Agency Contract Checklist .docx
DOCX document 74 KB Posted
- Solicitation number
- BPM058926
- Issued by
- Washington County, Maryland
About this file
This is an Agency Contract Checklist for the Western Maryland Hospital Center (WMHC), a regional chronic/long-term care facility operated by the Maryland Department of Health. The checklist establishes mandatory documentation and verification requirements for contractors providing staffing services, specifically for a Licensed Nursing Home Administrator position requiring forty (40) service hours per week, seven days per week, between 7:00 a.m. and 8:00 p.m. EST. The contract term is approximately twelve (12) weeks, initiating on or about September 28, 2026. The position requires a minimum of ten (10) years of experience within a facility with at least fifty (50) beds. All contractor verification documentation must be submitted to WMHC's Human Resources Department no later than ten (10) days before the employee's orientation date to ensure completion of the onboarding process.
The checklist mandates comprehensive credentialing and health screening requirements for all contract employees. Required documentation includes current licensure verification, copy of driver's license, resume confirming required experience, communicable disease history, seven-year criminal background check (including sex offender database screening), recent drug screening certification, general health statement, annual tuberculosis screening (two-part skin test within twelve months or chest X-ray within five years for BCG-vaccinated individuals), Hepatitis B vaccine verification per OSHA guidelines, immunization records for measles/mumps/rubella/varicella/tDap, influenza vaccination documentation (with mandatory masking September 1 through April 30 if declined), and COVID-19 vaccination documentation. Contractors must also notify HR when contract employees discontinue employment to initiate the offboarding process.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 1021Exhibit A -Revised Scope of Work - Nursing Home Administrator.docx | DOCX document | |
| FY27-NHA Bid Page.docx | DOCX document | |
| Immunization_letter.docx | DOCX document |
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
Agency Contract Checklist Continued WMHC- NHA Documentation Checklist
Contractor’s Name: __________________________________ Orientation Dates: __________________________
Employee’s Name: __________________________________ License/certification #: ______________________
Contractors Verified Information Credentialing & Registration Verified: Date: ______________ Yes No
Current Licensure for position as required by Classification.
Copy of Driver’s License: Date Verified: ______________ Yes No
Resume: Job Title/ Date of Hire: __________________________________________________ Yes No
Must include required experience for classification you are accepting.
History of Communicable Diseases: Date Verified: _____________ Yes No
Past history of communicable diseases and/or documentation of being free of communicable diseases.
Criminal Background Check: Date Verified: ______________ Yes No
A 7-year criminal background check identifying felony and misdemeanor convictions and screens sex offender.
Database. If not provided one will be done in-house. Checks may be done periodically thereafter should conditions warrant.
Drug Screening: Date Verified: ______________ Yes No
Recent report certifying drug-free. Agency reserves the right to conduct random drug testing thereafter should.
conditions warrant.
General Health Statement: Date Verified: ______________ Yes No
Documented Statement of General Health.
Annual Employee Tuberculosis Screening: Date Last Negative TB test: _________ Yes No
Two-part tuberculosis (two part is two skin tests within 21 days) (TB) within the last 12 months certifying TB-free.
A chest X-ray in the last five (5) years can be used to verify TB status for individuals who received the BCG vaccine.
Hepatitis B Vaccine: Date Verified: _____________ Yes No
Verification of Hepatitis B vaccine per Occupational Safety and Health Administration Blood Borne Pathogen Guidelines, or documentation of refusal and reasons for the refusal must be provided.
Immunizations Records: Date Verified: ______________ Yes No
Immunization records for measles, mumps, rubella, varicella, and tDap.. A titer can be used in place of records.
Influenza Vaccination: Date of vaccs: ____________, if Declined mark “No”’: Yes No
Documentation of flu vaccine. If flu vaccine is declined, he/she will be required to wear a mask from Sept 1 - April 30 for the contract period.
COVID Vaccination: Date of vaccs: ____________, if Declined mark “No”’: Yes No
Documentation of covid vaccine. If covid vaccine is declined, documentation of refusal and reasons for the refusal must be provided.
Verification of Agency Contract Employees must be received by WMHC’s Human Resources Department no later than 10 days before the employee’s orientation date to ensure all necessary documentation has been received and to start the onboarding process.
Reminder: HR must be informed when a Agency Contract Employee discontinues employment through the contract in order to begin the offboarding process.
image1.png
File details come from the government source that posted it. Updated .