RFQ 36C24822Q0801.docx

36C24822Q0801 Table of Contents

SECTION B – Schedule/SOW

1. PRICE/COST SCHEDULE

ITEM INFORMATION

VA Police Officer Annual review for Incumbent Police Officers Contract Period: Base POP Begin: 05-01-2022 POP End: 04-30-2023

Pre-Employment Evaluation-New Police Hires

Fitness for Duty Examination-Factors: Psychological or Emotional

VA Police Officer Annual review for Incumbent Police Officers Contract Period: Option 1 POP Begin: 05-01-2023 POP End: 04-30-2024

Pre-Employment Evaluation-New Police Hires

Fitness for Duty Examination-Factors: Psychological or Emotional

VA Police Officer Annual review for Incumbent Police Officers Contract Period: Option 2 POP Begin: 05-01-2024 POP End: 04-30-2025

Pre-Employment Evaluation-New Police Hires

Fitness for Duty Examination-Factors: Psychological or Emotional

VA Police Officer Annual review for Incumbent Police Officers Contract Period: Option 3 POP Begin: 05-01-2025 POP End: 04-30-2026

Pre-Employment Evaluation-New Police Hires

Fitness for Duty Examination-Factors: Psychological or Emotional

OPTION PERIOD UNDER FAR CLAUSE 52.217-8 – OPTION TO EXTEND SERVICES. NOTE: The specified rates under this clause will be those rates in effect pursuant to the CLINs under which the contractor is currently providing services

VA Police Officer Annual review for Incumbent Police Officers Contract Period: Option 4 POP Begin: 05-01-2026 POP End: 04-30-2027

Pre-Employment Evaluation-New Police Hires

Fitness for Duty Examination-Factors: Psychological or Emotional

OPTION PERIOD UNDER FAR CLAUSE 52.217-8 – OPTION TO EXTEND SERVICES. NOTE: The specified rates under this clause will be those rates in effect pursuant to the CLINs under which the contractor is currently providing services

VA Police Officer Annual review for Incumbent Police Officers

Pre-Employment Evaluation-New Police Hires

Fitness for Duty Examination-Factors: Psychological or Emotional

2. NF/SG VA POLICE OFFICER MEDICAL AND PSYCHOLOGICAL CERTIFICATION

STATEMENT OF WORK

I. PURPOSE

The purpose of this contractual agreement is to acquire psychological evaluations and testing for all North Florida/South Georgia VA Police Officers to determine police officers’ suitability to perform the duties of a police officer and to carry a firearm per 5 CFR 339 and VA Handbook 0730.

II. BACKGROUND

The Department of Veterans Affairs requires new hires and current VA Police Officers complete an annual physical examination and be cleared to continue without limitation to his/her duties as a VA Police Officer, which includes carrying a firearm.

Police Officers’ encounters are often with the mentally ill, irrational, or disturbed persons who, although assaultive or destructive, must be handled with understanding, full control of force, and unimpeded judgment. Any emotional or mental condition which could cause the applicant/officer to be a hazard to others or self during stressful situations and physical altercations will disqualify.

III. DESCRIPTION OF SERVICES

The Contractor shall provide initial and annual psychological evaluation of all VA Police Officers as well as any Fitness for Duty exams as required. All VA Police Officers, Detectives, Criminal Investigators, Training Instructors, Deputy Assistant Chief, and Chief of Police shall be reexamined annually to determine their continued emotional suitability to perform the duties of a VA Police Officer. It is not required that the Contractor be located within close proximity of the Malcom Randall VA medical Center as these evaluations can be performed via Telehealth, zoom, online etc.

A. Psychological Evaluation:

i. Pre-employment Psychological Evaluation.

The pre-employment psychological evaluation shall focus on the functional requirements for the position of VA police officer as well as suitability and stability for the role. It must consist of a standardized interview and standardized, objective psychological testing with symptom validity scales. At least two psychological tests must be administered, one normed using healthy individuals drawn from the general population to assess suitability for work as a police officer; the other shall be normed on a clinical population to evaluate substantial psychological dysfunction and/or emotional instability. The psychological evaluation shall include exploration of substance abuse and symptoms of other mental health disorders that may be considered an impediment to effective functioning as a VA police officer.

Tests will include: Personal History Questionnaire for Law Enforcement and Other Public Safety Applicants

At least two of the following tests, one of which is normed based on Police / Public Safety personnel and the other normed on a clinical population:

· Personality Assessment Inventory

· MMPI-2-RF

· California Psychological Inventory

· Inwald Personality Inventory

Any additional tests that the provider believes would add to a valid report may be utilized but must be approved by the Chief of Police and COR.

standardized instruments may be used. A positive response on any of these instruments is an indication that further evaluation is

further psychological testing may be done.

