Amended PWS FF Physical.docx

Amended Performance Work Statement (PWS) for

162d Air National Guard Pre-Employment & Annual Fire Fighter Physicals

1.0 General:

1.1 Scope: The objective of this Performance Work Statement (PWS) is to conduct and complete the requirements of physical examinations identified in NFPA (National Fire Protection Association) 1582, Standard on Comprehensive Occupational Medical Program for Fire Departments.

1.2 Pre-Employment FF Physical IAW with the most current edition of the NFPA 1582, Standard on Comprehensive Occupational Medical Program for Fire Departments, Chapter 6.

1.3 Annual FF Physical IAW with the most current edition of the NFPA 1582, Standard on Comprehensive Occupational Medical Program for Fire Departments, Chapter 8.

1.4 PFAS Blood Testing (IAW DoD Manual 6055.05, Occupational Medical Examinations: Medical Surveillance and Medical Qualification), per occurrence.

1.5 The contracted entity shall be responsible to provide all materials, labor, supervision, equipment, and any incidentals necessary to provide the services detailed herein. No Government furnished equipment or property is to be provided.

2.0 Background: Air National Guard Fire Protection Activity (ANGFPA) Fire Fighters will comply with a pre-employment baseline physical examination identified in National Fire Protection Association (NFPA) 1582, Standard on Comprehensive Occupational Medical Program for Fire Departments. Annual Physical/Medical Evaluation: ANGFPA Fire Fighters shall be medically evaluated periodically as specified in NFPA 1582.

3.0 Period of Performance (PoP): As specified in Master BPA

4.0 Schedule of Services: The contractor shall provide all services at a local Tucson off-base facility, between 8:00 AM and 5:00 PM (AZ time) Mon-Fri, except on recognized US holidays or when closed due to local or national emergencies. The vendor facility where services are to be provided shall not exceed fifteen (15.0) miles driving distance from 162nd Wing, 1500 E. Valencia Rd., Tucson, AZ 85706.

4.1 Recognized Holidays: The contractor is not required to provide services on the recognized Federal Holidays. The following are recognized United States (US) holidays.

a. New Year’s Day

b. Martin Luther King, Jr.’s Birthday

c. Washington’s Birthday / President’s Day

d. Memorial Day

e. Juneteenth National Independence Day

f. Independence Day: July 4th

g. Labor Day

h. Columbus Day

i. Veteran’s Day

j. Thanksgiving Day

k. Christmas Day

4.2 Quality Control (QC): The contractor shall develop and maintain an effective QC Plan (QCP) to ensure services are performed in accordance with this PWS. The contractor shall develop and implement procedures to identify, prevent, and ensure non-recurrence of defective services. The contractor’s QCP is the means by which it assures itself that its work complies with the requirements of the contract. As a minimum, the contractor shall develop QC procedures that address the areas identified in Technical Exhibit 1, Performance Requirements Summary (PRS).

4.3 Quality Assurance (QA): The Government will evaluate the contractor’s performance under this contract in accordance with the Quality Assurance Surveillance Plan (QASP). This plan is primarily focused on what the Government will do to ensure that the contractor has performed in accordance with the performance standards. It defines how the performance standards will be applied, the frequency of surveillance, and acceptable quality level(s) or defect rate(s).

4.4 Data Rights: The Government has unlimited rights to all documents/materials produced under this contract. All documents and materials, to include the source codes of any software, produced under this contract shall be Government owned and are the property of the Government with all rights and privileges of ownership/copyright belonging exclusively to the Government. These documents and materials may not be used or sold by the contractor without written permission from the KO. All materials supplied to the Government shall be the sole property of the Government and may not be used for any other purpose. This right does not abrogate any other Government rights.

4.5 Organizational Conflicts of Interest (OCI): The contractor and subcontractor personnel performing services under this contract may receive, have access to or participate in the development of proprietary or source selection information (e.g., cost or pricing information, budget information or analyses, specifications or work statements, etc.) or perform evaluation services which may create a current or subsequent OCIs, as defined in FAR Subpart 9.5. The contractor shall notify the KO immediately whenever it becomes aware that such access or participation may result in any actual or potential OCI and shall promptly submit a plan to the KO to avoid or mitigate any such OCI. The contractor’s mitigation plan will be determined to be acceptable solely at the discretion of the KO. In the event the KO unilaterally determines that any such OCI cannot be satisfactorily avoided or mitigated, the KO may impose other remedies as he or she deems necessary, including prohibiting the contractor from participation in subsequent contracted requirements which may be affected by the OCI.

5.0 Requirements: The contractor shall:

5.1 The Contractor shall provide the 162d WG Air National Guard (ANG) Public Health Office with a written Physician’s Medical Certification Pass/Fail Statement within two weeks (14 days) of the performing occupational physical stating if employee is medically certified to safely perform the essential job tasks. Deliver hard copy with results within 30 days.

5.1.1 The report shall identify the presence of Category A or disqualifying Category B medical conditions in accordance with NFPA 1582, Standard on Comprehensive Occupational Medical Program for Fire Departments, if present:

(1) Disqualifying Category B medical conditions in accordance with NFPA 1582, Standard on Comprehensive Occupational Medical Program for Fire Departments, if present.

Amended

(2) The Contractor shall perform an occupational physical and provide 162d WG Air National Guard (ANG) Public Health Office with Return to Work Medical Certification Statement for State firefighters out of work for surgery or serious injury.

(3) The Contractor’s office shall be staffed with physician that is a State of Arizona licensed as doctor of medicine or osteopathy who has completed residency training in an accredited medical training program and/or is American Boards of Medical Specialties (ABMS), or American Osteopathic Association (AOA) board certified or international equivalent.

(4) The Contractor shall schedule appointments for occupational physicals and shall have a provider in attendance Monday through Friday between 8:00 AM and 5:00 PM (AZ time).

(5) The Contractor shall schedule appointments as requested by the department within ten (10) business day.

(6) The Contractor shall have all necessary staff and equipment to perform all required services. Separate billing for outside services will not be accepted by the 162d WG ANG.

(7) Contractor shall forward copies of abnormal results along with patient instructions regarding primary care follow-up to firefighters with instructions to seek (as appropriate) medical follow-up to address any medical conditions, or lab abnormalities, identified during annual physical.

(8) If, during the physical exam, it is determined that the member needs to seek mental/behavioral health assistance, the contractor will have on staff or be able to refer member to a local mental/behavioral health specialist.

(9) Medical record keeping will be completed in accordance with NFPA 1582 and be subject to inspection by the Air National Guard.

(10) Firefighter Physicals will follow NFPA 1582, Standard on Comprehensive Occupational Medical Program for Fire Departments.

TECHNICAL EXHIBIT 1

Resources

Publication (Chapter/Page)

TECHNICAL EXHIBIT 2

Deliverables

Performance Requirements Summary (PRS)

This PRS includes performance objectives the Government will use to determine contractor performance and will compare contractor performance to the Acceptable Quality Level (AQL).

(AQL)

Surveillance Method / By Whom

Deliver Firefighter Physical results no later than 14 days after the event. Deliver hard copy with results within 30 days.

PWS Para 5.1

162D MDG PUBLIC HEALTH

162D MDG PUBLIC HEALTH

END PWS