W912JM23Q0011 DRAFT SOLICITATION v1.pdf

SEE ADDENDUM

(No Collect Calls)

W912JM23Q0011 11-May-2023

b. TELEPHONE NUMBER 8. OFFER DUE DATE/LOCAL TIME

08:00 AM 01 Jun 2023

5. SOLICITATION NUMBER 6. SOLICITATION ISSUE DATE

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

STANDARD FORM 1449 (REV. 2/2012)

Prescribed by GSA – FAR (48 CFR) 53.212

(TYPE OR PRINT)

(SIGNATURE OF CONTRACTING OFFICER)

ADDENDA ARE

26. TOTAL AWARD AMOUNT (For Gov t. Use Only )

23.

CODE 10. THIS ACQUISITION IS

SUCH ADDRESS IN OFFER

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT

BELOW IS CHECKED

TELEPHONE NO.

W912JM9. ISSUED BY

18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a. UNLESS BLOCK

7. FOR SOLICITATION

INFORMATION CALL:

a. NAME

2. CONTRACT NO. 3. AWARD/EFFECTIVE DATE 4. ORDER NUMBER

(TYPE OR PRINT)

30b. NAME AND TITLE OF SIGNER 30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER

30a. SIGNATURE OF OFFEROR/CONTRACTOR 31a.UNITED STATES OF AMERICA

0 27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1. 52.212-4. FAR 52.212-3. 52.212-5 ARE ATTACHED.

25. ACCOUNTING AND APPROPRIATION DATA

1. REQUISITION NUMBER

20.

ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED.

OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, AND 30

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

0011949057

ARE NOT ATTACHED

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA ARE ARE NOT ATTACHED

(BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE

SET FORTH HEREIN, IS ACCEPTED AS TO ITEMS:

. YOUR OFFER ON SOLICITATION

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN

% FOR:SET ASIDE:UNRESTRICTED OR X

SMALL BUSINESSX

17a.CONTRACTOR/ CODE FACILITY

OFFEROR CODE

USPFO-GA-P&C (W912JM)

1000 HALSEY AVE. BLDG 447

MARIETTA GA 30060

18a. PAYMENT WILL BE MADE BY CODE

RATED ORDER UNDER

DPAS (15 CFR 700)

13a. THIS CONTRACT IS A

13b. RATING

CODE15. DELIVER TO CODE 16. ADMINISTERED BY

SEE SCHEDULE

12. DISCOUNT TERMS11. DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

SEE SCHEDULE

14. METHOD OF SOLICITATION

RFQ IFB RFPX

678-569-6208FAX:

TEL: 678-569-6202 SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

8(A)

HUBZONE SMALL

BUSINESS

SIZE STANDARD:

$19,000,000

NAICS:

541620

X

OFFER DATED

29. AWARD OF CONTRACT: REF.

DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND

EMAIL:

TEL:

31c. DATE SIGNED

SEE SCHEDULE

SCHEDULE OF SUPPLIES/ SERVICESITEM NO. QUANTITY UNIT UNIT PRICE AMOUNT

24.22.21.19.

WOMEN-OWNED SMALL BUSINESS (WOSB)

ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

(CONTINUED)

PAGE 2 OF67

ACCEPTED, AND CONFORMS TO THE CONTRACT, EXCEPT AS NOTED: ______________________________________________________

32a. QUANTITY IN COLUMN 21 HAS BEEN

RECEIVED INSPECTED

32b. SIGNATURE OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

32c. DATE 32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE 32f . TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE

37. CHECK NUMBER

FINALPARTIALCOMPLETE

36. PAYMENT35. AMOUNT VERIFIED

CORRECT FOR

34. VOUCHER NUMBER

FINAL

33. SHIP NUMBER

PARTIAL

38. S/R ACCOUNT NUMBER 39. S/R VOUCHER NUMBER 40. PAID BY

41a. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT

41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER 41c. DATE

42a. RECEIVED BY (Print)

42b. RECEIVED AT (Location)

42c. DATE REC'D (YY/MM/DD) 42d. TOTAL CONTAINERS

STANDARD FORM 1449 (REV. 2/2012) BACK

Prescribed by GSA – FAR (48 CFR) 53.212

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

SEE SCHEDULE

20.

SCHEDULE OF SUPPLIES/ SERVICES

21.

QUANTITY UNIT

22. 23.

UNIT PRICE

24.

AMOUNT

19.

ITEM NO.