Note: Recurring evaluations can be conducted utilizing Microsoft Teams or Zoom.

Instruments will include at least:

· Structured verbal interview

· AUDIT

· PHQ2

· Other structured interview or self-report questions as determined appropriate by the provider

iii. Directed or Special Examination.

Incumbent police officers may be referred for a directed or special examination when there is objective evidence indicating the employee’s ability to perform essential job functions is compromised. A psychological directed or special examination may be required when it appears that the incapacity is due to a mental or psychological disorder. It is required that this be done in the context of an occupational health evaluation to ensure that medical conditions that may manifest with psychological, mental, or behavioral disturbance are identified.

iv. Reports.

The evaluator will use the forms and report templates included as a report to the Occupational Health Physician at the Malcom Randall VA Medical Center within 48 hours of evaluation. The report will indicate Pass/Fail, Recommended/Not Recommended regarding use of a firearm. The internal process for informing the Chief, Police Service shall be maintained, including completion of VA Form 0867f.

1) Privacy Act Notification – Any reports, as well as any internal working documents generated by the Contractor, are the property of the Malcom Randall VA Medical Center and shall be kept confidential from the officer. The Contractor and/or staff are not authorized to disclose any information pertaining to a VA employee to any source. Any request for information shall be forwarded to the Occupational Health Physician.

2) All results/reports shall be provided to the Occupational Health Physician by email within 48 hours and a hard copy provided within 5 business days and mailed to: Malcom Randall VA Medical Center, ATTENTION: OCCUPATIONAL HEALTH, 1601 SW Archer Road, Gainesville, Florida, 32608.

IV. STAFF QUALIFICATION/CREDENTIALING

The Contractor shall provide a licensed professional psychologist who has the appropriate qualifications, experience, and licensure commensurate with the particular job responsibilities as required to perform this service. The individual must at a minimum holds a PhD in Psychology and a license to practice independently.

V. SCHEDULING

a. The Contractor will be notified by the Chief of Police or Deputy Chief of Police for scheduling new Police Officer applicants, annual psychological evaluations, and Fitness for Duty evaluations; the Occupational Health annual evaluation notification to Police Officers shall remain unchanged.

b. If for any reason a deliverable cannot be delivered as scheduled, the Contractor is required to submit a request for a time extension to the Contracting Officer and the COR. The request must include the reason(s) for the delay, the impact on the overall project, and the impact on the cost of the project. The Contracting Officer will consider each request on the basis of its merit and will, if approved, issue a modification to the contract. The Contractor is required to proceed as originally scheduled until such modification is issued. The Contracting Officer is the only official authorized to make changes to the contract.

VI. CONTRACT AND EVALUATION CRITERIA

a. TYPE OF CONTRACT: This is a Firm Fixed Price Contract

b. Technical Approach. The contractor’s technical proposal is composed of two elements, which are listed in descending order of importance:

i. Understanding of the Project. Provide a written plan which details the approach and sequencing to accomplish all of the requirements of the Statement of Work. Also, demonstrate an understanding of the project and types of problems likely to be encountered, as evidenced by the completeness of the proposal and specific comments on procedures, technology, and proposed improvements. Descriptions of the offerors approach to accomplishing these projects within the stated time frames and with appropriate staff are important.

ii. Experience and qualifications of the project team staff, particularly in providing technical commercial services for a major federal agency (resumes required).

VII. Cost. Total cost will be evaluated by the Government by abstracting the initial cost proposals and comparing them against the Independent Government Cost Estimate. If final proposal revisions are requested, the revised cost proposals will be re-abstracted to assist in the final award decision. In evaluating the offeror’s proposed cost for this project, the Government concern includes determining whether:

a. It reflects the prospective contractor understanding of the project and ability to successfully organize and perform the contract.

b. It is based on adequate estimating procedures, supported by backup documentation, and is realistic in terms of the offeror’s proposed technical approach.

c. It is reasonable when compared to any other similar project/s; and

d. It reflects affordability when compared to the IGCE.

VIII. Order of Importance: Proposals will be evaluated on the basis of three major evaluation criteria: Technical, Past Performance, and Cost. The evaluation criteria are listed in descending order of relative importance. The technical component is significantly more important than past performance and cost when combined.

IX. PAYMENT

a. The Malcom Randall VA Occupational Health in cooperation with the Command Officer, Police Operations, will verify provision of service of new Police Officer applicant evaluations and/or annual police officer evaluations. The Contractor’s billing shall be by electronic processing (IPPS) for payment.

b. It is not required that the Vendor be located within close proximity of the Malcom Randall VA Medical Center as these evaluations can be performed via Telehealth, zoom, online etc.

X. TERM AND TERMINATION

The term of this contract shall be effective for one year beginning at award decision; the terms of the contract to be one (1) with four (4) options of one-year renewals, which may be exercised at the Government’s discretion.

