Statement of Work Medical Testing BPA.docx

Statement of Work for:

910th Occupational Medicine Support Services Statement of Work for CLIN 0001

General: This statement of work (SOW) provides for 910th Airlift Wing (AW) Medical Support Services, as required to ensure personnel meet Air Force medical and occupational standards. These services will be provided for the 910th Airlift Wing, Youngstown ARS, OH civilian and reserve personnel requiring medical accession, qualification, and surveillance services. These services may be provided preselection, preplacement, periodic, as requested and upon termination of workplace employment. Approximately 1200 personnel require various levels of medical support of which approximately 600 have workplace specific medical requirements. Individuals receiving medical support services may require all or some of the services identified to meet their workplace specific medical requirements through contract.

Section I: For the purpose of this SOW, the following abbreviations, definitions, and references apply:

1. 910th Medical Squadron: MDS, is the customer and is required to budget the appropriate funds for the services requested.

2. 910th Air Wing: AW, is the customer and is required to provide the MDS with appropriate funds for “as needed/indicated” services requested.

3. Method of payment shall be by Government Purchase Card (GPC) Visa.

4. MDS Mailing address: 910 Medical Squadron/SGP, Youngstown ARS, 3976 King Graves Rd Unit 11, Vienna OH 44473-5911

5. MDS e-mail org box: 910mds.sga@us.af.mil References:

1. 5 CFR Part 339

2. 29 CFR Part 1910, Occupational Safety and Health Standards

3. AFI 44-102, Medical Care Management

4. AFI 48-101, Aerospace Medicine Enterprise

5. AFI 48-123, Medical Examinations and Standards

6. AFI 48-127, Occupational Noise and Hearing Conservation Program

7. AFI 48-133, Duty Limiting Conditions

8. AFI 48-137, Respiratory Protection Program

9. AFI 48-145, Occupational and Environmental Health Program

10. AFI 48-149, Flight and Operational Medicine Program

11. AFI 90-821, Hazard Communication (HAZCOM) Program

12. AFI 91-202, The US Air Force Mishap Prevention Program

13. AFI 91-204, Safety Investigations and Reports

14. AFMAN 48-125, Personnel Ionizing Radiation Dosimetry

15. AFMAN 48-146, Occupational and Environmental Health Program Management

16. Air Force Fire & Emergency Services Technical Implementation Guide 1582

17. National Fire Protection Association (NFPA) 1582 Publication

18. DAFI 48-145, Occupational and Environmental Health

19. DAFMAN 48-146, Occupational Health Program Management

20. DoDI 48-127, Occupational Noise and Hearing Conservation

21. DoDM 6055.5, Occupational Medicine Examinations and Surveillance Manual Section II:

1. Medical support services are requested by the MDS Sr. Air Reserve Technician (ART), Non-Commissioned Officer in Charge (NCOIC) of Physical Exams, the Occupational Health Program Manager or designated representative only. Individuals and workplace contacts are not authorized to alter, modify, or request services from the contractor.

2. The MDS Sr. ART, NCOIC of Physical Exams, the Occupational Health Program Manager or designated representative will identify the scope and scale of workplace specific individual requirements to the contractor.

a. 910th MDS/ SGP (Flight Surgeon) or 910th MDS Occupational and Environmental Health Medical Consultant (IOEMC) approved changes may be coordinated by the MDS Sr. ART, NCOIC of Physical Exams, the Occupational Health Program Manager or designated representative with the contractor to ensure currency and adequacy of the occupational health examinations.

b. Workplace specific Clinical Occupational Health Exam Requirements (COHER) or equivalent will be provided to the contractor when coordinating workplace specific medical support services to communicate the scope and scale of workplace specific occupational health exam requirements.

c. The contractor may complete examination components identified “as needed/indicated” on the COHER and/or additional source material provided when medically indicated per the discretion of the contractors examining/evaluating physician. Preauthorization by the MDS is required for these services over $200.

d. Workplace specific services may include approximately 50 Individuals from Civilian Fire & Emergency Services. The workplace COHER, DoD 6055.5 Manual and NFPA 1582 TIG provide details relating to the requirements and qualification considerations of the firefighter exams.

e. Workplace specific services may include approximately 20 Individuals from various other industrial workplaces annually. These services will be coordinated individually as needed. COHERs and relative documents will be provided at the time of coordination.

f. Non workplace specific laboratory services may include approximately 250 individuals annually, see item 10 of this SOW for a list of laboratory services that may be requested.

g. Non workplace specific additional services may be requested for approximately 10 individuals annually, see item 13 of this SOW for a list of services that may be requested.

3. Contractor shall provide the personnel, equipment, supplies, and facilities necessary to complete contractor services.

4. Contractor will use customer supplied documents to record services when identified by the customer.

5. Upon request, the contractor will include exam components provided by the MDS in performance of a comprehensive review to determine an individual’s fitness for duty.

6. Contractor shall notify individuals of all abnormal results (e.g., lab work, audiogram, radiograph…) within 5 business days of abnormal result identification.

7. The contractors examining/evaluating physician must review all components of services requested and make referral recommendations as well as determine if individuals are qualified, cleared and/or fit for duty. Written; recommendations, notification of abnormal results, and clearance for duty must be provided to the MDS within 5 business days upon completion of the requested services.

a. The determination of abnormal results, qualifications, clearances, and fitness for duty will be performed in accordance with the applicable guidance and references provided by the customer. This includes, but is not limited to, the Department of the Air Force Instructions, Department of the Air Force Manuals, OSHA, NIOSH, and NFP.