Section SF 1449 - CONTINUATION SHEET

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

0001 1 Job IH Survey AASF #1 in Winder, GA BY

FFP

IH Survey AASF #1 in Winder, GA BY FOB: Destination

PURCHASE REQUEST NUMBER: 0011949057

PSC CD: R428

NET AMT

0002 1 Job IH Survey AASF #3 in Savannah, GA BY

FFP

IH Survey AASF #3 in Savannah, GA BY FOB: Destination

0003 1 Job IH Survey UAS (AASF 3) in Ft. Stewart BY

FFP

IH Survey UAS (AASF 3) in Ft. Stewart BY FOB: Destination

0004 1 Job IH Survey CSMS #1 in Atlanta, GA BY

FFP

IH Survey CSMS #1 in Atlanta, GA BY FOB: Destination

0005 1 Job IH Survey CSMS South Hinesville, GA BY

FFP

IH Survey CSMS South Hinesville, GA BY FOB: Destination

0006 1 Job IH Survey FMS #1 in Atlanta, GA BY

FFP

IH Survey FMS #1 in Atlanta, GA BY FOB: Destination

0007 1 Job IH Survey FMS #4 in Augusta, GA BY

FFP

IH Survey FMS #4 in Augusta, GA BY FOB: Destination

0008 1 Job IH Survey FMS #8 in Winder, GA BY

FFP

IH Survey FMS #8 in Winder, GA BY FOB: Destination

0009 1 Job IH Survey FMS #9 in Calhoun, GA BY

FFP

IH Survey FMS #9 in Calhoun, GA BY FOB: Destination

0010 1 Job IH Survey USPFO Warehouse Atlanta GA BY

FFP

IH Survey USPFO Warehouse Atlanta GA BY FOB: Destination

1001 1 Job IH Survey AASF #1 in Winder, GA BY1

FFP

IH Survey AASF #1 in Winder, GA BY1 FOB: Destination

1002 1 Job IH Survey AASF #3 in Savannah, GA BY1

FFP

IH Survey AASF #3 in Savannah, GA BY1 FOB: Destination

1003 1 Job IH Survey UAS (AASF 3) Ft Stewart BY1

FFP

IH Survey UAS (AASF 3) Ft Stewart BY1 FOB: Destination

1004 1 Job IH Survey CSMS #1 in Atlanta, GA BY1

FFP

IH Survey CSMS #1 in Atlanta, GA BY1 FOB: Destination

1005 1 Job IH Survey CSMS South Hinesville, GA BY1

FFP

IH Survey CSMS South Hinesville, GA BY1 FOB: Destination

1006 1 Job IH Survey FMS #1 in Atlanta, GA BY1

FFP

IH Survey FMS #1 in Atlanta, GA BY1 FOB: Destination

1007 1 Job IH Survey FMS #4 in Augusta, GA BY1

FFP

IH Survey FMS #4 in Augusta, GA BY1 FOB: Destination

1008 1 Job IH Survey FMS #8 in Winder, GA BY1

FFP

IH Survey FMS #8 in Winder, GA BY1 FOB: Destination

1009 1 Job IH Survey FMS #9 in Calhoun, GA BY1

FFP

IH Survey FMS #9 in Calhoun, GA BY1 FOB: Destination

1010 1 Job IH Survey USPFO WHSE in Atlanta, GA BY1

FFP

IH Survey USPFO WHSE in Atlanta, GA BY1 FOB: Destination

2001 1 Job IH Survey AASF #1 in Winder, GA BY2

FFP

IH Survey AASF #1 in Winder, GA BY2 FOB: Destination

2002 1 Job IH Survey AASF #3 in Savannah, GA BY2

FFP

IH Survey AASF #3 in Savannah, GA BY2 FOB: Destination

2003 1 Job IH Survey UAS (AASF 3) Ft Stewart GA BY2

FFP

IH Survey UAS (AASF 3) Ft Stewart GA BY2 FOB: Destination

2004 1 Job IH Survey CSMS #1 in Atlanta, GA BY2

FFP

IH Survey CSMS #1 in Atlanta, GA BY2 FOB: Destination

2005 1 Job IH Survey CSMS South Hinesville GA BY2

FFP

IH Survey CSMS South Hinesville GA BY2 FOB: Destination

2006 1 Job IH Survey FMS #1 in Atlanta, GA BY2

FFP

IH Survey FMS #1 in Atlanta, GA BY2 FOB: Destination

2007 1 Job IH Survey FMS #4 in Augusta, GA BY2

FFP

IH Survey FMS #4 in Augusta, GA BY2 FOB: Destination

2008 1 Job IH Survey FMS #8 in Winder, GA BY2

FFP

IH Survey FMS #8 in Winder, GA BY2 FOB: Destination

2009 1 Job IH Survey FMS #9 in Calhoun, GA BY2

FFP

IH Survey FMS #9 in Calhoun, GA BY2 FOB: Destination

2010 1 Job IH Survey USPFO WHSE Atlanta, GA BY2

FFP

IH Survey USPFO WHSE Atlanta, GA BY2 FOB: Destination

3001 1 Job IH Survey AASF #1 in Winder, GA BY3

FFP

IH Survey AASF #1 in Winder, GA BY3 FOB: Destination

3002 1 Job IH Survey AASF #3 in Savannah, GA BY3

FFP

IH Survey AASF #3 in Savannah, GA BY3 FOB: Destination

3003 1 Job IH Survey UAS (AASF 3) Ft Stewart BY3

FFP

IH Survey UAS (AASF 3) Ft Stewart BY3 FOB: Destination

3004 1 Job IH Survey CSMS #1 in Atlanta, GA BY3

FFP

IH Survey CSMS #1 in Atlanta, GA BY3 FOB: Destination

3005 1 Job IH Survey CSMS South Hinesville GA BY3

FFP

IH Survey CSMS South Hinesville GA BY3 FOB: Destination

3006 1 Job IH Survey FMS #1 in Atlanta, GA BY3

