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Q -- Firefighter Physicals

Notice Date
Notice Type
Solicitation Notice
621999 — All Other Miscellaneous Ambulatory Health Care Services
Contracting Office
Department of the Air Force, Air Force Reserve Command, 94 CONF/LGC, 1538 Atlantic Ave, Dobbins ARB, GA, 30069-4824
ZIP Code
Solicitation Number
Response Due
Archive Date
PERFORMANCE WORK STATEMENT FOR CIVILIAN HEALTH EXAMINATIONS AND MEDICAL REVIEW OFFICER PROCEDURES DOBBINS AIR RESERVE BASE. GA 12 JULY 2005 1.0 SCOPE: The contractor shall furnish all personnel, equipment, materials, and facilities necessary to perform health examinations for civilian employees of Dobbins ARB, GA. The frequency, scope and applicability of occupational health examinations will be determined by the Dobbins ARB Aeromedical Council and documented on one of the following forms: AF Form 2766, Clinical Occupational Health Requirements, . SF 88, Report of Medical Examination (Dobbins ARB overprinted version), SF 513, Medical Consultation Sheet, SF 93, Report of Medical History, or AF Form 895, Annual Medical Certification. 2.0 Explanation of Terms- As used throughout this work statement, the following terms shall have the meaning set forth below: 2.1 Occupational Health (OH) Examinations- Pre-placement, baseline, special purpose periodic, termination and fitness-for-duty examinations that are determined by the Dobbins ARB Aeromedical Council and federal directives. Examinations are to be performed to assess the health status of individuals as it relates to their workplace. 2.2 Pre-placement or Baseline Examinations-Specific test and examinations accomplished to establish and document baseline data for future use in the evaluation of potential exposures and to determine if the employee is at risk from potential occupational health hazards from the workplace. 2.3 Special Purpose Periodic Examinations- Specific test and physical examinations that are accomplished at intervals to evaluate and document the health of employees. 2.4 Termination Examinations-Specific tests and examinations that are accomplished to establish and document the health of employees at termination of employment. 2.5 Fitness-for-Duty Examination- Examinations conducted to assess and provide a determination concerning the employee's fitness for efficient performance of their assigned duties. 2.6 Medical Review Officer (MRO)- A licensed physician with knowledge of substance abuse disorders and the appropriate medical training to interpret and evaluate all positive test results together with an individual's medical history and any other relevant biomedical information. 2.7 Occupational Health Examination Program Monitor- Representative(s) of the Bioenvironmental Engineering/Military Public Health Services (BES/MPH) office and 94 ASTS POC whom will serve as the principal technical contacts with the occupational health examination contractor. The BES/MPH and ASTS will ensure the effective operation of the OH examination program by providing clarification of policies, procedures, and instructions to the contractor. The BES/MPH program monitor is not authorized to make changes in the contract or PWS. 3.0 PERSONNEL: 3.1 The contractor shall ensure that medical services are performed by a licensed physician who has graduated from an accredited medical school and has completed a residency program approved by the Council on Medical Education and Hospitals, American Medical Association, and be board certified in either Occupational Medicine or Preventive Medicine by the American Board of Preventive Medicine or Osteopathic Council of Preventive Medicine. The provider must possess a valid current license to practice medicine in Georgia. 3.2 The Medical Review Officer shall be a licensed physician who has graduated from an accredited medical school and possesses a degree of Doctor of Medicine. The MRO shall possess a valid current license to practice medicine in Georgia. The MRO must have knowledge of substance abuse disorders and appropriate medical training to interpret and evaluate positive drug test results together with an individual' s medical history and other relevant biomedical information. 3.3 Audiograms will be administered by 94 ASTS personnel who are certified by DOD Occupational Hearing Laboratory. Test results will be hand delivered by members via DD Form 2215 or DD Form 2216 for certification by physician. 3.4 Validation of Qualification, Licensor, and Certification (as applicable) The contractor shall provide written verification (and where necessary, photocopies) showing licensor, board certification, hospital affiliation, and furnish a report of health examinations to the contracting officer within 21 calendar days of any changes and prior to performing any services on this contract. Review by the Civilian Personnel Officer and 94 ASTS POC or their designees prior to change in contract personnel is required under this contract. 