivitis, skin infection, etc. When chronic illness or other complicated illness occurs the employee shall be referred to their personal physician.

3.1.7 Conduct on-site phlebotomy and other clinical testing, for required personnel.

3.1.8 Work in concert with PPPL Human Resources to administer the Worker Compensation Case Management Program.

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3.1.9 Administer the medical surveillance portion of the Laser Safety Program, including conducting of Laser Eye Examinations.

3.1.10 Administer the Safety Eye Glass Program with Environment Safety & Health (ES&H), including conducting of baseline job related eye examinations.

3.1.11 Administer the Bloodborne Pathogen and Infectious Disease Control Program.

3.1.12 Work in concert with Environment Safety & Health (ES&H) in the administration of the Hearing Conservation Program.

3.1.13 Advise the Executive Director of Human Resources and Organizational Development on employee issues or concerns, of a work related injury or illness.

3.1.14 Consult with Environment Safety & Health (ES&H) on the completion and review of Accident Investigations.

3.1.15 Maintain familiarity with the PPPL work-site and potential work-related hazards.

3.1.16 Provide professional administrative support and consultation to Senior Management.

3.1.17 Conduct a Blood Drive in the spring and fall.

3.1.18 Conduct periodic blood pressure screenings.

3.1.19 Complete assignments related to employee occupational medical issues.

3.1.20 With approval from the Executive Director of Human Resources and Organizational Development, offer influenza vaccinations.

3.2 Responsibilities

3.2.1 PPPL

3.2.1.1 Government Furnished Office Space and Furnishings

PPPL will furnish, at no cost to the Subcontractor, the necessary office space, utilities, telephone service, internet access, general office equipment, personal computers and office furniture for its personnel assigned to work under this subcontract.

3.2.2 Subcontractor

3.2.2.1 Disposable Supplies and Medications

The Subcontractor shall purchase and maintain disposable supplies and medications for the treatment of the general laboratory population. Upon delivery to the PPPL OMO, all disposable supplies and medications shall become the property of the United States Government, and shall be subject to inventory by the Executive Director of Human Resources and Organizational Development, or his/her delegated representative. The supply may include prescription medication and disposable suturing supplies, for treatment of employees. The Executive Director of Human Resources and Organizational Development shall approve the recommended list of purchases.

3.2.2.2 Durable Equipment

The Subcontractor shall evaluate the Occupational Medicine facility to determine the need for additional or updated durable equipment, such as examination room table, lighting, etc. This one time charge shall be added to the first year Subcontract price. Once payment for the material is made it will become the property of the United States Government. Any subsequent durable

PPL-PD-SERV-SOW; REV 0 (3/2017) Page 3 equipment requirements shall be submitted for approval in writing to the Executive Director of Human Resources and Organizational Development. Additional durable equipment may be purchased by the Subcontractor and billed as a pass through cost with no Subcontractor markup, or purchased directly by PPPL, at PPPL's option.

3.2.2.3 Non-Conformance & Corrective Action

The Subcontractor shall promptly identify and control nonconforming items or services.

Nonconforming items or services shall be positively identified, and segregated where possible, to prevent use. The Subcontractor shall document each nonconformance. Written approval of the PPPL Technical Representative is required prior to the use of the nonconforming item or service.

The Subcontractor’s system shall provide not only for timely resolution of nonconformance but also for analysis of nonconformance to detect recurring conditions and to implement appropriate corrective actions.

3.2.2.4 Calibration of Test and Measuring Equipment

Inspections and tests shall be performed using properly calibrated measuring and test equipment.

The Subcontractor shall have, or subcontract for, the necessary equipment to perform the required tests and inspections. The Subcontractor shall impose these calibration requirements on lower tier subcontractors.

3.2.2.5 Documentation Requirements

The Subcontractor shall maintain a clinical records system allowing prompt retrieval of information.

Records shall be maintained in accordance with Federal, and/or State regulations, statues and standards and PPPL policies and procedures. The records shall include tracking of surveillances, laboratory utilization data, and reports generated injury documentation, patient records (including physical information), procurement and billing information and other vital records. In designing, developing or operating this system of records, the Subcontractor shall comply with all requirements of the Privacy Act of 1974, Public Law 93-579, December 31, 1974 (5 U.S.C 552a) and applicable agency regulations and Appendix A to 10 CFR 851, Section 8, Park 8(f).

4.0 TASKS

4.1 The Medical Director and nurse attend weekly meetings with Environment Safety & Health (ES&H) and Human Resources.

4.2 Send drug testing results to the Executive Director of Human Resources and Organizational Development.

5.0 SUBCONTRACTOR QUALIFICATIONS

The Subcontractor shall assign personnel who are at a minimum, experienced in a broad range of respiratory, cardiac, musculoskeletal, ophthalmologic, hematological, neurologic, otolaryngologic, and dermatologic manifestations of occupational injury and illness. Assigned personnel shall include:

5.1.1 A Board Certified/Qualified, Occupational Medicine Physician. The PPPL occupational medicine services must be under the direction of the Physician, who must be a graduate of a school

PPL-PD-SERV-SOW; REV 0 (3/2017) Page 4 of medicine or osteopathy and licensed for the practice of medicine in New Jersey. The Physician shall be assigned to PPPL twelve (12) hours weekly. The 12 hours shall be spread over a three-day period. The days selected shall be approved by the Executive Director of Human Resources and Organizational Development. The Physician shall meet the requirements of 10 CFR 851 Appendix A Section 8, and NFPA Standard 1500 Section 8.6 Fire Department Physician.

