Addendum-5-25-00329-ACAC-03-27-26.pdf

March 27, 2026

Hello:

Attached, please find Addendum No. Five (5) for SEPTA RFP No. 25-00329-ACAC, Outsourced

Medical Services.

Addendum No. 5 must be acknowledged by signing the Addendum Acknowledgement Form and submitting it with your Technical Proposal.

The due date for the submission of Proposals remains unchanged as Friday, April 10, 2026 at

2:00PM.

This Addendum provides answers to the remaining questions received.

Any inquiries regarding this Addendum must be directed to Carolyn Cotton of the Procurement and Supply Chain Management Department at (215) 580-7599 or cCotton@SEPTA.org.

Thank you for your interest in SEPTA.

Sincerely, Carolyn Cotton

Carolyn Cotton Senior Contract Administrator Procurement & Supply Chain Management mailto:cCotton@SEPTA.org

Addendum No. 5, 25-00329-ACAC

Page 1 of 13 March 27, 2026

SEPTA’s RFP No. 25‐00329‐ACAC Outsourced Medical Services

This addendum to the Contract Documents is hereby part of the same and is incorporated in full as part of the Project. Proposer shall acknowledge Addendum No. 5 by completing the lines below, and returning this Addendum Acknowledgement Form with your Technical Proposal.

FIRM NAME (typed or printed) ______________________________

AUTHORIZED SIGNATURE _______________________________

TITLE _________________________________

NAME (typed or printed) ___________________________________

DATE_____________________

This Addendum includes:

A. General

The due date for the submission of Proposals remains unchanged as Friday, April 10, 2026 at 2:00PM. This Addendum provides answers to the remaining 13 questions received.

B. Remaining Questions and Answers (13)

Q1: What services are currently being performed onsite vs. offsite?

A1: Please see the chart below for details:

SERVICES Location

EAP/SAP Both X-ray (Asbestos) On-site FIT Testing/Pulmonary Function On-site Hearing Conservation On-site Health/Wellness Coaching On-site Wellness Resources Both Dietician Services Both Biohazard Waste (Pick up) On-site Vaccination Clinic On-site Lab (Clinical) Both MRO (Medical Review Officer) Off-site

Q2: Are there any special vision or dental testing requirements for law enforcement?

A2: There is a vision test required that isn’t required for other roles here. This is the depth perception test, which is tested on the same Titmus machine that’s used for our other vision testing. There are no dental requirements on the Medical Form that SEPTA Medical is required to complete. Please see the Municipal Police Officers’ Education and Training Commission Vision Examination document, at the end of this Addendum.

Page 2 of 13 March 27, 2026

Q3: What is the law enforcement physical protocol (and forms required) and what additional requirements, if any, apply to this group?

A3: The Transit Officer Physical is performed using the same new-hire medical examination form that we use for other pre-employment exams. It does require a depth perception test (as above) and an EKG. Additionally, applicants are offered hepatitis vaccinations and a PPD.

After the physical is completed, SEPTA Medical is required to complete the MPO-210 form (see attached “Police 1”) and provide it to our Police Recruitment team. Occasionally, if the vision test isn’t passed here, the MPO-211 form may be provided to the applicant to take to an optometrist or ophthalmologist (see attached). All Transit Officer applicants must undergo and pass an FTA D&A test. Please see the Municipal Police Officers’ Education and Training Commission Physical Examination document, at the end of this Addendum.

Q4: Please provide the total number of jobs and job classifications, as well as the surveillance categories required for each position as there was reference to “other general medical surveillance programs” in the RFP.

A4: Regarding jobs and job classifications: there are approximately 9,500 SEPTA employees with 6,300 being safety sensitive. No further breakdown of job classification is available at this time.

In reference to the surveillance categories per FTA Guidelines:

• Vision and hearing standards

• Cardiovascular health

• Neurological conditions

• Sleep disorder screening (e.g., sleep apnea)

• Medication review for impairment risk

• Medical evaluations to determine respirator fitness

• Periodic follow-ups depending on exposure or health changes

• Baseline audiograms

• Annual audiometric testing

• Monitoring for standard threshold shifts

• Initial and periodic medical exams

• Exposure-specific testing (e.g., blood tests for lead if applicable)

• Hepatitis B vaccination assessments

• Follow-up after exposure incidents

• Prolonged sitting

• Repetitive motion

• Fatigue screening

• Sleep disorder evaluation

• Hours-of-service monitoring

• Supported by FTA fatigue-risk research

Q5a: Regarding Staff absorption, please clarify under what circumstances would absorption be required?

