Statement_of_Work_Med_Surveillance_Fy18_revised.pdf

PERFORMANCE WORK STATEMENT

OCCUPATIONAL HEALTH

PROCUREMENT OF MEDICAL SURVEILLANCE EXAMINATIONS

1.0 General:

1.1. Scope: The medical examinations and procedures shall be the responsibility of the Medical Contractor. The administrative controls shall be the responsibility of the New York Army National Guard (NYARNG) Occupational Health Specialist. Any additional exams or tests performed shall be pre-approved by the NYARNG Health Specialist.

1.2. Background: The purpose of the NYARNG Mobile Occupational Medical Examination Program is to provide job-related medical surveillance examinations and occupational health services to NYARNG full-time support (FTS) and temporary personnel who are potentially exposed to health hazards in the work environment or who are assigned to positions requiring specific standards of physical fitness. The contractor shall conduct each test for the price of that test as stated in the schedule. The government may evaluate the quality of professional and administrative services provided but retains no control over the medical professional aspects of services rendered. The contractor shall provide all labor, tools, supervision and supplies to conduct mobile medical surveillance/occupational health services for the NYARNG.

1.3. Period of Performance (PoP): The PoP shall be from 3-24 April 2018. The contractor shall conduct medical surveillance examination/occupational health services at eleven work sites/locations as listed below:

Exam Location (Host Facility) Facilities Date # of EMPL

Jamestown (FMS 2) FMS 2, FMS 2 SS 3-Apr-18 8

Buffalo (FMS 10) FMS 1,10 4-Apr-18 22

Rochester (CSMS C) CSMS C 5-Apr-18 37

Rochester (AASF 2) AASF 2 6-Apr-18 26

Fort Drum (MATES) MATES 9-Apr-18 23

Fort Drum (MATES) MATES 10-Apr-18 23

Syracuse (FMS 5) FMS 4,5,6 11-Apr-18 27

Binghamton (FMS 13) FMS 13 13-Apr-18 13

Latham (JFHQ) AASF 3, FMS 15 17-Apr-18 28

Latham (JFHQ) FMS 3,16,17 18-Apr-18 28

Camp Smith (CSMS A) CSMS A, FMS 7 19-Apr-18 39

Camp Smith (CSMS A) MAKE-UP Date 20-Apr-18 TBD

Staten Island (CSMS B) CSMS B, FMS 12 23-Apr-18 34

Farmingdale (FMS 14) FMS9, AASF1,FMS14 24-Apr-18 38

1.4. New York Army National Guard Project Officer

1.5. The NYARNG Project officer is CPT Alicia Howard, Occupational Health Manager, MNAV- OS, 330 Old Niskayuna Rd, Latham, NY 12110-2224. Commercial Phone (518) 786-6097, Fax

(518) 786-6032.

2.0. References

2.1. Army Regulation 40-5, Preventive Medicine.

2.2. National Guard Regulation 385-10, Army National Guard Safety and Occupational Health Program.

2.3. U. S. Department of Labor (DOL) CFR 1910, Occupational Safety and Health Standards for General Industry.

2.4. Headquarters Department of the Army Pamphlet (DA PAM) 40-501, Hearing Conservation.

2.5. Military References made in the Statement of Work (SOW) are available from the COR.

3.0. Procedures and Standards

3.1. The contractor shall ensure that all procedures are conducted in accordance with applicable American Board of Occupational and Environmental Medicine (ABOEM), American Association of Occupational Health Nurses, U. S. Department of Labor, OSHA and NIOSH Standards.

3.2. The contractor shall ensure that all clinical laboratory/chemistry services are performed by a laboratory licensed by the U. S. Department of Health and Human Services 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 Pathologists.

3.3. The contractor must supply a copy of the certification/license to the government with the contractor’s bid.

3.4. A comprehensive review and evaluation will be performed within thirty (30) days following the conclusion of testing. The NYARNG will contact and schedule a follow-up review and evaluation meeting to discuss positive and negative aspects of testing.

