Performance Work Statement_Occupational Health Exams.pdf

Attachment 1

PERFORMANCE WORK STATEMENT (PWS)

FOR

Occupational Health Examination Services

1.0 General: Occupational Health Examinations for 158thFW Firefighters

1.1 Scope: The contractor shall provide all personnel, equipment, tools, materials, supervision, and quality control necessary, to perform Occupational Health Examinations in accordance with the National Fire Protection Agency (NFPA), and DoDM 6055.05, July 27, 2022 Change 1, April 5, 2024 as defined in this PWS.

1.2 Background: The Vermont Air National Guard (VTANG) uses commercial services for the Occupational Medical Surveillance Examination Program to full-time support and/or temporary personnel who are or could potentially be exposed to health hazards in the work environment. The VTANG does not have the qualified medical personnel to provide these services.

1.3 Period of Performance (PoP): The Period of Performance shall be 1 Base Year and two 12-months option year.

1.4 General Information:

1.4.1 Place and Performance of Services: The contractor shall provide services at vendor location between the week-day hours of operation of the vendor, except on recognized US holidays. The contractor shall always maintain an adequate work force for the uninterrupted performance of all tasks defined within this Performance Work Statement (PWS). When hiring personnel, the contractor shall keep in mind that the stability and continuity of the work force are essential.

1.4.2 Recognized Holidays: The following are recognized United States (US) holidays.

The contractor shall not perform services on these days:

1.4.2.1 New Year’s Day: January 1st

1.4.2.2 Martin Luther King, Jr.’s Birthday

1.4.2.3 President’s Day

1.4.2.4 Memorial Day

1.4.2.5 Juneteenth National Independence Day: June 19th

1.4.2.6 Independence Day: July 4th

1.4.2.7 Labor Day

1.4.2.8 Columbus Day

1.4.2.9 Veteran’s Day: November 11th

1.4.2.10 Thanksgiving Day

1.4.2.11 Christmas Day: December 25th

1.4.3 Reserved

1.4.4 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).

1.4.5 Access and General Protection/Security Policy and Procedures. The contractor shall comply with all applicable installation/facility access and local security policies and procedures, which may be obtained from the Contracting Officer’s Representative (COR). The contractor shall also provide all information required for background checks to meet installation access requirements to be accomplished by the local installation’s Security Forces, Director of Emergency Services or local Security Office. The contractor shall ensure compliance with all personal identity verification requirements as directed by DoD, Headquarters Air Force (HAF) and/or local policy. Should the Force Protection Condition (FPCON) change, the Government may require changes in contractor security matters or processes.

1.4.5.1 Reserved

1.4.5.2 Reserved

1.4.5.3 Reserved

1.4.5.4 Reserved

1.4.5.5 Communications Security/Information Technology (COMSEC/IT) Security. All communications with DoD organizations are subject to COMSEC review. All telephone communications networks are continually subject to intercept by unfriendly intelligence organizations. DoD has authorized the military departments to conduct COMSEC monitoring and recording of telephone calls originating from, or terminating at, DoD organizations. Therefore, the contractor is advised that any time contractor personnel place or receive a call they are subject to COMSEC procedures. The contractor shall ensure wide and frequent dissemination of the above information to all employees dealing with DoD information. The contractor shall abide by all Government regulations concerning the authorized use of the Government's computer network, including the restriction against using the network to recruit Government personnel or advertise job openings.

1.4.5.6 Reserved

1.4.5.7 Reserved

1.4.5.8 Reserved

1.4.5.9 Reserved

1.4.5.10 Protection of Personally Identifiable Information (PII). The contractor shall protect all PII encountered in the performance of services in accordance with Defense Federal Acquisition Regulation Supplement (DFARS) 224.103 Personally Identifiable Information and Department of Defense Directive (DoDD) 5400.11, Department of Defense Privacy Program, and DoD 5400.11-R. If a PII breach results from the contractor’s violation of the said policies, the contractor shall bear all notification costs, call-center support costs, and credit monitoring service costs for all individuals whose PII has been compromised.

1.4.5.11 Reserved

1.4.5.12 Reserved

1.4.5.13 Reserved

1.4.5.14 Reserved

1.4.6 Physical Security. The contractor shall safeguard all Government property provided for contractor use. At the close of each work period, Government facilities, equipment and materials shall be secured.

