2019_PWS_Occ_Med_Surv_7_Mar_19.docx

PERFORMANCE WORK STATEMENT (PWS)

FOR

North Carolina Army National Guard (NCARNG) Occupational Medical Surveillance Services

Table of Contents

1.0 General

2.0 Definitions and Acronyms

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

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

5.0 Requirements

6.0 Applicable Publications

TECHNICAL EXHIBIT 1 - Performance Requirements Summary TECHNICAL EXHIBIT 2 - Deliverables Schedule

Performance Work Statement (PWS)

1.0 General:

1.1 Scope: The contractor shall provide all personnel, equipment, tools, materials, supervision, and quality control necessary except as specified in Paragraph 3.0 as Government Furnished, to perform Occupational Medical Surveillance Non-Personal Services.

1.2 Background: The North Carolina Army National Guard (NCARNG) Mobile Occupational Health Medical Surveillance Examination Program provides job-related medical surveillance examinations to full-time and temporary personnel who are or could potentially be exposed to health hazards in the work environment on an annual basis. The number of personnel to be tested may change due to military related obligations.

1.3 Period of Performance (PoP): 1 APR 2019 - 31 JUL 2019

1.4 General Information:

1.4.1 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). A final QCP shall be submitted to the Contracting Officer Representative (COR) NLT 10 days after contract award. A final QCP shall be submitted to the Contracting Officer Representative (COR) NLT 10 days after contract award. After acceptance of the QCP, the contractor shall obtain the Contracting Officer’s (KO’s) acceptance in writing of any proposed changes to its QCP.

1.4.2 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).

1.4.3 Reserved

1.4.4 Place and Performance of Services: The events generally begin at 0700 and run until completion. The events shall occur during the normal workweek (Mon-Fri).

Raleigh

150 soldiers seen over the course of one event

1.4.4.1 Telework: The contractor shall at all times maintain an adequate work force for the uninterrupted performance of all tasks defined within this PWS when the Government facility is not closed for the above reasons. When hiring personnel, the contractor shall keep in mind that the stability and continuity of the work force are essential. Telework is not authorized.

1.4.4.2 Unscheduled gate closures by the Security Police may occur at any time causing all personnel entering or exiting a closed installation to experience a delay. This cannot be predicted or prevented. Contractors are not compensated for unexpected closures or delays. Vehicles operated by contractor personnel are subject to search pursuant to applicable regulations. Any moving violation of any applicable motor vehicle regulation may result in the termination of the contractor employee’s installation driving privileges.

1.4.4.3 The contractor’s employees shall become familiar with and obey the regulations of the installation; including fire, traffic, safety and security regulations while on the installation. Contractor employees should only enter restricted areas when required to do so and only upon prior approval. All contractor employees shall carry proper identification with them at all times, and shall be subject to such checks as may be deemed necessary. The contractor shall ensure compliance with all regulations and orders of the installation which may affect performance. The Government reserves the right to direct the removal of an employee for misconduct, security reasons, or any overt evidence of communicable disease. Removal of contractor employees for reasons stated above does not relieve the Contractor from responsibility for total performance of this contract.

1.4.5 Security Requirements. The contractor shall comply with all applicable installation/facility access and local security policies and procedures, which may be obtained from the COR. The contractor and all associated subcontractor employees shall provide all information required for background checks to meet installation access requirements to be accomplished by installation Provost Marshal Office, Director of Emergency Services or Security Office. The contractor shall ensure compliance with all personal identity verification requirements as directed by Department of Defense (DoD), Headquarters Department of Army (HQDA) and/or local policy. Should the Force Protection Condition (FPCON) change, the Government may require changes in contractor security matters or processes.

The KO may require the Contractor to remove from the job those employees who endanger persons or property; those who manufacture, distribute, dispense, possess or use controlled substances at the worksite; and those whose continued employment under this contract is inconsistent with the interest of military security.

1.4.5.1 Reserved

1.4.5.2 For contractors that do not require a CAC, but require access to a DoD facility or installation: Contractor and all associated sub-contractors employees shall comply with adjudication standards and procedures using the National Crime Information Center Interstate Identification (NCIC-III) and Terrorist Screening Database (TSDB) (Army Directive 2014-05/AR 190-13), and applicable installation, facility and area commander installation/facility access, and local security policies and procedures (provided by a government representative).

