16_May_Performance_Work_Statement.docx

PERFORMANCE WORK STATEMENT

OCCUPATIONAL HEALTH

PROCUREMENT OF MEDICAL SURVEILLANCE EXAMINATIONS

1.0 GENERAL

1.1. Scope. This Performance Work Statement (PWS) is for non-personal health care services to support the Vermont Army National Guard’s (VTARNG) requirement for Occupational Medical Surveillance Examination Program in accordance with the Occupation Safety and Health Association (OSHA) and other regulations. There is one location that requires this service: Army Aviation Support Facility at 141 Shamrock Rd South Burlington VT 05403. The estimated number of personnel to be examined is eighty (80). The Government has the right to increase and/or decrease the number of employees/military personnel and the locations for service.

1.2. Background: The purpose of the Occupational Medical Surveillance Examination Program is to provide job-related Medical Surveillance Examinations and Occupational Health Services to the VTARNG full-time support (FTS) and/or temporary personnel who are or could potentially be exposed to health hazards in the work environment. The examination shall include personnel assigned to positions requiring specific standards of physical fitness.

1.3. Period of Performance (PoP): The Period of Performance shall be 1 Base Year and 2 12 month option years: Base year will most likely have 2 events during the duration of the PoP, (refer to Exhibit III Estimated Workload)

1.4. General Information:

1.4.1. Quality Control (QC): RESERVED

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. Recognized Holidays: The following are recognized United States (US) holidays. The contractor shall not perform services on these days:

1.4.3.1. New Year’s Day: January 1st

1.4.3.2. Martin Luther King, Jr.’s Birthday

1.4.3.3. President’s Day

1.4.3.4. Memorial Day

1.4.3.5. Independence Day: July 4th

1.4.3.6. Labor Day

1.4.3.7. Columbus Day

1.4.3.8. Veteran’s Day: November 11th

1.4.3.9. Thanksgiving Day

1.4.3.10. Christmas Day: December 25th

1.4.4. Place and Performance of Services: The contractor shall provide services between the hours of 0730-1600 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. Performance shall be at the Army Aviation Support Facility at 141 Shamrock Rd South Burlington VT 05403. 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. When hiring personnel, the contractor shall keep in mind that the stability and continuity of the work force are essential. Telework is not authorized.

1.4.4.1. RESERVED

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.

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). 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.

1.4.5.6. AT Level 1 Awareness Training (AT): All contractor employees, including subcontractor employees, requiring access to Army installations, facilities, and controlled access areas shall complete Level 1 AT within 30 calendar days after contract start date and within 30 calendar days of new employees commencing performance. The contractor shall submit certificates of completion for each affected contractor and subcontractor employee to the COR within 15 calendar days after completion of training. Level 1 AT is available at http://jko.jten.mil/courses/atl1/launch.html .

1.4.5.7. RESERVED

1.4.5.8. RESERVED

1.4.5.9. The contractor and all associated subcontractors with an area of performance within an Army-controlled installation, facilities or area shall brief all employees on the local iWATCH program. This local developed training shall be used to inform employees of the types of behavior to watch for and instruct employees to report suspicious activity to the COR or the KO. This training shall be completed within 30 calendar days of contract award and within 30 calendar days of new employees commencing performance. The contractor shall report completion for each contractor employee and subcontractor employee to the COR within 15 calendar days after completion of training.

1.4.5.10. 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 15 calendar days after completion of training. Level 1 OPSEC training is available at http://cdsetrain.dtic.mil/opsec/.

1.4.5.11. RESERVED

1.4.5.12. RESERVED

1.4.5.13. RESERVED

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

1.4.6.1. RESERVED

1.4.6.2. RESERVED

1.4.7. Special Qualifications:

1.4.7.1. Contractor shall provide a Board eligible or Certified Occupational Medicine Physician to conduct job-related medical surveillance physical examinations and occupational health consultation services.

1.4.7.2. Contractor shall ensure Pulmonary Function Tests (PFTs) are performed by a licensed physician, Certified Pulmonary Function Technologist, or Registered Respiratory Therapist

1.4.7.3. Contractor shall 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).

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 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. RESERVED

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.

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. 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 Multi-year Contract: The key distinguishing difference between multi-year contracts and multiple year contracts is that multi-year contracts, defined in the statutes cited at FAR part 17.101, buy more than 1 year’s requirement (of a product or service) without establishing and having to exercise an option for each program year after the first.