1.4.7 Special Qualifications: The contractor shall ensure all employees possess all required licenses for conducting occupational health examinations and consultation services. This does not include education or other qualifications for the position in which the contractor employee is performing, dress codes, or other information. (NOTE: The Government does not provide training to contractors. Contractors must ensure that any personnel performing under a contract are fully trained, licensed, certified, and otherwise qualified to provide services.)

1.4.7.1 Contractor shall ensure audiogram technician is certified by the Council for Accreditation in Occupational Hearing Conservation (CAOHC) or the equivalent military Defense Occupational and Environmental Health Readiness System - Hearing Conservation (DOEHRS-HC).

1.4.8 Post Award Conference/Periodic Progress Meetings: The contractor agrees to attend any post award conference convened by the KO in accordance with FAR 42.5.

The KO, COR and other Government personnel, as appropriate, may meet periodically with the contractor to review the contactor’s performance. At these meetings, the KO will apprise the contractor of how the Government views the contractor’s performance and the contractor shall apprise the Government of problems, if any, being experienced.

The contractor shall resolve outstanding issues raised by the Government. Contractor attendance at these meetings shall be at no additional cost to the Government.

1.4.9 Contract Manager (CM): The contactor shall designate a CM who shall ensure performance under this contract. The name of this person, and an alternate who shall act for the contractor when the CM is absent, shall be designated in writing to the KO.

The CM or alternate shall have full authority to act for the contractor on all contract matters relating to daily operation of this contract. The CM shall work through the COR, to resolve issues, receive technical instructions, and ensure adequate performance of services. The CM shall ensure that contractor employees do not perform any services outside the scope of the contract without an official modification issued by the KO. The CM shall ensure contractor employees understand that services performed outside the scope of the contract are performed wholly at the expense of the contractor.

1.4.10 Reserved

1.4.11 Combating Trafficking in Persons: The United States Government has adopted a zero-tolerance policy regarding trafficking in persons. Contractors and contractor employees shall not engage in severe forms of trafficking in persons during the period of performance of the contract; procure commercial sex acts during the period of performance of the contract; or use forced labor in the performance of the contract. The Contractor shall notify its employees of the United States Government’s zero tolerance policy, the actions that will be taken against employees for violations of this policy. The contractor shall take appropriate action, up to and including termination, against employees or subcontractors that violate the US Government policy as described at

FAR 22.17.

1.4.12 Reserved

1.4.13 Reserved

1.4.14 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.

1.4.15 Reserved

2.0 Definitions and Acronyms:

2.1 Definitions:

2.1.1 Contractor: A supplier or vendor awarded a contract to provide specific supplies or service to the Government. The term used in this contract refers to the prime.

2.1.2 Defective Service: A service output that does not meet the standard of performance associated with the PWS.

2.1.3 Deliverable: Anything that can be physically delivered and includes non-manufactured things such as meeting minutes or reports.

2.1.4 Key Personnel: Contractor personnel that are evaluated in a source selection process and that may be required to be used in the performance of a contract by the PWS. When key personnel are used as an evaluation factor in best value procurement, an offer can be rejected if it does not have a firm commitment from the persons that are listed in the proposal.

2.1.5 Physical Security: Actions that prevent the loss or damage of Government property.

2.1.6 Quality Assurance: The Government procedures to verify that services being performed by the Contractor are performed according to acceptable standards.

2.1.7 Quality Assurance Surveillance Plan (QASP): An organized written document specifying the surveillance methodology to be used for surveillance of contractor performance.

2.1.8 Quality Control: All necessary measures taken by the Contractor to ensure that the quality of service shall meet contract requirements.

2.1.9 Subcontractor: One that enters into a contract with a prime contractor. The Government does not have privity of contract with the subcontractor.

2.2 Acronyms:

AEI Army Enterprise Infostructure AR Army Regulation AT/OPSEC Antiterrorism/Operational Security BI Background Investigation CM Contract Manager COR Contracting Officer Representative DA Department of the Army DD254 Department of Defense Contract Security Classification Specification DFARS Defense Federal Acquisition Regulation Supplement DoD Department of Defense FAR Federal Acquisition Regulation GFP/M/E/S Government Furnished Property/Material/Equipment/Services HQDA Headquarters, Department of the Army HSPD Homeland Security Presidential Directive