A5a: SEPTA is unable to provide clarification at this time.

Page 3 of 13 March 27, 2026

Q5b: Is absorption mandatory or optional?

A5b: SEPTA is unable to provide clarification at this time.

Q5c: What is the maximum number of staff?

A5c: SEPTA is unable to provide clarification at this time.

Q5d: What are the applicable roles and job descriptions?

A5d: SEPTA is unable to provide clarification at this time.

Q5e: What are the qualifications, licensure and union credentials?

A5e: SEPTA is unable to provide clarification at this time.

Q5f: What is the employment status and compensation expectations?

A5f: SEPTA is unable to provide clarification at this time.

Q5g: What is the cost treatment and caps?

A5g: SEPTA is unable to provide clarification at this time.

Q5h: What is the timing, transitions and knowledge transfer?

A5h: SEPTA is unable to provide clarification at this time.

Q5i: What is the liability, indemnification and pre-existing claims?

A5i: SEPTA is unable to provide clarification at this time.

Q5j: Whether each absorption requires written approval and a change order?

A5j: SEPTA is unable to provide clarification at this time.

Q6: How many locations are involved?

A6: Wellness Coaching is offered at SEPTA’s Fern Rock, Suburban Station, Midvale, Frankford, 69th Street and Victory Locations.

Q7: With respect to Attachment 2, Scope of Services, Bullet 7:The provision states that, The

Facility(s) shall not subcontract any part of SEPTA's laboratory-based drug testing. All such testing shall be performed on the facility/laboratory's own premises. Is the correct interpretation that the same company collecting specimens must also be the HHS-certified laboratory performing the analysis? As there are only two HHS-Certified laboratories in Pennsylvania?

A7: The company collecting the specimen does not perform the analysis on the specimen. The collection site and the HHS-certified laboratory are 2 separate sites.

Q8: Alternatively, may analysis be performed at a separate location, provided it is conducted by the same company?

A8: Analysis by the laboratory can be performed at different locations as long as it is done by the same company.

Q9: Or may collections be performed by PA code 24-7 compliant collection sites, with analysis

Page 4 of 13 March 27, 2026 performed by an HHS-Certified laboratory through proper chain of custody?

A9: The 24-7 compliant collection site must be within an hour of the employee's location.

Analysis must be performed by an HHS-certified laboratory with proper chain of custody.

Q10: The RFP details several currently contracted services supporting SEPTA employees. For those services, who are the incumbent vendors and does SEPTA want interfaces for data exchange between vendor systems (if available) and the new EMR? If so, which specific vendors/services would SEPTA require interfaces? Would those interfaces be unidirectional or bidirectional?

A10: The incumbent vendor list is proprietary information. SEPTA prefers the data exchange, if available. Unidirectional with input coming from incumbent vendors into new EMR.

Q11: Notwithstanding anything to the contrary, Contractor/Consultant or its applicable subcontractor shall be the sole owner of the software that is used by or on behalf of Contractor/Consultant in the provision of the services under the Contract (“Supplier Software”), which expressly includes any software referenced or made available via a Scope of Work, including all updates, modifications, derivative works, documentation, and other information related thereto as well as all related intellectual property rights (including trade secrets, copyrights, trademarks, services marks, and patents), whether any of the preceding items are created pursuant to a Statement of Work or as an additional service or otherwise and regardless of whether the preceding items are patented or patentable or copyrighted or copyrightable. SEPTA acknowledges that it has no rights with respect to the Supplier Software or any related intellectual property other than the rights of access and use provided under an executed Statement of Work. SEPTA shall not have any ownership rights in any configuration or customization performed by Contractor/Consultant at the request of SEPTA unless such ownership rights are explicitly set forth in a Statement of Work, and SEPTA hereby explicitly disclaims any ownership interest in the Supplier Software. SEPTA shall not take any action to jeopardize, limit, or interfere in any manner with the Contractor/Consultant’s ownership of the Supplier Software. Further, SEPTA shall not and shall not grant permission to third parties to (a) directly or indirectly copy, modify, reverse engineer, disassemble, decompile, create derivative works, or otherwise attempt to discover the source code, object code or underlying structure of the Supplier Software; or (b) use the Supplier Software to store or transmit any infringing, libelous, obscene, or otherwise unlawful or tortious material, or to store or transmit any material or data in violation of a third party’s privacy or intellectual property rights. Any access rights to the Supplier Software directly by any end user may be subject to Terms of Use. In the event of a conflict between the Terms of Use and this Contract, the terms of this Contract shall control. SEPTA further agrees not to remove from any Supplier Software any copyright and proprietary information notices or otherwise circumvent or attempt to circumvent any technological or other protective measures for controlling access to Supplier Software, and that any such removal or circumvention shall be deemed a violation under 17 U.S.C. Sec. 1201 et seq. subject to all prescribed remedies and penalties thereunder.

