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05. Amend 1 Medical Services PWS.pdf

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Aug. 11, 2022, 2:10 p.m.
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WAPA

DESERT SOUTHWEST REGION

PERFORMANCE WORK STATEMENT

OCCUPATIONAL MEDICAL EXAMINATION SERVICES

1. GENERAL INFORMATION

SCOPE OF WORK

The Contractor shall provide all necessary facilities, staff, materials and equipment to provide periodic occupational health
examinations, as well as exit medical examinations, and fit for duty in this Performance Work Statement (PWS), for
employees of the Western Area Power Administration, Desert Southwest Region (WAPA), located in and around Arizona and
Nevada. The scope of work is outlined in each specific exam packet that is located in Attachment B (WAPA Order 340.1).

LOCATION OF PERFORMANCE

Performance under this contract shall primarily occur at the DSW Regional Office located at 615 S. 43rd Avenue, Phoenix,
Arizona. The Contractor must also be able to provide service to employees located in the following locations Yuma, AZ;
Flagstaff, AZ; Phoenix, AZ; Casa Grande, AZ; Gilbert, AZ; Lake Havasu, AZ; Las Vegas, NV; Mesa, AZ; and Henderson, NV.

PERIOD OF PERFORMANCE

This contract shall be awarded with a base year and with four option years.

1.4 GOVERNMENT PERSONNEL

The Contracting Officer (CO) is the individual executing this contract on behalf of the Government and is responsible for the
overall administration of the contract. The CO is the only person authorized to make any changes in the prices, terms, or
other conditions of the contract.

CONTRACTOR PERSONNEL

Physicians must be qualified in occupational health and assisted by licensed nurses or physician’s assistants qualified in the
occupational field. Each Certified Medical Examiner must be licensed to practice in the state in which they reside. Staff must
include certified medical examiners listed on the National Registry of Certified Medical Examiners in accordance with Title 49,
C.F.R. §391.41-49.

INSURANCE REQUIREMENTS

The Contractor shall obtain and carry in full force during the period of this contract such permits, licenses, bonds and
insurance required by state, municipal and federal law pertaining to the scope of professional practice described herein. Proof
of insurance shall be provided to the Contracting Officer in accordance with contract clause FAR 52.237-7.

1.7 OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION REGULATIONS

The Contractor shall comply with the latest effective standards promulgated by the Department of Labor, Occupational Safety
and Health Administration, Safety and Health Standards, 29 CFR 1910 and 29 CFR 1926.

PRE-PERFORMANCE MEETING

The CO will schedule a pre-performance meeting with the Contractor and the WAPA POC, within 5 days of contract award to
discuss contract requirements.

PAYMENT

The Contractor shall submit invoices listing each employee’s examination, itemizing in detail all charges (including any tests,
lab work or other services provided by other medical entities), to the address specified in the Contract. Separate invoices
shall be submitted within 30 calendar days of the last service rendered in a month, to include all services done
in that particular month.

Invoice example:

Date of Physical

Employee Name

Charge Amount

Payments

01/01/20236

WAPA Employee

Charge
Description
Audiogram
DOT Recertification
$$

Balance Due:

All invoices will be submitted through IPP.gov

Upon receipt of invoice, and after all deliverables required (under Parts 2.3 and 3.1 of this PWS) have been completed in
accordance with this Performance Work Statement, the CO will approve payment only for those services and tests required
and authorized by the Contract. Invoices that have not met all of the deliverables required will be rejected and sent back to
the Contractor.

2. DESCRIPTION OF SERVICES TO BE PERFORMED

2.1 GENERAL

The Contractor shall provide periodic occupational health and exit examinations for WAPA employees and shall provide the
required documentation in accordance with Attachment B (WAPA Order 340.1). The occupational health examinations
shall be conducted by or under the direction of a qualified and licensed occupational health physician. The purpose of the
exam is to determine fitness for duty according to the requirements of the employee’s position. Any deficiencies must be
identified and documented, especially in connection with hearing, respiratory, lifting, and other adverse environmental
conditions and hazardous or arduous duties. The examining physician must report these deficiencies to the employee and the
WAPA POC, HR, in a written analysis (see Part 2.3 below).

PERIODIC PHYSICAL EXAMS / EXIT EXAMINATIONS

Employees being examined will provide the examining physician a medical packet containing all required forms and
information at the time of examination.