IA Information Assurance IS Information System(s) KO Contracting Officer NIOSH National Institute for Occupational Safety and Health NFPA National Fire Protection Association NGB National Guard Bureau OCI Organizational Conflict of Interest PII Personally Identifiable Information PIPO Phase In/Phase Out POC Point of Contact PRS Performance Requirements Summary PWS Performance Work Statement QA Quality Assurance QASP Quality Assurance Surveillance Plan QC Quality Control QCP Quality Control Program SCR Service Contract Reporting SSN Social Security Number TE Technical Exhibit USD(I) Under Secretary of Defense for Intelligence VTANG Vermont Air National Guard

3.0 Government Furnished Property, Material, Equipment and Services (GFP/M/E/S):

The Government will provide the property, material, equipment, and/or services listed below solely for the purpose of performance under this contract:

3.1 Government personnel will provide historical medical documentation from previous annual physicals.

4.0 Contractor Furnished Property, Materials, and Equipment (CFP/M/E):

4.1 General: Except for those items specifically stated to be Government-Furnished in Paragraph 3.0, the contractor shall furnish everything required to perform these services as indicated in Paragraph 1.1.

4.2 Location Radius. The place of performance shall be within Chittenden County, Vermont to accommodate employee travel to examination site.

5.0 Requirements: The contractor shall:

5.1 Scheduling

5.1.1 The contractor shall provide appointments within 10 working days of request by the COR.

5.2 Medical Assessment

5.2.1 Contractor shall ensure all procedures are conducted in accordance with NFPA Standards and DODM 6055.05, Occupational Medical Exams: Medical Surveillance and Medical Qualification.

5.2.2 Contractor shall ensure all clinical laboratory services are performed by a laboratory licensed through the U.S. Department of Health and Human Services

(DHHS).

5.2.3 Contractor shall provide a Board eligible or Certified Occupational Medicine Physician to conduct medical surveillance, physical examinations, and consultation services.

5.2.4 Contractor shall provide an assessment between the previous and current annual medical history questionnaire for current employees as outlined in DOD Manual 6055.05, Occupational Medical Examinations: Medical Surveillance and Medical Qualifications, Section 6.6 dated 27 Jul 2022 Change 1, April 5, 2024 ; document any changes in employee medical history.

5.2.5 Contractor shall conduct a medical history questionnaire for newly hired employees IAW Air Force Fire Emergency Services Technical Implementation Guide 1585-18, Attachment 2 (Firefighter Health History) or an equivalent questionnaire for Occupational Medical Examinations.

5.2.6 Contractor shall ensure all examinees complete and sign an authorization for release of health information pursuant to HIPAA to the 158th Vermont Air National Guard Medical Group upon initial appointment.

5.3 Conduct Physical Examination

5.3.1 Contractor shall conduct a physical examination of each employee following the guidelines as outlined in DOD Manual 6055.05, Occupational Medical Examinations:

Medical Surveillance and Medical Qualifications, Section 6.6 dated 27 Jul 2022, Change 1, April 5, 2024

5.3.1.1 Contractor shall document physical examination report on the NFPA Physical Exam Form 1582 ensuring all examination details and results are included.

5.4 Administer Ancillary Tests

5.4.1 Contractor shall administer annual ancillary tests for current employees and initial tests for newly hired employees. Each ancillary test shall be conducted following the standards outlined in the National Fire Protection Agency (NFPA) 1582, Standard on Comprehensive Occupational Medical Program for Fire Departments and DOD Manual 6055.05, Occupational Medical Examinations: Medical Surveillance and Medical Qualifications, Section 6.6 dated 27 Jul 2022, Change 1, April 5, 2024.

5.4.2 Contractor shall document ancillary test results on the NFPA Physical Exam Form 1582 ensuring all laboratory results are included.

5.5 Medical Reports and Recordkeeping.

5.5.1 Contractor shall complete documentation of the annual examination results within 10 working days of completion of the examination and any follow-on ancillary or laboratory testing.

5.5.2 Contractor shall complete documentation of initial examination results within 2 working days of completion of the examination and any follow-on ancillary or laboratory testing.

5.5.3 Contractor shall notify the COR when reports are ready, which will be physically picked up by the COR at the location of service performance.

5.5.4 Contractor shall immediately contact the COR by telephone if results of medical surveillance screening(s), which are questionable and/or of critical significance and/or require follow-up within 5 days of the examination completion.