In the event that the Supplier Software may be delivered to a federal government end user or for ultimate federal government use, or should the Federal Acquisition Regulations apply: Contractor/Consultant provides the Supplier Software solely in accordance with the

Page 5 of 13 March 27, 2026 following: Government technical data and software rights related to the Services include only those rights customarily provided to the public as specified in this Agreement. This customary commercial license is provided in accordance with FAR 12.211 (Technical Data) and FAR 12.212 (Software) and DFAR 227.7202-3 (Rights in Commercial Computer Software or Computer Software Documentation). If a government agency has a need for rights not granted under these terms, it must negotiate with Contractor/Consultant to determine if there are acceptable terms for granting those rights, and a mutually acceptable written addendum specifically granting those rights must be included in any applicable agreement.

A11: Denied.

Q12: 13. Data to Become Property of SEPTA Intellectual Property and Ownership of Work

Products

13.1 SEPTA and Contractor/Consultant shall each retain ownership of, and all right, title and interest in and to, their respective, pre-existing intellectual property, and no license therein, whether express or implied, is granted by this Contact or as a result of the services performed hereunder. To the extent the parties wish to grant to the other rights or interests in pre-existing intellectual property, separate license agreements on mutually acceptable terms will be executed.

13.2 Contractor/Consultant grants to SEPTA a royalty free, paid up, worldwide, perpetual, non-exclusive, non-transferable license to use any Intellectual Property incorporated in any deliverable item listed in the Contract, solely for SEPTA’s internal business purposes and for the purpose as defined in the Contract. Contractor/Consultant shall retain ownership of and unrestricted right to use any Intellectual Property. The services performed and any deliverable items produced pursuant to this Contract are not “works for hire.”

13.3 Nothing in this Contract shall prevent Contractor/Consultant from utilizing any Intellectual Property acquired or developed during the performance of this Contract, on behalf of itself and its future clients. Contractor/Consultant may perform the same or similar services for others, provided that any Client confidential, proprietary or trade secret information is treated in accordance with Section 12.

13.4 As used herein, “Intellectual Property” shall mean inventions (whether or not patentable), works of authorship, trade secrets, techniques, know how, ideas, concepts, algorithms, and other intellectual property incorporated in any deliverable and first created or developed by Contractor/Consultant in providing the services.

All data, notes and other works developed in the performance of the Contract shall become the sole property of SEPTA and may be used on any other Project without additional compensation to Contractor/Consultant. Contractor/Consultant agrees not to assert or authorize others to assert any rights nor establish any claim under the design patent or copyright laws. Contractor/Consultant, for a period of three years after completion of the Project, agrees to furnish all retained works on the request of SEPTA's Project Representative. Unless otherwise provided in the Contract, Contractor/Consultant shall have the right to retain copies of all works beyond such period.

A12: Denied.

Page 6 of 13 March 27, 2026

Q13: 16. Subcontracting

a. Subcontracting Restricted Beyond those subcontractors/subconsultants proposed identified within the Proposal by the Contractor/Consultant and made part of the Contract and/or is recruited/contracted after execution to perform services within the Contractor/Consultant’s Provider Network, Contractor/Consultant shall not subcontract any portion of the services which are the subject of the Contract without the prior written consent of SEPTA.

Contractor/Consultant agrees to be fully liable and responsible for the acts and omissions of subcontractors and subconsultants just as Contractor/Consultant is for the acts and omissions of persons employed by Contractor/Consultant.

b. Award of Subcontracts and Other Contracts for Portion of the Work

(1) Any new, additional, or substituted subcontractor/subconsultant proposed by

Consultant after the award, excluding those identified in Section 16.A shall be subject to the prior written approval of SEPTA's Project Representative.