1.4.5.3 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.

1.4.5.4 Reserved

1.4.5.5 Protection of Personally Identifiable Information (PII)/Health Information Portability and Accountability Act (HIPAA). 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 aforementioned 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. Additionally, the HIPAA Privacy Rule creates national standards to protect individuals’ medical records and other personal health information. All contract employees shall complete HIPAA certification course on a yearly basis. The contractor shall submit certificates of completion for each affected contractor and subcontractor employee, to the COR, or to the KO if a COR is not assigned, within 15 calendar days after completion of training. HIPAA training is available at http://www.health.mil/Training-Center/Joint-Knowledge- Online-JKO (https://jkodirect.jten.mil/Atlas2/page/login/Login.jsf)

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:

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 Subpart 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 Identification of Contractor Employees: All contractor personnel attending meetings, answering Government telephones and working in other situations where their contractor status is not obvious to third parties are required to identify themselves as such to avoid creating an impression that they are Government employees. The contractor shall ensure that all documents or reports produced by contractor personnel are suitably marked as contractor products or that contractor participation is appropriately disclosed. The contractor’s status as a “contractor” shall be predominantly displayed in all correspondence types (to include signature blocks on e-mail) and dealings with Government or non-Government entities. Contractor personnel shall wear identification badges distinguishing themselves as such. The badges shall have the company name, employee name and the word “contractor” displayed. The contractor shall retrieve all identification media (including vehicle passes) from its employees who depart employment for any reason. The contractor shall return all identification media (i.e., badges and vehicles passes) to the COR within 14 days of an employee’s departure.

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 Contracting Officer (KO): A person with authority to enter into, administer, and or terminate contracts, and make related determinations and findings on behalf of the government. Note: The only individual who can legally bind the government.

2.1.3 Contracting Officer Representative (COR): An employee of the U.S. Government designated by the KO to monitor contractor performance. Such appointment will be in writing and will state the scope of authority and limitations. This individual has authority to provide technical direction to the Contractor as long as that direction is within the scope of the contract, does not constitute a change, and has no funding implications. This individual does NOT have authority to change the terms and conditions of the contract.

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

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

2.1.6 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.

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

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

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

2.1.10 Quality Control: All necessary measures taken by the Contractor to ensure that the quality of an end product or service shall meet contract requirements.

2.1.11 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 Infrastructure AFARS Army Federal Acquisition Regulation Supplement AR Army Regulation ARNG Army National Guard AT/OPSEC Antiterrorism/Operational Security AUP Acceptable Use Policy CFP/M/E Contractor Furnished Property, Materials, and Equipment CFR Code of Federal Regulations COMSEC Communication Security CONUS Continental United States (excludes Alaska and Hawaii) COR Contracting Officer Representative COTS Commercial-Off-the-Shelf DA Department of the Army DFARS Defense Federal Acquisition Regulation Supplement DOD Department of Defense DoDI Department of Defense Instruction FAR Federal Acquisition Regulation FMR Fully Medical Ready FPCON Force Protection Condition GFP/M/E/S Government Furnished Property/Material/Equipment/Services HIPAA Health Information Portability and Accountability Act IA Information Assurance IMR Individual Medical Readiness IS Information System(s) JFHQ Joint Force Headquarters JTR Joint Travel Requirement KO Contracting Officer NGB National Guard Bureau NCARNG North Carolina Army National Guard OCI Organizational Conflict of Interest OHN Occupational Health Nurse PII Personally Identifiable Information POC Point of Contact PoP Period of Performance PPOM Personnel Policy Operational Message PRS Performance Requirements Summary PWS Performance Work Statement QA Quality Assurance QAP Quality Assurance Program QASP Quality Assurance Surveillance Plan TE Technical Exhibit

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

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

3.1 Property: Physical space outside of the armories/locations will be provided for the contractor’s mobile units to park

3.2 Materials: Plain Paper Copier. Both the Government and contractor share this unit.

The Government shall provide all service and supplies, including paper, which is mutually used by all parties. Contractor use of the copier shall be limited to that work which is generated in the performance of this contract.

3.3 Equipment: Power Source. Each location identified in Paragraph 1.4.4 contains a 240 Volt, 60 Amp receptacle that may be used as an alternate power source in lieu of a Contractor furnished generator.

