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STATEMENT OF WORK FOR
TURKEY BASE MAINTENANCE CONTRACT
APPENDIX H
OCCUPATIONAL HEALTH AND INDUSTRIAL
HYGIENE PROGRAM
INCIRLIK, IZMIR, ANKARA, TURKEY
31 OCTOBER 2002
REVISED 9 JANUARY 2003
Part I—Section C—Description/Specifications/Statement of Work Contract No. F61521-03-C-5400
Solicitation No. F61521-03-R-5010
TABLE OF CONTENTS
SECTION PARAGRAPH TITLE PAGE
I Description of Service
1. Program Overview 3
1.1. Release of Medical Information 3
1.2. Communication 3
1.3. Quality Improvement/Assessment 3
1.4. Occupational Health and Industrial Hygiene Program 3-4
1.5. Occupational Health and Industrial Hygiene Plan 4-5
II Service Delivery Summary 6
III Government Furnished Property and Services
3.1. Government Furnished Property 7
3.2. Government Furnished Equipment 7
3.3. Government-Furnished Material 7
3.4. Government-Furnished Services 7
IV General Information
4.1. Scope of Work 8
4.2. Contractor Personnel 8-9
4.3. Quality Control 9
4.4. Quality Assurance 9
4.5. Physical Security 9
4.6. Hours of Operation 9
4.7. Conservation of Utilities 9
4.8. Place of Performance 9
4.9. Records 9
TECHNICAL EXHIBITS
TE1 Workload Estimates 10
TE2 Required Reports 11-12
ATTACHMENT 1 – Statement of Work 2
APPENDIX H - Occupational Health and Industrial Hygiene Program
Table of Contents
Part I—Section C—Description/Specifications/Statement of Work Contract No. F61521-03-C-5400
Solicitation No. F61521-03-R-5010
SECTION I
DESCRIPTION OF SERVICE
1. PROGRAM OVERVIEW: The contractor shall provide all personnel, equipment, tools, materials, supervision,
and other items and services necessary to perform Occupational Health and Industrial Hygiene Services as defined in
this Statement of Work, except as specified in Section III, Government Furnished Property and Services at Incirlik AB,
Turkey.
1.1. RELEASE OF MEDICAL INFORMATION. The contractor shall only release medical information
obtained during the course of this contract to other medical providers involved in the care and treatment of that
individual patient.
1.2. COMMUNICATION: 39th Wing emergency response services operate on the UHF band. The contractor
shall use equipment that allows two-way communication between contractor and 39th Wing emergency response
elements, as listed in Section 3. Ensure open and professional communication with members of the Disaster Control
Group (DCG).
1.3. QUALITY IMPROVEMENT/ASSESSMENT: The contractor and 39th Wing shall assess response time to
calls and on-scene time. Certified Industrial Hygienist (CIH), Certified Associate Industrial Hygienist (CAIH), and
Occupational Safety Health Technician (OSHT) personnel shall participate in a continual process of performance
improvement in the execution of OH/IH programs.
1.4. OCCUPATIONAL HEALTH AND INDUSTRIAL HYGIENE PROGRAM. The contractor shall:
1.4.1. Develop and implement an Occupational Health and Industrial Hygiene Program in order to operate and
maintain all contractor work areas at all installations in Turkey in a manner promoting the safety and health of all
personnel. Comply with host nation, U.S. Occupational Safety and Health Administration (OSHA) regulations,
FGS-T, (chapters 5,6, 11,15, 17, 18) and general industry standards necessary for the protection of personnel, real
property, equipment and the environment.
1.4.2. Promptly report existing occupational health and safety hazards involving Air Force real property,
equipment, and the environment to the ACO and QAP. Investigate the circumstances and report findings involving
only contractor employees; take action as validated by the QAP and/or ACO to correct unsafe conditions or
hazards identified. AF Form 1118, Notice of Hazard and AF Form 979, Danger Tag, shall be used consistent with
the USAF intent and purpose of alerting personnel of potential work area hazards.
1.4.3. Perform all work in keeping with the code of ethics for the practice of industrial hygiene and the generally
accepted practices for industrial hygiene work. Ensure all submittals are clearly organized and sufficiently detailed
to allow review of work area conditions and industrial hygiene work performed through review of the submittal
documentation.