3.5. The contractor will arrange for initial coordination of services with the Project Officer within fifteen (15) working days after award of the contract.

3.6 The contractor will arrange for the opportunity to consult with a representative of the company by telephone to coordinate or resolve issues that might arise before, during, and after the testing period.

3.7. Only licensed medical technicians will perform medical surveillance screening/testing elements. Personnel performing audiograms will be certified by the Council for Accreditation in Occupational Hearing Conservation (CAOHC). The contractor will work with the Project Officer to receive a DoD Certificate Number for hearing tracking purposes. Personnel conducting spirometry will be certified through a program approved by the National Institute of Occupational Safety and Health (NIOSH). License and certifications must be available.

3.8. Instrumentation must meet or exceed appropriate performance standards, and accuracy must be verified IAW current Occupational Medicine Certification standards.

3.9. The contractor must provide the NYARNG Project Officer with a quality assurance medical surveillance plan, listing the procedures or processes which will be utilized to meet the performance work statement requirements.

4.0 Medical Surveillance

4.1. Examination by qualified Board Certified Occupational Health and Medicine Provider, with written report of all findings and recommendations, signed by provider. In lieu of a Board Certified Occupational Health and Medicine Provider, a qualified provider with extensive military or occupational health experience may be substituted.

4.2. Laboratory—To include the drawing of blood and disposal of all waste products generated by the blood draw in accordance with the Blood-Borne Pathogen Standard. The waste products will not be disposed of at the testing site. The lab analysis will consist of a chemistry screen 25, CBC, Urogram, and PSA for male employees over the age of 40. Painters and welders will have screening for heavy metals, blood lead and ZPP. Additional employees may be screened for blood lead upon request.

4.3. Respiratory clearance per OSHA Standard 29 CFR 1910.34 for selected employees.

4.4. Audiogram:

4.4.1 EXAMINER: The following are the requirements for certified hearing technician examiners performing hearing testing for Army Hearing Conservation and Readiness.

4.4.2 Hearing testing must be completed by a physician, audiologist or certified hearing technician.

4.4.3 Hearing technicians must administer audiometric tests under the supervision of a physician or audiologist.

4.4.4 Hearing technicians must have Council for Accreditation in Occupational Hearing Conservation (CAOHC) or equivalent military certification. Hearing technicians trained and certified at a military course will have the appropriate certification number assigned at the time of their course.

4.4.5 Hearing technicians certified at a civilian CAOHC course must obtain a DoD certification number that is compatible with the Defense Occupational Environmental Health Readiness System – Hearing Conservation (DOEHRS-HC) software from the U. S. Army Public Health Command, Army Hearing Program. Requests for the DoD numbers should be submitted to usarmy.apg.medcom-phc.mbx.army-hearing-program@mail.mil by the installation Hearing Program Manager, Deputy State Surgeon or Occupational Health Nurse. The request should include a scanned copy of the CAOHC certificate and the hearing technician’s name, complete address, phone number and e-mail address.

mailto:usarmy.apg.medcom-phc.mbx.army-hearing-program@mail.mil

4.4.6 Hearing technicians shall be trained for otoscopic examination and earplug fitting.

4.4.7 Hearing technicians must have current HIPAA and Information Assurance training.

5.0 EQUIPMENT;

5.1 Hearing testing will be completed using the approved DOEHRS-HC audiometer. The current version of the DOEHRS-HC software must be utilized. IAW AR 40-501, Chapter 11g.(1) “The Defense Occupational Environmental Hearing Readiness Application – Hearing Conservation (DOEHRS-HC) audiometer is the only authorized audiometer for conducting and recording DD Form 2215 (Reference Audiogram) and DD Form 2216 (Hearing conservation Data).” The current DoD approved DOEHRS-HC audiometer is the Benson CCA 200 or CCA 200mini.

5.2 Audiometers must have an annual, comprehensive electro-acoustical calibration to ensure it is functioning properly and IAW the American National Standards Institute (ANSI) Standard S3.6.

5.2.1 Audiometers must pass a daily calibration and functional check. Daily calibration check results must be recorded on a DD Form 2217, Biological Audiometer Calibration Check.

