CSO_Program_Physical_and_Medical_Standards.pdf

DJM-17-A32-RFI-MED-0001

CSO Program Physical and Medical Standards

C.9 PHYSICAL AND MEDICAL STANDARDS

C.9.1

When recruiting or considering applicants to perform under this contract, the Contractor shall ensure that the individual can withstand the physical demands of the position. All individuals performing in a CSO position shall be physically fit and be able to meet all of the physical and performance requirements of this contract.

C.9.1.1 Physical Demands The duties and responsibilities of a CSO require frequent and prolonged walking, standing, running, sitting, and stooping without assistance. In addition, a CSO is required to subdue violent or potentially violent people. Physical stamina in all of its forms (e.g., mental, climatic) is a basic requirement of this position. Therefore, “light duty” post assignments are not available under this contract.

C.9.1.2 Physical Fitness The Contractor shall encourage its employees working as CSOs to maintain a fitness program. Staying physically fit shall help the individuals performing as CSOs endure the stress generally associated with the performance demands of this contract and prepare them to respond to emergencies.

C.9.1.3 The medical condition of the CSO workforce is critical to the overall safety of the Judiciary. As such, the medical examination process is part of the overall clearance process. To ensure that each CSO is medically qualified to perform all CSO duties, each prospective CSO shall undergo a medical examination and meet all of the medical standards stated in this contract. Thereafter, each CSO shall undergo and pass a biennial examination during the life of the contract for qualification purposes. The Contractor shall ensure that each CSO undergo and pass a subsequent biennial examination to occur during their birth month.

C.9.1.4

The Government reserves the right to require a CSO to undergo a medical examination whenever such actions are necessary to ensure the safety and security of the Judiciary.

The medical clearance shall be determined based upon the results of each required medical examination. Therefore, a CSO can be determined unsuitable to perform under this contract at any time for medical reasons.

C.9.1.5

Each CSO, including CSO applicants, shall meet the medical standards outlined below.

Failure to meet any one of the required medical and/or physical qualifications shall disqualify an individual from performing as a CSO under this contract. The Contractor shall not allow any individual to perform under this contract until the individual’s qualification status has been determined by the Federal Occupational Health (FOH) and a written approval has been granted by the Chief, OCS.

C.9.1.6 Contractor entitlement of costs incurred in the conduct of individual CSO medical examinations shall be expressly limited to basic examination costs and shall not apply to any follow-up consultation resulting from the Government’s review.

C.9.1.7 The Government will not reimburse nor shall the Contractor bill for any overtime hours associated with medical examinations.

C.9.2 Selecting and Qualifying Physicians C.9.2.1

The Contractor shall establish and maintain a list of licensed physicians to perform and document medical examinations for all CSOs on behalf of their company. The Contractor shall designate licensed physicians for each city in a given District where CSOs are assigned. Medical examinations shall only be performed by designated physicians.

C.9.2.2

Designated examining physicians shall possess a current State medical license and a board certification to practice in their field of expertise in the United States or a United States territory. The designated examining physician shall possess and use medical equipment and supplies that are essential for conducting a complete and comprehensive occupational health medical examination.

C.9.2.3 To qualify a physician as a designated CSO medical examination physician, the Contractor shall maintain on file a detailed resume of the physician’s credentials and employment history and written certification that the credentials of the respective physician have been verified for accuracy and authenticated by accrediting agencies, medical schools, residency training programs, licensing boards, and other data sources.

In addition, the Contractor shall maintain on file, an annual written certification that each designated examining physician continues to be licensed by the State Board of Medical Examiners to practice in their field of expertise.

C.9.2.4

All required physicians records shall remain on file with the Contractor during the entire contract period, in accordance with the requirements stipulated in the contract. See Section C.25.4 Records and Section F Deliverables or Performance.

C.9.2.5

The USMS reserves the right to disqualify physicians from providing services under this contract, at any time, if: (1) their license has been suspended or revoked by a licensing board; (2) they have been convicted of a Federal crime; or (3) their performance is considered unsatisfactory by the Government.

C.9.3 Medical Examination Process

C.9.3.1 The Contractor shall require all CSOs and each CSO applicant to complete a comprehensive medical form CSO-229 Certification of Medical Examination for Court Security Officers Attachment J.2(H) and undergo a medical examination by a designated examining physician.

• CSO Applicant Packages – The completed CSO-229, including all supporting medical information, should be included in the Applicant Package and uploaded to the Contractor’s provided folder on the Justice Enterprise File Sharing (JEFS) Network.

