A_07__W912LM-18-Q-0022__CST_Physical.doc

Section SF 1449 - CONTINUATION SHEET

PHYSICAL EXAMINATIONS Base FY18

FFP

Physical Examinations

FOB: Destination

PURCHASE REQUEST NUMBER: 0010940714-0003

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URINALYSIS DIPS LABORATORY TEST

Physical Examinations

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EKG TEST

Physical Examinations

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RECTAL EXAMINATIONS

Physical Examinations

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URINE MICROSCOPE LABORATORY TEST

Physical Examinations

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INTRAOCULAR PRESSURE EXAMINATIONS

Physical Examinations

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PSA LABORATORY TEST

Physical Examinations

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CHEM-24 AND/OR EQUIVALENT

Physical Examinations

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CBC LABORATORY TEST

Physical Examinations

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SERUM MERCURY LABORATORY TESTS

Physical Examinations

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SERUM LEAD LABORATORY TESTS

Physical Examinations

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SERUM CHOLINESTERASE LAB TESTS

Physical Examinations

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HEP B SABY TESTS

Physical Examinations

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HEP C SABY TESTS

Physical Examinations

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CPK TESTS

Physical Examinations

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CHEST X-RAYS

Physical Examinations

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PFT (PULMONARY FUNCTION TEST)

Physical Examinations

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HEAVY METAL TESTING (RANDOM URINE)

Physical Examinations

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VARICELLA (CHICKEN POX TITER)

Physical Examinations

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FEMALE PELVIC EXAMINATION

Physical Examinations

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PAP SMEAR

Physical Examinations

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MAMMOGRAPHY

Physical Examinations

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PHYSICAL EXAMINATIONS (increment)

Funding Request: INC PIIN: W912LM13C0006 ACRN: AG CLIN: 4001 Physical Examinations

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EKG TEST (increment)

Funding Request: INC PIIN: W912LM13C0006 ACRN: AG CLIN: 4006 Physical Examinations

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URINE MICROSCOPE LABORATORY TEST (incre)

Funding Request: INC PIIN: W912LM13C0006 ACRN: AG CLIN: 4008 Physical Examinations

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CHEM-24 AND/OR EQUIVALENT (increment)

Funding Request: INC PIIN: W912LM13C0006 ACRN: AG CLIN: 4011 Physical Examinations

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CBC LABORATORY TEST (increment)

Funding Request: INC PIIN: W912LM13C0006 ACRN: AG CLIN: 4012 Physical Examinations

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SERUM MERCURY LABORATORY TESTS (increme)

Funding Request: INC PIIN: W912LM13C0006 ACRN: AG CLIN: 4013 Physical Examinations

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SERUM LEAD LABORATORY TESTS (increment)

Funding Request: INC PIIN: W912LM13C0006 ACRN: AG CLIN: 4014 Physical Examinations

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SERUM CHOLINESTERASE LAB TESTS (increme)

Funding Request: INC PIIN: W912LM13C0006 ACRN: AG CLIN: 4015 Physical Examinations

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HEP B SABY TESTS (increment)

Funding Request: INC PIIN: W912LM13C0006 ACRN: AG CLIN: 4016 Physical Examinations

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HEP C SABY TESTS (increment)

Funding Request: INC PIIN: W912LM13C0006 ACRN: AG CLIN: 4017 Physical Examinations

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CPK TESTS (increment)

Funding Request: INC PIIN: W912LM13C0006 ACRN: AG CLIN: 4018 Physical Examinations

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CHEST X-RAYS (increment)

Funding Request: INC PIIN: W912LM13C0006 ACRN: AG CLIN: 4019 Physical Examinations

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PFT (PULMONARY FUNCTION TEST) (incremen)

Funding Request: INC PIIN: W912LM13C0006 ACRN: AG CLIN: 4020 Physical Examinations

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VARICELLA (CHICKEN POX TITER) (incremen)

Funding Request: INC PIIN: W912LM13C0006 ACRN: AG CLIN: 4022 Physical Examinations

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Manpower Reporting Base Year FY18

See Manpower Reporting Requirements

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PWS

PERFORMANCE WORK STATEMENT (PWS) FOR

Occupational Health Medical Examination Services

1.1 General:

1.2 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 Health Medical Examination Services, as defined in this PWS.

1.3 Background: IAW NGR 500-3 prospective members and current members of Civil Support Teams must undergo periodic occupational health medical examinations to determine their fitness for assignment and continued service on a Civil Support Team.