5.2.2 Earphone cushions must be clean and in good condition.

5.2.3 Headbands must be in good condition and provide proper tension.

5.2.4 Earphone cords must be in good condition with no cracks or breaks in the insulation or shorts in the wires.

5.2.5 The Contractor will be issued a DOEHRS-HC Laptop to be used in conjunction with their Benson Audiometers. This will meet the requirements for DoD.

5.3 TEST ENVIRONMENT:

5.3.1 Audiometric tests must be completed in a sound booth. The noise levels within the hearing test environment must not exceed those shown in DA PAM 40-501, Table 7-1.

Audiometric test booths must be evaluated on an annual basis using sound level meter equipment conforming to:

5.3.2. At least the Type 1 requirements of the ANSI Standard S1.4-1983 (R 1997) and S1.4A- 1985 Amendment (or latest approved standard).

5.3.3. The band filter sets shall conform to requirements for Order 3, Type 3-D, extended range as specified by the latest ANSI Standard S1.11.

5.3.4 Sound booth noise measurements must be recorded on the U. S. Army Public Health Command Audiometric Test Booth Certification Form with a copy furnished to the Hearing Program Manager or their representative. The USAPHC Audiometric Test Booth Certification Form is available at:

http://phc.amedd.army.mil/PHC%20Resource%20Library/AudiometricTestBoothCertification.pdf

5.3.5 Ventilation systems in audiometric test booths must provide adequate air exchange for patient comfort and acceptable sound levels for valid audiometric testing.

5.3.6 The standard for testing maximum permissible ambient noise levels (MPANL) within DoD is the ANSI S3.1, 1999 (R 2008) standard which requires sound measurements with a Type 1 http://phc.amedd.army.mil/PHC%20Resource%20Library/AudiometricTestBoothCertification.pdf sound level meter. The OSHA standard which allows measurements with a Type 2 sound level meter and allows much higher MPANL is not applicable for testing within DoD.

5.3.6 Hearing technicians will ensure that tests are completed in a sound booth that meets the DoD and Army Maximum Permissible Ambient Noise Levels (MPANL) IAW ANSI standards for MPANL and will ensure that the USAPHC Audiometric Test Booth Certification Form is posted on their test booth(s).

5.4 AUDIOMETRIC EVALUATION REQUIREMENTS

5.4.1 Hearing technicians will accurately enter their personal and certification information into the DOEHRS-HC system as examiners. Use of other examiners information is prohibited.

Incidents of falsified or shared examiner information shall be immediately reported to the USAPHC, Army Hearing Program, usarmy.apg.medcom-aphc.mbx.army-hearing-program@mail.mil

5.4.2 Hearing technicians will complete the daily functional checks and daily calibration on their DOEHRS-HC audiometers at the beginning of each test day with results recorded on a DD Form 2217, Biological Audiometer Calibration Check. The hearing technician will, upon request, provide the Hearing Program Manager, Case Manager or their representative a copy of the DD Form 2217.

5.4.3 The hearing technician will ensure all Army National Guard Soldiers have their Major Command identified as NGB in the DOEHRS-HC system and that the correct state or territory is selected for the Soldier being tested. Contractor hearing technicians will ensure that when they test on site for Army National Guard contracts their DOEHRS-HC examiner information lists the state or territory where they are testing.

5.4.4 The hearing technician shall ensure that all demographic information for personnel tested is entered correctly and accurately at the time of the test. Hearing technicians will not enter noise data unless there is specific noise exposure information available for the individual being tested. Hearing technicians will ensure that Unit Identification Code (UIC) information is entered correctly.

5.4.5 Otoscopic examinations will be performed prior to the hearing test.

5.4.6 Hearing technicians will ensure hearing aids and any other objects that may interfere with testing (glasses, earrings, gum, etc.) are removed prior to administering any monitoring audiometry hearing tests.