• CSO Biennial Medical Packages – The completed CSO-229, including all supporting medical information, should be uploaded to the Contractor’s respective folder on the Justice Enterprise File Sharing (JEFS) Network. If significant medical conditions are noted by the examining physician which could preclude the incumbent CSO from performing all the essential job functions and the Contractor has not removed the CSO from duty, the CSO-229 can be scanned/emailed to the CSO Medical Mailbox cso.medical.mailbox@usdoj.gov for priority review by FOH. In the event that the Contractor has removed the CSO from performing CSO duties based on concerns noted by the examining physician, the Contractor must submit the CSO-229 to the CSO Medical Mailbox with either a CSO-012 Request to Reevaluate Court Security Officer’s Medical Qualification Attachment J.2(K) or a detailed medical report completed by the CSO’s treating physician for priority review by FOH.

C.9.3.2 The Contractor shall require the examining physician to record the CSOs (both applicants and incumbents) medical results on the CSO-229 when the examination is being administered and sign the form after completion of the examination. All positively checked history items must be accompanied by a detailed description of all positive and pertinent negative examination findings related to that item. All ancillary medical reports, tests, or any other information submitted by the CSO/applicant for review during his examination must be included in the CSO-229 packages for review by FOH. All corrections made by the examining physician or examining facility staff member must be done by drawing a single line through the information which is being corrected and initialing the corrections. The use of white out or correction tape on the CSO-229 is strictly prohibited. The information stated on the CSO-229, including any required additional information (e.g., print-outs or reports of lab data, electrocardiogram, vision and hearing test records, a summary of the applicant’s treatment plan, etc.) shall be legible, truthful, complete and precise, in order for FOH to render a sound medical determination. In addition, to ensure the integrity and privacy of the medical examination, the Contractor shall require the examining physician/clinic to return the results of the medical examination directly to the Contractor in a sealed envelope. All mailto:cso.medical.mailbox@usdoj.gov incumbent CSO-229 examinations shall be submitted by the Contractor to USMS within 60 days of the examination date.

C.9.3.3 Upon receipt of the CSO-229, the FOH will review the form for completeness. If the CSO-229 is considered complete, the CSO-229 will be evaluated to render a qualification determination. If the CSO-229 is not considered complete or acceptable (due to missing, incomplete, or illegible information) FOH will initially notify the contractor by email. If the missing or incomplete information is not received from the Contractor within 3 days of the FOH email, the Reviewing Medical Officer (RMO) will issue a Medical Review Form (MRF) stating that the CSO-229 is incomplete and cannot be reviewed until the missing/incomplete information is received. Common reasons why the CSO-229 cannot be reviewed include but are not limited to:

• The medical findings are illegible.

• Requested and necessary information was not provided.

• The medical findings or documentation are incomplete, conflicting or questionable.

• Necessary and complete additional information was not included with the submission.

C.9.3.4

Incomplete CSO-229s will delay the process of qualifying an individual and thus impact the Contractor’s performance and ability to supply the required security coverage. For that reason, the Contractor shall establish and enforce quality assurance procedures to minimize such delays. All corrections regarding missing, incomplete or illegible information shall be submitted to FOH within 30 days of notification.

C.9.3.5 After the CSO-229 passes the initial review by FOH, the form is reviewed for a medical qualification determination. The USMS will receive a medical review record directly from FOH documenting their findings. If the FOH initial review can determine, based on the information contained in the CSO-229, that the individual is clearly medically qualified or disqualified, the USMS will inform the Contractor in writing.

C.9.3.6 If, for any reason, the FOH is unable to make a final medical determination or it is necessary to clarify or prove that a disqualifying condition has been corrected or eliminated, the FOH will issue a “deferred” determination and request additional information from the Contractor. In such cases, the Contractor shall require the CSO to submit specific supplemental information within 60 days, unless otherwise specified by FOH or USMS, for completion of a specific test, in order to medically qualify. Failure by the CSO or applicant to submit the requested information within these time frames may result in disqualification for noncompliance.

C.9.3.7 In the event all of the requested information is not received by the USMS within the 60-day time frame, or as required for the completion of a specific test, the individual may be disqualified to perform under this contract. If the Contractor submits the required information to the USMS within the 60-day time frame, FOH will review the necessary information for an evaluation and medical qualification determination. After reviewing all of the medical documentation, FOH will determine whether the individual meets the medical standards as outlined in this contract. FOH will notify the Government of their findings and the USMS will then notify the Contractor in writing of the final determination. In the event that FOH determines that the CSO/applicant has been noncompliant with the previous request for medical information (i.e. complete information was not submitted), the CSO/applicant may be disqualified to perform under this contract.