1.4.4. Within three months of contract award, review the Occupational Health and Industrial Hygiene existing
records at 39 MDOS/SGOAB, Bioenvironmental Engineering to determine which records are pertinent to the
contractor operation. Photocopy all applicable records and maintain the copies and all new records as required by
OSHA regulations and Turkish laws. Establish industrial hygiene records for all new shops created by the
contractor operation. All records generated by the contractor in the performance of these requirements are
government property to be maintained by the contractor, but turned over to the Government at the end of the
contract.
1.4.5. Recognize, evaluate, and control occupational health hazards. This includes but is not limited to hazard
monitoring (air sampling, noise dosimetry, health risk evaluation, etc.), training, respiratory protection fit testing,
designating and periodically evaluating engineering controls, conducting a confined space program, respiratory
protection program, a lockout/tag-out program, and providing personnel protective equipment. Specifically
ATTACHMENT 1 – Statement of Work 3
APPENDIX H - Occupational Health and Industrial Hygiene Program
SECTION I – Description of Services
Part I—Section C—Description/Specifications/Statement of Work Contract No. F61521-03-C-5400
Solicitation No. F61521-03-R-5010
conduct all occupational medicine, training, fit-testing, and evaluations associated with contractor’s in-house
asbestos abatement, hazardous materials spill response team, hazardous waste operations, Fire Fighting element,
food services, and lead abatement teams, civil engineering maintenance and transportation maintenance personnel,
if such functions exist.
1.4.6. Annually review potential health and safety hazards, and identify controls within each work area by visiting
the physical work area and documenting findings in the shop case file. The Industrial Hygienist shall document
and report significant findings of risk assessments at the Combined Safety Council (CSC) for notification of
abatement priority.
1.4.7. Evaluate all new hazards or changes in existing hazards and document findings in the appropriate shop file.
Hazard evaluation shall include on-site measurement as necessary to meet applicable OSHA standards and Turkish
laws. Report significant findings to the CSC.
1.4.8. The contractor is responsible for health and safety of its employees under the scope and terms of this
contract IAW AFOSH STD 91-301, sec. 9. However, to alert government employees in the proximity of
contractor operations AFOSH STD 91-301, sec. 16-18, and Atch 7, shall be followed for uniformity of hazard
identification and warning procedures. Additionally, AFOSH STD 91-202, The USAF Mishap Prevention
Program, is applicable to work safety and health programs
1.5. OCCUPATIONAL HEALTH AND INDUSTRIAL HYGIENE PLAN. Prepare an Occupational Health and
Industrial Hygiene Plan (OHIHP) describing the contractor’s overall Occupational Health and Industrial Hygiene
Program and the strategy for implementing the program, to include procedures for complying with all requirements
of the contract. (See Technical Exhibit 2, CDRL H001). The focus of the plan shall be the recognition, evaluation,
and control of occupational health hazards in the workplace. Conduct the Occupational Health and Industrial
Hygiene program according to the written OHIHP. The plan shall be reviewed annually, and updated as necessary.
1.5.1. The OHIHP is a management plan to identify all known physical, chemical, and/or biological hazards in
each shop or work area. Assess potential health and safety risks through coordination on construction projects,
design reviews, (35%, 90% and 100%) and Base Civil Engineer Work Request (AF Forms 332). The regulations
to follow include, but are not limited to, MIL-HDBK-1008C, Fire Protection for Facilities Engineering, Design,
and Construction; (secs. D and E., Policy Guidelines for Installation Planning Design, construction, and Upkeep;
(Chap 4, and Chaps 8-10); MIL-HDBK-1003/17C (Chapters 3,5,7,8 and 10); Military Industrial Ventilation
Handbook; Design of Pest Facilities (Sec. 3); ACGIH Industrial Ventilation: Manual of Recommended Practice;
MIL-STD 1472F, Human Engineering (Sec 5.8.2); the Illumination Engineering Society Lighting Handbooks, and
the American society of Heating, Refrigeration and Air-Conditioning Engineering (ASHRAE, pub 62), Ventilation
for Acceptable Indoor Air Quality shall be used as design guides for measurement criteria for ventilation, lighting
and general safety as referenced.
1.5.2. The OHIHP shall identify all required controls to protect personnel from all identified hazards. This
includes, but is not limited to, engineering controls, personnel protective equipment, and administrative controls.