5.4.7 DD Form 2215 and DD Form 2216 Audiograms will be completed using the DOEHRS-HC system. Thresholds will be completed for 500 Hz, 1000 Hz, 2000 Hz, 3000 Hz, 4000 Hz and 6000 Hz using the Benson CCA 200 or CCA 200mini audiometer, Standard Test Configuration, Modified Hughson-Westlake threshold procedure, and DoD Significant Threshold Shift method.

5.4.8 The hearing technician shall ensure that all DD Form 2215 and DD Form 2216 audiograms are printed immediately following the completion of the test.

5.4.9 Hearing test results will be explained to the individuals being tested.

5.4.10 DOEHRS-HC automatically generates recommendations for referral when specific criteria are met. The hearing technician will inform both the individual and the Hearing Program Manager, Case Manager or their representative of the need for a referral at the time of the test.

mailto:usarmy.apg.medcom-aphc.mbx.army-hearing-program@mail.mil mailto:usarmy.apg.medcom-aphc.mbx.army-hearing-program@mail.mil

5.4.11 The hearing technician shall ensure that all consult referral forms are printed and saved immediately following the completion of the test.

5.4.12 In the event of a negative STS, hearing technicians will ensure that the follow-up test is repeated on the same day. If a negative STS is confirmed, a new baseline will be re-established at the time of testing.

5.4.13 In the event of a positive significant threshold shift (STS), hearing technicians will ensure the individual signs the DD Form 2216 to acknowledge that the test results and required follow-up steps were explained to the individual.

5.4.14 In the event of a positive STS, the Hearing Program Manager, the Case Manager or their representative will be notified on the day of testing so the follow-up hearing test(s) can be scheduled within 90 days of the periodic test.

5.4.15 The hearing technician will ensure that positive STS follow-up tests are performed at least fourteen hours noise free prior to the test. If necessary, hearing technicians will complete follow-up two immediately after completing follow-up one. Hearing technicians will ensure that a new baseline is established when the positive STS is confirmed after completing follow-up two.

5.4.16 All DOEHRS-HC data must be uploaded to the DOEHRS-HC Data Repository at the end of each test day, at a minimum.

5.4.17 The hearing technician will, upon request, provide the Hearing Program Manager, Case Manager or their representative desired reports at the end of each test day. The profile report, daily report logs, STS reports and test summary are standard reports available in the DOEHRS- HC system.

6.0 Vital signs—To include height, weight, blood pressure and pulse.

6.1 Visual acuity exams for all employees.

6.2. In the event of contractor’s equipment failure, the contractor will ensure that the scheduled day’s testing can be completed. This may be accomplished by moving the testing into a fixed facility as provided by the host facility with input from the COR as to suitability of the location.

7.0. Physician Services:

7.1. Physician will provide an on-site evaluation of the mobile testing to the (FTS) employees approximately (five) weeks after mobile testing has been completed.

7.2. The Physician’s evaluations will be provided at the locations delineated in paragraph 1-3.

8.0. Medical Records and Reports

8.1. The contractor will ensure two (2) copies of the employee examination findings are furnished. One copy is to be sent to the NYARNG Project Officer, and one copy is to be mailed directly to the individual employee’s home of record. Medical examination results shall include all diagnostic tests, graphs, charts, reports, examination results. The contractor will provide the NYARNG Project Officer with a hardcopy of these results within thirty (30) working days of the completion of testing. The contractor will also provide the Project Officer the medical examination results on compact disc format capable of being uploaded into the Defense Occupational Environmental Health Readiness System (DOEHRS) within forty-five (45) working days of completion of testing. Results of medical surveillance testing which are questionable and/or of critical significance will be communicated directly, and immediately, to the NYARNG Project Officer by telephone or express mail.