FFP

IH Survey FMS #1 in Atlanta, GA BY3 FOB: Destination

3007 1 Job IH Survey FMS #4 in Augusta, GA BY3

FFP

IH Survey FMS #4 in Augusta, GA BY3 FOB: Destination

3008 1 Job IH Survey FMS #8 in Winder, GA BY3

FFP

IH Survey FMS #8 in Winder, GA BY3 FOB: Destination

3009 1 Job IH Survey FMS #9 in Calhoun, GA BY3

FFP

IH Survey FMS #9 in Calhoun, GA BY3 FOB: Destination

3010 1 Job IH Survey USPFO WHSE Atlanta GA BY3

FFP

IH Survey USPFO WHSE Atlanta GA BY3 FOB: Destination

4001 1 Job IH Survey AASF #1 in Winder, GA BY4

FFP

IH Survey AASF #1 in Winder, GA BY4 FOB: Destination

4002 1 Job IH Survey AASF #3 in Savannah, GA BY4

FFP

IH Survey AASF #3 in Savannah, GA BY4 FOB: Destination

4003 1 Job IH Survey UAS (AASF 3) Ft Stewart BY4

FFP

IH Survey UAS (AASF 3) Ft Stewart BY4 FOB: Destination

4004 1 Job IH Survey CSMS #1 in Atlanta, GA BY4

FFP

IH Survey CSMS #1 in Atlanta, GA BY4 FOB: Destination

4005 1 Job IH Survey CSMS South Hinesville GA BY4

FFP

IH Survey CSMS South Hinesville GA BY4 FOB: Destination

4006 1 Job IH Survey FMS #1 in Atlanta, GA BY4

FFP

IH Survey FMS #1 in Atlanta, GA BY4 FOB: Destination

4007 1 Job IH Survey FMS #4 in Augusta, GA BY4

FFP

IH Survey FMS #4 in Augusta, GA BY4 FOB: Destination

4008 1 Job IH Survey FMS #8 in Winder, GA BY4

FFP

IH Survey FMS #8 in Winder, GA BY4 FOB: Destination

4009 1 Job IH Survey FMS #9 in Calhoun, GA BY4

FFP

IH Survey FMS #9 in Calhoun, GA BY4 FOB: Destination

4010 1 Job IH Survey USPFO WHSE Atlanta, GA BY4

FFP

IH Survey USPFO WHSE Atlanta, GA BY4 FOB: Destination

DELIVERY INFORMATION

CLIN DELIVERY DATE QUANTITY SHIP TO ADDRESS DODAAC /

CAGE

0001 POP 01-JUL-2023 TO

30-JUN-2024

N/A ARNG CLAY

USPFO - GEORGIA

1000 HALSEY AVE BLDG 447

MARIETTA GA 30060

FOB: Destination

W33MLL

0002 POP 01-JUL-2023 TO

30-JUN-2024

N/A W8AM GAARNG ELEMENT, JF HQ

ARNG STAFF ELEMENT, JOINT FORCE

HEA

1000 HALSEY AVE BLDG 447 CNGC

SUITE S1079B

MARIETTA GA 30060-4277

678-569-5943

0003 POP 01-JUL-2023 TO

N/A (SAME AS PREVIOUS LOCATION)

0004 POP 01-JUL-2023 TO

N/A (SAME AS PREVIOUS LOCATION)

0005 POP 01-JUL-2023 TO

N/A (SAME AS PREVIOUS LOCATION)

0006 POP 01-JUL-2023 TO

N/A (SAME AS PREVIOUS LOCATION)

0007 POP 01-JUL-2023 TO

N/A (SAME AS PREVIOUS LOCATION)

0008 POP 01-JUL-2023 TO

N/A (SAME AS PREVIOUS LOCATION)

0009 POP 01-JUL-2023 TO

N/A (SAME AS PREVIOUS LOCATION)

0010 POP 01-JUL-2023 TO

N/A (SAME AS PREVIOUS LOCATION)

1001 POP 01-JUL-2024 TO

30-JUN-2025

N/A (SAME AS PREVIOUS LOCATION)

1002 POP 01-JUL-2024 TO

N/A (SAME AS PREVIOUS LOCATION)

1003 POP 01-JUL-2024 TO

N/A (SAME AS PREVIOUS LOCATION)

1004 POP 01-JUL-2024 TO

N/A (SAME AS PREVIOUS LOCATION)

1005 POP 01-JUL-2024 TO

N/A (SAME AS PREVIOUS LOCATION)

1006 POP 01-JUL-2024 TO

N/A (SAME AS PREVIOUS LOCATION)

1007 POP 01-JUL-2024 TO

N/A (SAME AS PREVIOUS LOCATION)

1008 POP 01-JUL-2024 TO

N/A (SAME AS PREVIOUS LOCATION)

1009 POP 01-JUL-2024 TO

N/A (SAME AS PREVIOUS LOCATION)

1010 POP 01-JUL-2024 TO

N/A (SAME AS PREVIOUS LOCATION)

2001 POP 01-JUL-2025 TO

30-JUN-2026

N/A (SAME AS PREVIOUS LOCATION)

2002 POP 01-JUL-2025 TO

N/A (SAME AS PREVIOUS LOCATION)

2003 POP 01-JUL-2025 TO

N/A (SAME AS PREVIOUS LOCATION)

2004 POP 01-JUL-2025 TO

N/A (SAME AS PREVIOUS LOCATION)

2005 POP 01-JUL-2025 TO

N/A (SAME AS PREVIOUS LOCATION)

2006 POP 01-JUL-2026 TO

30-JUN-2027

N/A (SAME AS PREVIOUS LOCATION)

2007 POP 01-JUL-2025 TO

N/A (SAME AS PREVIOUS LOCATION)

2008 POP 01-JUL-2025 TO

N/A (SAME AS PREVIOUS LOCATION)

2009 POP 01-JUL-2025 TO

N/A (SAME AS PREVIOUS LOCATION)

2010 POP 01-JUL-2025 TO

N/A (SAME AS PREVIOUS LOCATION)

3001 POP 01-JUL-2026 TO

N/A (SAME AS PREVIOUS LOCATION)

3002 POP 01-JUL-2026 TO

N/A (SAME AS PREVIOUS LOCATION)

3003 POP 01-JUL-2026 TO

N/A (SAME AS PREVIOUS LOCATION)

3004 POP 01-JUL-2026 TO

N/A (SAME AS PREVIOUS LOCATION)

3005 POP 01-JUL-2026 TO

N/A (SAME AS PREVIOUS LOCATION)

3006 POP 01-JUL-2026 TO

N/A (SAME AS PREVIOUS LOCATION)