3.5 Contractor Health Requirements-All contractor employees (includes subcontractors) performing services shall receive a complete physical examination prior to the commencement of work. No later than five calendar days after contract award, the contractor shall provide the contracting officer with a certification that all employees performing work under the contract have had a complete physical examination within the last 30 days. The certification shall state the date of which the physical examination was completed, the name and telephone number of the doctor who performed the examination, and the statement concerning the physical health of the contractors' employee. The certification will also contain the following statement: "(Name of contractor's employee) is not suffering from a communicable disease to include but is not limited to HIV Pos (AIDS), tuberculosis, hepatitis and sexually transmissible diseases." Contractor employees with a communicable disease after contract award must provide written documentation of treatment and non-communicability prior to returning to work under this contract. Employees performing services under this contract shall be required to undergo further physical examinations and provide the certification of good health described above upon the determination by the contracting officer that such action is necessary in the interest of the Government. The expense for all physical examinations required under these provisions shall be borne by the contractor. 3.6 The contracting officer is the only person authorized to make changes in the contract or PWS. 4.0 Requirements: 4.1 All service shall be performed at the contractor's facility .The contractor's facility must be located within a radius of 15 miles of Dobbins ARB, GA. 4.2 Contractor shall conduct all physical examination between the hours of 7:30 a.m. and 4:15 p.m., Monday through Friday. All Federal holidays are excluded. 4.3 All health examinations (excluding fitness for duty) and tests (pre-placement or baseline, periodic and termination) shall be performed in accordance with requirements which have been established and approved by the Dobbins Air Reserve Base Aeromedical Council and documented on AF Form 2766, SF 513 and SF 88 in accordance with applicable AF directives. Physical examination techniques must comply or be equal to the examination requirements prescribed by AFI 48-123. 4.3.1 The contractor shall provide the 94 ASTS a copy of any standard or guidelines used to interpret laboratory test results except drug testing. 4.3.2 Health examinations shall be conducted within 14 calendar days after the request from the Government POC. 4.3.3 The contractor shall determine if the government employee meets existing physical requirements and medical standards. NOTE: When non-occupational medical problems are identified, the patient will be informed of the abnormality and advised to seek proper medical care (private physician). If a non-occupational abnormality is remedial (e.g., otosclerosis) or is likely to be temporary (e.g., external otitis), but may interfere with the ability of the person to wear personnel protective equipment (PPE) such as hearing protection and/or respiratory protection, or perform their job, etc., appropriate temporary duty restrictions shall be recommended. The physical determination as to whether the employee meets physical requirements and medical standards shall be documented on AF Form 2770 by the contractor. 4.3.4 Estimated number of specific tests and approximate number of test are reflected in the extended line item description. . 4.3.5 Pre-placement physical examinations shall be performed within five (5) working days after receipt of verbal request for appointment from a staff member of the Civilian Personnel Office/DPCE. 4.3.6 Examination requirements which include a pulmonary function test (PFT) will include a forced vital capacity (FVC) and forced expiratory volume (FEY} The equipment must be of an approved type, as recommended by the American Thoracic Society, and be properly calibrated. Persons, other than licensed physicians, who administer the PFT shall have completed a training course in spirometry sponsored by an appropriate academic or professional institution and be supervised by a physician. The professional medical staff shall evaluate and make appropriate recommendations based on findings and indicate whether an employee is physically able to perform their work while wearing the prescribed respiratory protection. 