Attachment%20G%20Medical%20Examination.pdf
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- Attached to
- Facility Protection Services - UPDATED State and local contract opportunity
- Solicitation number
- RFP 32110-22726
- Issued by
- Davidson County, Tennessee
About this file
Attachment G is a medical examination confirmation form developed by the Tennessee Peace Officer Standards and Training (POST) Commission for use by the State of Tennessee Department of General Services in evaluating Facility Protection Officer (FPO) candidates for the facility protection services contract. The form is completed by a licensed medical examiner, physician, nurse practitioner, or physician assistant and documents whether an applicant is physically fit for police officer certification pursuant to Tennessee Code Annotated Section 38-8-106. The medical examiner must evaluate the candidate and mark the form indicating either "Physically Fit" or "Not Physically Fit," with space provided to document specific reasons for any fitness determination. The completed form must be attached to the Application for Certification and submitted to the POST Commission. The pre-response conference for the facility protection services RFP is scheduled for February 26, 2026, with proposals due April 1, 2026, at 2:00 p.m. CST, and a Notice of Intent to Award expected May 11, 2026. The contract will commence January 1, 2027, with an initial thirty-six-month term and two optional twelve-month renewal periods, potentially extending to sixty months.
All FPO candidates must successfully complete a medical examination as a mandatory requirement for certification and employment under this contract. The contractor bears all costs associated with medical examinations, background checks, drug screening (including quarterly random testing of ten percent of the workforce), training, licenses, permits, equipment, uniforms, vehicles, and firearms. The medical examination requirement is part of the comprehensive training and qualification standards that all FPO personnel must meet, which include 24 hours of firearms instruction with 75 percent proficiency demonstration, 8 hours of intermediate weapons training, 4 hours of emergency medical training, 18 hours of patrol procedures, and 40 hours of annual in-service training.
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Text version
TENNESSEE
PEACE OFFICER STANDARDS AND TRAINING COMMISSION
CONFIRMATION OF MEDICAL EXAMINATION
(To be completed by a licensed medical examiner)
OFFICER:______________________________________________________SSN:____________________
AGENCY:______________________________________________________________________________
TO THE HEAD OF LAW ENFORCEMENT AGENCY
This form should be presented to the medical examiner for the purpose of police officer certification. Upon completion of physical evaluation, the examiner should sign the appropriate statement and this form should be returned to the law enforcement agency. This form should then be attached to the Application for Certification – Police Officer, and should be forwarded to the POST Commission.
TO THE MEDICAL EXAMINER
Pursuant to Tennessee Code Annotated, Section 38-8-106, applicants for police certification must have passed a physical examination by a licensed physician or a nurse practitioner or physician assistant, so long as the task is expressly included in the written protocol developed jointly by the supervising physician and the nurse practitioner or physician assistant, whichever is applicable, setting forth the range of services that may be performed by the nurse practitioner or physician assistant. Upon completion of evaluation, please sign the appropriate statement and return this document to the law enforcement agency.
CONFIRMATION STATEMENT OF ATTENDING PHYSICIAN
I have performed a medical examination and find that this officer is:
PHYSICALLY FIT – This person is physically fit within reasonable degree of medical certainty.
NOT PHYSICALLY FIT – This person is not physically fit for the following reasons:
Comment:
(Signature of Medical Examiner) (Street Address)
(Date) (Telephone) (City/State)
RDA #1494
IN-1778 10/4/13
| OFFICER: |
| SSN: |
| NOT PHYSICALLY FIT This person is not physically fit for the following reasons 1: |
| NOT PHYSICALLY FIT This person is not physically fit for the following reasons 2: |
| NOT PHYSICALLY FIT This person is not physically fit for the following reasons 3: |
| Comment 1: |
| Comment 2: |
| Street Address: |
| Date: |
| Telephone: |
| CityState: |
| AGENCY: |
| FIT: Off |
| UNFIT: Off |
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