3007 POP 01-JUL-2026 TO

N/A (SAME AS PREVIOUS LOCATION)

3008 POP 01-JUL-2026 TO

N/A (SAME AS PREVIOUS LOCATION)

3009 POP 01-JUL-2026 TO

N/A (SAME AS PREVIOUS LOCATION)

3010 POP 01-JUL-2026 TO

N/A (SAME AS PREVIOUS LOCATION)

4001 POP 01-JUL-2027 TO

30-JUN-2028

N/A (SAME AS PREVIOUS LOCATION)

4002 POP 01-JUL-2027 TO

N/A (SAME AS PREVIOUS LOCATION)

4003 POP 01-JUL-2027 TO

N/A (SAME AS PREVIOUS LOCATION)

4004 POP 01-JUL-2027 TO

N/A (SAME AS PREVIOUS LOCATION)

4005 POP 01-JUL-2027 TO

N/A (SAME AS PREVIOUS LOCATION)

4006 POP 01-JUL-2027 TO

N/A (SAME AS PREVIOUS LOCATION)

4007 POP 01-JUL-2027 TO

N/A (SAME AS PREVIOUS LOCATION)

4008 POP 01-JUL-2027 TO

N/A (SAME AS PREVIOUS LOCATION)

4009 POP 01-JUL-2027 TO

N/A (SAME AS PREVIOUS LOCATION)

4010 POP 01-JUL-2027 TO

N/A (SAME AS PREVIOUS LOCATION)

PERFORMANCE WORK STATEMENT

1.0 General: This is a non-personal services requirement that will anticipate, recognize, and evaluate potential health hazards associated with processes performed at Army National Guard (ARNG) facilities. Contractor shall be required to provide sound recommendations for hazard control. The surveys shall serve as a baseline of workplace conditions or provide an update for a previously conducted survey. The purpose of a survey is to document a worker’s history of exposures for both civilian and military employees.

1.1 Scope: The contractor shall provide all personnel, equipment, tools, materials, supervision, and quality control necessary to perform industrial hygiene surveys, as defined in this PWS. The exception is specified in Paragraph 3.0 as Government Furnished.

1.1.1 Objectives The contractor shall conduct a comprehensive industrial hygiene survey and prepare a comprehensive report for the specified facilities as defined in this PWS.

1.2 Background: The RIHS has a requirement to anticipate, recognize, and evaluate potential health hazards associated with processes performed at National Guard (NG) working facilities and to provide sound recommendations for hazard control. The surveys will serve to establish a baseline of workplace conditions or update a previous baseline so that a worker’s history of exposures is provided for both civilian and military employees (Army Regulation (AR) 385-10 The Army Safety Program).

1.3 Period of Performance (PoP): The Period of Performance shall be 12 months. The contractor will have no more than thirty (30) calendar days from award of Contract to schedule the appointment/ Site visit through the Point of Contact (POC) at the survey site. The contractor will have no more than ninety (90) calendar days from scheduled survey date to complete all survey requirements to include submission of report to RIHS office and survey samples to appropriate laboratories.

1.4 General Information:

1.4.1 Place and Performance of Services: The contractor shall provide services between the hours of each facility is open during the week 0730-1730 on Monday through Friday, except on recognized US holidays or when the Government facility/installation is closed due to local or national emergencies, administrative closings, or similar Government-directed facility/installation closings. 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/installation is not closed for the above reasons.

1.4.1.1 Telework: The Government does not permit the contractor to telework in support of this requirement.

1.4.1.2 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.

1.4.1.3 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 from Government property or revoke access to Government systems 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.

1.4.2 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 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. 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.

1.4.4 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 Installation Access and 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 (see PWS 6.0). Should the Force Protection Condition (FPCON) change, the Government may require changes in contractor security matters or processes.

1.4.5.1 Failure to comply with these requirements may result in withholding of final payment.

1.4.5.2 Awareness Training (AT) Level 1: This standard language is for contractor employees with an area of performance within an Army controlled installation, facility or area. All contractor employees, to include subcontractor employees, requiring access Army installations, facilities and controlled access areas shall complete AT Level I Awareness training within calendar 30 days after contract start date or effective date of incorporation of this requirement into the contract, whichever is applicable. The contractor shall submit certificates of completion for each affected contractor employee and subcontractor employee, to the COR or to the contracting officer, if a COR is not assigned, within 5 calendar days after completion of training by all employees and subcontractor personnel. AT level I Awareness training is available at the following website: https://jko.jten.mil/courses/atl1/launch.html.

1.4.5.3 iWATCH Training: This standard language is for contractor employees with an area of performance within an Army controlled installation, facility or area. The contractor and all associated sub‐contractors shall brief all employees on the local iWATCH Army program (training standards provided by the requiring activity Antiterrorism Officer). This local developed training will be used to inform employees of the types of behavior to watch for and instruct employees to report suspicious activity to the COR. This training shall be completed within 30 calendar days of contract award and within 5 calendar days of new employees commencing performance with the results reported to the COR NLT 30 calendar days after contract award.

1.4.5.4 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.

1.4.5.5 OPSEC Training: In accordance with AR 530-1, Operations Security, new contractor employees shall complete Level I OPSEC training within 30 calendar days of their reporting for duty and annually thereafter. The contractor shall submit certificates of completion for each contractor employee to the COR within 5 calendar days after completion of training. Level 1 OPSEC training is available at https://securityawareness.usalearning.gov/opsec/index.htm.

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 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.

1.4.8 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.

1.4.9 Identification of Contractor Employees: Contractor personnel shall wear identification badges distinguishing themselves as such. The badges shall have the company name, employee name and the word “contractor” displayed.

