Technician Physicals
PERFORMANCE WORK STATEMENT
OCCUPATIONAL HEALTH
MEDICAL SURVEILLANCE EXAMINATIONS
1. GENERAL
The Performance Work Statement (PWS) supports the Minnesota Army National Guard (MNARNG) for Occupational Medical Surveillance Examination Program in accordance with the Occupation Safety and Health Association (OSHA) and other regulations. There are several locations that require this service. The estimated number of personnel to be examined is 300 spread across the state of Minnesota. For Base Year; Technician Physicals are ideally to be scheduled September 10-21 2018. Option years will be similar in time frame but may be subject to change with advance notice of at least 60 days. Contractor is to be within 750 mile radius of Minneapolis, Minnesota.
2. PURPOSE
2.1. The purpose of the Occupational Medical Surveillance Examination Program is to provide job-related Medical Surveillance Examinations and Occupational Health Services to the MNARNG full-time support (FTS) and/or temporary personnel who are or could potentially be exposed to health hazards in the work environment. Personnel not included under these examinations are State Employees, civilian contractors, and the part-time traditional Soldiers.
2.2. The Government may evaluate the quality of professional and administrative services provided, but retain no control over the medical professional aspects of services rendered such as testing procedures, etc. The Contractor will provide Board Certified Occupational Health Physician(s), supervision, all labor, tools, materials, equipment, and incidentals required to conduct the Medical Surveillance Examination / Occupational Health Services for the MNARNG.
3. PROCEDURES and STANDARDS
3.1. This contract is for "Non Personal" Health Care "Services". The Contractor will maintain medical liability insurance which is not less than the amount normally prevailing within the local community for the medical physicals. Scheduled patients should be seen within 15 minutes of their appointment time.
3.2. 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.
3.3. 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.
3.4. Contractor shall provide a Medical Board eligible or Certified Occupational Medicine Physician to conduct job-related medical surveillance physical examinations and occupational health consultation services.
3.5. Contractor shall arrange for the opportunity to consult with an Occupational Health Manager of the MNARNG by telephone to coordinate or resolve issues that might arise before, during, and after the testing period.
3.6. 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.
3.7. Contractor will provide vital signs to include height, weight, blood pressure, pulse and respirations.
3.8. Contractors will provide a Job Functional Analysis or Kraus-Weber diagnostic test results that include back strength and flexibility. Note any pain or recommended lifting limitations if less than 50 lbs
3.9. 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) training in accordance with 29 CFR 1910.95.
a. Hearing screenings will be conducted only on employees exposed to occupational noise > 85 dBA or 140 dBA impact noise.
b. All hearing tests will be entered into a format compatible with DOEHRS-HC.
c. Otoscopic Exam.
d. Test Only 500, 1000, 2000, 3000, 4000 and 6000.
e. Hearing aids must be removed.
f. Employee must be noise free for at least 14 hours prior to screening.
g. All hearing screenings (with the exception of the baseline) will be compared against the employee's baseline to determine if there is a Significant Threshold Shift (STS) and retested immediately and if there is still a STS notify the Occupational Health Manager (OMH) within 10 days so that timely retesting can be scheduled. Baseline screenings will be included for new employees only and selected by the OHM/COR
3.10. Contractor shall ensure Pulmonary Function Tests (PFTs) are performed by a licensed physician, Certified Pulmonary Function Technologist, or Registered Respiratory Therapist in accordance with 29 CFR 1910.1001.
a. Screenings will only be conducted on employees exposed to respiratory hazards that will require a respirator to mitigate their hazards that are above the action level.
b. Test will include as a minimum Forced Expiratory Volume in one second (FEV1), Forced Vital Capacity (FVC), comparison with recognized normal's for the individual's height and weight, sex, race, age and a documented interpretation by a pulmonologist or certified Occupational Health physician.
c. Follow NIOSH and ATS-ERS (American Thoracic Society/European Respiratory Society) standard requirements:
i. Continue testing individual when the patient is improving until improvement is <30ml.
ii. Test results are acceptable with a minimum of three acceptable maneuvers that are free from a leak, obstructed mouthpiece, hesitation, false starts, cough, glottis closure, early termination, and have a good curve of at least 6 seconds duration.
iii. Test results are reproducible in that they have the same result from the individual (two largest FVCs are within 0.150 L of each other and two largest FEV1's are within 0.150 L of each other) when the test is repeated several times. Testing is continued until criteria are met or 8 trials are attempted, or the employee being tested cannot or should not continue.
iv. If three (3) acceptable and two (2) repeatable tests cannot be obtained, the technician performing the PFT must document the reason the standard could not be met.
v. Always use measured height not reported height by the nearest half inch without footwear.
vi. Always indicate source of reference value on reports for adjusted predicted value
vii. No smoking within 1 hour prior
viii. No cold, flu or allergies within two weeks
ix. No inhaler use prior to test that would still be in the patient's system
d. Specifications regarding equipment guidelines and calibration, test administration, and test interpretation must meet applicable OSHA and ANSI standards. Supporting documentation will be provided to this office daily or annually depending on manufacturing guidelines of spirometer.
e. Respirator clearance documented and a copy given to employee at time of visit.