XI. CONTRACT ADIMISTRATION

The Contractor may request amendments to the contract. The CO is the only person authorized to approve, change, or modify any of the requirements under this contract.

The Contractor shall communicate with the CO on all matters pertaining to contract administration.

Only the CO is authorized to make commitment or issue changes that will affect price, quantity, or quality of performance of this contract.

In the event the Contractor effects any such change at the direction of any person other than the CO, the change shall be considered to have been made without authority and no adjustment will be made in the contract price to cover any increase in cost incurred thereof.

The Contractor shall perform the specific services listed herein in a professional manner, in accordance with high quality standard practices and in accordance with local/federal laws and regulations.

a. POST AWARD CONFERENCE: A post award conference will be held at a time and place designated by the CO to be attended by the Contractor, the Contractor’s supervisor(s), the COR, CO, and other officials designated by the CO. The conference agenda will include as a minimum:

a. Performance Requirements

b. Certifications and VA Qualifications

c. Quality Assurance Program

b. Meetings - During the course of the contract there may be times where it may be necessary to schedule a meeting to address areas of concern and/or to exchange information. This would be if phone calls, or emails do not resolve the issue. Attendees should include but may not be limited to the CO, COR, and contractor. Such meetings are to be at no additional cost to the Government.

The North Florida South Georgia Veteran Health System will assign a VA representative as the COR to represent the Contracting Officer in furnishing technical guidance and advice regarding the work being performed under this contract. The foregoing is not to be construed as authorization to interpret or furnish advice and information to the Contractor relative to the financial or legal aspects of the contract. If there is a conflict between the COR and the Contractors interpretation of the PWS requirements the Contractor shall immediately forward the concerns in writing to the contracting officer.

d. NF/SG Contracting Officers Representative (COR):

Kenneth W. Schaffer Gatti Service: Supply Chain Management Service Title: Acquisition and Utilization Specialist Phone: 352.548.7169 Email: Kenneth.schaffergatti@va.gov

XII. ACESS TO VA INFORMATION AND VA SENSITIVE INFORMATION

A. GENERAL

Contractors, contractor personnel, subcontractors, and subcontractor personnel shall be subject to the same Federal laws, regulations, standards, and VA Directives and Handbooks as VA and VA personnel regarding information and information system security.

B. ACCESS TO VA INFORMATION AND VA INFORMATION SYSTEMS

1. A contractor/subcontractor shall request logical (technical) or physical access to VA information and VA information systems for their employees, subcontractors, and affiliates only to the extent necessary to perform the services specified in the contract, agreement, or task order.

2. All contractors, subcontractors, and third-party servicers and associates working with VA information are subject to the same investigative requirements as those of VA appointees or employees who have access to the same types of information. The level and process of background security investigations for contractors must be in accordance with VA Directive and Handbook 0710, Personnel Suitability and Security Program. The Office for Operations, Security, and Preparedness is responsible for these policies and procedures.

3. Contract personnel who require access to national security programs must have a valid security clearance. National Industrial Security Program (NISP) was established by Executive Order 12829 to ensure that cleared U.S. defense industry contract personnel safeguard the classified information in their possession while performing work on contracts, programs, bids, or research and development efforts. The Department of Veterans Affairs does not have a Memorandum of Agreement with Defense Security Service (DSS). Verification of a Security Clearance must be processed through the Special Security Officer located in the Planning and National Security Service within the Office of Operations, Security, and Preparedness.

4. Custom software development and outsourced operations must be located in the U.S. to the maximum extent practical. If such services are proposed to be performed abroad and are not disallowed by other VA policy or mandates, the contractor/subcontractor must state where all non-U.S. services are provided and detail a security plan, deemed to be acceptable by VA, specifically to address mitigation of the resulting problems of communication, control, data protection, and so forth. Location within the U.S. may be an evaluation factor.

5. The contractor or subcontractor must notify the Contracting Officer immediately when an employee working on a VA system or with access to VA information is reassigned or leaves the contractor or subcontractor’s employment. The Contracting Officer must also be notified immediately by the contractor or subcontractor prior to an unfriendly termination.

B. VA INFORMATION CUSTODIAL LANGUAGE

1. Information made available to the contractor or subcontractor by VA for the performance or administration of this contract or information developed by the contractor/subcontractor in performance or administration of the contract shall be used only for those purposes and shall not be used in any other way without the prior written agreement of the VA. This clause expressly limits the contractor/subcontractor's rights to use data as described in Rights in Data - General, FAR 52.227-14(d) (1).