(2) Consultant shall not make any substitution of any subcontractor/ subconsultant or for any person or organization that has been previously accepted by SEPTA as part of the Contract unless and until requested to do so by SEPTA and/or unless such substitution is expressly approved by SEPTA in writing. No increase in total contract price shall be allowed for any such substitution.

c. Subconsultant/Subcontractor Relations The Contractor/Consultant shall deal with each Subcontractor/Subconsultant in accordance with the terms and conditions of a written Contract between the Contractor/Consultant and such Subcontractor/Subconsultant. Said written Contract shall not be inconsistent with any term or condition of the Contract, shall include all terms and conditions required by the Contract and shall in every respect protect SEPTA's interests in the Work and the conduct thereof.

In the absence of good and sufficient reasons, within twenty (20) business days of the receipt of payment from SEPTA by the Contractor/Consultant, the Contractor/Consultant shall pay each Subcontractor/Subconsultant with whom it has contracted their earned share of the payment the Contractor/Consultant received. In addition, Contractor/Consultant shall pay its Subconsultant(s)/Subcontractor(s) any retainage Contractor/Consultant has withheld from its Subconsultant(s)/Subcontractor(s) within twenty (20) business days after a Subconsultant’s/Subcontractor’s work is satisfactorily completed.

With regard to any claim or dispute with respect to payment of a subconsultant or subcontractor, or supplier at any tier, Contractor/Consultant expressly agrees to defend, indemnify and hold SEPTA harmless in the event any suit is brought on account of a dispute between any of the parties including but not limited to subconsultants, subcontractors, suppliers and materialmen and in particular, Contractor/Consultant shall assume the defense affirmatively at its sole cost whenever such suit is brought in any jurisdiction.

The Contractor shall notify SEPTA of any current or prospective legal matters that may

Page 7 of 13 March 27, 2026 affect the Federal Government, including but not limited to fraud, waste, and abuse.

When apprised, SEPTA shall promptly notify FTA Chief Counsel and FTA Counsel for Region 3. Contractor shall include an equivalent notification clause in its Third- Party Agreements and shall require each Third-Party Participant to include an equivalent notification clause in its sub-agreements, so that such third-party legal notice requirement will be binding on parties at every tier in all agreements deemed a “covered transaction” according to 2 C.F.R. §§180.220 and 1200.220.

A13: Accepted (A&B) Denied (C).

Page 8 of 13 March 27, 2026

ATTACHMENTS

MPO-211 (3/2018)

MUNICIPAL POLICE OFFICERS’ EDUCATION AND TRAINING COMMISSION

8002 Bretz Drive Harrisburg, Pennsylvania 17112-9748 http://www.psp.pa.gov/MPOETC

VISION EXAMINATION

This form is to be used by both municipal police officer applicants and police academy cadet applicants.

THIS EXAMINATION MUST BE ADMINISTERED by a licensed optometrist or ophthalmologist who is licensed in Pennsylvania. This examination is to determine the physical fitness, specifically related to specific vision standards, of the applicant to be certified as a police officer in Pennsylvania. The applicant who you are about to examine is applying for certification and will be vested with a position of public trust.

LAST NAME FIRST NAME MIDDLE INITIAL

STREET ADDRESS CITY/BORO STATE ZIP CODE

SOCIAL SECURITY NUMBER DATE OF BIRTH GENDER DATE OF EXAM

VISION: The applicant must have vision of at least 20/70, uncorrected, in the stronger eye, correctable to 20/20; and at least 20/200, uncorrected, in the weaker eye, correctable to at least 20/40; have normal depth perception and color vision, and must be free of any significant visual abnormality.

RIGHT EYE UNCORRECTED 20/_____ LEFT EYE UNCORRECTED 20/_____

CORRECTED 20/_____ CORRECTED 20/_____

Does the applicant have normal depth perception? (Stereopsis >48% or Arc Seconds <100) YES NO

Does the applicant have normal color perception? (Farnsworth or Ishihara) YES NO

Is the applicant free from any other significant visual abnormalities? YES NO

THE APPLICANT SHOULD BE MARKED “CAPABLE” IN THE BLOCK BELOW ONLY IF VISION MEETS ALL STATED REQUIREMENTS

PROFESSIONAL OPINION

PHYSICALLY CAPABLE (VISION) - I have examined the applicant, and it is my professional opinion that the person named above meets the vision standards which are described above and required to perform the duties a certified police officer in Pennsylvania.