3.11. Contractor will provide quantitative fit testing in accordance with 29 CFR 1910. 134 appendix A. The masks/respirator will be brought to the testing site by the individual employee who has one assigned to them for their utilization.
3.12. 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.
3.13. 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. Provide a copy of lab results to employee for their primary care physician. Tests include:
a. Blood Chemistries (serum) with H&H, BUN and Creatinine.
b. Liver Function to include AP and if abnormal include GGTP.
3.14. Contractor shall ensure dermatological examinations are performed by a physician and include an inspection of the entire integumentary system with emphasis on areas most likely to be affected by the employee's occupational (i.e. radiation) exposures. Documentation will include the presence of any dermatomes or lesions of the skin.
3.15. Contractors shall ensure that chest X-rays are performed by a certified X-ray technician. The interpretation and classification will be performed by a B-reader, or a board eligible or certified radiologist meeting the requirements of 29 CFR 1910.1001 Appendix E
a. Chest X-rays are only performed for asbestos exposed employees.
b. Be a posterior-anterior and left lateral view.
3.16. Contractor shall ensure instrumentation meets or exceed appropriate performance standards, and accuracy must be verified in accordance with current Occupational Medicine Certification standards.
3.17. Contractor shall provide the Contracting Officer with a Quality Assurance Medical Surveillance Plan listing the procedures or processes, which shall be utilized to meet the requirements discussed in the PWS.
4. REFERENCES
4.1. Title 29, Code of Federal Regulations, Part 1910: Occupational Safety and Health Standards.
http://www.ecfr.gov/cgi-bin/retrieveECFR?gp=&SID=a40d49322fd01949a04c9af579e28063&r=PART&n=29y5.1.1.1.8
4.2. Title 29, Code of Federal Regulations, Part 1960: Safety and Health Provisions for Federal Employees.
http://www.ecfr.gov/cgi-bin/text-idx?c=ecfr&SID=a40d49322fd01949a04c9af579e28063&rgn=div5&view=text&node=29:9.1.1.1.9&idno=29
4.3. American National Standards Institute (ANSI) Z88.6-2006, American National Standard for Respiratory Protection, Respirator Use, Physical Qualifications for Personnel.
http://books.google.com/books?id=9xOKL7h2SyMC&pg=PA19&lpg=PA19&dq=free+ANSI+Z88.6-2006&source=bl&ots=ql4hl7jiOh&sig=lcw6A9-hGB8AG3bIY2XYyBMk0VU&hl=en&sa=X&ei=_gVKUc--CoLi4APHp4G4DA&ved=0CEYQ6AEwAg#v=onepage&q=free%20ANSI%20Z88.6-2006&f=false
4.4. Threshold Limit Values and Biological Exposure Indices (TLVs), American Conference of Governmental Industrial Hygienists (ACGIH), Cincinnati, Ohio.
https://www.acgih.org/
4.5. Army Regulation 40-5, Preventive Medicine 25 May 2007 http://www.armypubs.army.mil/epubs/xml_pubs/r40_5/cover.xml
4.6. Department of Defense 6055.05M, Occupational Medical Surveillance Manual 2 May 2007
http://www.dtic.mil/whs/directives/corres/pdf/605505mp.pdf
4.7. U.S. Department of Labor, Code of Federal Regulations 29 (CFR) 1910.120 (f) (5), Medical Surveillance
http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=9765#1910.120(f)(5)
4.8. Army Regulation 11-34, The Army Respiratory Protection Program 15 Feb 1990 http://www.armypubs.army.mil/epubs/xml_pubs/r11_34/cover.xml
4.8. Headquarters, Department of the Army Pamphlet (DA PAM) 40-501 Hearing Conservation 10 Dec 1998
http://www.armypubs.army.mil/epubs/pdf/r40_501.pdf
4.9. Headquarters, Department of the Army Pamphlet (DA PAM) 40-506 Vision Conservation 15 Jul 2009
http://www.armypubs.army.mil/epubs/pdf/p40_506.pdf
5. MEDICAL REPORTS AND RECORDKEEPING
5.1 Contractors shall immediately report to the Occupational Health Manager by telephone at 320-616-3175 if results of medical surveillance screening(s), which are questionable and / or of critical significance and / or require follow-up. Contractor shall send 2 copies, of 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 working days of completion of testing to:
Minnesota Army National Guard
ATTN: Andrea Turner, OHN
15000 Hwy 115 8-81
Little Falls MN 56345
And
Minnesota Army National Guard
4843 Hamline Avenue North
Arden Hills, MN 55112
One set of the 2 will be in envelopes identified with employee's name.