2. VA information should not be co-mingled, if possible, with any other data on the contractors/subcontractor’s information systems or media storage systems in order to ensure VA requirements related to data protection and media sanitization can be met. If co-mingling must be allowed to meet the requirements of the business need, the contractor must ensure that VA’s information is returned to the VA or destroyed in accordance with VA’s sanitization requirements. VA reserves the right to conduct on site inspections of contractor and subcontractor IT resources to ensure data security controls, separation of data and job duties, and destruction/media sanitization procedures are in compliance with VA directive requirements.

3. Prior to termination or completion of this contract, contractor/subcontractor must not destroy information received from VA, or gathered/created by the contractor in the course of performing this contract without prior written approval by the VA. Any data destruction done on behalf of VA by a contractor/subcontractor must be done in accordance with National Archives and Records Administration (NARA) requirements as outlined in VA Directive 6300, Records and Information Management and its Handbook 6300.1 Records Management Procedures, applicable VA Records Control Schedules, and VA Handbook 6500.1, Electronic Media Sanitization. Self-certification by the contractor that the data destruction requirements above have been met must be sent to the VA Contracting Officer within 30 days of termination of the contract.

4. The contractor/subcontractor must receive, gather, store, back up, maintain, use, disclose and dispose of VA information only in compliance with the terms of the contract and applicable Federal and VA information confidentiality and security laws, regulations, and policies. If Federal or VA information confidentiality and security laws, regulations and policies become applicable to the VA information or information systems after execution of the contract, or if NIST issues or updates applicable FIPS or Special Publications (SP) after execution of this contract, the parties agree to negotiate in good faith to implement the information confidentiality and security laws, regulations, and policies in this contract.

5. The contractor/subcontractor shall not make copies of VA information except as authorized and necessary to perform the terms of the agreement or to preserve electronic information stored on contractor/subcontractor electronic storage media for restoration in case any electronic equipment or data used by the contractor/subcontractor needs to be restored to an operating state. If copies are made for restoration purposes, after the restoration is complete, the copies must be appropriately destroyed.

6. If VA determines that the contractor has violated any of the information confidentiality, privacy, and security provisions of the contract, it shall be sufficient grounds for VA to withhold payment to the contractor or third party or terminate the contract for default or terminate for cause under Federal Acquisition Regulation (FAR) part 12.

7. If a VHA contract is terminated for cause, the associated BAA must also be Terminated and appropriate actions taken in accordance with VHA Handbook 1600.01, Business Associate Agreements. Absent an agreement to use or disclose protected health information, there is no business associate relationship.

8. The contractor/subcontractor must store, transport, or transmit VA sensitive Information in an encrypted form, using VA-approved encryption tools that are, at a minimum, FIPS 140-2 validated.

9. The contractor/subcontractor’s firewall and Web services security controls, if applicable, shall meet or exceed VA’s minimum requirements. VA Configuration Guidelines are available upon request.

10. Except for uses and disclosures of VA information authorized by this contract for performance of the contract, the contractor/subcontractor may use and disclose VA information only in two other situations: (i) in response to a qualifying order of a court of competent jurisdiction, or (ii) with VA’s prior written approval. The contractor/subcontractor must refer all requests for, demands for production of, or inquiries about, VA information and information systems to the VA contracting officer for response.

11. Notwithstanding the provision above, the contractor/subcontractor shall not release VA records protected by Title 38 U.S.C. 5705, confidentiality of medical quality assurance records and/or Title 38 U.S.C. 7332, confidentiality of certain health records pertaining to drug addiction, sickle cell anemia, alcoholism or alcohol abuse, or infection with human immunodeficiency virus. If the contractor/subcontractor is in receipt of a court order or other requests for the above-mentioned information, that contractor/subcontractor shall immediately refer such court orders or other requests to the VA contracting officer for response.

12. For service that involves the storage, generating, transmitting, or exchanging of VA sensitive information but does not require C&A or an MOU-ISA for system interconnection, the contractor/subcontractor must complete a Contractor Security Control Assessment (CSCA) on a yearly basis and provide it to the COR.

C. SECURITY INCIDENT INVESTIGATION

1. The term “security incident” means an event that has, or could have, resulted in unauthorized access to, loss or damage to VA assets, or sensitive information, or an action that breaches VA security procedures. The contractor/subcontractor shall immediately notify the COTR and simultaneously, the designated ISO and Privacy Officer for the contract of any known or suspected security/privacy incidents, or any unauthorized disclosure of sensitive information, including that contained in system(s) to which the contractor/subcontractor has access.

2. To the extent known by the contractor/subcontractor, the contractor/subcontractor’s notice to VA shall identify the information involved, the circumstances surrounding the incident (including to whom, how, when, and where the VA information or assets were placed at risk or compromised), and any other information that the contractor/subcontractor considers relevant.

3. With respect to unsecured protected health information, the business associate is deemed to have discovered a data breach when the business associate knew or should have known of a breach of such information. Upon discovery, the business associate must notify the covered entity of the breach. Notifications need to be made in accordance with the executed business associate agreement.