C.9.3.8 The CSO applicant may be removed from further consideration when a final medical determination cannot be rendered for any reason within 180 days of the initial applicant package submission to USMS.

C.9.3.9

The Government will reimburse the Contractor the medical amount identified in the start-up cost only one time for the initial examination. The Government will not reimburse the Contractor or pay for any additional medical exams, follow-ups, specific tests, and re-examinations required to qualify an applicant to begin work.

C.9.4 Biennial Medical Examinations and Other Medical Examination Requirements

C.9.4.1 After the CSO successfully completes the initial applicant examination and qualification process, the Contractor shall require the CSO to complete and pass a biennial medical examination to occur every two years during their birth month. No more than 30 months may elapse between the examination date of the initial applicant examination and the month in which the first incumbent biennial medical examination is due.

• CSOs with an even birth year are to complete and pass medical examination during even calendar years.

• CSOs with an odd birth year are to complete and pass medical examination during odd calendar years.

If an incumbent CSO is not performing under the contract during their birth month for any reason, the missed biennial examination must be scheduled within 30 days, and must be completed and submitted within 60 days of the CSO’s return to contract performance.

If the CSO fails to complete and pass the biennial examination, the CSO shall be rendered disqualified and the Contractor shall prohibit the individual from performing under this contract. The requirements and procedures outlined in Section

C.9.3 Medical Examination Process shall be followed for the biennial medical examination process.

C.9.4.2

A CSO is required to report to the Contractor any new medical diagnosis, new medication and or change in existing medical condition. When, at any time, the Contractor observes, suspects or is notified that a CSO’s medical or physical condition impedes the security of the Judiciary or the duties required of a CSO, the Contractor shall immediately, on a temporary or permanent basis, remove the individual from performing under this contract. In addition, the Contractor shall require the CSO to undergo a medical examination separate from and outside of the biennial medical requirement.

Failure of the Contractor to take action shall be considered poor performance and may result in Government action. Additionally, the Government reserves the right to direct the CSO to undergo a medical examination outside of the biennial medical requirement.

Medical examinations other than the biennial medical requirement shall be administered at no additional cost to the Government.

C.9.4.3 When the Contractor is notified that a CSO is unable to perform under this contract due to an injury, illness, inpatient or outpatient surgery/procedure, hospitalization or emergency room visits, or extended medical reasons, the Contractor shall complete and submit CSO-001, within two (2) business days after being informed of the situation.

C.9.4.4 The Contractor shall prohibit a CSO from performing under this contract until a re-examination of the individual’s medical condition has been administered. The Contractor and the individual’s treating physician shall complete all applicable areas of the CSO-012 at the time the treating physician determines the CSO capable of returning to full and unrestricted duty. The results of the examination will be submitted on a CSO-012 for review by the FOH no later than fourteen (14) calendar days after the date the treating physician determines the CSO capable of returning to full and unrestricted duty.

C.9.4.5 Once completed, the Contractor shall submit the completed CSO-012 form to the USMS CSO Medical Mailbox cso.medical.mailbox@usdoj.gov for an official medical clearance review by FOH. The CSO-012 shall be reviewed for completeness and a final medical qualification determination. If the form submitted is incomplete or the information is deficient, the FOH will consider the form unacceptable and issue a Medical Review Form (MRF) advising the Contractor of the additional medical information required to render a final medical determination. In such cases that additional medical information is required, the FOH will determine whether the CSO can resume CSO duties pending review of requested medical information.

mailto:cso.medical.mailbox@usdoj.gov

C.9.4.6 When the FOH review can determine, based on the information contained in the CSO- 012, that the individual is clearly medically qualified or disqualified, the USMS will notify the Contractor in writing.

C.9.5 Medical Standards

C.9.5.1 Vision

Corrected distant visual acuity required is 20/30, or better, as measured with both eyes viewing (binocular). Complete loss of vision in one eye is disqualifying. Corrected distant visual acuity required is 20/125, or better, in the worst eye. Corrected near vision of 20/40, or better, as measured with both eyes viewing (binocular) is required. Ability to distinguish basic colors, as well as shades of color, is required; color vision testing at the time of the CSO-229 medical examination must be performed using the Ishihara 14 plate test. Further testing utilizing the Farnsworth D-15 test may be required.