1.4.10 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 pass) to the KO 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 Contractor Travel: No travel expenses will be reimbursed.

1.4.13 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.

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 a product or service shall meet contract requirements.

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

2.2 Acronyms:

AASF Army Aviation Support Facility ACOR Alternate Contracting Officer’s Representative AEI Army Enterprise Infrastructure AFARS Army Federal Acquisition Regulation Supplement AIHA American Industrial Hygiene Association ANG Air National Guard AQL Acceptable Quality Levels AR Army Regulation ARNG Army National Guard

AT Antiterrorism AT/OPSEC Antiterrorism/Operational Security AUP Acceptable Use Policy AVCRAD Combined Maintenance Aviation Classification Repair Activity Depot BBP Best Businesses Practice CA Contract Administrator CFR Code of Federal Regulations CMF Combined Maintenance Facility COMSEC Communications Security CONUS Continental United States (excludes Alaska and Hawaii) COR Contracting Officer Representative COTS Commercial-Off-the-Shelf CS Contract Specialist CSMS Combined Support Maintenance Shop CST Civil Support Team CUI Controlled Unclassified Information DA Department of the Army DD250 Department of Defense Form Receiving Report DD254 Department of Defense Contract Security Requirement List DFARS Defense Federal Acquisition Regulation Supplement DMDC Defense Manpower Data Center DOD Department of Defense DODD Department of Defense Directive FAR Federal Acquisition Regulation FMS Field Maintenance Shop FPCON Force Protection Condition GA ARNG Georgia Army National Guard GA DOD Georgia Department of Defense / Georgia National Guard GA NG Georgia National Guard GFP/M/E/S Government Furnished Property/Material/Equipment/Services HHIM Health Hazard Information Forms HHSC Health Hazard Severability Code HIPAA Health Insurance Portability and Accountability Act of 1996 HQDA Headquarters, Department of the Army IA Information Assurance IH Industrial Hygiene IS Information System(s) IT Information Technology KO Contracting Officer MATES Maneuver Area Training Equipment Site NG National Guard NGB National Guard Bureau NLT No Later Than OCI Organizational Conflict of Interest OCONUS Outside Continental United States (including Puerto Rico, Virgin Islands…) ODC Other Direct Costs OEL Occupational Exposure Limit OPSEC Operational Security OSHA Occupational Safety and Health Administration P&C Purchasing and Contracting PII Personally Identifiable Information PIPO Phase In / Phase Out POC Point of Contact PoP Period of Performance PRS Performance Requirements Summary PWS Performance Work Statement

QA Quality Assurance QAP Quality Assurance Program QASP Quality Assurance Surveillance Plan QC Quality Control QCP Quality Control Plan RC Readiness Center RIHS Regional Industrial Hygiene Office Southeast SEG Similar Exposure Group SF Standard Form STEL Short Term Exposure Limit TASMG Theater Aviation Sustainment Maintenance Group TE Technical Exhibit TWA Time Weighted Average UAS Unmanned Aerial Surveillance USPFO United States Property and Fiscal Office UTES Unit Training Equipment Site

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 Property: The Government will furnish the necessary workspace for the contractor to perform services outlined in this PWS to include desk space.

3.2 Materials: The RIHS may provide the Contractor with materials necessary to complete the Industrial Hygiene survey upon request from the Contractor. The Contractor must submit an Equipment Request Form no later than (NLT) two (2) weeks prior to on-site survey to the RIHSE office email address, ng.ga.gaarng.mbx.rihse@army.mil. Contractor must pick-up the materials from the Industrial Hygiene Southeast Regional Office. (See Exhibit One (1) – Equipment Request Form)

3.3 Equipment: The RIHS may provide the Contractor with equipment necessary to complete the Industrial Hygiene survey upon request from the Contractor. This is a courtesy, not a requirement. The equipment, if available, are on a first come-first serve basis. Contractor must submit an Equipment Request Form no later than (NLT) two (2) weeks prior to on-site survey. Contractor must pick-up the equipment from the RIHS office. (See Exhibit One (1) – Equipment Request Form) The contractor will be responsible for replacing any lost or damaged equipment. The contractor shall return the equipment NLT thirty (30) days after receiving it, unless authorized to return at a later date. If equipment is not returned in this time, the contractor will no longer be able to use the equipment for future surveys and is responsible for the associated replacement costs. The contractor shall not hold the government liable for any injuries related to use of the borrowed equipment. The contractor is responsible for all costs related to making this equipment available for use (pick-up of equipment), such as payment of all transportation, installation, or rehabilitation costs.

3.4 Utilities: All utilities in the facility 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.

3.5 For contractors that do not require 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 Index (NCIC-III) and Terrorist Screening Database (TSDB) (Army Directive 2014-05/AR 190-13), applicable installation, facility and area commander installation/facility access and local security policies and procedures (provided by government representative), or, at OCONUS locations, in accordance with status of forces agreements and other theater regulations.

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 section 5.

5.0 Requirements: The contractor shall: Unless otherwise stated in this PWS, the contractor shall furnish all labor, materials and IH equipment to perform IH baseline surveys, follow-up IH surveys and special studies in the following facilities:

FACILITY

NAME

FACILITY ADDRESS City State County

5.0.1 AASF #1 889 Ronald Wood Road Winder GA Barrow

5.0.2 AASF #3

483 North Lightning Rd.

Bldg 805

Savannah GA Chatham

5.0.3 UAS (AASF #3)

8161 GA Hwy 144 East, Bldg 19150

Ft.