4.4 The contractor shall have government employees that are identified for asbestos physical complete a DD Form 2493-1 and DD Form 2493-2 on their history of workplace exposure. After completion, the form must be placed in the employee's medical record. The DD Form 2393-1 provides an initial history and is not required for any subsequent incidents of asbestos exposure. 4.4.1 All chest x-rays required in connection with potential asbestos exposure physicals shall be interpreted and classified only by a B-reader, a board eligible/certified radiologists or an experienced physician with known expertise in pneumoconiosis. All interpreters, whenever interpreting chest roentgenograms made under Appendix E to CFR Title 29, Part 1910, Section 1001 shall have immediately available for reference a complete set of the ILO-U/C International Classification of Radiographs for Pneumoconiosis, 1980. Contractor will contact 94ASTS/POC (678-655-4995) if x-ray films show abnormal findings suggestive of asbestosis, Mesothelioma or other disease associated with asbestos exposure (i.e.lung cancer). 4.4.2 The contractor's written opinion for asbestos physicals shall conform to the requirements of Title 29, Part 1910, Section 1001 of the Code of Federal Regulation. 4.5 After coordination with the Dobbins ARB, 94th ASTS POC, the contractor staff shall administer any additional tests as deemed necessary by the attending physician to discern the employees occupational health disposition and to resolve questions about test validity and/or other occupationally related medical conditions present which prevent a final disposition. 4.6 The contractor shall be responsible for conducting Hearing Conservation Occupational Examinations (audiograms and clinical examinations) and completing the required forms in accordance with AFOSH STD 161-20, Hearing Conservation Program. 4.6.1 Hearing Occupational Conservation Examination (Audiogram): Reference pre-placement, annual, periodic, termination and follow-up. Audiograms shall be conducted on personnel as required by AF Form 2766, SF 88 or SF 513. 4.6.2 Hearing Occupational Physical Examination (clinical): A clinical examination of the ears, nose and throat will be performed by the examining practitioner on all employees getting a reference audiogram check, those with a Standard Threshold Shift (STS), those required to be examined based on history and those undergoing a fitness and risk evaluation (AF Form 1753- Section 1 ). During the examination the practitioner must note: ( 1) Cerumen plugging the ear canals. (2) Otitis extema. (3) Condition of the tympanic membranes. (4) Any middle ear disease. (5) Eustachian tube function. (6) Any other ENT disease or condition, which might adversely affect the audiogram results. (7) Any condition that may interfere with the wearing of hearing protection (permanently or temporarily). 4.6.3 Using the criteria found in AFOSH 161-20, the contractor shall determine whether an STS has occurred and notify the 94 ASTS/POC by completing the AF Form 2770, Assessment and Disposition Record. Telephone notification (678) 655-4259 is required for personnel who: have less than a H-l profile on their pre-placement (reference) audiogram, have a STS after the 15- and 40-hour noise-free follow-up audiogram. All telephone notification with 94 ASTS/POC must be followed up a written notification (AF Form 2770) within 5 working days. The completed AF Form 2770 will serve as written notification of audiogram results and follow-up requirements; however, this does not preclude the contractor from providing other written patient disposition when warranted to describe the patient's medical disposition. 4.6.4 The contractor shall instruct any person who is found to have STS on their annual audiogram to report to Bioenvironmental Engineering Office (BES) prior to returning to work. The contractor shall notify the ASTS at (678) 655-4259, of all STS the same day they are identified. The patient will be restricted from working around hazardous noise until ASTS or BES has released them. 4.7 Fitness-for-Duty Physicals (FDP)- The FDP is scheduled by the Employee Relations Specialist from the Civilian Personnel Office/DPCE and the requirements for the physical will be listed on SF 513. Generally the physical shall be accomplished within 5 (five) working days. In cases where there is a question about physical fitness for duty and the Government has an immediate need to determine whether to remove the employee from the duty area, the physical shall be accomplished on the same duty day as requested. The physician shall call the supervisor not later than (NLT) the morning of the next workday to provide diagnosis. SF 513 will be mailed to: 94th ASTS/SGA 1175 Fourth St, Bldg 550, Dobbins ARB, GA 30069-4506 4.8 Final Assessment and Disposition: A medical doctor shall review all examination results, histories and make a final determination if the individual is at increased risk due to his/her health from the occupational exposures to which he/she is potentially exposed. AF Form 2755 that details each employee's potential occupational exposure is found in the employee's medical folder. All assessment and dispositions shall be documented on AF Form 2770 and accompanying documentation provided by the Civilian Personnel Office/DPCE, (SF 513). 