3.4 Services: None

3.4 Utilities: All utilities in the facilities wherein the events are hosted will be available for the contactor’s use in the performance of this contract. The contractor shall instruct employees in utilities conservation practices. The contractor shall operate under conditions that preclude the waste of utilities, which include turning off the water faucets or valves after using the required amount.

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

5.0 Requirements: The contractor shall:

5.1 Event Requirements

5.1.1 Exam Documentation: The contractor shall provide two copies of all medical surveillance tests and exams in hard copy format, to the Gov’t POC within 30 business days of each event. Board eligible or Certified Occupational Medicine Physician shall develop/provide written statement to notify employee of abnormal results identified in the medical surveillance physical examination results.

5.1.2 Event Summary Reporting: Provide a final report for all services provided to include the below information regarding all soldiers receiving services. Submit report to the Gov’t POC as designated for each event within 3 business days of each event.

Date Location Total number of patients scheduled Total number of patients examined A by name listing of all Soldiers examined

5.1.3 Medical Liability Insurance: Maintain medical liability insurance, in a coverage amount acceptable to the Contracting Officer, which is not less than the amount normally prevailing within the local community for the medical specialty concerned. The Contractor is required to ensure that its subcontractors, if any, for provisions of health care services, contain the requirements of the clause at 52.237-7, Indemnification and Medical Liability Insurance, including the maintenance of medical liability insurance. Indemnify the Government for any liability producing act or omission by the Contractor, its employees and agents occurring during contract performance. The contractor shall furnish to the COR prior to contract award evidence of its insurability concerning the medical liability insurance required by this clause.

5.1.4 Occupational Health Specific Exams: Ensure all procedures are conducted in accordance with applicable American Board of Occupational and Environmental Medicine (ABOEM), American Association of Occupational Health Nurses (AAOHN), U.S. Department of Labor, Occupational Safety and Health Administration (OSHA), and the National Institute for Occupational Safety and Health (NIOSH) Standards.

5.1.5 Laboratory Services: Ensure all clinical laboratory services are performed by a laboratory licensed through the U.S. Department of Health and Human Services (DHHS), Health Care Financing Administration pursuant to the terms of the Clinical Laboratories Improvement Act of 1967 (42 U.S.C. 263a) and the College of American Pathologies. Laboratory services shall be performed by personnel certified under the American Society of Clinical Pathology. Chemistry panel/CBC/Urinalysis: The number of labs historically is 95% or more of the total number of personnel tested. Blood Lead/ZPP: The number of labs historically is 15% or more of the total number of personnel tested. There may be more or less; however, these are unknown factors at this time.

5.1.6 Bloodborne Pathogens Compliance: Ensure each healthcare worker complies with the requirements of 29 CFR 1910.1030 Bloodborne Pathogens Standard.

5.1.7 Hazardous Waste: Ensure disposal of all infectious waste is in accordance with local, state, and federal regulation and disposed of by the contractor unless other accommodations have been coordinated in writing.

5.1.8 Equipment: Ensure instrumentation must meet or exceed appropriate performance standards, and calibration accuracy in accordance with local, state, and federal regulation, and calibration accuracy must be verified in accordance with current Occupational Medicine Certification standards. Supporting documentation indicating equipment compliance shall be provided as requested.

5.1.9 Scheduling of events: Scheduling/coordination shall be a joint effort between the Government and the Contractor, and will begin when the event dates/attendees/location becomes known.

5.1.10 Phlebotomy Service for Occupational Health events: Perform all phlebotomy services as needed to include:

a. Bilirubin, total.

b. Blood urea nitrogen (BUN).

c. Complete Blood Count (CBC) including differential and blood platelet counts (actual).

d. Creatinine, serum.

e. Eosinophil count.

f. Hemoglobin and hematocrit.

g. Peripheral smear morphology.

h. Red cell indices.

i. Reticulocyte count.

j. Triglycerides, Total Cholesterol to include HDL and LDL.

k. Urinalysis (UA), screening and microscopic.

l. Alkaline phosphatase (Alk PO4), Gamma Glutamyl Transpeptidase (GGTP), Serum Glutamic Oxalacetic Transaminase (SGOT), and Serum Glutamic Pyruvic Transaminase (SGPT) either individually or as part of a Liver Profile.

m. Zinc Protoporphyrin (ZPP) and Serum Lead must be processed by a laboratory meeting standards set forth in 29 CFR 1910.1025. Only on selected individuals Note: Other labs may be required based on exposure, i.e. chromium, copper, formaldehyde, benzene, etc.