4. In instances of theft or break-in or other criminal activity, the contractor/subcontractor must concurrently report the incident to the appropriate law enforcement entity (or entities) of jurisdiction, including the VA OIG and Security and Law Enforcement. The contractor, its employees, and its subcontractors and their employees shall cooperate with VA and any law enforcement authority responsible for the investigation and prosecution of any possible criminal law violation(s) associated with any incident. The contractor/subcontractor shall cooperate with VA in any civil litigation to recover VA information, obtain monetary or other compensation from a third party for damages arising from any incident, or obtain injunctive relief against any third party arising from, or related to, the incident.

D. LIQUIDATED DAMAGES FOR DATA BREACH

1. Consistent with the requirements of 38 U.S.C. §5725, a contract may require access to sensitive personal information. If so, the contractor is liable to VA for liquidated damages in the event of a data breach or privacy incident involving any SPI the contractor/subcontractor processes or maintains under this contract.

2. The contractor/subcontractor shall provide notice to VA of a “security incident” as set forth in the Security Incident Investigation section above. Upon such notification, VA must secure from a non-Department entity or the VA Office of Inspector General an independent risk analysis of the data breach to determine the level of risk associated with the data breach for the potential misuse of any sensitive personal information involved in the data breach. The term 'data breach' means the loss, theft, or other unauthorized access, or any access other than that incidental to the scope of employment, to data containing sensitive personal information, in electronic or printed form, that results in the potential compromise of the confidentiality or integrity of the data. Contractor shall fully cooperate with the entity performing the risk analysis. Failure to cooperate may be deemed a material breach and grounds for contract termination.

3. Each risk analysis shall address all relevant information concerning the data breach, including the following:

a) Nature of the event (loss, theft, unauthorized access).

b) Description of the event, including:

1. date of occurrence.

2. data elements involved, including any PII, such as full name, social security number, date of birth, home address, account number, disability code.

a. Number of individuals affected or potentially affected.

b. Number of individuals or groups affected or potentially affected.

c. Ease of logical data access to the lost, stolen or improperly accessed data in light of the degree of protection for the data, e.g., unencrypted, plain text.

d. Amount of time the data has been out of VA Control.

e. The likelihood that the sensitive personal information will or has been compromised (made accessible to and usable by unauthorized persons).

f. Known misses of data containing sensitive personal information, if any.

g. Assessment of the potential harm to the affected individuals.

h. Data breach analysis as outlined in 6500.2 Handbook, Management of Security and Privacy Incidents, as appropriate: and

i. Whether credit protection services may assist record subjects in avoiding or mitigating the results of identity theft based on the sensitive personal information that may have been compromised.

j. Based on the determination of the independent risk analysis, the contractor shall be responsible for paying to the VA liquidated damages in the amount of $37.50 per affected individual to cover the cost of providing credit protection services to the affected individuals consisting of the following:

a. Notification

b. One year of credit monitoring services consisting of automatic daily monitoring of at least 3 relevant credit bureau reports.

3. Data breach analysis.

4. Fraud resolution services, including writing dispute letters, initiating fraud alerts and credit freezes, to assist affected individuals to bring matters to resolution.

5. One year of identity theft insurance with $20,000.00 coverage at $0 deductible; and Necessary legal expenses the subjects may incur to repair falsified or damaged credit records, histories, or financial affairs.

APPENDIX A

INFORMED CONSENT FORM

Applicant/Incumbent Name: ________________________ D.O.B.: _________

Social Security Number: _________________

The following information is provided to allow full disclosure of the purpose of this evaluation and the rights you have in this evaluation process.

PURPOSE OF EVALUATION

Each applicant/incumbent Police Officer is required to successfully complete a psychological evaluation prior to employment and as part of the periodic physical examination.

The purpose of this evaluation is to provide information to the Veterans Health Administration (VHA) Occupational Health provider about your suitability and emotional stability, both of which have been determined to be essential to performing the duties of a Police Officer. This evaluation will assist the VHA Occupational Health provider in recommending hiring/retention as a Police Officer in the VA. This assessment is not for counseling or health care purposes. The findings concerning your psychological qualifications or suitability as a Police Officer in the VA are not a statement of opinion about your general psychological health, or your suitability as a Police Officer with a different agency, or suitability for a different position within the VA. This evaluation is not intended for any use other than its stated purpose of evaluating your qualifications for employment as a Police Officer at the VHA.

This evaluation may consist of taking psychometric tests. You will be answering questions in written or computer administered examinations that will measure your psychological characteristics. Additionally, you will participate in a clinical interview. This will include questions about relevant employment, educational or behavioral experiences and you may be asked about your responses to test questions in order to aid in test interpretation.