Personal protective equipment will be certified for appropriateness and suitability using the ACGIH Guidelines for
the Selection of Chemical Protective Clothing; NFPA 1851-01 Selection, Care, and Maintenance of Structural Fire
Fighting Protective Ensembles; NFPA 1971-00, Standard on Protective Ensemble for Structural Fire Fighting;
NFPA 1875-99, Standard on Station/Work Uniforms for Fire and Emergency Services; NFPA 1976-00, Standard
on Protective Ensemble for Proximity Fire Fighting; NFPA 1991-00, Standard on Vapor Protective Ensembles for
HAZMAT Emergencies; NFPA 1992-00, Standard on Liquid Splash-Protective Clothing for HAZMAT
Emergencies and NFPA 1994-01, Standard on Protective Ensembles for Chemical/Biological Terrorism Incidents.
Manufacturers test data using ANSI and/or ASTM, et al, testing criteria shall be consulted to validate suitability.
1.5.3. The OHIHP shall identify all training and training frequency required to meet OSHA, general industry
standards, FGS-T, and Turkish laws applicable with identified hazards and regulations. HAZMAT response
training for Fire Fighters shall be validated using NFPA 472-02, Standard for Professional competence of
Responders to HAZMAT Incidents.
ATTACHMENT 1 – Statement of Work 4
APPENDIX H - Occupational Health and Industrial Hygiene Program
SECTION I – Description of Services
Part I—Section C—Description/Specifications/Statement of Work Contract No. F61521-03-C-5400
Solicitation No. F61521-03-R-5010
1.5.4. The OHIHP shall identify all medical exams and other occupational medicine required by OSHA, consensus
industry standards, NFPA 1581-00, Standard on Medical Requirements for Fire Fighters, NFPA 1583-00, Standard
on Health-Related fitness Programs for Fire Fighters; DOD 6055.5M, Occupational Medical Surveillance Manual,
Chapters 2 and 3, sec. 3.2.2.2 and 3.2.3.1.1, and AFJI 48-110, sec. 21.4 and Turkish laws. Biological Exposure
Indices (BEIs) from the ACGIH 7th ed., Documentation of Threshold Limit Values and BEIs and Procter &
Hughes, Chemical Hazards in the Workplace, may be consulted for differential diagnosis of occupational illness.
The plan shall spell out all projected samples required to conduct the identification and evaluation of hazards to
include routine required samples to comply with OSHA, consensus standards, and Turkish regulations.
1.5.5. OCCUPATIONAL HEALTH AND INDUSTRAL HYGIENCE PROGRAM ASSESSMENT: Prepare an
Occupational Health and Industrial Hygiene Program assessment detailing the contractor’s overall execution of
Occupational Health and Industrial Plan to reprioritize hazard surveillance activities as processes become
increasingly well-defined on a Worst-Hazard-First methodology, and support resource solicitation, i.e, monitoring
equipment purchases, new industrial ventilation systems, and/or other forms of controls including capital
investment in facilities or human resource development. The focus of the assessment shall be the accomplishment
of work area surveillance and occupation health examinations based upon the written OHIHP. Annually assess the
overall implementation of the OHIHP and report the result of this assessment to the ACO and QAP. (See Technical
Exhibit 2, CDRL H002).
1.5.6. Prepare and manage a hazard communication program per 29 CFR1910.1200. Maintain a master file
(inventory) of all hazardous materials used on site and maintain MSDS for all materials. Provide a copy of the
inventory to the government upon request. DOD 6050.5L, Hazard Materials Information System; Federal Standard
313D, Federal Standard Material Safety Data and Disposal Data for Hazardous Materials Furnished to Government
Activities; and DOD 6055.5H, Department of Defense Hazardous Chemical Warning Label System shall be used
to standardize compliance within all work area. DD Forms 2521 and 2522, Hazardous Chemical Warning Labels;
8.5”X 11” and 4.5” X 6”, respectively; shall be used to label locally procured hazardous materials and transfer
containers as necessary by the standard. Additional hazard labeling on a yellow background is required by Turkish
Government Gazette no 85/9/9727 on the entrances to facilities indicating the hazards contained within the
facilities. An explanation of AFVA 91-216, USAF Explosives and Chemical Hazard Symbols, shall also be
included.
1.5.7. Monitor, issue, use, and dispose of material for hazardous and toxic substances as defined by Federal
Standard 313D. Authorize through health/safety coordination on AF Forms 3952 for materials issued either by
hardcopy or when available, using the Environmental Management Information System (EMIS) database at the
installation IAW AFI 32-7086, Hazardous Materials Management, chapter 2, Atch 1 and Atch 2.
1.5.8. Maintain data on all radio frequency radiation (RFR) emitters consistent with Institute of Electrical and
Electronics Engineers (IEEE) C95.1-1999 and LASER emitters per ANSI Standard Z136.1-2000. Include any
hazards in the applicable shop file and OHIHP.