5.1.11 Eye Exam Testing: Conduct visual acuity testing in accordance with DA PAM 40-506 using multiphasic vision screening equipment to measure the following primary visual skills:

a. Visual acuity for distance and near.

b. Lateral phorias for distance and near.

c. Vertical phorias for distance and near.

d. Depth perception.

e. Color perception.

f. Peripheral vision.

5.1.12 Pulmonary Screening: Performed in accordance with AR11-34. Examinations shall include as a minimum Forced Expiratory Volume in one second (FEV1), Forced Vital Capacity (FVC), comparison with recognized normal for the individual's height and weight, sex, race, age and a documented interpretation by a pulmonologist or certified Occupational Health physician. Written Respirator Clearance documentation shall be provided by the Physician and included in Exam Documentation specified in 5.1.1.

5.1.13 Hearing Screening: Perform audiograms in accordance with Standard Testing Procedures for Army Hearing Conservation and Hearing Readiness IAW AR 40-501 and DA-PAM 40-501.

5.2 Key Personnel

5.2.1 Board eligible or Certified Occupational Medicine Physician

5.2.2 Medical Technicians: Shall be credentialed but will work under the auspices of the licensed provider. Contractor shall be held liable and is responsible for ensuring and verifying the appropriate level of Credentialing / Privileging (Licensure, Diploma, background checks, etc.) for all contact providers in support of any NCARNG event.

5.2.3 Pulmonary Function Tests (PFTs) shall be performed by a licensed physician, Certified Pulmonary Function Technologist, or personnel certified through a program approved by the National Institute for Occupational Safety and Health (NIOSH) in accordance with 29 CFR 1910.1001.

5.2.4 Audiogram Screening Technicians: Shall be certified by the Council for Accreditation in Occupational Hearing Conservation (CAOHC).

5.3 Contractor Manpower Reporting Application (CMRA):

5.3.1 The contractor shall report ALL contractor labor hours (including subcontractor labor hours) required for performance of services provided under this contract for the National Guard Bureau via a secure data collection site.

5.3.2 The contractor shall completely fill in all required data fields using the following web address: http://www.ecmra.mil/. Reporting inputs shall be for the labor executed during the period of performance during each Government fiscal year (FY), which runs October 1 through September 30. While inputs may be reported any time during the FY, all data shall be reported no later than October 31 of each calendar year, beginning with 2019. Contractors may direct questions to the help desk at http://www.ecmra.mil.

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

AR 190-13

The Army Physical Security Program

Homeland Security Presidential Directive (HSPD)-12 Policy for a Common Identification Standard for Federal Employees and Contractors

DoDD 5400.11 Department of Defense Privacy Program

DoD 5400.11-R Department of Defense Privacy Program

DoDD 8140.01 Cyberspace Workforce Management

DoD 8570.01-M Information Assurance Workforce Improvement Program

AR 25-2

Information Assurance

AR 530-1

Operations Security

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

DD 1172-2

Application for Identification Card/DEERS Enrollment

I-9 Employment Eligibility Verification

DD 441

Department of Defense Security Agreement

TECHNICAL EXHIBIT 1

Performance Requirements Summary

Note: The tasks below are merely a small sampling of tasks required by the PWS which performance will be tracked by the COR. All work within the scope of this PWS remains subject to Government Surveillance at all times

PWS

Paragraph

5.1.1 5.1.2 Documentation & Reporting

5.1.10

Phlebotomy Services

TECHNICAL EXHIBIT 2

Surveillance Deliverables Schedule

1.4.5.5 Initial and annual HIPAA (Health Information Portability and Accountability Act) training certificates.

5.1.1 Examination Documentation

Delivery Designated Event Gov’t POC

5.1.2 Event Summary Report

Designated Event Gov’t POC

5.1.3 Medical Liability Insurance

COR

5.1.12 Written Respirator Clearance

Delivery Designated Event Gov’t POC

Ver. May 2018