8. Contractor shall consolidate all results and documentation generated and/or gathered for an individual and submit the finalized package to the MDS within 2 weeks upon completion of work.

9. Upon request, Medical Support Services will be provided by the contractor at Youngstown Air Reserve Station 3976 King Graves Rd, Vienna, OH 44473 in a location provided by the government and designated by the MDS Sr. ART, NCOIC of Physical Exams, the Occupational Health Program Manager or designated representative for approximately 20 Individuals Saturdays between 9:30 am to 12:00 pm during an “A” UTA weekend. The customer will coordinate the UTA schedule with the contractor. Alternate dates and times may be coordinated between the parties.

10. Services may be performed at contractor’s facility and/or contractor associated facilities. Scheduling will be coordinated by the MDS Sr. ART, NCOIC of Physical Exams, the Occupational Health Program Manager or designated representative. Workplace POC may assist with scheduling. The contractor must confirm the schedule with the MDS Sr. ART, NCOIC of Physical Exams or the Occupational Health Program Manager or designated representative. Failure to coordinate scheduling with MDS may delay payment to the contractor.

11. Contractor shall provide laboratory services upon request to include but not limited to specimen collection, processing, and documentation of results for such tests as Complete Blood Count, Complete Blood Count w/differential, Complete Metabolic Panel, Liver Function Test, Blood Glucose, Cholesterol Panel, Cholinesterase, Hepatitis A&B Vaccine & Titer, Tetanus & Diphtheria Vaccine & Titer, Lipid Panel, Pesticide Panel, Renal Panel, Uric Acid Panel, Hepatic Panel, Urine Pregnancy Screening, Blood Type, Blood Alcohol Test, G6PD, Sickle Cell, PFAS/PFOA Blood Test. Blood Chemistry Panel, Urinalysis (ph, specific gravity, protein, glucose, ketones, blood, red blood cells, white blood cells), HIV Testing.

12. Contractor shall submit reports of laboratory results to the MDS within 72 hours of contractor receipt of results.

13. Contractor shall provide services upon request to include but not limited to: Pre Placement Screening and Clearance, Occupational Injury/Illness Evaluation, Fitness for Duty Evaluations, Occupational Spirometry, Audiometric Testing and Evaluation, Chest Radiography, Vision Examination (Color Vision, Confrontational Fields, Near Visual Acuity, Fundoscopic Evaluation), complete or partial Physical Examination, Respiratory Fit Testing, Electrocardiogram and Interpretation, Exposure History/Review (Medical, Occupational, Respiratory, Audio), Vital Signs (Temperature, Blood Pressure, Pulse), Height, Weight, Body Mass Index, Cardiovascular Screening and Risk Stratification to include Atherosclerotic Cardiovascular Disease Assessment, assessment for psychiatric or psychological diagnosis/conditions/symptoms adversely impacting behavior, Evaluation factors that could interfere with or prevent satisfactory performance of job function, Assessment of Emotional and Mental Stability using the Teng Mini-Mental status Examination or equivalent.

a. Physical examination may include: Eyes, Ears to include tympanic membranes, Thyroid, Cardiovascular System, Respiratory System, Liver (check for inguinal or femoral hernia) Back and Musculoskeletal System, Skin (rash, erosion, ulcer, pigment, eczema), Central Nervous System, Peripheral Nervous System (strength, sensation, deep tendon reflex), and Functional Assessment (lifting, carrying, pulling, pushing, reaching, use of both hands, walking, standing, crawling, kneeling, bending, climbing, mental/muscular coordination)

14. Audiometric Testing Considerations

a. Contractor performing audiograms as part of the USAF HCP will be trained as Hearing Conservationists as established by the Counsel of Accreditation in Occupational Hearing Conversation (CAOHC). Training costs are the responsibility of the contractor. Current CAOHC certificate of training must be provided to the MDS.

b. Contractor shall document Initial or Re-established Baseline/Reference Audiograms on DD Form 2215.

c. Contractor shall document annual audiogram on DD Form 2216; reference/baseline audiogram will also be transcribed onto DD Form 2216. Reference/baseline audiograms will be compared to determine the presence of significant threshold shifts in hearing. Contractor will perform follow-up testing IAW AFI 48-127. Furthermore, contractor shall notify 910 MDS in writing through electronic medium within 5 business days of any Significant Threshold Shift. The notification shall include follow up recommendations.

d. The information provided will be compliant with OSHA, CAOHC, manufacturer standards, and AFI 48-127, and will be documented on the DD Form 2215 and DD Form 2216. This includes the full name and training certification number of the individual administering the hearing test, as well as the audiometer type, model number, manufacturer number, and serial number.

15. Firefighter Exam Specific Consideration

a. Firefighter exams will be scheduled by the 910th Fire Department Assistant Chief of Health and Safety in conjunction with the MDS Sr. ART, NCOIC of Physical Exams, the Occupational Health Program Manager or designated representative.

b. Contractor must reference NFPA 1582 to ensure compliance and appropriateness of AF comprehensive firefighter exams.

c. Occupational/Medical history and physical exam review and qualification must be completed by a Licensed Doctor of Medicine or Osteopathy to provide professional expertise in areas of occupational safety and health as they relate to emergency services.

i. The contractor must discuss the results of the exam with the employee.

ii. The contractor must provide certification of the exam indicating if the employee is qualified for duty.

iii. The contractor must determine of the employee should follow up with their primary care manager regarding elements of the exam and communicate recommendations to the employee.

16. The contractor will not be entitled to payment prior to successful accomplishment of the event or performance criterion for which payment is requested. Payments will be made when the service has been successfully accomplished in accordance with the terms of the contract.