Stewart

GA Liberty

5.0.4 CSMS #1 1140 Lester Ave. SE Atlanta GA Fulton

5.0.5 CSMS South 10531 Troupe Ave Hinesville GA Liberty

5.0.6 FMS #1 936 United Avenue Bldg 16 Atlanta GA Fulton

5.0.7 FMS #4

88 Milledge Road

Augusta GA Richmond

5.0.8 FMS #8

889B Ronald Wood Rd

Winder GA Barrow

5.0.9 FMS #9

300 North River Street

Calhoun GA Gordon

5.0.10

USPFO

Warehouse 935 United Avenue Atlanta GA Fulton

5.1. Requirements: The contractor shall:

5.1.1 Conduct a thorough IH investigation to determine the potential for any IH and/or occupational health and safety hazards in the facility where NG employees work as defined by AR 385-10 Army Safety Program.

5.1.2 Evaluate each facility for applicable Army and OSHA specific programs (see Exhibit 2).

The evaluation shall include determination that program documents exist and are readily available.

5.1.3 Workplace control evaluation. The selected contractor shall properly document the existing engineering, administrative and personal protective equipment used in each process (see Exhibit 3). Annotate noise reduction ratings for all hearing protection devices as well as the specific type of protective gloves used.

5.1.4 All existing and operational ventilation systems shall be evaluated for compliance with

OSHA, NGB or applicable standards/guidance (Vehicle exhaust ventilations are provided in Exhibit 4).

Provide evaluation details including type of ventilation (local exhaust or dilution), process/operations (spray painting, vehicle exhaust, welding, etc.), recorded measurements used to determine compliance (face or capture velocity) and other observations made during the evaluation.

5.1.5 To determine occupational exposure levels, conduct air breathing zone sampling for the complete work shift or portion of the work shift when the highest exposure is anticipated. Ensure that sufficient air sampling volume is achieved so that the laboratory limit of detection is less than the hazard occupational exposure limit (OEL). The exposure results shall be used to determine the work shift time weighted average (TWA) or short-term exposure limit (STEL) for each targeted hazard. If the sample results exceed the applicable hazard OEL (use ACGIH TLV when more conservative than OSHA PEL) contact the RIHS office immediately via the office mailbox at ng.ga.gaarng.mbx.rihse@army.mil If the work shift is greater than 8 hours, adjust the OEL accordingly.

5.1.6 Personal air sampling for hexavalent chromium shall be conducted using an Institute of

Medicine (IOM) sampler with polyvinyl chloride (PVC) filter. The IOM cassettes (reusable or disposable) should be ordered from the laboratory identified in the PWS along with a calibrator adapter.

5.1.7 Conduct noise survey measuring sound levels using calibrated sound level meters and properly completing DD Form 2214 – Noise Survey (see Exhibit 5). Perform noise dosimetry on as many employees as possible to ensure the Army Safety and OSHA standards are met (listed on DD Form 2214).

When noise dosimetry is performed, personnel shall be separated into similar exposure groups (SEGs) based on the process(es) performed (vehicle maintenance, sanding/grinding, spray painting, etc.) and/or position description/job duties.

5.1.8 Obtain a shop layout plan and clearly depict the location of operations identified during the survey.

5.1.9 Conduct an illumination investigation to determine if lighting is adequate in each area in the facility where personnel perform job duties.

5.1.10 Take photographs of the exterior and interior of each facility. Photograph all potential hazards or items of concern noted during survey. Catalog and describe each photograph by location and concern.

5.1.11 Prepare and provide a signed report in PDF format to the RIHS Office mailbox at ng.ga.gaarng.mbx.rihse@army.mil.

5.1.12 Address report to the Shop Supervisor of each facility.

5.1.13 Notify RIHS immediately of any Immediately Dangerous to Life and Health (IDLH) concerns identified during the survey.

5.1.14 Conduct Indoor Air Quality (IAQ) investigations upon identification of mold/water intrusion problems within an administrative facility or if IAQ issues are reported by building occupants (administrative areas only). If there are no visual indications of potential IAQ issues or reported IAQ issues, measurement of IAQ parameters is not required.

5.1.15 After completing a worksite visit, the contractor records identified workplace deficiencies

(issues evaluated and non-compliant with Federal standards, Service specific regulations, authoritative standards, and recommended practices) using the spreadsheet attached as Exhibit 6. Each identified deficiency is assigned a risk assessment code (RAC) based on the type of risk: health, noise, safety or ergonomic. Once a RAC is assigned for each deficiency, recommendations are made for corrective actions and included in the installation hazard abatement plan or its equivalent.

6.0 Applicable Publications

6.1 Publications applicable to this PWS are listed below:

Publication (Chapter/Page)

Date of Publication

Mandatory or Advisory

Website

Title 29, Code of Federal Regulations (CFR), Part 1910, Occupational Safety and Health Administration

Current Ed M https://www.osha.gov/laws-regs/regulations/standardnumber/1910

Department of Defense Instruction (DODI) 6055.01, Department of Defense Occupational Safety and Health (OSH) Program

14JUL2020. M https://www.esd.whs.mil/Portals/54/Documents/DD/issua nces/dodi/605501p.pdf

AR 40-5, Medical Services, Preventive Medicine.