You have the right to terminate this process at any time, although your refusal to complete this evaluation could result in withdrawal of an offer of employment or administrative or personnel action if you are an incumbent Police Officer.

INTENDED RECIPIENT OF THE PSYCHOLOGICAL EVALUATION

All psychological test materials, test data, and personal information you provide shall be the property of the VA. The psychologist or psychiatrist performing this psychological evaluation is employed by or under contract with VA. The evaluation is disclosed to the Occupational Health provider only.

FEES

The VA will pay all fees connected with the evaluation they refer you for. The VA does not cover the cost of any other reports or information you would like to provide to the mental health or Occupational Health provider.

PROFESSIONAL RELATIONSHIPS

You have the right to be treated in a professional, respectful manner. You do not have a doctor-patient privilege in your communication with the psychologist or psychiatrist performing this evaluation. You will not be given any feedback or a copy of your evaluation results except as may be required by law.

The examining psychologist or psychiatrist may consult with other health and mental health professionals. The other professionals are legally and ethically bound to keep the information confidential.

The psychologist or psychiatrist, whether employed or contracted by VA, is working for the VA and the primary responsibility is to the VA.

CONFIDENTIALITY AND RELEASE OF INFORMATION

The psychological evaluation will be used as one of several elements to determine your qualifications for this position and whether or not you will be hired or retained as a Police Officer.

All of the information obtained from this evaluation belongs to the VA. Results of your psychological evaluation will not become part of your personnel file. Your psychological evaluation will be safeguarded with due regard to your personal privacy.

A report of this evaluation including pertinent findings and conclusions and the professional opinion as to your qualifications for this position will be provided to the VA Occupational Health provider. If there are indications of any mental or emotional disorders and/or maladaptive behavioral patterns which could significantly interfere with your ability to safely and effectively perform the duties of a Police Officer, or if you are not truthful while participating in this evaluation, your conditional job offer or continued employment as a VHA Police Officer may be withdrawn.

The report generated will contain the minimum level of disclosure to satisfy the requirements of evaluation and support its findings, conclusions, and recommendations.

The report will be provided only to the VA Occupational Health provider. Information will not be released to other sources except as required by law or with your informed consent with certain exceptions. Some of the circumstances in which the examining psychologist or psychiatrist has a legal duty to release information include but are not limited to: abuse of children or other vulnerable persons; threats of harm to others, the evaluator, or yourself; upon binding court order or in the process of a lawsuit; and where disclosure is required by State or Federal Law.

In addition, results may be used in validating the screening process, teaching, and research or development of police psychological screening procedures. If used in such ways, your name or personally identifying formation will not be associated with results or otherwise disclosed.

DISCLOSURE ACKNOWLEDGMENT AND RELEASE

I have read and understand the information in this Informed Consent form. I give my informed consent to participate in this psychological evaluation. I understand that confidentiality will be maintained. I understand that this psychological evaluation is only one component of a larger process in determining my qualifications for employment as a Police Officer. I understand this evaluation is not for the purpose o evaluating any mental health conditions. I further understand that the psychologist or psychiatrist will provide a summary report to the VA Occupational Health provider as to my qualifications for employment as a Police Officer. I understand this report is the property of the Office of Personnel Management and is under the custody of VA Occupational Health.

I release the psychologist or psychiatrist from all liability or claims of damage associated with furnishing this report to the VA Occupational Health provider including the opinions and recommendations of the examining psychologist or psychiatrist.

I authorize the examining psychologist or psychiatrist to use and disclose the findings as to my psychological qualification, suitability, and/or fitness for the position of a VA Police Officer to the VHA Occupational Health provider.

I do not need to sign this authorization. However, my refusal will mean that the required psychological evaluation will not take place. This fact may have implications for my employment at the VHA as a Police Officer.

QUESTIONS

Should you have any additional questions or concerns about the psychological evaluation, you may direct them to the evaluator conducting this assessment or the VA Employee health physician.

Your signature below indicates that you have read and understood the terms above, and that you are choosing to proceed with your participation in the evaluation as described above.

Signature: __________________________________ Date: _____________ Psychologist/Psychiatrist: _____________________ Date: _____________

APPENDIX B

POLICE OFFICER EVALUATION TEMPLATE

Assessment:

Applicant___ Recurring___ Directed or Special Examination___

Employee Name: _______________________________________

Last 4 of SSN: _________________________________________

Employing Facility: _____________________________________

Date of Evaluation: _____________________________________

Date of Report: ________________________________________

Evaluated by: _________________________________________

REFERRAL INFORMATION

Reason for Referral:

Indicate if pre-employment ___, recurring ___, or as follows:

If the assessment is a directed or special examination, include a description of events or behaviors that prompted the evaluation. If the findings suggest that the Officer is not capable of performing the functional requirements of a VA Police Officer, the evaluation must include objective evidence that would indicate the employee is not capable of performing the functional requirement, and what evidence suggests that this impairment in functioning is due to an emotional or psychological condition.