1.4 Period of Performance (PoP): The Period of Performance shall be one Base Year of 12 months and (4) 12-month option years.

1.4.1 Recognized Holidays: The following are recognized US holidays. The contractor shall not perform services on these days:

1.4.1.1 New Year’s Day: January 1st

1.4.1.2 Martin Luther King, Jr.’s Birthday

1.4.1.3 President’s Day

1.4.1.4 Memorial Day

1.4.1.5 Independence Day: July 4th

1.4.1.6 Labor Day

1.4.1.7 Columbus Day

1.4.1.8 Veteran’s Day: November 11th

1.4.1.9 Thanksgiving Day

1.4.1.10 Christmas Day

1.4.2 Place and Performance of Services: The contractor shall provide services between the hours of 0730-1700 on Monday through Friday, except on recognized US holidays. Performance shall be at the contractor’s facility, which shall not be more than 20 miles from the work location of the 55th CST at 612 Militia Dr., St. Paul, MN 55111. The contractor shall at all times maintain an adequate work force for the uninterrupted performance of all tasks defined within this PWS. When hiring personnel, the contractor shall keep in mind that the stability and continuity of the work force are essential. Telecommuting is not authorized.

1.4.3 COMSEC/IT Security. All communications with DOD organizations are subject to communications security (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 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.

1.4.4 Protection of Personally Identifiable Information (PII). The contractor shall protect all Personally Identifiable Information (PII) encountered in the performance of services in accordance with DFARS 224.103 and 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 who’s PII has been compromised.

1.4.5 Special Qualifications: The contractor shall ensure all employees possess all required licenses or certifications for operating medical equipment used in the performance of this contract. 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 qualified to provide services.

1.4.6 Post Award Conference/Periodic Progress Meetings: The contractor agrees to attend any post award conference convened by the KO in accordance with Federal Acquisition Regulations Subpart 42.5. The KO, Contracting Officer’s Representative (COR), and other Government personnel, as appropriate, may meet periodically with the contractor to review the contactor’s performance. At these meetings, the Contacting Officer 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.

1.4.7 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, (or the KO if a COR is not assigned), 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.

1.4.8 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. Such actions may include, but are not limited to, removal from the contract, reduction in benefits, or termination of employment.

1.4.9 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.Data Rights: The Government has unlimited rights to all documents/material 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.

1.4.10 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 and in the event the KO unilaterally determines that any such OCI cannot be satisfactorily avoided or mitigated, the KO may affect 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.

1.5 General Information:

1.5.1 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. After acceptance of the QCP, the contractor shall obtain the Contracting Officer’s (KO) acceptance in writing of any proposed changes to its QCP.

1.5.2 Quality Assurance (QA): The Government shall 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 must 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) (defect rate(s)).

2.0 Definitions and Acronyms:

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'S REPRESENTATIVE (COR). An employee of the

U.S. Government designated by the KO to monitor contractor performance. Such appointment shall be in writing and shall 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 Performance Work Statement.

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 Key Personnel listed in 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 assure 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.

2.1.12 WORK DAY. The number of hours per day the Contractor provides services in accordance with the contract.

2.1.13 WORK WEEK. Monday through Friday, unless specified otherwise.

2.2 ACRONYMS:

AEI

AFARS

Army Federal Acquisition Regulation Supplement AR Army Regulation

AT/OPSEC

Antiterrorism/Operational Security CFR Code of Federal Regulations

CONUS

Continental United States (excludes Alaska and Hawaii) COR Contracting Officer Representative

COTS

Commercial-Off-the-Shelf

DA

Department of the Army

DD250

Department of Defense Form 250 (Receiving Report) DD254 Department of Defense Contract Security Requirement List DFARS Defense Federal Acquisition Regulation Supplement

DOD

Department of Defense

FAR

Federal Acquisition Regulation

GFP/M/E/S

Government Furnished Property/Material/Equipment/Services IA Information Assurance

IS

Information System(s)

KO

Contracting Officer

OCI

Organizational Conflict of Interest

ODC

Other Direct Costs

OSHA

Occupational Safety and Health Administration

PII

Personally Identifiable Information

PIPO

Phase In/Phase Out

POC

Point of Contact

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 Program

TE

Technical Exhibit

3.0 Property: None

3.1 Government Furnished Property, Material, Equipment and Services (GFP/M/E/S): The Government will provide the property, material, equipment, and services listed below solely for the purpose of performance under this contract.

