C08.3 Attachment 2 Facility Access Letter.pdf

Dear ir or Madam:

DEPARTMENT OF THE NAVY

PUGET SOUND NAVAL SHIPYARD

AND INTERMEDIATE MAINTENANCE FACILITY

1400 FARRAGUT AVENUE STOP 2090

BREMERTON WASHINGTON 98314-2090

UBJE T: FA ILITY A E REQUIREM T

IN REPl Y REFER TO er 1100/012 February 14, 2022 ommander, Puget ound aval hipyard and Intermediate Maintenance Facility (P & IMF) is implementing the Department of Defen e (DoD) oronavirus Disea e 2019 ( OV I D-19) Vaccination Attestation, creening Testing, and

Vaccination Verification Program. All contractors and official visitors acces ing the P IMF ontrolled Industrial Area (all buildings, property, and facilitie ); P & IMF occupied space at aval Base Kitsap Bremerton, WA (including spaces in building 466,467,514, 900, and 943); P & IMF occupied spaces at aval Ba e E erett, WA, (including pace in buildings 2000 and 2200); orth Island in an Diego, , P & IMF Detachment (enclave and facilities); a al Base Yokosuka, Japan P & IMF Detachment (encla e and facilitie ) will be impacted as a result.

This notice is to pro ide contractors and other official vi itor with P & IMF area of re pon ibility acce requirements and does not constitute a change to existing contract terms and condition .

In order to gain phy ical acce to P & IMF buildings, facilities, or real property (including leased) in which official

DoD busine s takes place, contractor per onnel mu t attest to being fully vaccinated against COVJD-19, or atte t to a negati e OVID-19 test result. Beginning February 28, 2022 it will be the contractors' responsibility to maintain a current ontractor Per onnel and Visitor Certification of Vaccination form (DD 3150). This form must be completed and shown to

DoD authorized personnel upon request regardless of vaccination status.

on tractor per onnel who are not fully vaccinated against OV ID-19 must te t weekly and maintain a Weekly Attestation ofNegative OVID-19 elf- ertification for DoD ontractors form (NAY EA 6220/2). egative test elf-certification results must reflect the test was admini tered within the last 7 days and mu t be shown to DoD authorized personnel upon reque t. ontractors who have que Lions about these access requirements should contact their facility acce s pon or officer.

II other official visitors must attest to their vaccination tatu u ing the ontractor Per onnel and Vi itor ertification of accination (form DD 3150). Official visitors who are not fully vaccinated must produce, or show negati e re ult from a U .. Food and Drug Administration-auU1orized or approved OVID-19 test administered no earlier than 72 hour prior to their visit. Official visitor who have que tions about the e acce requirements should contact their ponsor.

Individuals are considered fully vaccinated 2 weeks after completing the 2nd do e of a 2-dose vaccine or 2 weeks after receiving I dose of a I -dose COVID-19 vaccine. Individual mu t be vaccinated with accines that are either fully licen ed or authorized for emergency use by the Food and Drug Admini tration. ontractor personnel or official i itor who refu e to attest to their vaccination tatu , or produce proof or elf-certification of their negative te t result will be denied acce to P IMF buildings, facilities and property.

inc rely, Commander

Enclosures: I. DD Form 3150 - " ontractor Personnel and Visitor ertification of Vac ination"

2. AV E 6220/2 - "Weekly Atte talion of egative OVID-19 elf-Certification for DoD ontractor "

Attachment 2

DD orm ,, 150 - " 011tractor Per 01111 I and ertificati 11 of ac i11ation"

CONTRACTOR PERSONNa AND V ISITOR CERTIFICATION Of' VACCINATION

AGENCY otSCLOSURE OTIC E The pubic repatng b..-der fa this c leclJen r:l lnfamlllen Is esUmal ed to 1ver1ge 2 ln�es per response. 11\dudng the tme f relll ng lnstructlens.

se c ng exlstng dllla rces ga erlng ■nd mant&Jll'l!l the data needed and c�etng end rev-ew,ng fie coUectla, r:I n famllllon. Send ccmments reoerdng this burden estlmate o, any other aspect r:lthls cotectJen Of lnfo,matl . ncudng suggestions f redJcng • e burden. lot e Departmert r:I Defense.

Washing eadqu 1rt..-s SeN1ces, at wns mc-alex esd mbX d<ktod-ln!ol1T'8t«.ocllecttons mad m,I Respendents sho<Jd be a re mat n lhs!andng erry

,.. pr en of law no person shall b e SJ to any penalty orlai ng locomplywllh a cdledlon r:I famelion tit d nd ry a curenttyvalld B cootrot number

PRIVACY ACT STATEM�T

Autho, : DoD IS •�a-.zed lo collect the nfamallon en s tom, p..-SJant to Exec """ Order(EO) 14042. Ers nng Adequate COi/iD S..loty Protoco(s for Federal C<nracton E O 13991. Protec•ng the Federal Woncbrce and Req.,n g sk·,.. eamg; and E.O 121 Occlil)lllonal Safety ■nd e Program Federal EmptO)'ees. as well es 10 U S.C 113, 10 U.S.C . 136 10 USC 7013. 10 USC e013. 10 USC 13, 10 USC 2672. USC cha;,ter 79. and DoD Instruction 6200 03