Referral Question:

Is the individual psychologically fit to perform the functional requirements of a Police Officer for the Veterans Health Administration?

For Directed or Special Examinations Only: Employee’s perception of events of concern:

HISTORY REVIEW

Note: Only information pertinent to the findings of this evaluation will be provided in this report. This information should be included in recurring evaluations only when it is determined that the employee does not meet the functional requirements for a VA police officer.

Family history:

Education:

Employment history:

Military history:

Marital status:

Legal history:

Financial status:

Medical history:

Mental health history:

Other information pertinent to referral question:

Background or collateral information received from sources other than employee:

MENTAL STATUS EVALUATION

INTERVIEW RESULTS - summarize

PSYCHOLOGICAL TESTING

Tests administered:

Testing validity:

Test findings:

SIGNIFICANT FINDINGS

See summary check sheet of psychological dimensions for police officers attached as last page of this report.

Discussion of any psychological dimensions in which applicant was determined to be “Unsuitable”:

LIMITATIONS TO FINDINGS

APPENDIX C

REPORT OF PSYCHOLOGICAL ASSESSMENT OF POLICE OFFICERS

Assessment:

Applicant ___ Recurring ___ Directed or Special Examination___

Name:

Employee Name: _______________________________________

Last 4 of SSN: _________________________________________

Employing Facility: _____________________________________

Date of Evaluation: _____________________________________

Date of Report: ________________________________________

Tested Administered: __________________________________

It must be noted that this evaluation is based in part on the applicant’s self-reported history and that no background information or collateral information was available for this assessment. Additional information regarding the applicant’s history and behaviors could result in different findings and conclusions.

Risk of Performance Problems

Psychological Dimensions for Police Officer

Low Risk Moderate Risk High Risk

Social Competence: Able to communicate with others in a tactful and respectful manner and showing sensitivity and concern in one’s daily interactions.

Teamwork: Works effectively with other to accomplish goals, as well as subordinating personal interests for the good of the working group and the organization.

Adaptability: Flexibility: Able to change gears and easily adjust to the many different, sudden, and sometimes competing demands of the job.

Conscientiousness/Dependability: Demonstrates diligent, reliable, conscientious work patterns, and performs in a timely, logical manner in accordance with rules, regulations, and organizational policies.

Impulse Control/Attention to Safety: Takes proper precautions and avoids impulsive and/or unnecessary risky behavior to ensure the safety of oneself and others.

Integrity/Ethics: Maintains high standards of personal conduct, including honesty, impartiality, trustworthiness, and abiding laws, regulations, and procedures.

Emotional Regulation/Stress Tolerance: Able to maintain composure and stay in control, particularly during time-critical emergency events and other stressful situations.

Decision-Making/Judgment: Has common sense, “street smarts,” and the ability to make sound decisions, demonstrated by the ability to size up situations quickly to determine and take the appropriate action.

Assertiveness/Persuasiveness: Able to unhesitatingly take control of situations in a calm and appropriately assertive manner, even under dangerous or adverse conditions.

Avoiding substance Abuse and Other Risk-Taking Behavior: Avoids participation in behavior that is inappropriate, self-damaging, and can adversely impact organizational functioning.

Discussion of test and interview findings is required for any psychological dimension(s) marked as being “”Moderate Risk” or “High Risk.”

Conclusion for suitable: NAME did not reveal evidence of behaviors or psychological traits that are expected to interfere with his/her ability to perform the functional requirements of the position of Police Officer with the Veterans Health Administration.

Conclusion for not suitable: Psychological interview and test results revealed that NAME has demonstrated behaviors and/or psychological traits that indicate the applicant would not be able to perform the functional requirements of the position of Police Officer with the Veterans Health Administration.

Conclusion for indeterminate: Psychological interview and test results for NAME were inclusive in determining whether the applicant would or would not be able to perform the functional requirements of the position of Police Officer with the Veterans Health Administration. In the absence of collateral information, a conclusion of suitable or unsuitable cannot be made. These results may be most useful for considering suitability in the context of the overall occupation health evaluation and other medical limitations. This conclusion may be reconsidered, if necessary, collateral information becomes available.

Evaluator signature

ANCHORS FOR LOW, MEDIUM, AND HIGH RISK

· Low Risk: No significant concerns were identified in the applicant’s test findings, interview results, or reported history. It is anticipated that any performance problems in this dimension could be resolved through training, experience and/or supervision.

· Moderate Risk: Concerns were identified in the applicant’s test findings, interview results, or reported history, yet the concerns were not substantiated by more than one source of data; or there is favorable evidence in the domain in addition to the unfavorable evidence. Corroborating information for the concerns from other aspects of the selection process would elevate the risk in this dimension and may be grounds for rejection.

