NPR 1800.1 Updated.pdf

| NODIS Library | Organization and Administration(1000s) | Search |

NASA

Procedural Requirements

NPR 1800.1D

Effective Date: October 06, 2009 Expiration Date: March 06, 2022

COMPLIANCE IS MANDATORY FOR NASA EMPLOYEES

NASA Occupational Health Program Procedures

Responsible Office: Office of the Chief Health & Medical Officer

ChangeHistory

Table of Contents Preface P.1 Purpose P.2 Applicability P.3 Authority P.4 Applicable Documents and Forms P.5 Measurement/Verification P.6 Cancellation

Chapter 1. Introduction

1.1 Designated Agency Safety and Health Official

1.2 Medical Waiver Authority

1.3 General Center Responsibilities

1.4 Required Annual Reports

1.5 Drug-Free Workplace

1.6 Credentialing, Education, and Training of Occupational Health Professionals

1.7 Web Site Initiatives and Capabilities

1.8 Support of Federal and Interagency Initiatives

1.9 Occupational Health Program Periodic Review Overview

1.10 Recordkeeping, General

Chapter 2. Occupational Medicine

2.1 Occupational Medicine, General

2.2 Medical Quality Assurance

NPR 1800.1D -- TOC

This document does not bind the public, except as authorized by law or as incorporated into a contract. This document is uncontrolled when printed. Check the NASA Online Directives Information System (NODIS) Library to verify that this is the correct version before use: https://nodis3.gsfc.nasa.gov.

NPR 1800.1D -- TOC Page 1 of 207 https://nodis3.gsfc.nasa.gov/main_lib.html https://nodis3.gsfc.nasa.gov/lib_docs.cfm?range=1___ https://nodis3.gsfc.nasa.gov/adv_search.cfm https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/

2.3 Disease and Injury Prevention

2.4 Diagnosis and Treatment of Occupational Illness or Injury

2.5 Immunizations

2.6 Medical Support to Emergency Preparedness Planning

2.7 Pandemic Planning

2.8 Physical Examinations

2.9 Emergency Medical Services

2.10 Automated External Defibrillator (AED) Program

2.11 Bloodborne Pathogens

2.12 Infection Control

2.13 Medical Record Management

2.14 Shift Work and Balancing Work-Rest Cycles

2.15 International Travel or Assignment

Chapter 3. Primary Prevention and Health Promotion

3.1 Primary Prevention and Health Promotion

3.2 Primary Prevention

3.3 Fitness Centers

Chapter 4. Environmental Health

4.1 General

4.2 Occupational Exposure Limits (OEL's)

4.3 Occupational Exposure Assessment and Management

4.4 Sampling, Analytical Methods, and Equipment Calibration

4.5 Reproductive and Developmental Health

4.6 Nanotoxicology

4.7 Control of Hazardous Substances and Articles Acquisitions

4.8 Hearing Conservation

4.9 Ergonomics

4.10 Indoor Air Quality

4.11 Biosafety

4.12 Food Safety

4.13 Radiation, General

4.14 Radioactive Materials

4.15 Ionizing Radiation-Generating Equipment

4.16 Laser and Non-laser Optical Radiation

4.17 Radio Frequency Electromagnetic Radiation

Chapter 5. Employee Assistance Program (EAP)

5.1 General

5.2 EAP Confidentiality

5.3 EAP Record Access

5.4 Release of Case Information and Secondary Disclosure

5.5 EAP Roles

NPR 1800.1D -- TOC

This document does not bind the public, except as authorized by law or as incorporated into a contract. This document is uncontrolled when printed. Check the NASA Online Directives Information System (NODIS) Library to verify that this is the correct version before use: https://nodis3.gsfc.nasa.gov.