3.2 Materials: The following documents will be provided to the contractor for each physical exam: ‘55th CST OSHA Respiratory Protection Questionnaire’, ‘DD Form 2807-1’, ‘DD Form 2808’, and ‘FOH 5’.

3.3 Equipment: None

3.4 Services: None

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

4.2 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 General

5.1.1 Maintain medical liability insurance which is not less than the amount normally prevailing within the local community for the medical physicals.

5.1.2 See patients within 15 minutes of their appointment time.

5.1.3 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.

5.1.4 Provide a Medical Board eligible or Certified Occupational Medicine Physician to conduct job-related medical surveillance physical examinations and occupational health consultation services.

5.1.5 Ensure instrumentation meets or exceed appropriate performance standards, and accuracy must be verified in accordance with current Occupational Medicine Certification standards.

5.1.6 Arrange for the opportunity to consult with the 55th CST Medical Officer by telephone to coordinate or resolve issues that might arise before, during, and after the testing period.

5.2 Examination Scheduling

5.2.1 Coordination of scheduling shall be a joint effort between the government contract representative and the contractor. This will be accomplished via a phone conversation using the contractor’s public scheduling line.

5.2.2 In the event of Contractor equipment failure, specific testing and / or parts of examinations that are not completed during the testing period shall be completed at a scheduled time mutually convenient for the Contractor, Occupational Health Manager and the Facility (ies). Unfinished testing / examinations will be completed at no additional cost to the Government. Physicals not completed due to equipment failure shall be done at no cost to the Government. The Contractor shall be directly responsible to cover costs for completing these make-up screenings.

5.3 Examination

5.3.1 Have the capability to perform the following services for each type of exam in the total quantities specified during the contract year:

MAINT. EXAM OVER

# 2

MAINT. EXAM UNDER 40

# 3

TRANSIT EXAM OVER

# 4

TRANSIT EXAM UNDER 40

# 5

OFF YEAR MODIFIED (UNDER 40 ONLY)

# 6

LAB BLOOD DRAW

X

X

X

X

N/A

5.3.1 Assess employee vital signs to include height, weight, blood pressure, pulse and respirations. Contractor shall record those findings on all pertinent materials provided by the government.

5.3.2 Provide a Job Functional Analysis or Kraus-Weber diagnostic test results that include back strength and flexibility. Note any pain or recommended lifting limitations if less than 50 lbs.

5.3.3 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.

5.3.4 Ensure audiogram 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) training in accordance with 29 CFR 1910.95.

a. Hearing screenings will be conducted only on employees exposed to occupational noise > 85 dBA or 140 dBA impact noise.

b. All hearing tests will be entered into a format compatible with DOEHRS-HC.

c. Otoscopic Exam.

d. Test Only 500, 1000, 2000, 3000, 4000 and 6000.

e. Hearing aids must be removed.

f. Employee must be noise free for at least 14 hours prior to screening.

g. All hearing screenings (with the exception of the baseline) will be compared against the employee’s baseline to determine if there is a Significant Threshold Shift (STS) and retested immediately and if there is still a STS notify the Occupational Health Manager (OMH) within 10 days so that timely retesting can be scheduled. Baseline screenings will be included for new employees only and selected by the OHM/COR.

5.3.5 Ensure Pulmonary Function Tests (PFTs) are performed by a licensed physician, Certified Pulmonary Function Technologist, or Registered Respiratory Therapist in accordance with 29 CFR 1910.1001.

a. Screenings will only be conducted on employees exposed to respiratory hazards that will require a respirator to mitigate their hazards that are above the action level.

b. Test will include as a minimum Forced Expiratory Volume in one second (FEV1), Forced Vital Capacity (FVC), comparison with recognized normal’s for the individual's height and weight, sex, race, age and a documented interpretation by a pulmonologist or certified Occupational Health physician.

c. Follow NIOSH and ATS-ERS (American Thoracic Society/European Respiratory Society) standard requirements:

i. Continue testing individual when the patient is improving until improvement is <30ml.

ii. Test results are acceptable with a minimum of three acceptable maneuvers that are free from a leak, obstructed mouthpiece, hesitation, false starts, cough, glottis closure, early termination, and have a good curve of at least 6 seconds duration.

iii. Test results are reproducible in that they have the same result from the individual (two largest FVCs are within 0.150 L of each other and two largest FEV1's are within 0.150 L of each other) when the test is repeated several times. Testing is continued until criteria are met or 8 trials are attempted, or the employee being tested cannot or should not continue.

iv. If three (3) acceptable and two (2) repeatable tests cannot be obtained, the technician performing the PFT must document the reason the standard could not be met.

v. Always use measured height not reported height by the nearest half inch without footwear.

vi. Always indicate source of reference value on reports for adjusted predicted value

vii. No smoking within 1 hour prior

viii. No cold, flu or allergies within two weeks

ix. No inhaler use prior to test that would still be in the patient’s system

d. Specifications regarding equipment guidelines and calibration, test administration, and test interpretation must meet applicable OSHA and ANSI standards. Supporting documentation will be provided to this office daily or annually depending on manufacturing guidelines of spirometer.

e. Respirator clearance documented and a copy given to employee at time of visit.