PHYSICALLY UNFIT (VISION) - I have examined the applicant, and it is my professional opinion that the person named above does not meet the vision standards which are described above and required to perform the duties a certified police officer in Pennsylvania.

I hereby certify that the information and statements contained in the tables above and in the attached examination report are true and correct, and that I am signing this document with the full understanding that any false information or statement will subject me to criminal penalties of Title 18, Crimes code, Section 4904, relating to unsworn falsification to authorities.

This examination form must be forwarded to the employing police department, certified Act 120 police academy, or MPOETC by the optometrist or ophthalmologist within 15 days of the date of examination, even if the applicant is found physically unfit, pursuant to 37 Pa. Code § 21.11(4)(iv).

SIGNATURE – PENNSYLVANIA LICENSED OPTOMETRIST/OPHTHALMOLOGIST DATE

OPTOMETRIST/OPHTHALMOLOGIST NAME (PRINTED) LICENSE NO. TELEPHONE NO.

STREET ADDRESS CITY/BORO STATE ZIP CODE

RELEASE OF PHYSICAL INFORMATION

Having applied for certification/training as a police officer in Pennsylvania and having subjected myself to a vision examination by a licensed optometrist or ophthalmologist, as required by the Act, I reserve the right to have the data and conclusions of the physician remain confidential except to those whom I designate. Accordingly, I hereby authorize the optometrist or ophthalmologist named above to release all information related to my vision examination to the Municipal Police Officer’s Education and Training Commission (MPOETC) AND to any additional police departments and/or academies listed below, for purposes consistent with the application process pursuant to this Act. No other release of this information, explicit or implied, is granted at this time.

NAME OF MUNICIPAL POLICE DEPARTMENT AND/OR CERTIFIED ACT 120 ACADEMY (Print)

ADDRESS CITY STATE ZIP CODE FAX EMAIL

SIGNATURE – APPLICANT DATE

http://www.psp.pa.gov/MPOETC

MPO-210 (6/2023) SUPERCEDES ALL PREVIOUS VERSIONS OF THE MUNICIPAL POLICE OFFICER PHYSICAL EXAMINATION FORM.

MUNICIPAL POLICE OFFICERS’ EDUCATION AND TRAINING COMMISSION

8002 Bretz Drive

Harrisburg, Pennsylvania 17112-9748 http://www.psp.pa.gov/MPOETC

PHYSICAL EXAMINATION

This form is to be used by both municipal police officer applicants and police academy cadet applicants.

NOTICE AND INSTRUCTIONS TO EXAMINING PHYSICIAN

THIS EXAMINATION MUST BE ADMINISTERED BY A LICENSED PHYSICIAN, PHYSICIAN’S ASSISTANT, OR CERTIFIED NURSE PRACTITIONER

WHO IS LICENSED IN PENNSYLVANIA. THE APPLICANT IS APPLYING FOR TRAINING OR CERTIFICATION AS A POLICE OFFICER IN PENNSYLVANIA AND WILL BE EXPECTED TO BE PHYSICALLY CAPABLE OF PERFORMING THE VARIOUS TASKS ASSOCIATED WITH THIS

PROFESSION. MORE INFORMATION ABOUT THE SPECIFIC JOB TASKS IS CONTAINED ON THE BACK OF THIS FORM.

LAST NAME FIRST NAME MIDDLE INITIAL

STREET ADDRESS CITY/BORO STATE ZIP CODE

SOCIAL SECURITY NUMBER DATE OF BIRTH BIOLOGICAL SEX GENDER IDENTITY (IF DIFFERENT) DATE OF EXAM

OVERALL FITNESS

A. Is the applicant’s physical condition such that they can reasonably be expected to withstand significant cardiovascular stress required to perform the essential functions of a police officer or safely participate in required training? YES NO

B. Is the applicant free from debilitating conditions such as tremor, incoordination, convulsion, fainting episodes, or other neurological conditions which would limit their ability to perform the essential functions of a police officer or safely participate in required training? YES NO