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

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

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

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

2.1.12 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:

DOEHRS-HC Defense Occupational and Environmental Health Readiness System-Hearing Conservation (DOEHRS-HC) FAR Federal Acquisition Regulation FTS Full Time Support

JTR Joint Travel Regulation

PFT Pulmonary Function Test

VTARNG Vermont Army National Guard

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

3.1 Property: The Government will NOT furnish the necessary workspace for the contractor to perform services outlined in this PWS to include desk space, telephones, computers and other items necessary to maintain an office environment.

3.2 Materials: The government will not furnish any materials. Contractor will provide all materials necessary for administrative and clinical operations occurring during the contract

3.3 Equipment: The government will not furnish any equipment needed for testing or examinations during the contract period. Contractor shall provide all equipment necessary for testing and examinations.

3.4 Services: The contractor will provide all services within the scope of the contract

3.5 Utilities: None Available.

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

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

4.1.1 Contractor shall provide capability to perform services utilizing an off-site clinic or a self-contained and self-powered mobile medical van to perform all services as described in this performance work statement.

5.0 Requirements: The contractor shall:

5.1 This contract is for “Non Personal” Health Care “Services”, as defined in 37.101. In accordance with FAR Part 37.4 the Government may enter into a non-personal health care services contract with physicians, dentists and other health care providers under authority of 10 U.S.C. 2304 and 41 U.S.C. 253. The Government shall evaluate the quality of professional and administrative services provided, while the Government retains no control over the medical, professional aspects of services rendered.

5.2 The Contractor will indemnify the Government for any liability producing act or omission by the Contractor, its employees and agents occurring during contract performance. The Contractor will 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.

5.3 Contractor shall 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.

5.4 Contractor shall 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.

5.5 Contractor shall provide a Board eligible or Certified Occupational Medicine Physician to conduct job-related medical surveillance physical examinations and occupational health consultation services.

5.6 Contractor shall arrange for the opportunity to consult with the VTARNG Occupational Health Manager by telephone, face-to-face, or email to coordinate or resolve issues that might arise before, during, and after the testing period

5.7 Contractor shall perform a comprehensive review and evaluation within 30-days following the conclusion of testing. The Contracting Officer’s Representative will contact and schedule a follow-up review and evaluation meeting to discuss positive and negative aspects of testing.

5.8 Contract shall meet the following testing criteria:

5.8.1 Contractor will provide vital signs to include height, weight, blood pressure, pulse and respirations.

5.8.2 Contractors will provide a Job Functional Analysis or Kraus-Weber that includes back strength and flexibility. Note any pain or recommended lifting limitations if less than 50lbs.

5.8.3 Contractor shall ensure audiogram must be 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, “Occupational Noise Exposure.” The estimated number of personnel to receive audiograms are eighty (80).

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

5.8.3.1.2 Otoscopic Exam.

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

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

5.8.3.1.5 Hearing aids must be removed

5.8.3.1.6 All hearing screenings besides the baseline will be compared against the employee’s baseline to determine if there is a Significant Threshold Shift (STS). The contractor will notify the Occupational Health Manager on the day of testing while the employee is still present so that timely retesting can be scheduled.

5.8.3.1.7 Audiometer serial number and evidence of annual calibration will be provided to the Occupational Health Nurse prior to date of testing. Additionally, the hearing technician’s CAOHC certification number shall be provided to the Occupational Health Nurse, as this is needed for recordkeeping.

5.8.4 Contractor shall ensure Pulmonary Function Tests (PFTs) Performed by a licensed physician, Certified Pulmonary Function Technologist, or Registered Respiratory Therapist in accordance with OSHA publication 3637-03 2013, Spirometry Testing in Occupational Health Programs. The estimated number of personnel to receive PFTs are fourteen (14).

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

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

5.8.4.1.2 Follow NIOSH and ATS-ERS standard requirements:

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

5.8.4.1.2.2 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.

5.8.4.1.2.3 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.

5.8.4.1.2.4 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.

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

5.8.4.1.2.6 Always indicate source of reference value on reports for adjusted predicted value

5.8.4.1.2.7 No smoking within 1 hour prior

5.8.4.1.2.8 No cold, flu or allergies within two weeks

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

5.8.4.1.2.10 . 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.

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

5.8.5 Contractor will provide quantitative fit testing in accordance with 29 CFR 1910. 134 appendix A, “Respiratory Protection.” The estimated number of personnel to receive fit testing is fourteen (14).The masks/respirator will be brought to the testing site by the individual employee who has one assigned to them for their utilization.