5.3.6 Ensure that vision screenings are 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.

5.3.7 Ensure laboratory tests will be processed by certified clinical laboratories and performed by personnel certified under the American Society of Clinical Pathology. The supporting laboratory will provide employee instruction and equipment necessary for tests requiring special collection methods and/or containers. Document that employee has been counseled by examining provider about laboratory test results. Provide a copy of lab results to the contracting office representative and examinee when available. Tests include:

a. Blood Chemistries (serum) with H&H, BUN and Creatinine.

b. Liver Function to include AP and if abnormal include GGTP.

5.3.8 Ensure dermatological examinations are performed by a physician and include an inspection of the entire integumentary system with emphasis on areas most likely to be affected by the employee's occupational (i.e. radiation) exposures. Documentation will include the presence of any dermatomes or lesions of the skin.

5.3.9 Ensure that chest X-rays are performed by a certified X-ray technician. The interpretation and classification will be performed by a B-reader, or a board eligible or certified radiologist meeting the requirements of 29 CFR 1910.1001 Appendix E.

a. Chest X-rays are only performed for asbestos exposed employees.

b. Be a posterior-anterior and left lateral view.

5.3.10 Ensure electrocardiograms (EKG) are performed by a certified EKT technician (CET). The interpretation will be performed by a board certified physician.

5.4 Medical Reports and Recordkeeping

5.4.1 Immediately report to the 55th Civil Support Team medical officer by telephone at (651) 281-3878 if results of medical surveillance screening(s) are questionable and / or of critical significance and / or require follow-up.

5.4.2 Provide a copy of the completed DD 2807-1, DD 2808, FOH 5, 55th CST OSHA Respiratory Protection Questionnaire, Spirometry, EKG (if applicable), Chest X-ray Findings (if applicable), and Vision Exam Summary (if applicable) to the examinee at the completion of the exam.

5.4.3 Provide a copy of all items listed in paragraph 5.4.2 plus lab results and the contractor’s evaluation status report, to the 55th Civil Support Team within 15 working days of completion of the exam to:

55th WMD-CST

ATTN: Medical Operations Officer

612 Militia Dr.

St. Paul, MN 55111

If you wish to send electronically you must coordinate your ability to do so via encrypted email with the contracting officer representative at the 55th CST.

5.4.4 If the contractor deems a service necessary to ensure the health and fitness of an employee, but is outside the scope of this contract, the contractor shall immediately contact the government contract representative to gain approval prior to performing the service.

5.4.5 Contractor shall identify all medical records with the employee’s full name, social security number, date of birth, job code, and the name of the employee’s work place or facility at a minimum. The contractor shall ensure work / health history forms and medical reports are complete and legible (typed / printed).

5.5 Summary Report

5.5.1 The contractor shall provide a comprehensive data processed analytical end report in a binder with dividers that outlines the following information in an Excel spreadsheet format:

a. Tab # 1 - Classification Summary to include

i. Colum # 1 - Employee Name

ii. Colum # 2 – SSN

iii. Colum # 3 - D.O.B.

iv. Colum # 4 –Blood Pressure (B/P) N = normal, A = abnormal

v. Colum # 5 – AUDIO – N= normal, A = abnormal

vi. Colum # 6 – PFT N = normal, A = abnormal

vii. Colum # 7 – Vision N = normal, A = abnormal

viii. Colum # 8 – Chest X-Ray – N = normal, A = abnormal

ix. Colum # 9 – Urine Dip Stick (Urine) – N = normal, A = abnormal

x. Colum # 10 – Phys Exam – N = normal, A = abnormal

xi. Colum # 11 – Resp. Clear - P = Pass, TNP = Test Not Performed

xii. Colum # 12 - LAB – PSA – N = normal, A = abnormal, TNP – Test Not Performed

xiii. Colum # 13 LAB CHEM – N = normal, A = abnormal

xiv. Colum # 14 – LAB – CBC – N = normal, A = abnormal

xv. Colum # 15 LAB – Lead- N = normal, A = abnormal

xvi. Colum # 16 LAB – ZPP- N = normal, A = abnormal.