5.1.2 A Registered/Certified Occupational Health Nurse/Administrator, or equivalent, who is licensed, registered, or certified as required by Federal or New Jersey law, Monday – Friday from 08:30 – 14:00, local time.

5.2 Support Staff

5.2.1 An Administrative Assistant Monday-Friday. The Administrative Assistant schedule shall not exceed twenty work hours weekly.

Occupational medicine physicians, occupational health nurses, and other occupational health personnel providing occupational medicine services must be licensed, registered, or board certified as required by Federal or New Jersey law.

PPPL may require nursing or physician services in addition to the normal operating hours.

5.2.2 OMO Operational Schedule

The PPPL OMO operation, as detailed in 5.0, shall be conducted during the normal core hours of the Laboratory (8:00 AM to 5:00 PM, Monday-Friday) on a schedule approved by the Executive Director of Human Resources and Organizational Development. The OMO and all assigned Subcontractor staff shall observe the Princeton University schedule of holidays and closures, as adopted by Princeton University. The Princeton University holiday schedule may be viewed via the Internet at http://www.princeton.edu/hr/wrksched/holiday.htm

6.0 ENVIRONMENT, SAFETY, AND HEALTH

6.1 The Subcontractor must comply with PPPL training requirements applicable to the work performed, as identified by the PPPL Technical Representative. The Subcontractor must provide to the PPPL Technical Representative a list of all employees who will be required PPPL’s General Employee Training. This training course is required for any employee or subcontractor who will be on site for a period of 40 hours or greater in a calendar year and must be completed with a passing grade of 85% every 3 years.

6.2 Additional safety requirements and/or training may be required. PPPL will provide these courses on an as needed basis.

6.3 The Subcontractor shall notify the PPPL Technical Representative and the PPPL Industrial Hygienist of all chemicals to be used on site prior to their use. This notification shall include a copy of the Material Safety Data Sheet (MSDS). PPPL reserves the right to restrict the use of any chemical on site.

7.0 Quality Assurance Requirements

7.1 All Occupational Medicine Operations must adhere to all applicable regulations and be able to withstand the scrutiny of internal audits, and state and federal inspections.

http://www.princeton.edu/hr/wrksched/holiday.htm

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7.2 PPPL and/or DOE representatives shall have the right to access the subcontractor’s facility to audit non-medical records.

8.0 DELIVERABLES

8.1 The Subcontractor shall provide professional services in accordance with the requirements of section 5.

8.2 The Subcontractor shall provide the services of a Board Certified/Occupational Medicine Physician who is a graduate of a school of medicine or osteopathy and licensed for the practice of medicine in New Jersey, a Nurse Administrator who is licensed, registered, or certified as required by Federal or New Jersey law, and an Administrative Assistant.

8.3 The Subcontractor shall maintain a clinical records system that allows for prompt retrieval of information.

8.4 The Subcontractor shall submit to PPPL for approval a list of the core group of persons who will work under this Subcontract, and their resumes. The list shall include resumes of those personnel who will provide coverage during periods when assigned personnel are unavailable (due to vacation, illness, etc.). If for any reason during the Subcontract period of performance it becomes necessary to substitute personnel for those previously approved by PPPL, the Subcontractor shall submit the names and resumes of its proposed replacements for PPPL approval. The replacement employee shall not commence work at PPPL until PPPL approval is granted.

8.5 With its proposal and thereafter as required, the Subcontractor shall submit documentation that demonstrates completion of the required certifications/licenses for the persons listed above.

8.6 With its proposal and annually thereafter the Subcontractor shall submit a recommended list of disposable materials and supplies and their associated MSDSs.

8.7 With its proposal and annually thereafter the Subcontractor shall submit a recommended list of supplies required to maintain PPPL’s Pharmaceutical Formulary.

8.8 With its proposal and thereafter as required, the Subcontractor shall submit a recommended list of durable medical equipment.

8.9 The Subcontractor shall provide notification to the Executive Director of Human Resources and Organizational Development or the Director of Procurement when contract funding expenditures have reached the 85% level.

8.10 The Subcontractor shall provide an annual report to the Executive Director of Human Resources and Organizational Development documenting the usage of the OMO facilities and Medical Services.

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Document Deliverables Required (when applicable)

When Deliverabl e Is Required

Deliverabl e format (paper, electronic, etc.)

Storage Location for Deliverable

Deliverable Received

1 Submit for approval, core list of persons who will work under this Subcontract.

60 days from date of award

Email or paper

N/A

2 Submit documentation demonstrating completion of required certifications and licenses.

On award Paper N/A

3 Submit a recommended list of supplies required to maintain PPPL’s Pharmaceutical Formulary.

On award Paper N/A

4 Submit recommended list of disposable materials and supplies

30 days from date of award

Paper N/A

5 Submit a recommended list of durable medical equipment.

60 days from date of award

Paper N/A

6 Provide annual summary documenting usage of the OMO facilities and medical services

1 year from date of award

Paper N/A

Exceptions (Add justification for any missing document deliverables that will not be received):