B08_ATTACH_4_Memo_Certification_of_Vaccination_Form.pdf

Memorandum

To:

From:

Re:

Department of the Interior Contract Holder

Contracting Officer

Certification of vaccination for contractor employees working in any Federal building or Federally controlled indoor worksite

In order to take steps to prevent the spread of COVID-19 and to protect the health and safety of all Federal employees, onsite contractors, visitors to Federal buildings or Federally controlled indoor workspaces, and other individuals interacting with the Federal workforce, employees under the subject contract who are required to work on site in Federal buildings or Federally controlled indoor worksites must:

• Complete the attached form, Certification of Vaccination, prior to entering any Federal building or Federally controlled indoor worksite;

• Maintain this form during their time on Federal premises;

• Show this form upon entry to a Federal building or Federally controlled indoor worksite, even if they have badged access to the facility;

• Show this form and/or information from a health screening to a Federal employee who is supervising or managing their work on Federal premises if asked;

• Not enter any Federal building or Federally controlled indoor worksite if they do not have a completed form, even if they have badged access to the facility. If a contractor employee arrives at a Federal building or Federally controlled indoor worksite without the completed form, they must obtain a blank form from this link and fill it out. They must not enter until they complete the form; and

• Fully comply with DOI policy regarding masking, social distancing, and testing while in the facility.

o In areas of high or substantial transmission, as defined by CDC, everyone— including fully vaccinated people—must wear a mask indoors when not alone in their office, consistent with federal requirements.

o In areas of low or moderate transmission, fully vaccinated people generally can safely participate in most activities, indoor or outdoor, without needing to wear a mask or maintain physical distance, and do not need to undertake regular testing.

o Individuals who are not fully vaccinated or those who decline to respond must:

Wear a mask regardless of the level of community transmission;

Physically distance; and Provide proof of having received a negative COVID-19 test from within the previous 3 days. Costs incurred as a result of testing shall not be reimbursed by the Government.

https://www.saferfederalworkforce.gov/downloads/CertificationVaccinationPRAv7.pdf

If a contractor employee fails to complete the signed attestation or obtain a required negative COVID-19 test, they may be denied entry to a Federal facility. The attestation form shall be completed under penalty of perjury, and a knowing and willful false statement on the form can be punished by fine or imprisonment or both (18 U.S.C. 1001) or could result in additional administrative action up to and including removal from the contract.

Contractors must disseminate this information and the Certification of Vaccination form to all employees who are working under a Department of the Interior contract. However, only those employees who will work in or visit Federal buildings or Federally controlled indoor worksites are required to complete the form. If you have any questions regarding this notification, please contact your Contracting Officer.

Attachment: Certification of Vaccination form

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