Princip I Purpose: This lnformatm Is befng coleded to lmptemert Caooawus Osease 2019 (COVI0-19) ace s■ f ety plars lncludng DoDs COVID-19 leslilg programs !Wld o ensure e safely and proteaien orthe DoD ce woncplace !Wld ether DoO feel ti es and e ooments, cen stent tne ab011e-referenced I th Ues the CO\.10-19 'M>dcµace Safely Agency Model Safely Pnnoples e5111bl1 ed b-J the 511 r Federal 'Norl(face T as Face and gu dance tom the C ert en fo, Dis se Coot and PrevenU>n and the OcaipaU>nal Safety ■nd He th Aanlnl!tra t

Ro11ln1 Use{s): l e the informatJon eq,.iested on th s tam Is nlended lo be usedprm■nlyfo,lntemlll purposes. in cert n clraimstances l ybe necessary to dsclose this n! U exlemal'y, f exa le to dsclose nfamallon lo a person. erg za!len. o, go,.,errmenlal enUy as necessary nd relevant to notify them of. respond to or guwd agelnst a plblc healh emer cy a Clller s llar cnsls. lnc'ud1ng to c ply th laws QCMITllllO the ttponng ct comm,n,ca disease o, other s ccrcemlng hell and s■lety In fie erl"liraYnenl adjud<:IIIIVe or lldmln slrlllve bOdes o, oals wt\en the records are relevant and necesnry to an •�udrcalve a a nl trve proceedng contrad . gantees experts <X>nS�l!Jru s'.Udents and o ers as nec es ry lo perfam r dJ�es f Ille Federal rrment, agencies courts.and per s as necessary d rdevant,n eCOJrse ofl, gallon and as necessary and In accadance r wrements ror I enl cement: a to a p erson aUI onzed to aa y::,s beh ,n the ■ppllc e Syslem r:I Recads !lee (SOR assooated wth the oolectJoo or this nlonTI oo c tract persoonel and DoD III las. DPR 39 DoO. DoD Persoond .-.Cccoot b and Asses ert �• r:I Reaxds, e5 Fed Reg 17047 (Mat 26. 2020) (also av a.leb e 1! tips /fdpc,d defense gcv/Pcllals/49/ ntsJA-lvacy/SOR Ns.lOSDJStDPR-JS. DoD pcf) Consequencu of Falu, to Provide lnfo,madon: PrO\idng this ln famllloo Is vounary H ever If !al o pro,,de thlslrlorm en. ycuwil be ll!ed as not f\aly vacc.nated fa p,.rposes or ptem�ng safety meas es. nckJdlng suqecl to COV10. 1 9 screening teSIJng andA>f denied access to DoD fa,cll es Fall..-e to prov<le 5IJCh Information mrv alsohnder DoD's ablity to m ' me-.t COVI0-19 place safety plans. th..-eby ncnasng the heath or safety r skto DoD•alf aled per5-0llnel and DoO racl1les

INSTRUCTIONS: This lam shrud bet eled Dy DoO conlracta persomd and offloaJ V!Sl'as In acccrdllnce GiJldllnce . DoD civ Ian e loy s should not complete s form

1. AME(La� First /tlf>. 12. OoO 10 U BE R:

PLEASE CHECK lliEBOX BELOW lliATCOI CICES WT™ YO UR COl/10-19 VACCINATI STAnJS:

I am tJl'y vacc nated

Protec�oo lndvtciialsare ca,sJdered 'tu y v■cc.naled"l'#oweelcs er compleUngthe second dosed a tw<><lose COl/10-191111ccna0< we s a0er receMng a ngle dose ct a ooe-dose ""cone Accepted CO D-19 1111cc.nes ■re those tich have receved a I nse a emerg cyuse auth zlllon cm t US Food and Drug hlmnlstratlon and tho COVI0-19 vacclres en the orld H I Orga atlon Emergency Use Listing "Fully vacanllled" so Ind.ides crc..-nst ces In whlch the lnd1lll<11al was I pa c,pent in a US s,te cinlcal 1111 and as rec d all ended doses

7 1 am not yet fully vaccinated I recerved enty ooe dose of a1 accepted two-dose COVI0-19 vaccine or I recetved my nal dose r:I an accepted COVI0-19 vaccne less than owee sago.

:=.J I have not been vatonated

==i I declne to respond tnd'lllduals • och005e not to c <le the form be ■ss..-ned lo be not ly ""ccln ed fer purposes or ■pplcahal of I e sa ety praOCX>ls. I f ycu are rot 1111cclnaled due lo dlc:111 a rd,g cus reasons, pt ease check e er ·1 hive not been vacc na:ed· a·1 decJl'le to respood.' "lote t at ifyoo ave alreacfy receved ooe dose o I vacc , but arena yel l.lly wccnBled, o, If you ved )Ot.r final dose l ess an ow s age, then you wll be treated 1s nol fully vaccinated ootll ycu are a l lea,t two weeks past )IOUr ftnal dose and resub your vaccn lnfamat

==i I c fy t Ill the lnr011T'8ticn prwded n s lam Is accu-ale and true to the best of mJ °" edge

I unders.1nd I hat a kn ng and I false stalemerrl this f m can be punl!hed by re ord" does not con!LIUle a lse slalemenl

4. DATE

DD FORM 3150, OCT 2021 CUI (when filled in) mp,lsonment o, both (18 us C 1001) cnec ng ·1 dedrte 10

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