OH_Pre_Placement_Job_Related_Exams_PWS_2019.pdf

PERFORMANCE WORK STATEMENT (PWS)

FOR

Occupational Health Pre Placement and Job Related Exams Services

1.0 General: Designated full-time support (FTS), both civilian, and uniformed federal technicians who are selected to be employees or current employees who are potentially exposed to health hazards in the work environment are required to undergo job related Occupational Health exams. The Performance Work Statement (PWS) supports the Massachusetts Army National Guard (MA ARNG) Occupational Health Program in accordance with the Occupation Safety and Health Association (OSHA) and other regulations. The estimated number of personnel to be examined and tested is from a minimum of 10 to a maximum of 125 each year. The Government has the right to increase or decrease the number of personnel depending on employee population.

1.1 Scope: The contractor shall provide all labor, personnel, equipment, tools, materials, supervision, and quality control necessary, except as specified in Paragraph 3.0 as Government Furnished, to perform the service of testing and physical exam of each employee as defined in this PWS.

1.2 Background: The Massachusetts Army National Guard (MAARNG) Occupational

Health Program encompasses providing job-related medical examinations. Exams are performed to identify any health ailments precluding an individual from performing the essential functions of their position, to prevent work-related health ailments by assessing the health status of individuals in relation to their work, and making medical recommendations regarding placement, accommodation, and exposure controls. The classification of medical examinations includes:

a. Pre-placement

b. Periodic

c. Termination / Retirement

d. Fitness for duty

e. Audiologist evaluations.

Test Requirements may be different for each classification of exam and will be identified at the time of exam scheduling. Therefore, cost quotes should be on a per test basis with the overall requirements being taken into consideration.

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

1.4 General Information:

Alexandru.Sava Highlight

Alexandru.Sava Highlight

1.4.1 Quality Control (QC): The contractor shall develop and maintain an effective QC Plan (QCP) to ensure services are performed in accordance with this PWS. The contractor shall develop and implement procedures to identify, prevent, and ensure non-recurrence of defective services. The contractor’s QCP is the means by which it assures itself that its work complies with the requirements of the contract. Quality Control/Assurance measures consist of checks and rechecks to ensure equipment is operating properly and the right employee receives the right examinations.

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 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 timeframe of exam scheduling and processing as well as acceptable timing, quality level(s), and (defect rate(s)).

1.4.3 Recognized Holidays: The following are recognized 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

1.4.4 Place and Performance of Services: The contractor shall provide services between the hours of 0700-1500 Monday through Friday, except on recognized US holidays. Performance shall be at locations within Massachusetts where the capability to perform all required testing can be performed. The contractor shall at all times maintain an adequate work force for the uninterrupted performance of all tasks defined within this PWS within the time specified. When hiring personnel, the contractor shall keep in mind that the stability and continuity of the work force are essential.

Telecommuting is not authorized.

1.4.5.1 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.

1.4.5.2 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.

1.4.6 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 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.

1.4.9. 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. 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.

1.4.10 Organizational Conflicts of Interest (OCI): The contractor and any 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.

2.0 Definitions and Acronyms:

2.1 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.

2.2 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.

2.3 CONTRACTING OFFICER'S 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.

2.4 DEFECTIVE SERVICE. A service output that does not meet the standard of performance associated with the Performance Work Statement.

2.5 DELIVERABLE. Anything that can be physically delivered and includes non-manufactured things such as meeting minutes or reports.

2.6 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.

2.7 PHYSICAL SECURITY. Actions that prevent the loss or damage of Government property.

2.8 QUALITY ASSURANCE. The government procedures to verify that services being performed by the Contractor are performed according to acceptable standards.

2.9 QUALITY ASSURANCE SURVEILLANCE PLAN (QASP). An organized written document specifying the surveillance methodology to be used for surveillance of contractor performance.

2.10 QUALITY CONTROL. All necessary measures taken by the Contractor to assure that the quality of an end product or service shall meet contract requirements.

2.11 SUBCONTRACTOR. One that enters into a contract with a prime contractor. The Government does not have privity of contract with the subcontractor.

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

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

2.2 ACRONYMS:

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

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

3.1 Property: The Government will furnish any agency specific forms necessary.

Government will furnish specific criteria for testing.

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

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

5.0 Requirements: The contractor shall indemnify the Government for any liability producing act or omission by the Contractor, its employees and agents occurring during contract performance. The Contractor shall 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. The contractor, upon request by the Contracting Officer, shall furnish prior to contract award evidence of its insurability concerning the medical liability insurance required by this clause.

5.1 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.

5.1.1 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.

5.1.2 Contractor shall provide a Board eligible or Certified Occupational Medicine Physician to conduct or provide oversight of physician assistants or nurse practicioners with appropriate qualifications, training, licensing, and experience in occupational health performing physical examinations and occupational health consultation services.

