SOW Attachment (4) NSWCPD Entry Screening Assessment.pdf
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- Solicitation number
- 21-SEL-031
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This document contains a screening questionnaire and self-assessment for COVID-19 symptoms related to entry into the Naval Surface Warfare Center in Philadelphia. The questionnaire includes questions about international and domestic travel within the prior 14 days, close contact with anyone diagnosed with COVID-19, and current COVID-19 symptoms. Employees are instructed to telework or take leave if answering yes to any questions and contact supervisors for determination.
The second part describes a solicitation for a 150-ton minimum capacity air-cooled rotary-screw or scroll-type chiller to replace an existing chiller in Building 4 at the Naval Business Center in Philadelphia. The selective deconstruction, draining and chiller removal work must be performed between 0700 to 1630 Monday through Friday or on weekends, while electrical and mechanical system outages can occur off-hours or weekends. The period of performance including delivery is estimated at 120 days from notice to proceed. The solicitation will be issued by the Naval Surface Warfare Center Philadelphia Division under the Department of the Navy Naval Sea Systems Command.
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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.
mailto:DPHcall@delaware.gov neal.j.moran Text Box SOW Attachment (4) Sheet 1 of 1
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