5.8.6 Contractor will ensure that vision screenings are in accordance with DA PAM 40-506, “The Army Vision & Conservation Readiness Program,” using multiphasic vision screening equipment to measure the following primary visual skills. The estimated number of personnel to receive vision screening is eighty (80).

5.8.6.1 Visual acuity for distance and near.

5.8.6.2 Lateral phorias for distance and near.

5.8.6.3 Vertical phorias for distance and near.

5.8.6.4 Depth perception.

5.8.6.5 Color perception.

5.8.6.6 Peripheral vision.

5.8.7 Contractor shall 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. Tests include:

5.8.7.1 Blood Chemistries (serum) with H&H, BUN and Creatinine. Estimated quantity: 5

5.8.7.2 Liver Function to include AP and if abnormal include GGTP. Estimated quantity: 5

5.8.7.3 Cadmium Blood Profile. Estimated Quantity: 5

5.8.7.4 Chromium Blood Profile. Estimated Quantity: 5

5.8.7.5 Mercury Blood Profile. Estimated Quantity: 5

5.8.8 Contractor shall ensure dermatological examinations must be 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.

5.8.9 Contractor shall ensure instrumentation meets or exceeds appropriate performance standards, and accuracy must be verified in accordance with current Occupational Medicine Certification standards.

5.8.10 Contractor shall provide the Contracting Officer’s Representative with a Quality Assurance Medical Surveillance Plan listing the procedures or processes, which shall be utilized to meet the requirements discussed in the PWS.

5.8.11 PERSONAL PROTECTIVE EQUIPMENT (PPE)

5.8.11.1 Contractor shall furnish and assure healthcare workers are provided with the appropriate Personal Protective Equipment (PPE) such as, but not limited to: gloves, protective eyewear, and etc., where there is a potential for exposure to blood or other potentially infectious materials.

5.8.11.2 Contractor shall ensure each healthcare worker complies with the requirements of 29 CFR 1910.1030, Blood borne Pathogens Standard.

5.8.12 INFECTIOUS WASTE DISPOSAL

5.8.12.1 Contractor shall dispose of all infectious waste in accordance with local, state, and federal regulation and disposed of by the contractor off site.

5.8.12.2 Contractor shall ensure puncture resistant sharps containers are readily accessible to healthcare workers and located in all treatment areas where sharps could potentially be used.

5.8.13 MEDICAL SURVEILLANCE SCREENING AREA CONFIGURATION

5.8.13.1 Medical Surveillance screening will occur in an area provided by the contractor to ensure complete individual privacy. Desired features of the space shall include, but are not limed to, a climate-controlled atmosphere, patient waiting / holding area for registration, changing room, on board restroom, testing / phlebotomy station, individual audiometric testing booth, and physical examination area.

5.8.14 CONTRACTOR MANPOWER REPORTING APPLICATION (CMRA):

5.8.14.1.1 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.

5.8.14.1.2 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

5.8.15 MEDICAL REPORTS AND RECORDKEEPING

5.8.15.1 Contractors shall immediately report to the Occupational Health Manager by telephone at 802-338-3640 if results of medical surveillance screening(s), which are questionable and / or of critical significance and / or require follow-up. All abnormal hearing test results will be reported to the Occupational Health Manager on the day of testing. Contractor shall send all results to include all diagnostic tests, graphs, charts, reports, questionnaires, waivers, employee consent forms, physical findings, and examination results to the Occupational Health Manager within 30 calendar days of completion of testing to: Vermont Army National Guard, ATTN: MAJ Martin Silverstrim, OHN 141 Shamrock Rd South Burlington VT 05403

5.8.15.2 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).

5.8.15.3 Contractor shall ensure that each employee signs the Privacy Act Statement (DD Form 2005) during the registration process.

5.8.15.4 Summary Report: The Contractor will provide a comprehensive data processed analytical end report in a binder with dividers that outline the following in an Excel Spread Sheet Format:

Tab # 1 - Classification Summary to include, Colum # 1 - Employee Name, Colum # 2 – SSN, Colum # 3 - D.O.B., Colum # 4 –Blood Pressure (B/P) N = normal, A = abnormal, Colum # 5 – AUDIO – N= normal, A = abnormal, Colum # 6 – PFT N = normal, A = abnormal, Colum # 7 – Vision N = normal, A = abnormal, Colum # 8 – Phys Exam – N = normal, A = abnormal, Colum # 9 – Resp. Clear - P = Pass, TNP = Test Not Performed, Colum # 10 LAB CHEM – N = normal, A = abnormal, Colum # 11 – LAB – CBC – N = normal, A = abnormal.