Contractor shall provide a certified Audiologist to perform any audiology consultation requests. Audiologist exams will include the following:

a. Noise exposure history

b. Pure tone audiometry

c. Bone conduction audiometry

d. Acoustic reflexes

e. Speech discrimination

f. Other indications as applicable based on referral

5.1.3 Contractor shall ensure the right employee receives the right tests and examinations as requested by the MA AARNG Occupational Health Nurse (OHN). Each exam request will include individual employee by name and define the testing and exam required for that person based on the type of exam requested. As a second quality control/assurance measure, all test results will be organized and mailed, forwarded directly to the OHN by the contractor (hard copies, or encrypted downloads/email or other electronic media). Contractor will mail directly to each employee a hard copy of all testing results. Exam and screening criteria may include any of the following:

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

5.1.5 Contractors will provide physical exam assessment that includes, inguinal hernia screening for male employees, and back strength, flexibility and, range of motion for all employees. Note any abnormalities or symptoms and recommended lifting limitations if necessary.

5.1.6 Contractor shall ensure any requested Pulmonary Function Tests (PFTs) are Performed by a licensed physician, Certified Pulmonary Function Technologist, or Personnel certified through a program approved by the National Institute for Occupational Safety and Health (NIOSH) in accordance with 29 CFR 1910.1001.

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

b. Specifications regarding equipment guidelines and calibration, test administration, and test interpretation must meet applicable OSHA and ANSI standards.

Supporting documentation will be provided to the OHN depending on manufacturing guidelines of spirometer.

c. Respirator clearance documented and a copy given to employee at time of visit for employees requiring respirator clearance.

5.1.7 Contractor will 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.

5.1.8 Contractor shall ensure laboratory tests will be processed by certified clinical laboratories and performed by personnel certified under the American Society of Clinical Pathology. Tests may include any or all of the following:

a. Bilirubin, total.

b. Blood urea nitrogen (BUN).

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

d. Creatinine, serum.

e. Eosinophil count.

f. Hemoglobin and hematocrit.

g. Peripheral smear morphology.

h. Red cell indices.

i. Reticulocyte count.

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

k. Urinalysis (UA), screening and microscopic.

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

m. Zinc Protoporphyrin (ZPP) and Serum Lead must be processed by a laboratory meeting standards set forth in 29 CFR 1910.1025. Only on selected individuals

n. Heavy Metals to include chromium and cadmium (urine and blood levels). Only on selected individuals.

Note: Other labs may be required based on exposure, i.e. chromium, copper, formaldehyde, benzene, etc.

5.1.8 Audiograms must be performed in accordance with Standard Testing Procedures for Army Hearing Conservation and Hearing Readiness in accordance with Technical Exhibit 4 and will include a record of the threshold of audibility of each ear for pure tone test frequencies 500, 1000, 2000, 3000, 4000, and 6000 Hertz.

5.1.9 Contractor shall ensure dermatological examinations must include an inspection of the integumentary system with emphasis on areas most likely to be affected by the employee's occupational (i.e. radiation or chemical) exposures. Documentation will include the presence of any dermatomes or lesions of the skin.

5.1.10 Contractor will perform Chest X Rays for B-Read and EKGs when requested as testing to be included in exam.

5.1.11 Contractor shall ensure instrumentation must meet or exceed appropriate performance standards, and accuracy must be verified in accordance with current Occupational Medicine Certification standards.

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

5.1.13 Contractor will notify of abnormal findings; any abnormal findings may be confirmed by repeat analysis. Confirmed results will be reported immediately to the OHN. If abnormal findings are due to vendor contractor error, tests will be repeated at no additional charge to the government.

5.2 PERSONAL PROTECTIVE EQUIPMENT

5.2.1 Contractor shall furnish and assure healthcare workers are provided with the appropriate PPE such as: gloves, protective eyewear, and etc., where there is a potential for exposure to blood or other potentially infectious materials.

5.2.2 Contractor shall ensure each healthcare workers comply with the requirements of 29 CFR 1910.1030 Blood borne Pathogens Standard.

5.3 MEDICAL REPORTS AND RECORDKEEPING

5.3.1 Contractors shall immediately report to the OHN by telephone or encrypted electronic method if results of tests and exams which are questionable, of critical significance, or require follow-up. 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 OHN within 15 working days of completion of testing to:

Massachusetts Army National Guard JFHQ ATTN: Maria Costa, OHN 2 Randolph Road

Hanscom AFB, MA 01731

5.4 Examination Scheduling and Processing

5.4.1 Coordination of scheduling shall be a joint effort between the SOH Office and the Contractor. A representative of the SOH Office will contact the contractor to schedule each individual employee. At that time, the type of exam / testing will be identified and verified with the contractor. An appointment shall be available within 15 working days of the scheduling request.