1.5.9. The contractor shall not bring onto nor use at the site any Nuclear Regulatory Commission (NRC)
specifically or generally licensed radioactive material without the express written approval of the ACO and the
base Radiation Safety Officer (39 MDOS/SGOAB) IAW AFI 40-201, Managing Radioactive Materials in the
USAF, sec 1.20.3. Any approval is subject to the conditions of 10 CFR. Monitor worker exposures to ionizing
radiation in accordance with Turkish Government Gazette dated 24 July 1985, No. 85/9727, if occupational
exposure is likely to exceed 500 milliRem per year (mRem/yr).
1.5.10. Perform all required occupational medical exams and industrial hygiene analytical services.
1.5.11. Maintain oversight of the compressed breathing air quality control program for Grade ‘D’ breathing air
IAW Compressed Gas Association (CGA) G-7 criteria.
ATTACHMENT 1 – Statement of Work 5
APPENDIX H - Occupational Health and Industrial Hygiene Program
SECTION I – Description of Services
Part I—Section C—Description/Specifications/Statement of Work Contract No. F61521-03-C-5400
Solicitation No. F61521-03-R-5010
SECTION II
SERVICE DELIVERY SUMMARY
Performance Objective SOW Performance Threshold
Paragraph
1. Prepare and maintain an all inclusive and current OHIH 1.5. The plan contains no (0) defects and
plan that complies with all applicable regulations, directives, is updated as required
codes, standards and Turkish laws.
2. The OHIH program implementation and execution is in 1.4. 100 % of the time
strict compliance with the written OHIH plan and promotes
maximum safety and health of all personnel.
ATTACHMENT 1 – Statement of Work 6
APPENDIX H - Occupational Health and Industrial Hygiene Program
SECTION II – Service Delivery Summary
Part I—Section C—Description/Specifications/Statement of Work Contract No. F61521-03-C-5400
Solicitation No. F61521-03-R-5010
SECTION III
GOVERNMENT FURNISHED PROPERTY AND SERVICES
3.1. GOVERNMENT-FURNISHED PROPERTY: SEE APPENDIX F.
TABLE OF GOVERNMENT-FURNISHED FACILITIES
LOCATION DESCRIPTION
Incirlik AB, Turkey Office space for OH/IH is located within Bldg. 346,
Program Management
3.2 GOVERNMENT-FURNISHED EQUIPMENT:
NSN NOMENCLATURE QUANTITY
6625-01-478-3188 Meter, Noise Level 2
6625-01-462-7721 Calibrator, Sound Level 1
6685-01-487-0540 Monitor, Heat Stress 1
7030-01-362-2769 Software, QuestSuite for Windows 1
6625 Analyzer, Octave Band 1
6630-01-479-2133 Analyzer, Gas 1
7605 Training Video Tapes 10
4240 Portacount Plus w/ N95 Companion 1
6680 Thermal Anemometer (velometer) 1
6665 DC Lite Air Pump Calibrator 1
6665 Air Sampling Pumps w/low flow regulators 2
77 Motorola Astro Handheld Transceiver 2
3.3. GOVERNMENT-FURNISHED MATERIAL. NONE
3.4 GOVERNMENT-FURNISHED SERVICES: SEE APPENDIX F.
ATTACHMENT 1 – Statement of Work 7
APPENDIX H - Occupational Health and Industrial Hygiene Program
SECTION III – Government-Furnished Property and Services
Part I—Section C—Description/Specifications/Statement of Work Contract No. F61521-03-C-5400
Solicitation No. F61521-03-R-5010
SECTION IV
GENERAL INFORMATION
4.1. SCOPE OF WORK. In addition to the description of services provided in Section I, the contractor shall comply
with the following:
4.2. CONTRACTOR PERSONNEL. SEE APPENDIX F.
The contractor shall ensure that all personnel involved in containment, handling, and cleaning up of oil or fuel spills and
other hazardous substances receive the necessary training in Hazardous Waste Operations (HAZWOPER) IAW
29CFR120.
4.2.1. Occupational Health and Industrial Hygiene (OHIH) Program Manager: a Certified Industrial Hygienist
(CIH) registered with the American Board of Industrial Hygienists (ABIH). (Mandatory AN)
Experience. A minimum of 5 years management experience in practice of industrial hygiene and occupational
safety and health. Education. Not less than a Bachelor’s degree from an accredited University in one of the
following disciplines: Engineering, Industrial Hygiene, or a related field approved by the American Board of
Industrial Hygiene (ABIH). Security Clearance. Shall have or be capable of obtaining a U.S. Secret clearance.