8.2. The Contractor will provide a comprehensive report that outlines the following in an Excel Spread Sheet Format:

a. Column # 1 - Employee Name,

b. Column # 2 – SSN,

c. Column # 3 – D.O.B.,

d. Column # 4 – Facility of employment.

e. Column # 5 – Phys Exam – N = normal, A = abnormal,

f. Column # 6 – Blood Pressure (B/P) N = normal, A = abnormal,

g. Column # 7 – AUDIO – N= normal, A = abnormal,

h. Column # 8 Speech Frequencies – Normal, Mild Hearing Loss, Moderate Hearing Loss, Moderate Severe Hearing Loss, and Profound Hearing Loss

i. Column # 9 – High Frequencies – Normal, Mild Hearing Loss, Moderate Hearing Loss, Moderate Severe Hearing Loss, and Profound Hearing Loss

j. Column # 10 – Vision N = normal, A = abnormal,

k. Column # 11 – Urine Dip Stick (Urine) – N = normal, A = abnormal,

l. Column # 12 – Urine microscopy – N = normal, A = abnormal

m. Column # 13 – PFT N = normal, A = abnormal, TNP – Test Not Performed,

n. Column # 14 – Resp. Clear - P = Pass, TNP = Test Not Performed,

o. Column # 15 – LAB – PSA – N = normal, A = abnormal, TNP – Test Not Performed,

p. Column # 16 – LAB – Blood work – N = normal, A = abnormal,

q. Column # 17 – LAB CHEM – N = normal, A = abnormal,

r. Column # 18 – LAB – CBC – N = normal, A = abnormal,

s. Column # 19 – LAB – Lead- N = normal, A = abnormal, TNP – Test Not Performed,

t. Column # 20 – LAB – ZPP- N = normal, A = abnormal, TNP – Test Not Performed.

9.0. Examination Scheduling

9.1. Coordination of scheduling shall be a joint effort between the Occupational Health Specialist-and the Contractor, a draft copy of the scheduled will be initiated by the Occupational Health Specialist and sent to the Contractor for review and any needed adjustments. One patient/employee per 15 minute intervals. All workdays include a one-hour lunch break. No testing shall be performed between 1130 – 1230 hours.

9.2. 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 Specialist 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.

10.0. Mobile Unit Configuration

10.1. Medical surveillance testing shall be accomplished via a state-of-the-art mobile unit designed to be conducive to an efficient continuous flow of patients, yet maintain the dignity of the patient and achieve complete individual privacy at all times. The unit should be designed to enhance maintenance of hygiene; e.g., running water sources should be distributed throughout the unit so that personnel movement is minimized, but that people undergoing examinations have access to hand washing and hygiene amenities. Features of the unit should include, but are not limited to, a climate -controlled atmosphere, patient waiting/holding area for registration, separate changing room, separate on board restroom, testing/phlebotomy station, individual audiometric testing booth, on-board x-ray processing, an on-board computer system to maintain the quality control during the data entry and physician examination area. The unit should be physically structured such that each examination component can be conducted independently;

e.g., with respect to the EKG and the examination conducted by the physician, an EKG and a physician's exam should be able to be conducted concurrently. The Contractor shall provide a schematic and sufficient interior and exterior photographs of the unit proposed for use under the contract with their bid, such that the Government can determine the Contractor has met the requirements set forth in this paragraph. Mobile units are to be equipped with separate power source/ generator to operate in conditions without access to shore power.

11.0. Personal Protective Equipment (PPE)

11.1. Contractor shall furnish and assure health workers are provided with appropriate PPE such as, but not limited to, gloves, protective eyewear etc., where there is a potential for exposure to blood or other potential infectious materials.

11.2. Contractor will ensure each health care worker complies with the requirements of 29 CFR 1910.1030 Blood-borne Pathogens Standard

12.0. Infectious Waste Disposal

12.1. Disposal of all infectious waste must be in accordance with local, state, and federal regulation and disposal of by the contractor.

12.2. Puncture resistant sharps containers must be readily accessible to health care workers and located in all treatment areas where sharps could potentially be used.

13.0. The Office of the Assistant Secretary of the Army (Manpower & Reserve Affairs) operates and maintains a secure Army data collection site where the contractor will report ALL contractor manpower (including subcontractor manpower) required for performance of this contract. The contractor is required to completely fill in all the information in the format using the following web address “https://contractormanpower.army.pentagon.mil https://contractormanpower.army.pentagon.mil/