5.4.2 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, the OHN,de and the employee.

Unfinished testing / examinations will be completed at no additional cost to the Government. The option to re-schedule physicals not completed due to equipment failure shall be done at no additional cost to the Government. The Contractor shall be directly responsible to cover costs for completing these make-up screenings.

5.4.3 Privacy and Security. The Contractor shall ensure that all findings are clearly recorded on Government or other approved forms, and are protected by Privacy Act of 1974 and Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandated safeguards to ensure confidentiality of health information.

5.4.4 The contractor shall only charge per test, staff level, and set up for quantity of services rendered.

5.4.5 Contractor shall arrange for the opportunity to consult with the Occupational Health Nurse of the MAARNG to coordinate or resolve issues that might arise before, during, and after exams.

5.4.6 Contractor shall perform a comprehensive review and written evaluation within 30-days following the conclusion of the service contract. The Occupational Health Nurse may contact and schedule a periodic review and evaluation meeting to discuss positive and negative aspects of testing as necessary.

5.4.7Contractor shall ensure licensed medical technicians will perform the medical examination screening/testing elements. The person(s) conducting the audiogram must be certified by the Council for Accreditation in Occupational Hearing Conservation (CAOHC). Personnel conducting Spirometry shall be certified through a program approved by the National Institute for Occupational Safety and Health (NIOSH).

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

5.5 Contractor Manpower Reporting Application (CMRA):

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

5.5.2 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 2018. Contractors may direct questions to the help desk at http://www.ecmra.mil.

http://www.ecmra.mil/ http://www.ecmra.mil/

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

Publication (Chapter/Page)

Date of Publication

Mandatory or Advisory

Website

Title 29, Code of Federal Regulations, Part 1910:

Occupational Safety and

Health Standards.

Mandatory

Title 29, Code of Federal Regulations, Part 1960:

Safety and Health Provisions for Federal Employees.

Mandatory

American National Standards Institute (ANSI) 288.6-1884, American National Standard for Respiratory Protection, Respirator Use, Physical

Qualifications for Personnel.

Advisory

Threshold Limit Values and Biological Exposure Indices

(TLVs), American Conference of Governmental Industrial

Hygienists (ACGIH), Cincinnati, Ohio.

Advisory

Army Regulation 40-5, Preventive Medicine

25 May 2007 Mandatory

Department of Defense 6055.05M, Occupational

Medical Surveillance

2 May 2007 Mandatory

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

Mandatory

Army Regulation 11-34, The Army Respiratory Protection

Program

15 Feb 1990 Mandatory

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

15 Jul 2009 Mandatory

TECHNICAL EXHIBIT 1

Performance Requirements Summary

This Performance Requirements Summary includes performance standards. The Government will use these standards to determine contractor performance and will compare contractor performance to the Acceptable Quality Level (AQL).

PWS Paragraph Task Performance Standard

Acceptable Quality Levels

(AQL)

Surveillance Method / By Whom

1.4.4 Contractor

shall be able to provide all exam and testing requirements at the location where employee is scheduled in one (1) day

The contractor performs all exams and testing at the scheduled site on the same day

Employee will not need to report to more than one site for exam and testing. All testing will be conducted in one (1) day

On Site Inspection - Government representative and employee feedback

5.1.3 Contractor

shall ensure that each employee receives the correct testing and examination as identified during scheduling

99% of personnel identified as needing testing and screening receive the correct testing scheduled for them

1% failure rate of personnel not receiving the testing and examination as requested

Periodic Inspection

- OHN will review results of medical exams and testing.

5.4 Contractor

shall schedule the employee for an exam within designated timeframe

The contractor shall schedule no later than 15 working days from scheduling request

Exams scheduled within 15 working days of request

Periodic Inspection

- COR and OHN will examine and cross check results and service records

TECHNICAL EXHIBIT 2

Deliverables Schedule

PWS Reference / Deliverable Title

Frequency Number of Copies

Medium/Format Submit To

1.4.1 QC Plan Within 30 days of

contract award

1 Electronic or Hard Copy

KO

5.3.1 results to include all diagnostic tests, graphs, charts, reports, questionnaires, waivers, employee consent forms, physical findings, and examination results

Provide within 15 working days after testing and examinations completed

2 Electronic and Hard Copy

1 hard copy directly to employee and one hard or electronic copy to OHN

TECHNICAL EXHIBIT 3

Estimated Workload Data

(This information is provided for historical background only. It is not a guarantee of workload quantities.)