C.9.5.1.1 Peripheral Vision Testing Documentation of testing of Peripheral Vision, both temporal and nasal perimeter scores for each eye is required. Contractor shall provide vision machine testing results documented on testing form for review by the FOH. An example is the Titmus 2s Vision Screening Record.

C.9.5.2 Hearing

The applicant or incumbent CSO shall be able to hear well enough to safely and efficiently carry out the essential requirements of the CSO position. This includes the ability to adequately comprehend speech during face-to face conversations; comprehend speech during telephone conversations; comprehend speech during radio transmissions;

comprehend speech when the individual cannot see another CSO; hear sounds that require investigation; and determine the source and location of sounds. In order to measure an individual’s ability to perform these essential job functions, the following test procedures are administered.

C.9.5.2.1 Hearing Testing Initially, all individuals shall be tested UNAIDED using an audiometer for measurement, testing each ear separately under headphones. The equipment and test setting shall meet the standards of the American National Standards Institute (see the Code of Federal Regulation Title 29 C.F.R. § 1910.95 Occupational noise exposure). Auditory acuity in each ear may be demonstrated by documentation of pure tone air conduction hearing thresholds, as specified below:

• In the frequency range from 500 - 2000 hertz (Hz), the pure tone audiometric deficit shall not exceed 30 decibels (dB) in either ear, without the use of hearing aids.

• At 3000 Hz, the pure tone audiometric deficit shall not exceed 40 dB in either ear, without the use of hearing aids.

• At 4000 Hz, the pure tone audiometric deficit shall not exceed 50 dB in either ear, without the use of hearing aids.

Contractor shall provide audiogram tape printout of audiometry results for review by the

FOH.

C.9.5.2.2 Evaluation of Hearing Test Results

C.9.5.2.2.1

If the performance on the above UNAIDED pure tone audiogram meets the standards set forth above in Section C.9.5.2.1 and the individual does not wear a hearing aid in either ear, no further assessment is needed and the individual is deemed medically qualified under the hearing standard.

C.9.5.2.2.2 If the performance on the above UNAIDED pure tone audiogram does not meet the standards set forth above in Section C.9.5.2.1 and the individual does not wear a hearing aid in either ear, or the CSO meets the UNAIDED pure tone standard set forth in Section C.9.5.1 but there is a history or evidence of reduced hearing capability, the individual must undergo UNAIDED functional hearing assessments, as described below in Section C.9.5.2.3. Based on the results of those functional hearing assessments and the recommendations of the reviewing physician, a determination of whether the individual is medically qualified with regard to hearing will be made as follows:

• If the performance on the UNAIDED functional hearing assessments is acceptable, no further assessment is needed and the individual is deemed medically qualified under the hearing standard.

• If the performance on the UNAIDED functional hearing assessment is unacceptable and the individual does not wear hearing aid(s), the following applies:

Applicants in this circumstance may acquire hearing amplification equipment or undergo medical and/or surgical treatment for hearing loss and reapply in the future.

Incumbents in this circumstance will be removed from duty, allowed an opportunity to acquire hearing amplification equipment or pursue medical and/or surgical evaluation and treatment for hearing loss, and then allowed to undergo subsequent functional hearing assessments after a minimum 30 day adjustment period, wearing his/her own hearing aid(s) for at least 8 hours each day as described below in Section C.9.5.2.3.

• For incumbents deemed not medically qualified who undergo medical and/or surgical treatment for hearing loss:

o If the performance on the subsequent UNAIDED functional hearing assessments is acceptable, the incumbent will be deemed qualified with regard to hearing performance and may be returned to duty.

o If the performance on the subsequent UNAIDED functional hearing assessments is unacceptable, the individual remains not medically qualified and may not return to duty.

• For incumbents deemed not medically qualified who acquire hearing amplification equipment, the results of the subsequent AIDED functional hearing assessments performed after a minimum 30 day adjustment period, wearing his/her own hearing aid(s) for at least 8 hours each day will be evaluated and a decision made on whether to allow reinstatement pursuant to Section C.9.5.2.3 below.

If the performance on the above UNAIDED pure tone audiogram does not meet the standards set forth above in Section C.9.5.2.1 and the individual wears a hearing aid in one or both ears, the individual must undergo UNAIDED and AIDED functional hearing assessments, as described below in Section C.9.5.2.3. Based on the results of those functional hearing assessments and the recommendations of the reviewing physician, a determination of whether the individual is medically qualified with regard to hearing will be made as follows.