5.2 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).
5.3 Contractor shall ensure that each employee signs the Privacy Act Statement (DD Form 2005) during the registration process.
6. 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:
a. Tab # 1 - Classification Summary to include
i. Colum # 1 - Employee Name
ii. Colum # 2 - SSN
iii. Colum # 3 - D.O.B.
iv. Colum # 4 -Blood Pressure (B/P) N = normal, A = abnormal
v. Colum # 5 - AUDIO - N= normal, A = abnormal
vi. Colum # 6 - PFT N = normal, A = abnormal
vii. Colum # 7 - Vision N = normal, A = abnormal
viii. Colum # 8 - Chest X-Ray - N = normal, A = abnormal
ix. Colum # 9 - Urine Dip Stick (Urine) - N = normal, A = abnormal
x. Colum # 10 - Phys Exam - N = normal, A = abnormal
xi. Colum # 11 - Resp. Clear - P = Pass, TNP = Test Not Performed
xii. Colum # 12 - LAB - PSA - N = normal, A = abnormal, TNP - Test Not Performed
xiii. Colum # 13 LAB CHEM - N = normal, A = abnormal
xiv. Colum # 14 - LAB - CBC - N = normal, A = abnormal
xv. Colum # 15 LAB - Lead- N = normal, A = abnormal
xvi. Colum # 16 LAB - ZPP- N = normal, A = abnormal.
b. Tab # 2 - Fit Test Summary to include;
i. Colum # 1 - The tested Employee Name
ii. Colum # 2 - SSN
iii. Colum # 3 - D.O.B.
iv. Colum # 4 - Test Date
v. Colum # 5 - Fit Test, 3M 6100 Half Face, and Result - P = Pass, F = Fail, TNP = Test Not Performed
vi. Colum # 6 - Fit Test, 3M 6200 Half Face, and Result P = Pass, F = Fail, TNP = Test Not Performed
vii. Colum # 7 - Fit Test, 3M 6300 Half Face, and Result P = Pass, F = Fail, TNP = Test Not Performed
viii. Colum # 8 - Fit Test, 3 M 7800 Full Face, and Result P = Pass, F = Fail, TNP = Test Not Performed.
c. Tab # 3 - Employee Listing with Hearing Classifications to include;
i. Colum # 1 Employee Name
ii. Colum # 2 SSN
iii. Colum # 3 Date
iv. Colum # 4 Speech Frequencies
v. Colum # 5 - High Frequencies - Normal, Mild Hearing Loss, Moderate Hearing Loss, Moderate Severe Hearing Loss, and Profound Hearing Loss
Tab # 4 - Employee Listing with All Hearing Tests
d. Tab # 5 - Hearing Summary Report - Bar Graph indicating total numbers related to Total Number of employees tested, break outs will be;
i. total # of Males tested
ii. total # of Females tested
iii. Number of Normal Hearing
iv. Number of Mild Loss
v. Number of Moderate Loss
vi. Number of Moderate Severe Loss
vii. Number of Severe Loss
viii. Number of Profound Loss
ix. Number of Standard Threshold Shift
x. Number of OSHA Recordable Shift if any.
e. Tab # 6 - Employee Listing with Most Recent PFT -
i. Colum # 1 Employee Names
ii. Colum # 2 - Date test conducted
iii. Colum # 3 - Classification - Normal, Mild Obstructive, Borderline Obstructive, Moderate Obstructive and Significant Obstructive as the test indicates
f. Tab # 7 - Employee Listing with most Recent PFT Results -
i. Colum # 1 Employee Names
ii. Colum # 2 Date test conducted
iii. Colum # 3 - FVC
iv. Colum # 4 - FEV1
v. Colum # 5 - FEV1/FVC and other information as tested.
g. Tab # 8 Pulmonary Summary Report - Analytical Breakdown to include;
i. Total number of employees
ii. Number of Employee Tested
iii. Number with Normal Screening
iv. Number with Mild Restriction
v. Number with Moderate Restriction
vi. Number with Severe Restriction
vii. Number with Borderline Obstruction, Number with Mild Obstruction
viii. Number with Moderate Obstruction
ix. Number with Severe Obstruction
x. Number with Superimposed Restriction.