ITEM NAME ESTIMATED QUANTITY

1 Pre-Placement Exams 25

2 Periodic / Medical Surveillance Exam 12

3 Fit For Duty Evaluation 5

4 Termination / Retirement Exam 7

5 Audiology Consultation 12

TECHNICAL EXHIBIT 4

STANDARD

TESTING PROCEDURES FOR ARMY

HEARING CONSERVATION AND HEARING READINESS

IAW DoDI 6055.12, AR 40-501 & DA PAM 40-501

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

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

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

C. 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 DoD certification number assigned at the time of their course.

D. Hearing technicians certified at a civilian CAOHC course must obtain a DoD certification number that is compatible with the Defense Occupational and Environmental Health Readiness System – Hearing Conservation (DOEHRS-HC) software from the U. S. Army Public Health Command, Army Hearing Program.

Requests for DoD numbers should be submitted to usarmy.apg.medcom-aphc.mbx.army-hearing-program@mail.mil by the installation Hearing Program Manager, Deputy State Surgeon or Occupational Health Nurse or other government POC. The request should include a scanned copy of the CAOHC certificate, HIPAA training certificate, IA training certificate, the hearing technician’s name, complete address, phone number and e-mail address.

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

F. The Defense Occupational and Environmental Health Readiness System -

Hearing Conservation (DOEHRS-HC) is a Department of Defense (DoD) Military Health System (MHS) Information System (IS) that contains Personally Identifiable Information (PII) and Protected Health Information (PHI). End users of the DOEHRS-HC system are required to complete annual Health Insurance Portability and Accountability Act (HIPAA) training and Information Assurance (IA) training. Joint Knowledge Online is the training system sanctioned by the Department of Defense (DoD) and is the official HIPAA training site for the DoD.

DOEHRS-HC users must complete annual HIPAA training through https://jkodirect.jten.mil/Atlas2/faces/page/login/Login.seam and provide proof of certification upon request.

mailto:usarmy.apg.medcom-aphc.mbx.army-hearing-program@mail.mil mailto:usarmy.apg.medcom-aphc.mbx.army-hearing-program@mail.mil https://jkodirect.jten.mil/Atlas2/faces/page/login/Login.seam

G. DOEHRS-HC users must also complete the DoD CyberAwareness Challenge and provide proof of certification upon request. The DoD CyberAwareness Challenge fulfills the annual Information Assurance training requirement and is available through the following site https://ia.signal.army.mil/dodiaa/default.asp.

2. EQUIPMENT

A. Hearing Conservation and Hearing Readiness 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-200mini.

B. An audiometer 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.

C. 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.

D. Earphone cushions must be clean and in good condition.

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

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

3. TEST ENVIRONMENT

A. Hearing Conservation and Hearing Readiness 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. Stationary audiometric test booths must be evaluated on an annual basis using sound level meter equipment conforming to:

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

b. 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.

https://ia.signal.army.mil/dodiaa/default.asp

B. Noise level 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 upon request. The USAPHC Audiometric Test Booth Certification Form is available at:

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

C. Noise level measurements for mobile audiometric test booths must be evaluated each time they are moved to a new location or at a minimum, annually, if they are never moved and are used as stationary audiometric test booths.

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

E. 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 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.

F. 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 the audiometric test booth(s).

4. AUDIOMETRIC EVALUATION REQUIREMENTS

A. Hearing technicians will accurately enter their examiner information into the DOEHRS-HC system. Sharing of Common Access Cards (CAC), training certification numbers, usernames and passwords is prohibited. Incidents of falsified or shared examiner information shall be immediately reported to the USAPHC, Army Hearing Program, usarmy.apg.mdcom-aphc.mbx.army-hearing-program@mail.mil

B. 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.

C. 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 http://phc.amedd.army.mil/PHC%20Resource%20Library/AudiometricTestBoothCertification.pdf http://phc.amedd.army.mil/PHC%20Resource%20Library/AudiometricTestBoothCertification.pdf mailto:usarmy.apg.mdcom-aphc.mbx.army-hearing-program@mail.mil mailto:usarmy.apg.mdcom-aphc.mbx.army-hearing-program@mail.mil 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.

D. 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.

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

F. 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.

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

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

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

J. 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.

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

L. In the event of a negative significant threshold shift (STS), hearing technicians will ensure that the follow-up test is conducted immediately. If a negative STS is confirmed, a new baseline will be re-established at the time of testing.

M. In the event of a positive 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.

N. 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 completed within 30-days (Civilian) or 90-days (Military) of the periodic test.

O. The hearing technician will ensure that positive STS follow-up tests are performed after at least fourteen noise free hours. 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.

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

Q. The hearing technician will, upon request, provide the Hearing Program Manager, Case Manager or their representative, requested DOEHRS-HC 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.

5. DHA STANDARD CONTRACT LANGUAGE REQUIREMENTS

A. DHA Standard Contract Language will be used for all contracts; Personal Identifiable Information (PII), Protected Health Information (PHI) and Federal Information requirements (Revised 2 April 2014):

http://www.tricare.mil/tma/privacy/contractlanguage.aspx http://www.tricare.mil/tma/privacy/contractlanguage.aspx