NPR 1800.1D -- TOC Page 2 of 207 https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory

5.6 Responsibilities

5.7 Program Elements

Chapter 6. Federal Workers' Compensation Program

6.1 General

6.2 Presidential Orders and Department of Labor Initiatives

6.3 Chargeback

6.4 Roles

6.5 Responsibilities

6.6 Employee Eligibility to File a Claim

6.7 Employee Requirement to File Claim

6.8 Determining Compensability of a Claim

6.9 Records and Confidentiality

6.10 Recordkeeping, Retention, and Requests for Copies

6.11 Federal Workers' Compensation • General Process

6.12 Traumatic Injury Claims: Form CA-16, Continuation of Pay, and Controversion

6.13 Occupational Disease/Exposure/Illness

6.14 Employee Appeals for Denial of Claim

Chapter 7. Occupational Health Program Review Process

7.1 Policy

7.2 Agency and Center Occupational Health Reviews

7.3 Agency Occupational Health Periodic Reviews

7.4 Responsibilities

7.5 Agency Occupational Health Review Process Description

7.6 Center Self-Reviews

Appendix A. Definitions Appendix B. Acronyms Appendix C. Physical Examination Matrix Appendix D. Partial Listing of Hazardous and Potentially Hazardous Substances and Articles Appendix E. References Appendix F. NASA Laser Safety Review Board Appendix G. Satellite Protection Guidance for the Laser Clearinghouse Appendix H. Federal Workers' Compensation: Form CA-16 Fact Sheet

NPR 1800.1D -- TOC

This document does not bind the public, except as authorized by law or as incorporated into a contract. This document is uncontrolled when printed. Check the NASA Online Directives Information System (NODIS) Library to verify that this is the correct version before use: https://nodis3.gsfc.nasa.gov.

NPR 1800.1D -- TOC Page 3 of 207 https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1800_001D_&page_name=ChangeHistory

Chg# Date Description/Comments 1 10/02/2018 Updated Appendix C., with administrative changes 2 04/03/2019 Administrative changes made to 1) include additional applicable documents to section P.4; 2) clarify requirement in paragraph 4.12.1.4; 3) update definitions in Appendix B;

4) update Appendix C; and 5) clarify employee rights to file claims if injured while working from home in paragraph 6.11.2.1.

3 09/11/2019 Updated Chapter 4, with requirements for Farmers Markets included in para 4.12 and definitions for the following were included in Appendix A: Cottage Foods; Cottage Food Vendor; Farmers Market; Farmers Market Vendor; Food Safety Inspectors; Market Manager; Produce; and Time/Temperature Control for Safety Food.

NPR 1800.1D --

ChangeHistory

This document does not bind the public, except as authorized by law or as incorporated into a contract. This document is uncontrolled when printed. Check the NASA Online Directives Information System (NODIS) Library to verify that this is the correct version before use: https://nodis3.gsfc.nasa.gov.

NPR 1800.1D -- ChangeHistory Page 4 of 207

Preface P.1 Purpose

a. This NASA Procedural Requirement (NPR) describes Occupational Health Program (OHP) procedures necessary to effectively carry out the mission of the Office of the Chief Health and Medical Officer (OCHMO) and ensure that the scope and quality of services provided by the OHP personnel at Centers are optimal. OHP professionals and allied health professionals throughout the Agency shall utilize these procedures in their daily tasks to ensure the health of employees and a safe work environment.

b. Where conflicts exist between other NASA health and safety requirements, Occupational Safety and Health Administration requirements and other Federal, state, or local regulations, the most protective requirements shall apply. The NASA Chief Health and Medical Officer (CHMO) is the final authority on the applicability of all Occupational Health (OH) requirements throughout the Agency.

c. OHP services encompass five constituent areas, as a holistic approach; all working synergistically to support employee health, yet functioning under different legal statutes and requiring unique professional expertise and different process procedures and outcome metrics. These five constituent programs include Occupational Medicine, Environmental Health (including Radiological Health), Health Promotion and Wellness, Federal Workers' Compensation, and Employee Assistance.

d. Recordkeeping is one area that overlaps all OHP constituent areas. While each area has recordkeeping requirements specific to it, there are a few requirements that apply across the board.

All OHP records shall be safeguarded, maintained, and dispositioned 1 in accordance with the following:

(1) NPR 1441.1, NASA Management Program Requirements;

(2) NRRS 1441.1, NASA Record Retention Schedules;

(3) Privacy Act of 1974, as amended, 5 U.S.C. 552a;

(4) The Health Information Management System (HIMS) in NASA's "Privacy Act; Annual Notice and Amendment to Systems of Records," published in the Federal Register;

(5) Records Management Plan for the NASA Electronic Health Record System, NASA-EHRS-RMP-000, February 28, 2012; and

(6) Genetic Information Nondiscrimination Act of 2008 (GINA), PL 110-233.