C. Is the applicant free from any other significant physical limitations or disability which would, in the physician’s opinion, impair their ability to perform the essential functions of a police officer or safely participate in required training? YES NO

D. Is the applicant free from the use of medications which would impair their ability to perform the essential functions of a police officer or safely participate in required training? YES NO

E. Does the applicant have all extremities, including digits, required to perform the essential functions of a police officer or safely participate in required training? YES NO

THE APPLICANT SHOULD BE MARKED “CAPABLE” ON THE BACK OF THE FORM ONLY IF ALL QUESTIONS ABOVE ARE MARKED “YES” DRUG SCREEENING: The applicant must be free from the excessive, addictive, or illegal use of controlled substances as determined using a five-panel drug screen. The results of the drug screen must be attached to this form and reviewed by the examining practitioner who may provide comments related to any positive results. The detection of illegal or unprescribed controlled substances renders the applicant “UNFIT” to participate in training or be employed as a police officer.

DATE TESTED _________________________________ TEST RESULTS ATTACHED YES NO

THE APPLICANT SHOULD BE MARKED “CAPABLE” ON THE BACK OF THE FORM ONLY IF SUPPORTED BY THE RESULTS OF THE DRUG SCREEN HEARING: The applicant must be able to distinguish a normal whisper at 15 feet. The test shall be independently conducted for each ear, with the tested ear facing away from the speaker and the other ear firmly covered with the palm of the hand. If the applicant fails the whisper test, they must take and pass a decibel audio test using an audiometer with an average loss not to exceed 25 or more decibels at the 500Hz, 1000Hz, 2000Hz, and 3000Hz levels in either ear, with no single frequency loss in excess of 40 decibels. The applicant is prohibited from using a hearing aid during the testing.

RIGHT EAR NORMAL LEFT EAR NORMAL

ABNORMAL ABNORMAL

THE APPLICANT SHOULD BE MARKED “CAPABLE” ON THE BACK OF THE FORM ONLY IF HEARING IS NORMAL IN BOTH EARS VISION: The applicant must have vision of at least 20/70, uncorrected, in the stronger eye, correctable to 20/20; and at least 20/200, uncorrected, in the weaker eye, correctable to at least 20/40; have normal depth perception, normal color vision, and must be free of any significant visual abnormality. If this section is not completed during the physical, a separate vision exam must be completed using a Form MPO-211 (Vision Examination).

RIGHT EYE UNCORRECTED 20/_____ LEFT EYE UNCORRECTED 20/_____

CORRECTED 20/_____ CORRECTED 20/_____

Does the applicant have normal depth perception? (Stereopsis >48% or Arc Seconds <100) YES NO

Does the applicant have normal color perception? (Farnsworth or Ishihara) YES NO

Is the applicant free from any other significant visual abnormalities? YES NO

THE APPLICANT SHOULD BE MARKED “CAPABLE” ON THE BACK OF THE FORM ONLY IF VISION MEETS ALL STATED REQUIREMENTS http://www.psp.pa.gov/MPOETC

REMARKS

PROFESSIONAL OPINION

PHYSICALLY CAPABLE - I have examined the applicant, and it is my professional opinion that this person is PHYSICALLY CAPABLE of performing the duties a certified police officer in Pennsylvania, including but not limited to:

• Standing, walking, and sitting for extended periods of time and while carrying assigned and/or required equipment.

• Participating in firearms training, responding to active shooter situations, and firing a weapon in defense of self and others.

• Operating an emergency law enforcement vehicle during daylight and at night, including at high speeds in congested areas.

• Physically struggling with and subduing individuals who are resisting or actively attacking, including after being hit or kicked.

• Maintaining concentration and making decisions regarding the appropriate use of force in noisy and high-stress situations.

PHYSICALLY UNFIT - I have examined the applicant, and it is my professional opinion that this person is currently PHYSICALLY UNFIT to perform the duties of a certified police officer in Pennsylvania. If this option is selected, a copy of the completed form must be forwarded to the Municipal Police Officers’ Education and Training Commission by email (mpocertification@pa.gov) or fax (717-346-7782).

I hereby certify that the information and statements contained in the tables above and in the attached examination report are true and correct, and that I am signing this document with the full understanding that any false information or statement will subject me to criminal penalties of Title 18, Crimes code, Section 4904, relating to unsworn falsification to authorities.