4.9 The contractor shall verify physical examination findings through verification of the original tests or additional testing as prescribed by the attending contract physician, after telephone coordination with the 94th ASTS/POC in the annual physicals, or the Civilian Personnel Office, in the case of pre-employment or fitness-for-duty physical. The case shall be pursued until it can be conclusively determined as an individual is/is not at an increased risk of health impairment from occupational exposure or is/is not physically able to perform their job. 4.10 An individual may be recommended for temporary removal from his/her work area or recommended limitations from specific working conditions or exposures until the specific nature of their medical condition can be determined through verification or additional testing. The contractor shall verbally notify the DPCE Representative immediately at 421-5036, but no later than one workday after the determination that limiting condition exists or that removal from the work area is recommended. Written notification will be provided via AF Form 2770 or SF 513, in the case of a fitness-for-duty physical. 4.11 The Medical Review Officer shall provide services review for the results of approximately 15 drug tests per quarter. Specimen will be routinely tested for cannibalis and cocaine and may also be tested for amphetamines, opiates, and phencyclidine when appropriate. The MRO shall provide services as follows: 4.11.1 Upon receipt of a positive test, contractor shall make an appointment through the individual's supervisor if possible or employee to discuss test results with the individual to provide the specimen to determine if there was an alternate valid medical records or other medical documentation made available by the employee to support the assertion of legitimate drug use. Verification can be made without interview if the employee declines the opportunity for an interview. 4.11.2 Conduct a limited physical examination to determine if there is clinical evidence (e.g. needle track marks) of illegal drug use in cases where a urine specimen is positive. 4.11.3 Make determination of a negative test results if a legal use of an appropriate drug is established or if the MRO concludes the result is scientifically insufficient or not in accordance with the Department of Human Services guidelines. MRO has the option of requesting a retest of the positive urine sample by the laboratory. 4.11.4 Prior to obtaining any information from the employee/applicant concerning an explanation for a positive drug test result, provide the individual a copy of the Privacy Act Statement. 4.11.5 MRO shall provide testimony in case of 3rd party hearing. Testimony shall be required to provide evidence of procedures followed and events that occurred in regard to verification of positive test. a. The name, address, and phone number of the management official empowered to recommend or take administrative action for referral of employees with MRO verified positive drug results. 4.12 The contractor shall maintain all records pertaining to its drug-testing program in an approved system of records, and in accordance with the requirements of the Privacy Act in accordance with Employee Medical File System, FPM 292-31, S6-1/7. 4.13 All contractor consultation with government laboratory toxicologists and collection site contractors shall be at the expense of the contractor. 4.14 Relationship of Parties- It is expressly agreed and understood that the services rendered by the contractor and its employees are rendered in the capacity of an independent contractor. Although the government may evaluate the quality of both professional and administrative services for purposes of contract inspection and acceptance, it retains no control over the services rendered, including, but not limited to professional judgments, diagnosis, or specific treatments. The contractor shall be solely responsible for any and all liability caused by the acts or commissions of its agents or employees. 4.15 Indemnification- The contractor expressly agrees to indemnity, hold harmless, and defend the government of the United States and all of its employees and agents acting officially or otherwise, from any and all liability, claims, demands, actions, debts, and attorney fees arising out of, claimed on account of, or in any manner predicated on loss or damage to the property of the injuries to, or death of any person whatsoever, which may occur as a result of or in connection with the services being provided under this contract. 