The requirements for pre-employment, annual and exit examinations are listed in (Attachment 3 of) WAPA Order 340.1.
The components of the examinations are dependent upon the employee’s position and are broken out in such a manner in
position description exam packet.

2.3 DETAILED REQUIREMENTS FOR ALL MEDICAL EXAMS

For each medical examination, the examining physician must:

a) Become familiar with the employee’s physical duty requirements.

b) Ensure medical equipment is adequate in terms of present day accepted standards of medical practice, maintained

in good working order, and properly calibrated.

c) Complete Parts B & C of the applicable OF 178, Certificate of Medical Examination (U.S. Office of

Personnel Management (Attachment 6 of WAPA Order 340.1).

d) Complete Part B of WAPA F 5400.31, Medical Examination Form (complete all parts of the position specific

exam packet).

e) Compare previous physical examination data with current results for all periodic exams. (When available WAPA will
provide a copy of prior year examination data via confidential mail if such records are not on file in physician’s
office.)

f) Review and discuss the abnormal examination results with the employee at the time of the examination.

g) Physician will obtain employee’s signature on the Medical Release Form, authorizing the physician to provide

the examination results to WAPA.

h) (This section required only for Commercial Driver Fitness Determinations) Complete the Medical Examination

Report for Commercial Driver Fitness Determination (649-F 6045) and the Medical Examiner’s
Certificate (650-FS-L2 6046), when provided in the examination packets (if necessary). These are Department of
Transportation requirements for employees who operate commercial vehicles over 26,000 pounds. Form 650-FS-
L2 and a copy of 649-F (6045) shall be returned to the employee with the written analysis described in Part 3.1
below. A copy of these forms shall be provided to the WAPA POC with the employer copy of the analysis described
below. The remaining individuals not required to obtain the aforementioned certificates (CDL) will receive a
physical exam within guidelines in Attachment B (WAPA Order 340.1).

i) Medical History: The Genetic Information Non-Discrimination Act of 2008 prohibits Western from
acquiring or using information about an employee or applicant's genetic information, including
family medical history. The Contractor, physician or physician-designee are not to inquire about an
individual's family medical history or other genetic information. If such information is disclosed to
the Contractor, the physician or the physician-designee, the information must be redacted and/or
withheld from any findings reported to W.
3.1 WRITTEN EXAMINATION ANALYSIS, TEST RESULTS AND DOCUMENTATION

REPORTING REQUIREMENTS

The examining physician shall provide a written analysis clearly describing all test results and documentation as required in
Part 2.3 (of this PWS), to the employee, at the employee’s home address when requested, within 45 calendar days of the

WAPA
Human Resources – A7200
PO BOX 281111
Lakewood, CO 80228-8111

examination. A copy of the analysis and test results shall also be sent to the attention of the WAPA POC, in the self-
addressed stamped envelope, marked confidential, that will be provided with the medical packet.

A cover letter, noting the type of exam given (e.g., annual/periodic, fitness-for-duty, or exit) and clearly describing overall
findings with emphasis on potential health concerns, hearing, CDL and respirator conditions, must accompany the results
provided to the employee and to the WAPA POC.

WAPA
Safety – G1900
PO Box 6457
Phoenix, AZ 85005

4. SCHEDULING OF TESTS

4.1 GENERAL

The WAPA POC will identify individuals who are required to receive an examination. This information will be provided to the
Contractor at the pre-performance meeting.

If the facility is unable to conduct specific tests, the Contractor shall be responsible for designating a specific testing facility
and scheduling an appointment on behalf of the employee. The Contractor shall pay for any such approved tests provided by
other medical subcontractors and bill WAPA for those tests.

If appointments are canceled/rescheduled WAPA will not incur any of the charges.

ADDITIONAL DIAGNOSTIC TESTS OR SPECIAL EXAMS

Any diagnostic test or special examination which the examining physician deems necessary, but not specifically required by
the Order or this Contract, must be approved by the WAPA POC prior to conducting such test or examination. Any tests or

services requested by the employee, which are not approved by the WAPA POC, are not authorized and are specifically
excluded from this Contract. The physician should refer the individual to their private health care provider.

Immunizations (Hepatitis B, Tetanus) [that are specially mentioned in Attachment B (WAPA Order 340.1)] are authorized
under this Contract and shall appear on t