• If the performance on the UNAIDED and AIDED functional hearing assessments is acceptable, no further evaluation is needed and the individual is deemed medically qualified with or without the use of hearing amplification while on duty.

• If the performance on the UNAIDED functional hearing assessments is unacceptable but the performance on the AIDED functional hearing assessments is acceptable, the individual is deemed medically qualified with the stipulation that the amplification equipment used during the aided functional assessments shall be used at all times while on duty.

• If the performance on the UNAIDED and AIDED functional hearing assessments is not acceptable, the individual is deemed not medically qualified.

If the performance on the UNAIDED pure tone audiogram meets the standards set forth above in Section C.9.5.2.1 and the individual wears a hearing aid in one or both ears, the individual must undergo UNAIDED and AIDED functional hearing assessments, as described below in Section C.9.5.2.3.

• If the performance on both the UNAIDED and AIDED functional hearing assessments is acceptable, the individual is deemed medically qualified with or without the use of hearing amplification while on duty.

• If the performance on the UNAIDED functional hearing assessments is unacceptable but the performance on the AIDED functional hearing assessments is acceptable, the individual is deemed medically qualified with the stipulation that the amplification equipment used during the aided functional assessments shall be used at all times while on duty.

• If the performance on the UNAIDED and AIDED functional hearing assessments is not acceptable, the individual is deemed not medically qualified.

Any incumbent who acquires or changes hearing aid equipment during the year (between the biennial periodic medical reviews) shall report that fact to his or her site supervisor, who then must notify the USMS. Additional assessment may be required to ensure that the individual’s hearing performance remains acceptable.

C.9.5.2.3 Functional Hearing Assessments

C.9.5.2.3.1

Pure tone audiograms provide limited assessment of overall hearing capability. They are useful as an initial screening test, but in circumstances where pure tone performance is poor, or where there is history or evidence of reduced hearing capability despite acceptable pure tone performance, more thorough evaluation is necessary. Functional hearing assessments which measure sound and speech recognition may reveal adequate performance in the presence of substandard pure tone performance. Alternatively, functional assessment may reveal significant hearing deficits suggested by history or other factors but not evident in the pure tone results.

C.9.5.2.3.2 As detailed above in Section C.9.5.2.2, functional hearing assessments will be used to determine the medical qualification of all individuals who: (1) do not meet the unaided pure tone hearing standard set forth in Section C.9.5.2.1 or (2) meet the unaided pure tone standard but choose to use hearing amplification or (3) reveal history or evidence of hearing difficulties. The functional hearing assessments will measure the following:

• The individual’s testing records shall clearly document UNAIDED pure tone air conduction audiogram testing at the frequencies 500, 1000, 2000, 3000, 4000, 6000, and 8000 Hz and UNAIDED pure tone bone conduction audiogram testing at the frequencies 500, 1000, 2000, 3000, and 4000Hz.

• UNAIDED Speech Reception Threshold shall be 35 dB, or better, in each ear.

Borderline performance may require further assessment. Recorded lists must be used.

• UNAIDED Speech Recognition in quiet shall be 90%, or above, in each ear with a presentation level no greater than 75 dB. Borderline performance may require further assessment. Recorded lists shall be used.

• UNAIDED Speech Recognition in noise tested in sound field shall be 50% or above with a speech presentation level no greater than 75 dB with competing noise 10 dB below the speech presentation level. Borderline performance may require further assessment. Recorded lists shall be used.

• If hearing aid equipment of any type is worn, the following additional assessments are required and are to be performed with the examinee’s own hearing aid or aids in place:

A statement describing the specific type of hearing amplification device(s) used and which ear or ears have been fitted shall be provided by the testing audiologist.

AIDED sound field audiogram using 5% FM warble tones or narrow bands of noise at 250, 500, 1000, 2000, 3000, 4000, 6000 Hz shall be clearly documented in the testing records.

AIDED Sound Field speech reception threshold measured with individual facing the signal speaker at a distance of 1 meter shall be 35 dB or better.

Each ear is to be tested separately; the non-tested ear must be adequately occluded with a foam earplug and then covered with a sound attenuating earmuff. AIDED Speech Recognition in quiet tested in sound field shall be 90%, or above, with a presentation level no greater than 75 dB. Each ear is to be tested separately; the non-tested ear must be adequately occluded with a foam earplug and then covered with a sound attenuating earmuff. If the client achieves a score of 90% or better, this phase of the test may be terminated and results reported. If a score of less than 90% is obtained, vary presentation level either up or down as appropriate to achieve maximum score, not to exceed 75 dB HL. Report %/Intensity function. Borderline performance may require further assessment. Recorded lists shall be used.