6.0 Applicable Publications: Publications applicable to this PWS are listed below:

Publication (Chapter/Page)

Date of Publication

Mandator y or

Advisory

Website

Federal Acquisition Regulation https://www.acquisition.gov/?q=browsefar Defense Federal Acquisition

Regulation Supplement http://www.acq.osd.mil/dpap/dars/dfarspgi/curren t/index.html or https://www.acquisition.gov/dfars National Fire Protection Agency

NFPA 1582; Standard on Comprehensive Occupational Medical

Program for Fire Departments

2022 M https://www.nfpa.org/codes-and-standards/all-codes-and-standards/list-of-codes-and-standards/detail?code=1582

DOD Manual 6055.05, Occupational Medical Examinations: Medical

Surveillance and Medical Qualifications, Section 6.6

July 27, 2022 Change 1, April 5, 2024

M https://www.esd.whs.mil/Portals/54/Documents/DD/is suances/dodm/605505m.PDF?ver=3u-UoR7v7wydz-

RIKQkI_Q%3D%3D

6.1 Applicable Forms: Forms applicable to the PWS are listed below:

Form Date Website NFPA Physical Exam Form

2022 https://www.nfpa.org/codes-and-standards/all-codes-and-standards/list-of-codes-and-standards/detail?code=1582

TECHNICAL EXHIBIT 1

Performance Requirements Summary (PRS) https://www.acquisition.gov/?q=browsefar http://www.acq.osd.mil/dpap/dars/dfarspgi/current/index.html http://www.acq.osd.mil/dpap/dars/dfarspgi/current/index.html https://www.acquisition.gov/dfars https://www.nfpa.org/codes-and-standards/all-codes-and-standards/list-of-codes-and-standards/detail?code=1582 https://www.nfpa.org/codes-and-standards/all-codes-and-standards/list-of-codes-and-standards/detail?code=1582 https://www.nfpa.org/codes-and-standards/all-codes-and-standards/list-of-codes-and-standards/detail?code=1582 https://www.esd.whs.mil/Portals/54/Documents/DD/issuances/dodm/605505m.PDF?ver=3u-UoR7v7wydz-RIKQkI_Q%3D%3D https://www.esd.whs.mil/Portals/54/Documents/DD/issuances/dodm/605505m.PDF?ver=3u-UoR7v7wydz-RIKQkI_Q%3D%3D https://www.esd.whs.mil/Portals/54/Documents/DD/issuances/dodm/605505m.PDF?ver=3u-UoR7v7wydz-RIKQkI_Q%3D%3D https://www.nfpa.org/codes-and-standards/all-codes-and-standards/list-of-codes-and-standards/detail?code=1582 https://www.nfpa.org/codes-and-standards/all-codes-and-standards/list-of-codes-and-standards/detail?code=1582

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

Performance

Objective Performance Standard Acceptable Quality

Levels (AQL) Surveillance Method /

By Whom 5.1.1

Scheduling Employee examination appointments scheduled within 10 business days of COR request

Not more than 2 instances of delayed scheduling of appointment

Random Monitoring /

COR

5.3.1 Conduct

Physical

Examination

Completed Medical Surveillance exams meet the standards as outlined in DODM 6055.05

No deviation from standards

Random Monitoring /

COR

5.4.1 Administer

Ancillary Tests

Completed Ancillary Tests/Labs meet the standards as outlined in

DODM 6055.05.

No deviation from standards

Random Monitoring /

COR

5.5.1 Medical

Reports and Recordkeeping

Complete annual examination documentation within 10 days of exam completion

No more than 2 instances of delayed reporting

Random Monitoring /

COR

5.5.2 Medical

Reports and Recordkeeping

Complete initial examination documentation within 2 days of exam completion

No more than 1 instance of delayed reporting

Random Monitoring /

COR

5.5.4 Medical

Reports and Recordkeeping

Notification to COR with a follow requirement within 5 business days of examination and/or test completion

No more than 2 instances of delayed notification.

Random Monitoring /

COR

TECHNICAL EXHIBIT 2

Deliverables Schedule

PWS

Reference / Deliverable

Title

Frequency Number of Copies

Medium/Format Submit To

5.5.1 Medical

Reports and Recordkeeping

Within 2 working days of Initial testing

2 Hard Copies COR

5.5.2 Medical

Reports and

Recordkeeping

Within 10 working days of Annual testing

2 Hard Copies COR

TECHNICAL EXHIBIT 3

Estimated Workload Data

This information is provided for historical background only. It is not a guarantee of workload quantities.

ITEM NAME ANNUAL ESTIMATED

QUANTITY

1 NFPA Occupational Health Initial

Exams 6 Initial

2 NFPA Occupational Health Exams.

(annual exams commonly occur between March and May)

21 Annual

3 PFAS Lab Test (Optional) 27 Each