EXAMINATION SCHEDULING
7.1 Coordination of scheduling shall be a joint effort between the Occupational Health Manager/COR and the Contractor. Technicians will coordinate with the Occupational Health Manager/COR with date ranges for their physicals. Then the Occupational Health Manager/COR will coordinate with the Contractor.
7.2 In the event of Contractor equipment failure, specific testing and / or parts of examinations that are not completed during the testing period shall be completed at a scheduled time mutually convenient for the Contractor, Occupational Health Manager and the Facility (ies). Unfinished testing / examinations will be completed at no additional cost to the Government. Physicals not completed due to equipment failure shall be done at no cost to the Government. The Contractor shall be directly responsible to cover costs for completing these make-up screenings.
8. SERVICE DELIVERY SUMMARY (SDS)
The service delivery summary is designed to be a concise statement of key deliverables which are measured to determine the contractor's performance success or failure.
Objective: Medical Surveillance Examinations and Occupational Health Services to the MNARNG full-time support (FTS) and/or temporary personnel who are or could potentially be exposed to health hazards in the work environment
Deliverable
Performance Standard
Acceptable Quality Level (AQL) Method Used / Frequency
Contractor provides Licensed and/or certified staff Go/No Go • Contractor personnel to posses appropriate level of credentialing Review
Spot Check or Inspection
Customer Complaint
Procedures are conducted in accordance with applicable standards Go/No Go • All procedures are conducted in accordance with applicable ABOEM, AAOHN, OSHA, and NIOSH Standards
Soldiers are seen in a timely manner. 95% are seen within 15 minutes • Soldiers receive examination/testing within 15 minutes of schedule appointment time.
Medical Reports and Recordkeeping Completes 98% of needed paperwork • Contractor completes and submits any required paperwork within 30 days of appointment.
Government Quality Assurance Plan (QAP):
In your role as Contracting Officers Representative (COR), you assume some Quality Assurance duties. You will monitor contractor performance, complete and sign the Quality Assurance Worksheet provided below at least monthly, but you can submit the worksheet more frequently if needed. This worksheet allows you to document compliance with the Contract and fill a regulatory requirement to ensure adequate oversight is being performed.
Quality Assurance Plan Worksheets are to be sent directly to the Contracting Officer (CO), not later than the 5th day of the month following the service (every month). At a minimum, the COR must send a completed copy of the worksheet to the CO after the first month of service and for any months where there is a rating other than Green. The CO will assume a quality performance rating of "Green" on all measured deliverables unless otherwise notified.
The quality rating may change from "Green" to "Red" without notice, however we encourage the COR to utilize the "Yellow" quality rating to alert the CO of quality issues that have the potential for a "Red" quality rating if corrective action is not taken.
Any time the rating is less than Green the COR shall clearly document the worksheet to indicate what did or did not occur per the PWS requirement. When an observation indicates other than a "Green" rating, the COR will require the Contractor to initial the observation. Initialing the observation does not constitute concurrence with the observation; it only acknowledges that they have been made aware of the defective performance. If the Contractor's response to an identified quality deficiency is unsatisfactory, the Contracting Officer will contact the Contractor to implement a plan of action to remedy the identified deficiency.
The COR referred to in this QAP is: Andrea Turner, OHN (320)616-3175, andrea.k.turner3.civ@mail.mil
Rating Description
Green Yes performance and technical specifications are being met at AQL.
Yellow Yes, performance and technical specifications are currently being met at the minimum AQL, but the following service / deliverable needs contractor attention.
The Customer must identify what component of the deliverable and/or service requires attention.
Red No, performance and technical specifications are not being met at AQL and the following service / deliverable needs immediate contractor resolution.
The Customer must identify what component of the deliverable and/or service is below the minimum AQL.
RECEIVERS - DENTAL QUALITY ASSURANCE PLAN WORKSHEET
Performance Rating
Deliverable/Service Quality Rating Causative Factors Effect on Mission Action Required / Date
Contractor provides Licensed and/or certified staff Green Comments Unnecessary for "Green" QA Rating.
Yellow
Red
Procedures are conducted in accordance with applicable standards Green Comments Unnecessary for "Green" QA Rating.
Yellow
Red
Soldiers are seen in a timely manner. Green Comments Unnecessary for "Green" QA Rating.
Yellow
Red
Medical Reports and Recordkeeping Green Comments Unnecessary for "Green" QA Rating.
Yellow
Red
Signed ___________________________________ Dated ______________________________
Jacob Lozano, Phone 3206162749, Email jacob.p.lozano.mil@mail.mil
