C08.5 Attachment 4 Facility Access Letter.pdf

DEPARTMENT OF THE NAVY

PUGET SOUND NAVAL SHIPYARD

AND INTERMEDIATE MAINTENANCE FACILITY

1400 FARRAGUT AVENUE STOP 2090

BREMERTON WASHINGTON 98314-2090 IN REPLY REFER TO:

Ser 1100/012 February 14, 2022

Dear Sir or Madam:

SUBJECT: FACILITY ACCESS REQUIREMENTS

Commander, Puget Sound Naval Shipyard and Intermediate Maintenance Facility (PSNS & IMF) is implementing the Department of Defense (DoD) Coronavirus Disease 2019 (COVlD-19) Vaccination Attestation, Screening Testing, and Vaccination Verification Program. All contractors and official visitors accessing the PSNS & IMF Controlled Industrial Area (all buildings, property, and facilities); PSNS & IMF oceupied spaces at Naval Base Kitsap Bremerton, WA (including spaces in building 466, 467, 514, 900, and 943); PSNS & IMF oecupied spaces at Naval Base Everett, WA, (including spaces in buildings 2000 and 2200); North Island in San Diego, CA, PSNS & IMF Detachment (enclave and facilities); Naval Base Yokosuka, Japan PSNS & IMF Detachment (enclave and facilities) will be impacted as a result.

This notice is to provide contractors and other official visitors with PSNS & IMF area of responsibility access requirements and does not constitute a change to existing contract terms and conditions.

In order to gain physical access to PSNS & IMF buildings, facilities, or real property (including leased) in whieh official DoD business takes place, contractor personnel must attest to being fully vaccinated against COVlD-19, or attest to a negative COVlD-19 test result. Beginning February 28, 2022 it will be the contractors’ responsibility to maintain a current Contractor Personnel 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.

Contractor personnel who are not fully vaccinated against COVlD-19 must test weekly and maintain a Weekly Attestation of Negative COVlD-19 Self-Certifieation for DoD Contractors form (NAVSEA 6220/2). Negative test self-eertification results must reflect the test was administered within the last 7 days and must be shown to DoD authorized personnel upon request. Contractors who have questions about these access requirements should contact their facility access sponsor officer.

All other official visitors must attest to their vaecination status using the Contractor Personnel and Visitor Certification of Vaccination (form DD 3150). Official visitors who are not fully vaccinated must produee, or show negative results from a U.S. Food and Drug Administration-authorized or approved COVlD-19 test administered no earlier than 72 hours prior to their visit. Official visitors who have questions about these aceess requirements should contact their sponsor.

Individuals are considered fully vaccinated 2 weeks after eompleting the 2nd dose of a 2-dose vaccine or 2 weeks after receiving 1 dose of a 1-dose COVlD-19 vaccine. Individuals must be vaccinated with vaccines that are either fully lieensed or authorized for emergency use by the Food and Drug Administration. Contractor personnel or official visitors who refuse to attest to their vaccination status, or produce proof or self-certification of their negative test result will be denied access to PSNS & IMF buildings, facilities and property.

Sincerely, RM^yiFl/ Executive blrecuor By Direction ofthe Commander

Enclosures; 1. DD Form 3150 - "Contractor Personnel and Visitor Certification of Vaccination"

2. NAVSEA 6220/2 - “Weekly Attestation of Negative COVlD-19 Self-Certifieation for DoD Contractors”

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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