12MAY2020 M https://armypubs.army.mil/epubs/DR_pubs/DR_a/pdf/we b/r40_5.pdf

AR 385-10, the Army Safety Program, 24JAN2017 M https://armypubs.army.mil/epubs/DR_pubs/DR_a/pdf/we b/ARN16777_ARN16343_AR385_10_FINAL.pdf

Department of the Army Pamphlet (DA PAM) 40-501, Medical Services, Army Hearing Program

8JAN2015 M https://armypubs.army.mil/epubs/DR_pubs/DR_a/pdf/we b/p40_501.pdf

DA PAM 40-11, Preventive Medicine 18MAY2020 M https://armypubs.army.mil/epubs/DR_pubs/DR_a/pdf/we b/p40_11.pdf

DA PAM 40-503, Medical Services, The Army Industrial Hygiene Program

2APR2013 M https://armypubs.army.mil/epubs/DR_pubs/DR_a/pdf/we b/p40_503.pdf

UFC 3-410-01FA, Heating, Ventilating, and Air Conditioning Systems

1NOV2019. A https://www.wbdg.org/FFC/DOD/UFC/ufc_3_410_01_2 013_c5.pdf

Threshold Limit Values (TLVs) and Biological Exposure Indices (BEIs), American Conference of Governmental Industrial Hygienists (ACGIH)

Current Ed. A https://www.acgih.org/forms/store/ProductFormPublic/do cumentation-of-the-threshold-limit-values-and-biological-exposure-indices-7th-ed

Industrial Ventilation – A Manual of Recommended Practice for Design, ACGIH

Current Ed. A https://www.acgih.org/forms/store/ProductFormPublic/in dustrial-ventilation-a-manual-of-recommended-practice-for-design-30th-edition

American National Standards Institute (ANSI)/International Safety Equipment Association (ISEA) Z358.1-2014, Emergency Eyewash and Shower Equipment.

2014 A https://www.gesafety.com/downloads/ANSIGuide.pdf

ANSI/American Society of Heating, Refrigerating and Air-Conditioning Engineers, Inc. (ASHRAE) 55-2020, Thermal Environmental Conditions for Human Occupancy.

2020 A https://www.ashrae.org/File%20Library/Technic al%20Resources/Standards%20and%20Guidelin es/Standards%20Addenda/55_2013_b_2014120 9.pdf

ANSI/ASHRAE 62.1-2019, Ventilation for Acceptable Indoor Air Quality.

2019 A https://www.ashrae.org/technical-resources/bookstore/standards-62-1-62-2

Army Directive 2014-05 Policy and Implementation Procedures for Common Access Card Credentialing and Installation Access for Uncleared Contractors

7MAR2014 M https://armypubs.army.mil/ProductMaps/PubForm/Army Dir.aspx

AR 25-2

Army Cybersecurity

4APR2019 M http://armypubs.army.mil/ProductMaps/PubForm/AR.asp x

AR 530-1

Operations Security

26SEP2014 M http://armypubs.army.mil/ProductMaps/PubForm/AR.asp x

AR 525-13

Antiterrorism

9DEC2019 M http://armypubs.army.mil/ProductMaps/PubForm/AR.asp x

AR 381-12

Threat Awareness and Reporting Program (TARP) (Section II, ¶ 2-4.b)

1JUN2016 M http://armypubs.army.mil/ProductMaps/PubForm/AR.asp x

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

Form Date Website

DD 441

Department of Defense Security Agreement

FEB2020

http://www.dtic.mil/whs/directives/forms/dd/ddforms0001-0499.htm

DD 250

Material Inspection and Receiving Report

AUG2000 https://www.esd.whs.mil/Directives/forms/dd0001_0499/

TECHNICAL EXHIBIT 1

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).

Performance Objective Performance Standard Acceptable Quality Levels (AQL)

Surveillance Method / By Whom

The contractor shall contact On-site Point of Contact: State OHN MAJ Nicole Jewell at (678) 569-3674 and IHT IHN Susan Stahl at (678) 409-7892 within 30 days of contract award date to schedule site visit

The contractor shall perform this step 100% of the time.

.5% failure to perform this task.

Periodic Inspection – RIHS office will review monthly.

The contractor shall contact RIHS office before starting site survey with EXACT dates and time that each facility is surveyed

The contractor shall perform this step 100% of the time.

3% failure to perform this task.

Periodic Inspection – RIHS office will review monthly.

The selected contractor shall properly document the existing engineering, administrative and personal protective equipment used in each process.

The contractor shall perform this step 100% of the time.

3% failure to perform this task.

3% failure to perform this task.

The selected contractor shall evaluate all operational ventilation systems for compliance with applicable standards.

The contractor shall perform this step 100% of the time.

3% failure to perform this task.

Each submitted report – RIHS office will review monthly.

The selected contractor will document the need for breathing zone sampling for all airborne hazards present due to the presents of maintenance activities within the readiness center.

The contractor shall perform this step 100% of the time.

3% failure to perform this task.

Each submitted report – RIHS office will review monthly.

The selected contractor shall measure noise levels on all operation equipment and record each measurement on a DD Form 2214.

The contractor shall perform this step 100% of the time.

3% failure to perform this task.

Each submitted report – RIHS office will review monthly.

The selected contractor shall perform noise dosimetry on as many maintenance personnel as possible. Personnel should be separated into SEGs, with description of job duties.

The contractor shall perform this step 100% of the time.

3% failure to perform this task.

Each submitted report – RIHS office will review monthly.

TECHNICAL EXHIBIT 2

Deliverables Schedule

PWS Reference / Deliverable Title

Frequency Number of Copies

Medium/Format Submit To

IH Survey Report Provide within 90 calendar days from contract award date

1 Electronic Submission to RIHS mailbox

RIHS Office Mailbox

1.4.5.2 AT Level 1

Awareness Training

Certificates

Provide within 15 calendar days after employee completes training.

1 Electronic Submission

COR

1.4.5.3 iWATCH Training Certificates

Provide within 15 calendar days after employee completes training.

1 Electronic Submission

COR

1.4.5.5 OPSEC

Training Certificates

Provide within 15 calendar days after employee completes training.