b. Tab # 2 – Employee Listing with Hearing Classifications to include;

i. Colum # 1 Employee Name

ii. Colum # 2 SSN

iii. Colum # 3 Date

iv. Colum # 4 Speech Frequencies

v. Colum # 5 – High Frequencies – Normal, Mild Hearing Loss, Moderate Hearing Loss, Moderate Severe Hearing Loss, and Profound Hearing Loss

c. Tab # 3 – Employee Listing with All Hearing Tests

d. Tab # 4 – Hearing Summary Report – Bar Graph indicating total numbers related to Total Number of employees tested, break outs will be;

i. total # of Males tested

ii. total # of Females tested

iii. Number of Normal Hearing

iv. Number of Mild Loss

v. Number of Moderate Loss

vi. Number of Moderate Severe Loss

vii. Number of Severe Loss

viii. Number of Profound Loss

ix. Number of Standard Threshold Shift

x. Number of OSHA Recordable Shift if any.

e. Tab # 5 – Employee Listing with Most Recent PFT –

i. Colum # 1 Employee Names

ii. Colum # 2 – Date test conducted

iii. Colum # 3 - Classification – Normal, Mild Obstructive, Borderline Obstructive, Moderate Obstructive and Significant Obstructive as the test indicates

f. Tab # 6 – Employee Listing with most Recent PFT Results –

i. Colum # 1 Employee Names

ii. Colum # 2 Date test conducted

iii. Colum # 3 – FVC

iv. Colum # 4 - FEV1

v. Colum # 5 – FEV1/FVC and other information as tested.

g. Tab # 7 Pulmonary Summary Report – Analytical Breakdown to include;

i. Total number of employees

ii. Number of Employee Tested

iii. Number with Normal Screening

iv. Number with Mild Restriction

v. Number with Moderate Restriction

vi. Number with Severe Restriction

vii. Number with Borderline Obstruction, Number with Mild Obstruction

viii. Number with Moderate Obstruction

ix. Number with Severe Obstruction

x. Number with Superimposed Restriction.

5.6 Contractor Manpower Reporting Application (CMRA):

5.6.1 The contractor shall report ALL contractor labor hours (including subcontractor labor hours) required for performance of services provided under this contract for the 55th Civil Support Team via a secure data collection site.

5.6.2 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 2013. 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:

https://www.ecfr.gov/cgi-bin/retrieveECFR?gp=&SID=a40d49322fd01949a04c9af579e28063&r=PART&n=29y5.1.1.1.8

https://www.ecfr.gov/cgi-bin/text-idx?c=ecfr&SID=a40d49322fd01949a04c9af579e28063&rgn=div5&view=text&node=29:9.1.1.1.9&idno=29

https://books.google.com/books?id=9xOKL7h2SyMC&pg=PA1&dq=ANSI+Z88.6-2006&hl=en&sa=X&ved=0ahUKEwjFtKb1-pXVAhVC7yYKHToHAksQ6AEIKDAA#v=onepage&q=ANSI%20Z88.6-2006&f=false

https://www.acgih.org/tlv-bei-guidelines/policies-procedures-presentations/overview

http://www.apd.army.mil/epubs/DR_pubs/DR_a/pdf/web/r40_5.pdf

http://www.esd.whs.mil/Portals/54/Documents/DD/issuances/dodm/605505mp.pdf

U.S. Department of Labor, Code of Federal Regulations 29 (CFR) 1910.120 (f) (5), Medical Surveillance

Advisory https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=9765#1910.120(f)(5)

http://www.apd.army.mil/epubs/DR_pubs/DR_a/pdf/web/r11_34.pdf

http://www.apd.army.mil/epubs/DR_pubs/DR_a/pdf/web/p40_501.pdf

http://www.apd.army.mil/epubs/DR_pubs/DR_a/pdf/web/p40_506.pdf

http://www.apd.army.mil/epubs/DR_pubs/DR_a/pdf/web/ARN3801_AR40-501_Web_FINAL.pdf

http://www.apd.army.mil/epubs/DR_pubs/DR_a/pdf/web/r40_66.pdf

TECHNICAL EXHIBIT 1

Performance Requirements Summary This Performance Requirements Summary includes performance standards.