4.2.2. Certified Associate Industrial Hygienist (CAIH): an ABIH registered and board-certified occupational safety
and health supervisor. (Mandatory AN)
Experience: Minimum of 5 years experience in the supervision and practice of industrial hygiene, and occupational
safety and health. Education: Not less than an Associate’s degree in vocational education in industrial hygiene,
occupational safety, or engineering related field or 10 years experience in the supervision and practice of industrial
hygiene, and occupational safety and health. Security Clearance: Shall have or be capable of obtaining a US
Secret clearance.
4.2.2. Occupational Safety Health Technician:
Shall be a National Safety Council registered and certified technician. Experience: Minimum 5 years experience in
measuring, collecting, analyzing, interpreting occupational health and safety data and recommending controls to
mitigate potential work area hazards. Education: Completion of ACGIH, AIHA, NIOSH, and/or university level
coursework in fields of industrial hygiene or safety to include chemical exposure monitoring, ventilation studies,
radiation safety principles and measurement, sound physics and measurement, respiratory protection and personal
protective equipment application.
4.2.4. Clerical/Administrative Support personnel.
Experience: Minimum 5 years in MS Office software database applications. Education: Minimum TOEFL
proficiency in the English language. Security Clearance: General background, routine security check.
4.2.5. Personnel Language Requirements. Personnel language proficiency levels. SEE APPENDIX F.
Employees in the following positions must meet the English and Turkish language proficiency levels indicated
below:
ATTACHMENT 1 – Statement of Work 8
APPENDIX H - Occupational Health and Industrial Hygiene Program
SECTION IV – General Information
Part I—Section C—Description/Specifications/Statement of Work Contract No. F61521-03-C-5400
Solicitation No. F61521-03-R-5010
ENGLISH TURKISH
POSITION READ SPEAK WRITE READ SPEAK WRITE
OH/IH Program Manager 4 4 4 2 2 1
Occupational Health Safety Hygienist 4 4 4 1 1 1
Occupational Health Safety Technician 3 3 3 2 2 2
Clerical/Admin Support 3 3 3 3 3 3
4.2.6. Employee Training. SEE APPENDIX F.
4.3. QUALITY CONTROL. SEE APPENDIX F.
4.4. QUALITY ASSURANCE. SEE APPENDIX F.
4.5. PHYSICAL SECURITY. SEE APPENDIX F.
4.6. HOURS OF OPERATION: SEE APPENDIX F.
4.7. CONSERVATION OF UTILITIES. SEE APPENDIX F.
4.8. PLACE OF PERFORMANCE. SEE APPENDIX F.
4.9. RECORDS. SEE APPENDIX F.
ATTACHMENT 1 – Statement of Work 9
APPENDIX H - Occupational Health and Industrial Hygiene Program
SECTION IV – General Information
Part I—Section C—Description/Specifications/Statement of Work Contract No. F61521-03-C-5400
Solicitation No. F61521-03-R-5010
TECHNICAL EXHIBIT 1
WORKLOAD ESTIMATES
2. VARIATIONS IN WORKLOAD. SEE APPENDIX F.
2.1. WORKLOAD ESTIMATES: This Technical Exhibit contains estimated workload factors that the contractor
can be expected to experience during the performance of this contract.
Manpower estimates may be quantified based upon American Society Safety Engineers (ASSE) publication, Proper
Staffing of an Occupational Safety and Health Office.
REQUESTED PERFORMANCE WORKLOAD ESTIMATES
Visit industrial work areas 140 work areas at three geographically separate
locations to be visited annually
Schedule and conduct pre- and post occupational 70 exams per month
medical examinations for all workers
Provide list of radioactive material (RAM-ionizing) to Approx. 5 items per year
include isotope, location and POC before bringing RAM
on base
Maintain a list of hazardous materials and wastes to Approx. 2000 items per year
include quantity, location and POC
Take sound level and/or noise dosimeter readings 20 per month
Assess/perform biomonitoring on non-routine tasks for 8 per quarter
emergency responses
Perform ergonomic assessments 5 per month
Take air samples for hazardous materials 20 per month
Maintain a list of radio frequency emitters to include Approx. 132 items per year
hazard, location and POC.