1 Electronic Submission

COR

1.4.5.12 OPSEC

Level II Certification for OPSEC Coordinator

Provide NLT 15 days after employees completed certification

1 Electronic Submission

COR

1.4.5.12 TARP

Training Certificates

Provide within 15 calendar days after training completion.

1 Electronic Submission

COR

1.4.10 Identification

Media

Return within 14 days of employee’s departure from contract performance.

Original(s) Hard Copy KO

Facility Information Table

Provide within 90 calendar days from contract award date

1 per facility Attachment within IH Survey report

RIHS

Hearing Conservation Letter

Provide within 90 calendar days from contract award date.

1 per employee

Attachment within IH Survey report

RIHS

DD 2214

NGB version 1

Provide within completed reports

1 Original(s) Hard Copy

RIHS

Laboratory Analysis Provide within completed reports

1 Original(s) Hard Copy

RIHS

Exhibit 1: Equipment Request Form (ERF) Submit request form at least 2 weeks prior to date equipment is needed

Return all equipment no later than 30 days after receipt

Location of Survey: ______________________________ Contract #: W912JM-2_-P-________ Type of Facility: ____________________________________ Number of Locations: ________ Requested By: _________________________________________________________________ Company Name: _______________________________________________________________ Phone #: __________________________ Email: ____________________________________ Date ERF Submitted: ___________________ Date Equipment Needed: ___________________ Last Day of Survey: ________________ Date Equipment Will be Returned: _________________

Equipment # Media #

Air Velocity Meter MCE Asbestos Cassette

Light Meter MCE Cassette

Noise Dosimeter Pre-weighted PVC Cassette

Noise Dosimeter Calibrator IOM Sampler w/PVC filter

Sound Level Meter Anasorb Sorbent Tube

Sound Level Meter Calibrator Charcoal Sorbent Tube

IAQ Meter (CO, CO2, RH and Temp) Silica Gel Sorbent Tube

Air Sampling Pump Passive Badges (list Organics)

Air Sampling Pump Charger

Air Sampling Pump Calibrator

Cassette Holder Wipe Media

Sample Tubing Ghost Wipe (Metals)

IOM Calibrator PVC Wipes (Hex Chrome)

Aluminum Cyclone and Calibrator Tubes & Caps

Lead Check Swabs

Batteries will be included for requested equipment

Exhibit 2: Regulatory Programs Review

Program Standard/Guidance Applies Program Documents Reviewed

OSHA Standard Chemicals

29 CFR 1910.1001

29 CFR 1910.1025

29 CFR 1910.1026

29 CFR 1910.1027

29 CFR 1910.1028

29 CFR 1910.1052

If Yes, specify

Hazard Communication (HAZCOM) 29 CFR 1910.1200

Electro-Magnetic Frequency (EMF) 29 CFR 1910.97

Respiratory Protection

29 CFR 1910.134

AR 11-34

Compressed Breathing Air (Supplied Air Respirators)

29 CFR 1910.134(i)(1)(ii) Grade D Air Testing

Noise

29 CFR 1910.95

DA PAM 40-501

Lasers

29 CFR 1910.1096

DA PAM 40-506

Ionizing Radiation 29 CFR 1910.1096

Permit-Required Confined Space 29 CFR 1910.146

Bloodborne Pathogens 29 CFR 1910.1030

Add other Programs

Exhibit 3: Process Personal Protective Equipment Inventory

Type of PPE PPE Codes Comments (MFG, Model, NRR, etc.) Process(es) E y e

Hearing H a n d

Clothing Respirator

Additional PPE Example

Type of PPE Comments Process(es) E y e a 1, 4 and 8

Hearing g E.A.R. NRR=31 1, 4, 5, 6 and 8 Clothing/Hand a g

Tyvek=QC, Gloves = Best Viton 3, 5, and 9

Respirator a

Manufacturer-3M Model 6122 w/ 6100 cartridge/P100

Eye and Hearing

Clothing and Hand

Protection

Respiratory Protection

Protecti on

Process Number

a. Safety glasses or safety goggles

a. Tyvek suit

a. 1/2 faced

1. OV

1. Vehicle Maintenance

b. Chemical splash goggles b. Long-sleeved shirt b. Full face 2. OV w/ prefilter

2. Welding Operations

c. Non-ventilated goggles

c. Tyvek hood c. Hood 3. Pesticide 3. Parts Cleaning

d. Face shield d. Cloth hood d. Helmet 4. N95 4. Sanding/Grinding

e. Welding goggles e. Leather jacket or vest e. Powered air PR 5. P100 5. Spray Painting

f. Welding helmet f. Chemical resistant apron

f. Supplied air 6. Cont. Flow 6. Abrasive Blasting

g. Single hearing Protection g. Chemical resistant gloves

g. SCBA 7. Press Demand

7. Soldering

h. Double hearing protection h. Barrier creams h. Other 8. Escape bottle 8. Woodworking

i. Heat resistant gloves 9. Other 9. Battery Maintenance

j. Cryogenic gloves

k. Other

Exhibit 4: ARNG Shop Local Exhaust Ventilation Memorandum

Exhibit 5: Example of Operation Description Format for Reports

Sample Process Description

CSMS Spray Painting Operation. The Paint Shop contained a large downdraft booth and was located adjacent to the vehicle maintenance bays in the “E” Wing of the CSMS. The dimensions of the booth were approximately 17.5 feet wide (17.5’ W), 40 feet long (40’ L), and 12.5 foot height (12.5’ H). Vehicle sized swing hinge doors were installed at each end of the booth and four human entry/exit doors were approximately 3’W X 7’H. Two full time painters were assigned and reported that at the current workload they were required to paint for a duration of approximately four hours, two to three days per week.

Exhaust Ventilation. See Exhibit 6 for the recommended average for cross…