Borderline performance may require further assessment. Recorded lists shall be used.

AIDED Speech Recognition in noise tested in sound field shall be 50% or above with a speech presentation level no greater than 75 dB with competing noise 10 dB below the speech presentation level. Borderline performance may require further assessment. Recorded lists shall be used.

C.9.5.2.3.3

In all cases for which functional hearing assessments are required, the results of the above functional hearing tests will be evaluated along with any other information or recommendations provided by the reviewing physician. Some conditions may require a further assessment, even if the results of the above functional tests are within the recommended limits, to ensure that the individual is able to safely perform the essential requirements of the CSO position. Unilateral hearing loss severely disrupts the ability to localize sound, an essential job function. Therefore, unilateral hearing loss is disqualifying.

C.9.5.3 Additional Medical Assessment

C.9.5.3.1

A final determination of medical qualification for CSOs shall be made pursuant to these additional assessments

C.9.5.3.1.1 Cardiovascular System Any condition that significantly interferes with heart function may be disqualifying.

Examples of conditions that may be disqualifying are hypertension, ischemic heart disease, heart failure, symptomatic peripheral vascular disease and severe varicose veins.

C.9.5.3.1.1.1 Blood Pressure Testing Examples of conditions that may be disqualifying are hypertension with repeated readings that exceed 150 systolic and 90 diastolic. Two additional blood pressure readings, separated by at least 5 minutes, performed after the 229 examination will be required if the blood pressure reading at the time the 229 examination exceeded 150 systolic and 90 diastolic.

C.9.5.3.1.1.2 Cardiac Testing All examinees will be individually assessed for risk of heart attack and stroke (cardiovascular disease) using the ACC/AHA Guideline on the Assessment of Cardiovascular Risk. Examinees indicating 10% or greater risk for heart attack and stroke using this Guideline may be required by the FOH to undergo further cardiac testing.

C.9.5.3.1.2 Respiratory System Any condition that significantly interferes with breathing capacity may be disqualifying.

Examinees diagnosed with Obstructive Sleep Apnea who have CPAP treatment recommended shall be required to provide a CPAP compliance report covering, at a minimum, the most recent three (3) month period. This compliance report shall include:

• time span of report

• number of nights CPAP used

• % of nights CPAP used 4 hours or more, and

• Apnea-Hypopnea Index (AHI).

C.9.5.3.1.3 Gastrointestinal System

Any disease or condition that requires rigid diets may be a disqualifying factor. An ulcer active within the past year may also be disqualifying.

C.9.5.3.1.4 Genitourinary System Disorders Any functional disorder rendering the person incapable of sustained attention to work tasks, e.g., urinary frequency and secondary discomfort, may be disqualifying.

C.9.5.3.1.5 Hernias Inguinal and femoral hernias, with or without the use of a truss may be a disqualifying factor. Other hernias may be disqualifying if they interfere with the performance of the duties of the position.

C.9.5.3.1.6 Nervous System Dysfunction of the central and peripheral nervous system that significantly increases the probability of accidents and/or potential inability to perform a variety of physical tasks may be disqualifying.

C.9.5.3.1.7 Endocrine System Any functional disorder rendering the person incapable of sustained attention to work tasks may be disqualifying.

C.9.5.3.1.7.1 Endocrine System Testing All examinees diagnosed with Diabetes or Pre-Diabetes shall have a Hemoglobin A1c test at the time of the medical examination.

C.9.5.3.1.8 Speech Permanent and significant conditions that result in indistinct speech may be disqualifying.

C.9.5.3.1.9 Extremities and Spine

Disorders affecting the musculoskeletal system that significantly prevents the individual from meeting basic movement, strength, flexibility requirements, use of extremities (fingers and toes) and coordinated balance may be disqualifying.

C.9.5.3.1.10 Hematopoietic System Any condition or medication that results in a significant bleeding or clotting disorder, reduced immunity, or anemia may be disqualifying.

C.9.5.3.1.11 Medications

Use of any medication that may interfere with safe and effective job performance, such as narcotics, benzodiazepines, anti-coagulants or any other medication that can interfere with attention, cognitive function, reflexes, or result in subtle or sudden incapacitation may be disqualifying.

C.9.5.3.1.12 Miscellaneous

Any other disease or condition that interferes with the full performance of duties may be disqualifying.

C.9 PHYSICAL AND MEDICAL STANDARDS