693KA8-25-R-00014 Attachment J.9 Certification of Physical Qualification.docx
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- Solicitation number
- 693KA8-25-R-00014
About this file
Attachment J.9 is a Certification of Physical Qualifications form for Federal Aviation Administration (FAA) Security Officers, detailing specific medical and physical requirements for personnel. The document outlines comprehensive screening criteria including drug testing, physical fitness, visual acuity, and hearing capabilities, with multiple specific health standards that must be met by potential security officers.
The form requires certification of an individual's ability to perform guard duties, with specific requirements such as binocular vision correctable to 20/30, ability to hear normal conversation at 20 feet, and precise hearing thresholds across different frequencies (500-5000 Hz). The form must be completed and signed by a physician, with additional certification by a contractor representative, and is part of the solicitation 693KA8-25-R-00014 for Contract Security Officer Services in the Western Service Area, which aims to provide physical security for FAA facilities and assets.
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Text version
CERTIFICATION OF PHYSICAL QUALIFICATIONS
FEDERAL AVIATION ADMINISTRATION SECURITY OFFICERS
| EMPLOYEE NAME: | ----------------------------------- DATE OF BIRTH:---------------- | |
| ADDRESS: | CONTRACTOR: | CONTRACT NUMBER: |
| // YES // NO |
| The individual named above has submitted to drug testing and screening. The results will be sent to the Contractor via separate correspondence. |
| // YES // NO |
| The individual named above is physically fit to perform guard duties and is in good general health without any physical defects or abnormalities. |
| // YES // NO |
| The individual named above possesses binocular vision correctable to 20/30 (Snellen) and is not color blind. |
| // YES // NO |
| The individual named above has the ability to hear normal conversation at 20 feet and whispered conversation at 10 feet without the benefit of a hearing aid. |
| // YES // NO |
| The individual named above possesses hearing (corrected with a hearing aid or uncorrected) at 500, 1000, 2000, and 3000 Hertz (Hz) at a level that is less than or equal to 25 decibels. |
| // YES // NO |
| The individual named above possesses hearing (corrected by a hearing aid or uncorrected) at 4000 and 5000 Hz at a level that is less than or equal to 45 decibels. |
| // YES // NO |
| The individual named above possesses hearing (corrected with a hearing aid or uncorrected) that is not affected by an ear disorder that affects equilibrium |
| SIR No. 693KA8-25-R-00014 | Part III - List of Documents, Exhibits, and Other Attachments |
| Section J – List of Attachments |
ATTACHMENT J.9
Physician’s Typed or Printed Name
Physician’s Signature Date
License Number
Address
Phone Number
CERTIFIED BY:
Contractor’ Representative’ Signature Date
Printed or Typed Name
Phone Number
File details come from the government source that posted it. Updated .