1 NASA is not required to comply with the Health Insurance Portability and Accountability Act (HIPAA), Pub. L 104-191, since we are not deemed a covered entity under the Act. However, where applicable, NASA should strive to meet the standard of privacy expected from HIPAA in the healthcare setting, specifically in the electronic transmission of health records, and when dealing with outside healthcare and insurance sources.

P.2 Applicability

NPR 1800.1D -- Preface This document does not bind the public, except as authorized by law or as incorporated into a contract. This document is uncontrolled when printed. Check the NASA Online Directives Information System (NODIS) Library to verify that this is the correct version before use: https://nodis3.gsfc.nasa.gov.

NPR 1800.1D -- Preface Page 5 of 207

a. This NPR is applicable to NASA Headquarters (HQ) and NASA Centers, including Component Facilities and Technical and Service Support Centers. This language applies to the Jet Propulsion Laboratory (JPL), other contractors, grant recipients, or parties to agreements only to the extent specified or referenced in the appropriate contracts, grants, or agreements. Portions of this NPR are applicable to visitors.

b. The OCHMO is a staff office that issues policy and provides guidance, Center technical support, and periodic reviews of Centers' OH programs. Periodic reviews shall not be considered direct "oversight" of Center programs and/or processes. Oversight, and implementation of policies set herein, is the responsibility of NASA Centers, Component Facilities, Service Support Centers, other NASA installations, and the NASA Management Office at the JPL (hereafter called "Centers").

c. The section of this NPR requiring the mandatory use of an electronic health record system (EHRS) does not apply to JPL.

d. In this NPR "shall" denotes a mandatory requirement, "may" or "can" denotes a discretionary privilege or permission, "should" denotes a good practice, and "will" denotes an expected outcome.

P.3 Authority

a. Health Services Programs, 5 U.S.C. § 7901.

b. The Occupational Safety and Health Act of 1970, as amended, 29 U.S.C. § 668, Section 19.

c. The National Aeronautics and Space Act, as amended, 51 U.S.C. § 20113.

d. Basic Program Elements for Federal Employee Occupational Safety and Health Programs and Related Matters, 29 CFR pt. 1960.

e. Occupational Safety and Health Programs for Federal Employees, E.O. 12196 (1980), dated February 26, 1980.

P.4 Applicable Documents and Forms

a. Federal Employees' Compensation Act, 5 U.S.C. § 8101, et seq.

b. Physical qualification standards for an individual with diabetes mellitus treated with insulin for control, 49 CFR pt. 46.

c. Physical Qualifications and Examinations, 49 CFR subpt. E.

d. NPD 1000.0, Strategic Management and Governance Handbook.

e. NPD 1210.2, NASA Surveys, Audits, and Reviews Policy.

f. NPD 1600.3, Policy on Prevention of and Response to Workplace Violence.

g. NPD 1850.1, NASA Medical System Quality Assurance.

h. NPR 1000.3, The NASA Organization.

i. NPR 1850.1, Quality Assurance of the NASA Medical Care System.

NPR 1800.1D -- Preface This document does not bind the public, except as authorized by law or as incorporated into a contract. This document is uncontrolled when printed. Check the NASA Online Directives Information System (NODIS) Library to verify that this is the correct version before use: https://nodis3.gsfc.nasa.gov.

NPR 1800.1D -- Preface Page 6 of 207

j. NASA Laser Safety Review Board (LSRB) Charter, April 2014.

k. Department of Federal Employees' Compensation Procedure Manual.

P.5 Measurement/Verification The triennial review process and interim Center self-reviews are used to measure program performance.

P.6 Cancellation NPR 1800.1C, NASA Occupational Health Program Procedures, dated October 6, 2009.

/s/ Richard S. Williams

NPR 1800.1D -- Preface This document does not bind the public, except as authorized by law or as incorporated into a contract. This document is uncontrolled when printed. Check the NASA Online Directives Information System (NODIS) Library to verify that this is the correct version before use: https://nodis3.gsfc.nasa.gov.

NPR 1800.1D -- Preface Page 7 of 207

Chapter 1. General

1.1 Designated Agency Safety and Health Official

1.1.1 The Chief Health and Medical Officer (CHMO) is the Designated Agency Safety and Health Officer (DASHO) and liaison to the Department of Labor (DOL).