4.16 Reserved. 5.0 DELIVERABLE 5.1 The contractor shall provide to the 94th ASTS a copy of any standard or guidelines used to interpret laboratory test results. 5.1 Contract physicians shall complete required forms and documentation in accordance with the corresponding attached Air Force regulations, directives and policies. 5.2 NOTIFICATION: The contractor shall follow the notification requirements listed below: EXAMINATION RESULTS TO METHOD NLT: Pre-placement 94 ASTS/SGA *Mail Within 5 work (678-655-4259) days after exam completion Annual 94 ASTS/SGA *Mail Within 5 work days after exam Fitness for Duty 94 ASTS/SGA *Mail Within 5 work (678-655-4259) days after exam completion. Termination 94 ASTS/SGA *Mail Within 5 work days after exam completion * All physical examination results that medically disqualify employees and/or abnormal laboratory results must be telephoned to the responsible office immediately after receipt. Telephone notification is not normally necessary for normal examination results; however, it must be provided if requested by ASTS/POC and or the Dobbins Civilian Personnel Office. ** All examination results will be reported on AF Form 2770 (with attachments as necessary) and distributed. Exception- Fitness for Duty physicals results will be reported on SF 513) ORIGINAL: File in the employee's medical folder (Mail to 94 ASTS/SGA if the examination is not completed during the employees' appointment.) Copy 1: 94 ASTS, 1175 4th St, Bldg 550, Ste 201, Dobbins ARB, GA. 30069-4506. Copy 2: GIVE TO THE EMPLOYEE (Must mail to employee if examinations are not completed during the appointment). Must not be sent to employee's supervisor. Must be sent to employee in sealed envelope marked "TO BE OPENED BY ADDRESSEE ONLY ." Copy 3: Mail to employee's supervisor. 5.5 The contractor shall provide the 94th ASTS office with a monthly list of all personnel tested. Included in the list shall be the identification of the tests administered and date and cost of each test. The list shall be compiled on a monthly basis and shall be received by the 94th ASTS not later than the fifth calendar day after the end of the month. 5.6 The contractor shall annotate the monthly examination roster as follows: "Completed" and the date completed, if the individual meets their exam appointment; "NO-show" and date and reason, if any, if the individual fails to meet or schedule their appointment. 5.7 The contractor shall send or fax (678-655-4255) the annotated monthly examination roster to 94 ASTS by the 25th day of the action month. 5.8 All required forms (except employee, SGPB) and supervisory copy of AF Form 2770) and transcription of examination results completed during the occupational health examination shall be filed in the employee's medical folder. The folder shall be sealed and returned to the employee to return to the Civilian Personnel Office/DCPS. All required forms and transcription not completed during the employee's appointment shall be completed within two working days after results are known by the contractor and forwarded by the contractor in a sealed envelope to 94th ASTS 5.9 The contractor medical personnel shall provide technical review of all examination data to ensure the highest level of quality control and accuracy of the completed occupational health examination data. In addition, the contractors' physician, nurse or technician shall sign the AF Form 2770 as having provided medical review. The copies of completed forms shall be sent to 94 ASTS/SGA. 5.10 The government will provide revisions to forms on an as required basis. Referenced Documents 1. Privacy Act Statement 2. Air Force Instruction (AFI) 48-123, 3. Air Force Occupational Safety and Health (AFOSH) Standard 161-20, Hearing Conservation Program 4. DoD Occupational Hearing 5. FPM 292-31, S6-1/7, Employee Medical File System 6. 29 Code of Federal Regulations (CFR), Part 1910, Section 1001 7. Standard Form (SF) 88, Report of Medical Examination, Dobbins ARB (overprint) 8. SF 93, Report of Medical History 9. SF 513, Medical Consultation Sheet 10. Dept. of Defense (DD) Form 2493-1, Asbestos Exposure, Part 2- Initial Medical Questionnaire 11. DD Form 2493-2, Asbestos Exposure, Part 2 -Periodic Medical Questionnaire 12. Air Force (AF) 895, Annual Medical Certification 13. AF Form 1753, Hearing Conservation Examination 14. AF Form 2770, Assessment and Disposition Record 16. AF Form 2766, Clinical Occupational Health Requirements
Place of Performance
Address: 94 AW, Dobbins ARB, Georgia
Zip Code: 30069-4824
Country: United States
SN00887099-W 20050908/050906211936 (fbodaily.com)
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