Tab # 2 – Fit Test Summary to include, Colum # 1 – The tested Employee Name, Colum # 2 – SSN, Colum # 3 – D.O.B., Colum # 4 – Test Date, Colum # 5 – Fit Test, 3M 6100 Half Face, and Result - P = Pass, F = Fail, TNP = Test Not Performed, Colum # 6 – Fit Test, 3M 6200 Half Face, and Result P = Pass, F = Fail, TNP = Test Not Performed, Colum # 7 – Fit Test, 3M 6300 Half Face, and Result P = Pass, F = Fail, TNP = Test Not Performed, Colum # 8 – Fit Test, 3 M 7800 Full Face, and Result P = Pass, F = Fail, TNP = Test Not Performed.

Tab # 3 – Employee Listing with Hearing Classifications to include, Colum # 1 Employee Names, Colum # 2 SSN, Colum # 3 Date, Colum # 4 Speech Frequencies, and Colum # 5 – High Frequencies – Normal, Mild Hearing Loss, Moderate Hearing Loss, Moderate Severe Hearing Loss, and Profound Hearing Loss Tab # 4 – Employee Listing with All Hearing Tests Tab # 5 – Hearing Summary Report – Bar Graph indicating total numbers related to Total Number of employees tested, break outs will be Number of Normal Hearing, Number of Mild Loss, Number of Moderate Loss, Number of Moderate Severe Loss, Number of Severe Loss, Number of Profound Loss, Number of Standard Threshold Shift and Number of OSHA Recordable Shift if any.

Tab # 6 – Employee Listing with Most Recent PFT – Colum # 1 Employee Names, Colum # 2 – Date test conducted, and Colum # 3 - Classification – Normal, Mild Obstructive, Borderline Obstructive, Moderate Obstructive and Significant Obstructive as the test indicates Tab # 7 – Employee Listing with most Recent PFT Results – Colum # 1 Employee Names, Colum # 2 Date test conducted, Colum # 3 – FVC, Colum # 4 - FEV1, Colum # 5 – FEV1/FVC and other information as tested.

Tab # 8 Pulmonary Summary Report – Analytical Breakdown to include – Total number of employees, Number of Employee Tested, Number with Normal Screening, Number with Mild Restriction, Number with Moderate Restriction, Number with Severe Restriction, Number with Borderline Obstruction, Number with Mild Obstruction, Number with Moderate Obstruction, Number with Severe Obstruction, and Number with Superimposed Restriction.

5.7.16 EXAMINATION SCHEDULING

5.7.16.1 Coordination of scheduling shall be a joint effort between the Occupational Health Manager and the Contractor, a draft copy of the schedule will be initiated by the Occupational Health Manager and sent to the Contractor for review and any needed adjustments. One patient/employee per 15 minute intervals. No testing shall be performed between 1130 – 1230 hours.

5.7.16.2 In the event of a 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. The option to schedule physicals not completed due to equipment failure, through a local occupational medical facility shall be done at no cost to the Government. The Contractor shall be directly responsible to cover costs for completing these make-up screenings.

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

Publication (Chapter/Page)

http://farsite.hill.af.mil/

DoDM 1000.13-M-V1 DoD Identification (ID) Cards (Enclosure 2, paragraph 3.b)

Federal Information Processing Standards (FIPS) Publication 201-2 Personal Identity Verification (PIV) of Federal Employees and Contractors (paragraph 9)

DoDM 5200.2 Regulation 5200.02 Procedures for the DoD Personnel Security Program (PSP)

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

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

DoD 5220.22-M National Industrial Security Program Operating Manual 02/28/2006 (Change 2: 05/18/2016)

AR 381-12

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

Title 29, Code of Federal Regulations, Part 1910.134: Occupational Safety and Health Standards. Respiratory Protection

Title 29, Code of Federal Regulations, Part 1910.1030: Occupational Safety and Health Standards. Bloodborne Pathogens.

Title 29, Code of Federal Regulations, Part 1960: Safety and Health Provisions for Federal Employees

https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.120

Headquarters, Department of the Army Pamphlet (DA PAM) 40-501 Army Hearing Program 08 January 2015

Headquarters, Department of the Army Pamphlet (DA PAM) 40-506 Vision Conservation 15 Jul 2009

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

DD 250

Material Inspection and Receiving Report

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).

prior to contract start Review by COR

by COR

Reports delivered within 30 days of examination 100% Inspection by COR

TECHNICAL EXHIBIT 2

Deliverables Schedule

1.4.5.10 OPSEC

Training Certificates

TECHNICAL EXHIBIT 3

Estimated Workload Data