1.1.2 All official, Agency-related communication with the Occupational Safety and Health Administration (OSHA) shall be through the DASHO.

1.1.3 The Center/Facility Director shall notify the DASHO within one hour when OSHA, Nuclear Regulatory Commission (NRC), or other occupational safety or health regulatory inspectors arrive on a NASA Center or Facility for the purpose of conducting an inspection or visit as per NPR 8715.1.

1.2 Medical Waiver Authority

1.2.1 As described in NPR 7120.11, the CHMO is the Agency Health and Medical Technical Authority (HMTA) for all health and medical technical requirements, standards, and matters. The CHMO possesses the final waiver authority for any NASA health and medical requirement and is the final interpretation authority on the applicability of all occupational health requirements across the Agency.

1.2.2 The CHMO gives medical authority to each Center's Chief Health Officer/Medical Director.

1.2.3 The CHMO promotes the health and safety of Agency personnel in space and on the ground.

The CHMO develops medical policy, establishes guidelines for health and medical practice, provides guidance for health care delivery, promotes professional competency, and reviews/approves human and animal research requirements across the Agency.

1.2.4 The CHMO serves as the HMTA for NASA-unique occupational health requirements included in:

a. Section 2.15, Shift Work and Balancing Work-Rest Cycles.

b. Section 4.2, Occupational Exposure Limits (OELs).

c. Section 4.5, Reproductive and Developmental Health.

d. Section 4.6, Nanotoxicology.

e. Section 4.8, Hearing Conservation.

1.3 General Center Responsibilities

1.3.1 Centers shall advocate for budget and resources for occupational health programs to ensure compliance with OSHA, state, and local standards and NASA requirements. If a reduction in budget is anticipated to have a significant impact on the delivery of Occupational Health (OH) services, the OCHMO shall be immediately informed.

NPR 1800.1D -- Chapter1 This document does not bind the public, except as authorized by law or as incorporated into a contract. This document is uncontrolled when printed. Check the NASA Online Directives Information System (NODIS) Library to verify that this is the correct version before use: https://nodis3.gsfc.nasa.gov.

NPR 1800.1D -- Chapter1 Page 8 of 207

OCHMO shall be immediately informed.

1.3.2 Center occupational health practitioners (e.g., physicians, nurses, industrial hygienists, health physicists, physical fitness professionals) shall be familiar with employees' tasks and work environment to better understand specific OH issues and cases, as well as the mechanism of injury, exposure, or illness; and evaluate safety and OH concerns.

1.3.3 Agency and Center Purchase Requesters/Requirements Initiators shall coordinate with Center OH offices to ensure requirements documents include all pertinent OH requirements.

1.3.4 Agency and Center Procurement organizations shall work with Center OH offices and Purchase Requesters/Requirements Initiators to ensure that all pertinent OH Federal and Agency provisions/clauses are included in contracts.

1.3.5 Centers shall ensure that all pertinent OH requirements are included in commercial partners, Space Act Agreements, other Federal agencies, international parties, and tenant agreements.

1.3.6 Centers shall implement effective OH programs as measured by the Agency's triennial OH review program.

1.4 Required Annual Reports

1.4.1 OSHA Report

1.4.1.1 NASA submits an annual report to the Secretary of Labor containing the status of NASA's Safety and Health Programs during the preceding year, goals and objectives for the current year, and a plan for achieving those goals. The procedure for collecting the requisite data is as follows:

a. The NASA Office of the Chief Health and Medical Officer (OCHMO) and the Office of Safety and Mission Assurance (OSMA) electronically forward the OSHA Annual Report format to the Centers each year soon after it is received from OSHA with a prescribed deadline for submission of the OSHA-requested information to the OCHMO.

b. The Safety and Health organizations at NASA Centers jointly complete the form, provide the associated documentation, and return all OSHA requested information to the OCHMO and the OSMA in the prescribed format and electronic media by the designated deadline.

c. Other NASA organizations shall support information compilation, editing, and writing of the OSHA Annual Report effort as needed.

d. The report shall be jointly prepared by the OCHMO and the OSMA, jointly signed by the DASHO and the Director, Safety and Assurance Requirements Division, and submitted to OSHA.