· High Risk: Evidence from at least two sources of data, or compelling evidence from a single source, indicate it is more likely than not that the applicant is not psychologically fit to meet the functional requirements of this position at this time.

Page 1 of Page 1 of

SECTION C - CONTRACT CLAUSES

ADDENDUM to FAR 52.212-4 CONTRACT TERMS AND CONDITIONS—COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES Clauses that are incorporated by reference (by Citation Number, Title, and Date), have the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available.

The following clauses are incorporated into 52.212-4 as an addendum to this contract:

1. 52.217-8 OPTION TO EXTEND SERVICES (NOV 1999)

The Government may require continued performance of any services within the limits and at the rates specified in the contract. These rates may be adjusted only as a result of revisions to prevailing labor rates provided by the Secretary of Labor. The option provision may be exercised more than once, but the total extension of performance hereunder shall not exceed 6 months. The Contracting Officer may exercise the option by written notice to the Contractor within 30 days.

NOTE: The specified rates under this clause will be those rates in effect pursuant to the CLINs under which the contractor is currently providing services.

(End of Clause)

2. 52.217-9 OPTION TO EXTEND THE TERM OF THE CONTRACT (MAR 2000)

(a) The Government may extend the term of this contract by written notice to the Contractor within 30 days; provided that the Government gives the Contractor a preliminary written notice of its intent to extend at least 60 days before the contract expires. The preliminary notice does not commit the Government to an extension.

(b) If the Government exercises this option, the extended contract shall be considered to include this option clause.

(c) The total duration of this contract, including the exercise of any options under this clause, shall not exceed five (5) years.

(End of Clause)

3. VAAR 852.212-70 PROVISIONS AND CLAUSES APPLICABLE TO VA ACQUISITION OF COMMERCIAL ITEMS (APR 2020)

(a) The Contractor agrees to comply with any provision or clause that is incorporated herein by reference to implement agency policy applicable to acquisition of commercial items or components. The following provisions and clauses that have been checked by the Contracting Officer are incorporated by reference.

[X] 852.203–70, Commercial Advertising.

[] 852.209–70, Organizational Conflicts of Interest.

[] 852.211–70, Equipment Operation and Maintenance Manuals.

[] 852.214–71, Restrictions on Alternate Item(s).

[] 852.214–72, Alternate Item(s). [Note: this is a fillable clause.] [] 852.214–73, Alternate Packaging and Packing.

[] 852.214–74, Marking of Bid Samples.

[X] 852.215–70, Service-Disabled Veteran-Owned and Veteran-Owned Small Business Evaluation Factors.

[X] 852.215–71, Evaluation Factor Commitments.

[] 852.216–71, Economic Price Adjustment of Contract Price(s) Based on a Price Index.

[] 852.216–72, Proportional Economic Price Adjustment of Contract Price(s) Based on a Price Index.

[] 852.216–73, Economic Price Adjustment—State Nursing Home Care for Veterans.

[] 852.216–74, Economic Price Adjustment—Medicaid Labor Rates.

[] 852.216–75, Economic Price Adjustment—Fuel Surcharge.

[] 852.219–9, VA Small Business Subcontracting Plan Minimum Requirements.

[] 852.219–10, VA Notice of Total Service-Disabled Veteran-Owned Small Business Set-Aside.

[] 852.219–11, VA Notice of Total Veteran-Owned Small Business Set-Aside.

[] 852.222–70, Contract Work Hours and Safety Standards—Nursing Home Care for Veterans.

[] 852.228–70, Bond Premium Adjustment.

[] 852.228–71, Indemnification, and Insurance.

[] 852.228–72, Assisting Service-Disabled Veteran-Owned and Veteran-Owned Small Businesses in Obtaining Bonds.

[X] 852.232–72, Electronic Submission of Payment Requests.

[] 852.233–70, Protest Content/Alternative Dispute Resolution.

[] 852.233–71, Alternate Protest Procedure.

[] 852.237–70, Indemnification and Medical Liability Insurance.

[] 852.246–71, Rejected Goods.

[] 852.246–72, Frozen Processed Foods.

[] 852.246–73, Noncompliance with Packaging, Packing, and/or Marking Requirements.

[X] 852.270–1, Representatives of Contracting Officers.

[] 852.271–72, Time Spent by Counselee in Counseling Process.

[] 852.271–73, Use and Publication of Counseling Results.

[] 852.271–74, Inspection.

[] 852.271–75, Extension of Contract Period.

[] 852.273–70, Late Offers.

[] 852.273–71, Alternative Negotiation Techniques.

[] 852.273–72, Alternative Evaluation.

[] 852.273–73,…