SOW Attachment (11) COVID Questionnaire.pdf
PDF 1 MB Posted
- Attached to
- Bldg 1000 Lab Server Rooms Cooling Units Federal contract opportunity
- Solicitation number
- N6449821R4037
About this file
This document contains a scope of work attachment and a related federal contract opportunity notice. The scope of work attachment provides a COVID-19 screening and self-assessment questionnaire for employees and visitors. It asks questions regarding international and domestic travel, contact with COVID-19 patients, and current COVID-19 symptoms. The federal contract opportunity is a solicitation notice seeking proposals to remove existing temporary cooling units and install new computer room air conditioning units in three server rooms at the Naval Surface Warfare Center in Philadelphia. The contractor must use an authorized Automated Logic installer and complete the work during normal business hours over a 120-day period after receiving a notice to proceed. The Department of the Navy Naval Sea Systems Command is the issuing agency.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| N6449821R4037-Amendment 0001.pdf | ||
| Brand Name Justification Bldg 1000 Lab Server Room--1_Redacted.pdf | ||
| PPQ (Attachment 13).doc | DOC document | |
| SOW Attach 7_Photographs B-1000 Lab Server Room CRAC units installation_rev01.docx | DOCX document | |
| SOW Attach 4_Contractor Lift Plan Form.pdf | ||
| SOW Attach 6_AHA Form.docx | DOCX document | |
| SOW Attach 5_Mobile Equipment Check List.pdf | ||
| Construction Cost Estimate (Attachment 12).xlsx | XLSX spreadsheet | |
| SOW Attachment (10) Contract Progress Report.pdf | ||
| SOW Attach 1_SiteMap PNBC.pdf | ||
| SOW Attach 9_Power Riser Diagram.pdf | ||
| SOW Attach 3_Contractor Production Report Form.doc | DOC document | |
| SOW Attach 2_NSWCPD ENTRY SCREENING ASSESSMENT.pdf | ||
| SOW Attach 8_PPE Lab Rm 410.pdf | ||
| N6449821R4037.pdf |
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Text version
15 July 2020 Revision 7
NSWCPD COVID-19 SCREENING & SELF-ASSESSMENT QUESTIONNAIRE
1. Have you traveled INTERNATIONALLY (to include Canada) within the last 14 days? YES or NO
2. Have you traveled DOMESTICALLY (U.S.) outside of our authorized local travel radius in the past 14 days (including the NYC metro area)? YES or NO (As a general rule the local travel radius is defined as 50 miles from the worksite. If the employee lives beyond 50 miles, then the local travel radius is extended for the normally used commute route. For non-swipe contractors/visitors, the NSWCPD POC shall be contacted for final disposition).
3. Have you had close personal contact, as defined below, with anyone who has been diagnosed with COVID 19 (lab or clinical diagnosis)? YES or NO
a. Within 6 feet for prolonged period (~15 minutes)
b. In a confined space (car, small room, shared stateroom, berthing proximity, office, etc.)
c. Had direct contact with infectious secretions (been coughed, sneezed on, etc.)
4. Are you currently experiencing any of the following symptoms?
Symptoms Yes No Symptoms Yes No
Fever or chills Loss of taste or smell
Shortness of breath Sore throat
Difficulty breathing Congestion or runny nose
Fatigue Nausea
Muscle or body aches Vomiting
Headache Diarrhea
Seek medical advice by calling your insurance provided health line number and/or:
Pennsylvania Department of Public Health: 1.877.724.3258 or visit, health.pa.gov
New Jersey Department of Public health: 1.800.962.1253 or text, NJCOVID to 898-211 or visit, NJ.gov/health
Delaware Department of Public Health: 1.866.408.1899 or email, DPHcall@delaware.gov
If you have answered YES to any of the above questions, it is highly recommended that you telework if eligible or take appropriate leave. You shall also contact your local supervisor/company/NSWCPD POC for final determination.
SOW Attachment (8) mailto:DPHcall@delaware.gov
File details come from the government source that posted it. Updated .