1.5 Drug-Free Workplace

1.5.1 General

1.5.1.1 The overall responsibility for NASA's Drug-Free Workplace Program (DFWP) lies with the Office of the Chief Human Capital Officer (OCHCO), with policies and procedures provided in NPR 3792.1. The OCHMO supports DFWP by ensuring Employee Assistance Programs (EAPs) across the Agency support the requirements of the program. The Agency Medical Review Officer

NPR 1800.1D -- Chapter1 This document does not bind the public, except as authorized by law or as incorporated into a contract. This document is uncontrolled when printed. Check the NASA Online Directives Information System (NODIS) Library to verify that this is the correct version before use: https://nodis3.gsfc.nasa.gov.

NPR 1800.1D -- Chapter1 Page 9 of 207 assigned to all Centers is located at the NASA Shared Services Center.

1.5.1.2 The OCHMO supports the DFWP through management of NASA Center EAP policy.

1.6 Credentialing, Education, and Training of Occupational

Health Professionals

1.6.1 General

1.6.1.1 All Occupational Health (OH) professional disciplines (Occupational Medicine (OM), Industrial Hygiene (IH), Health Physics (HP), Food Sanitation (FS), EAP, Federal Workers' Compensation (FWC), and Fitness) shall comply at all times with Federal, state, and professional requirements applicable to their respective disciplines.

1.6.2 Responsibilities

1.6.2.1 Credentialing and privileging of all licensed medical practitioners and non-licensed health-care support personnel providing health care for Agency personnel shall be governed by the requirements contained in NPR 1850.1, Quality Assurance of the NASA Medical Care System.

1.6.2.2 Centers shall establish and maintain effective organizations to fulfill OH requirements using professionally qualified persons, ensuring discipline-specific professional licensures, certifications, and accreditations necessary for operations are maintained.

1.6.2.3 NASA fully uses a Commercial Off-the-Shelf (COTS) Electronic Health Records System and has trained all Centers in its operation. As clinic contracts are re-negotiated and perhaps changed, it is the Center's responsibility to ensure that every clinic has a least one individual, other than the Medical Director, dedicated to operating and using the Agency's chosen electronic medical records system.

1.6.3 Process Description

1.6.3.1 Center hiring policies shall comply with Federal and NASA credentialing requirements and with state licensure statutes.

1.6.3.2 Centers shall hire OH professionals with experience and credentials commensurate with program requirements.

1.6.3.3 Centers shall have a process to ascertain and promote education, training, and credentialing requirements for all civil service and contractor OH program personnel that is commensurate with program needs.

1.6.3.4 Centers shall conduct assessments of OH professional and career development needs to determine the training required of their OH staff. These needs shall be communicated to Center management to meet professional OH licensure and certification.

1.7 Web Site Initiatives and Capabilities

1.7.1 General

1.7.1.1 NASA OCHMO's Web sites include the Agency OH Web site and public access Web site

NPR 1800.1D -- Chapter1 This document does not bind the public, except as authorized by law or as incorporated into a contract. This document is uncontrolled when printed. Check the NASA Online Directives Information System (NODIS) Library to verify that this is the correct version before use: https://nodis3.gsfc.nasa.gov.

NPR 1800.1D -- Chapter1 Page 10 of 207 which shall be available as resources for dissemination of OH related information to OH personnel to assist OCHMO in communicating to the Centers.

1.7.2 Responsibilities

1.7.2.1 The OCHMO maintains the Agency OH Web site as a means of disseminating information and providing guidance to NASA Centers and Facilities on OH-related topics and policies.

1.7.2.2 Centers shall refer to the Agency OH Web site for recommendations on meeting program requirements. NASA OH Documents, Guidelines, and Checklists referenced on the Agency OH Web site.

1.7.3 Process Description

1.7.3.1 The Agency OH Web site content meets all of NASA's security, accessibility, and data privacy regulations.

1.7.3.2 The Agency OH Web site shall be designed to meet the various NASA OH community needs.

1.8 Support of Federal and Interagency Initiatives

1.8.1 General

1.8.1.1 The OCHMO collaborates with the Office of Personnel Management (OPM) on health and work/life policies and initiatives.

1.8.1.2 The OCHMO provides guidance to Center Contracting Officer Representatives (CORs) on Center-specific health and work/life policies, and periodically reviews Center implementation of these policies.

1.8.2 Responsibilities

1.8.2.1 Centers shall adopt policies and implement programs in support of a healthy work environment as directed by the OCHMO, based on guidance from the OPM and other Federal authorities pertaining to work/life issues.