SIGNATURE – PENNSYLVANIA LICENSED EXAMINING PHYSICIAN/PA/CNP DATE

PHYSICIAN PRINTED NAME LICENSE NO. TELEPHONE NO.

STREET ADDRESS CITY/BORO STATE ZIP CODE

RELEASE OF PHYSICAL INFORMATION

Having applied for certification/training as a police officer in Pennsylvania and having subjected myself to a physical examination by a licensed physician, as required by the Act, I reserve the right to have the data and conclusions of the physician remain confidential except to those whom I designate. Accordingly, I hereby authorize the physician named above to release all information related to my physical examination to the Municipal Police Officers' Education and Training Commission (MPOETC) AND to any additional police departments and/or academies listed below, for purposes consistent with the application process pursuant to this Act. No other release of this information, explicit or implied, is granted at this time.

NAME OF MUNICIPAL POLICE DEPARTMENT AND/OR CERTIFIED ACT 120 ACADEMY (Print)

ADDRESS CITY STATE ZIP CODE FAX EMAIL

SIGNATURE – APPLICANT DATE

mailto:mpocertification@pa.gov

© MPOETC 2023 Page 1 of 2

POLICE OFFICER

ESSENTIAL JOB FUNCTIONS

1. Effect an arrest, forcibly if necessary, using handcuffs and other restraints; subdue resisting suspects using maneuvers and weapons and resort to the use of hands and feet and other approved weapons in self-defense.

2. Prepare and write investigative and other reports, including sketches, using appropriate grammar, symbols and mathematical computations.

3. Exercise independent judgment in determining when there is reasonable suspicion to detain, when probable cause exists to search and arrest and when force may be used and to what degree.

4. Operate a law enforcement vehicle during both the day and night; in emergency situations involving speeds in excess of posted limits, in congested traffic and in hazardous road conditions caused by factors such as fog, smoke, rain, ice and snow.

5. Communicate effectively and coherently over law enforcement radio channels while initiating and responding to radio communications, while operating a vehicle or communications desk.

6. Gather and interpret information in various investigations which may include interviewing and obtaining the statements of victims, witnesses, suspects and confidential informers.

7. Pursue fleeing suspects on foot and perform rescue operations which may involve quickly entering and exiting law enforcement vehicles; lifting, carrying and dragging heavy objects; climbing over and pulling up oneself over obstacles; jumping down from elevated surfaces; climbing through openings; jumping over obstacles, ditches and streams; crawling in confined areas; balancing on uneven or narrow surfaces and using body force to gain entrance through barriers.

8. Load, unload, aim and fire using each hand from a variety of body positions handguns, shotguns and other agency firearms under conditions of stress that justify the use of deadly force and at levels of proficiency prescribed in certification standards.

9. Perform searches of people, vehicles, buildings and large outdoor areas which may involve feeling and detecting objects, walking for long periods of time, detaining people and stopping suspicious vehicles and persons.

© MPOETC 2023 Page 2 of 2

Essential Job Functions (Cont.)

10. Conduct visual and audio surveillance for extended periods of time.

11. Engage in law enforcement patrol functions that include such things as working rotating shifts, walking on foot patrol and making physical checks of cars, homes, buildings, etc.

12. Effectively communicate with people, including juveniles, by giving information and directions, mediating disputes and advising of rights and processes.

13. Demonstrate effective communication skills and use proper demeanor in court and other formal settings.

14. Detect and collect evidence and substances which provide the basis of criminal offenses or infractions; and/or indicate the presence of dangerous conditions.

15. Endure verbal and mental abuse when confronted with the hostile views and opinions of suspects and other people encountered in an antagonistic environment.

16. Perform rescue functions at accidents, emergencies, civil disorders and disasters to include directing traffic for long periods of time, administering emergency medical aid, extinguishing small fires, lifting, dragging and carrying people away from dangerous situations and securing and evacuating people from particular areas.

17. Process (photograph, fingerprint) and transport arrested suspects, prisoners and committed mental patients using handcuffs and other appropriate restraints.

18. Put on and operate emergency equipment such as fire extinguisher, helmet, gas mask, etc. in situations as required.

19. Read and comprehend legal and non-legal documents, including the preparation and processing of such documents as citations, affidavits and warrants.