Train on and maintain a list of respirators to include 150 people annually
persons name, location and fit factor
Label hazards (noise, chemical, radiation, etc.) in work 50 facilities in 140 work areas at three geographically
areas separated locations
Maintain IH/OH work area records 140 work areas at three geographically separated
locations
Maintain a list of personal exposure records Approx. 1,500 people
ATTACHMENT 1 – Statement of Work 10
APPENDIX H - Occupational Health and Industrial Hygiene Program
TECHNICAL EXHIBIT 1 – Required Reports
Part I—Section C—Description/Specifications/Statement of Work Contract No. F61521-03-C-5400
Solicitation No. F61521-03-R-5010
TECHNICAL EXHIBIT 2
REQUIRED REPORTS
SEE ATTACHED FORM 1423.
ATTACHMENT 1 – Statement of Work 11
APPENDIX H - Occupational Health and Industrial Hygiene Program
TECHNICAL EXHIBIT 1 – Required Reports
Part I—Section C—Description/Specifications/Statement of Work Contract No. F61521-03-C-5400
Solicitation No. F61521-03-R-5010
CONTRACT DATA REQUIREMENTS LIST Form Approved
OMB No. 0704-0188
The public reporting burden for this collection of information is estimated to average 220 hours per response, including the time for reviewing instructions, searching existing data sources, gatheri ng and maintaining the data needed, and completing and
reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to Department of Defense, Washington Headquarters Services,
Directorate for Information Operations and Reports (0704-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty
for failing to comply with a collection of information if it does not display a currently valid OMB control number. PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ADDRESS. Send completed from to the Government Issuing Contracting Officer
for the Contract/PR NO. listed in Block E.
A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY:
TE 2 TDP __________ TM ________ OTHER x
D. SYSTEM/ITEM E. CONTRACT/PR NO. F. CONTRACTOR
Turkey BMC
1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE 17 .PRICE GROUP
H001 Occupational Health & Industrial Hygiene Plan
5. CONTRACT REFERENCE 6. REQURING OFFICE 18. ESTIMATED
4. AUTHORITY (Data Acquisition Document No.) TOTAL PRICE
Paragraph 1.5. 39 CONS/LGCM NSP
7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION
b. COPIES
Annually See Block 16
8. APP CODE 11. AS OF DATE 13. DATE OF SUBSEQUENT Final
a. ADDRESSEE
SUBMISSION
DRAFT
See Block 16 Reg Repro
16. REMARKS ACO 1
39MDOS/SGOAB 1
Block 12: Within 90 calendar days of phase-in start
Block 13: Every 12 months after first submission
A draft plan shall be provided with the proposal 15. TOTAL 2
1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE 17 .PRICE GROUP
H002 Assessment of OH & IH Program
5. CONTRACT REFERENCE 8. REQURING OFFICE 18. ESTIMATED
4. AUTHORITY (Data Acquisition Document No.) TOTAL PRICE
Paragraph 1.5.5. NSP
7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION
b. COPIES
Annually See Block 16
8. APP CODE 11. AS OF DATE 13. DATE OF SUBSEQUENT Final
SUBMISSION
a. ADDRESSEE
DRAFT
See Block 16 Reg Repro
16. REMARKS ACO 1
39MDOS/SGOAB 1
Block 12: Within 90 calendar days of phase-in start
Block 13: Every 12 months after first submission
15. TOTAL 2
1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE 17 .PRICE GROUP
5. CONTRACT REFERENCE 8. REQURING OFFICE 18. ESTIMATED
4. AUTHORITY (Data Acquisition Document No.) TOTAL PRICE
7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION
b. COPIES
8. APP CODE 11. AS OF DATE 13. DATE OF SUBSEQUENT Final
SUBMISSION
a. ADDRESSEE
DRAFT
Reg Repro
16. REMARKS
15. TOTAL
1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE 17 .PRICE GROUP
5. CONTRACT REFERENCE 8. REQURING OFFICE 18. ESTIMATED
4. AUTHORITY (Data Acquisition Document No.) TOTAL PRICE
7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION
b. COPIES
8. APP CODE 11. AS OF DATE 13. DATE OF SUBSEQUENT Final
a. ADDRESSEE
SUBMISSION DRAFT
Reg Repro
16. REMARKS
15. TOTAL
G. PREPARED BY H. DATE I. APPROVED BY J. DATE
Maj D’Amanda 31 Oct 02 Maj D’Amanda 31 Oct 02
DD FORM 1423, AUG 96 (EG) PREVIOUS EDITION MAY BE USED
ATTACHMENT 1 – Statement of Work 12
APPENDIX H - Occupational Health and Industrial Hygiene Program
TECHNICAL EXHIBIT 1 – Required Reports
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