1.8.2.2 The Medical CORs and the Medical Director shall actively support all CHMO-directed health initiatives.

1.8.2.3 The Health Promotion Workgroup (HPW) Team members shall coordinate all efforts at the Center level.

1.8.3 Process Description

1.8.3.1 The CHMO communicates Agency-sanctioned work/life and health and productivity initiatives to the Centers.

1.8.3.2 The Centers implement all Agency-directed initiatives, as appropriate, to their Center populations and to the extent they are able to provide.

1.9 Occupational Health Program Periodic Review Overview

NPR 1800.1D -- Chapter1 This document does not bind the public, except as authorized by law or as incorporated into a contract. This document is uncontrolled when printed. Check the NASA Online Directives Information System (NODIS) Library to verify that this is the correct version before use: https://nodis3.gsfc.nasa.gov.

NPR 1800.1D -- Chapter1 Page 11 of 207

1.9.1 General

1.9.1.1 The review process assesses OH program efficacy at all Centers for the following disciplines:• OM, IH, HP, FS, Fitness Center (FC), and EAP.• The FWC case management for the Agency is reviewed at the Johnson Space Center (for astronaut claims) and the NASA Shared Services Center (for all other NASA claims). The review of FWC case management handled at the NASA Shared Services Center will take place whenever an onsite OH review is conducted at the Stennis Space Center.

1.9.2 Responsibilities

1.9.2.1 The OCHMO assesses the effectiveness of the Agency's OH programs at all Centers. To carry out this responsibility, it conducts periodic onsite reviews of OH programs at all Centers.

1.9.2.2 Center Directors shall be responsible for providing adequate provisions and resources in support of an Agency review. This includes providing requested documentation and information in a timely fashion and in an orderly arrangement; onsite office and meeting room accommodations;

information technology support; and a status of the OH programs at in-briefings. It also includes:

identifying discipline-specific points of contact (POC); being present for and supporting the onsite review activities; and responding with corrective actions to review findings in a timely manner.

1.9.3 Process Description

1.9.3.1 A detailed description of the review process is found in Chapter 7 of this document.

1.10 Recordkeeping - Overall

1.10.1 General

1.10.1.1 Centers shall ensure that all OH contracts, at the time of their negotiation, expressly require record keeping of any and all records containing personnel health information as per Center needs.

1.10.1.2 All occupational health records at the Centers are NASA records and shall be retained at the Centers regardless of contract changes and dispositioned in accordance with NASA's record requirements and this NPR.

1.10.2. Responsibility

1.10.2.1 The Center shall ensure that each new OH contract or contract renewal contain specific language on record keeping requirements.

NPR 1800.1D -- Chapter1 This document does not bind the public, except as authorized by law or as incorporated into a contract. This document is uncontrolled when printed. Check the NASA Online Directives Information System (NODIS) Library to verify that this is the correct version before use: https://nodis3.gsfc.nasa.gov.

NPR 1800.1D -- Chapter1 Page 12 of 207

Chapter 2. Occupational Medicine

2.1 Occupational Medicine, General

2.1.1 General

2.1.1.1 The OM clinics shall meet all applicable requirements of Federal and state regulations, professional standards, the NASA Medical Quality Assurance (QA) Program, and other NASA program requirements.

2.1.2 Responsibilities

2.1.2.1 The CHMO shall establish policy requirements for the OM programs.

2.1.2.2 The Director of Health and Medical Systems shall ensure the oversight and advocacy of Center OM programs through regular periodic reviews.

2.1.2.3 The OCHMO shall have the opportunity to review any significant request for a change or relief of OH policy.

2.1.2.4 The Medical COR at each Center shall advocate for funding to meet all programmatic requirements within the scope of service being provided.

2.1.2.5 The Center Medical Director shall be responsible for meeting all Federal, state, and NASA requirements for that jurisdiction.

2.1.2.6 The NASA OH personnel shall notify the CHMO when a Medical Director change occurs at their Center.

2.1.3 Process Description

2.1.3.1 The NASA CHMO and Director of Health and Medical Systems shall be informed immediately of any of the following occupational health-related incidents at NASA Centers from:

a. Any employee death on duty;

b. Cluster investigations;

c. Infectious disease outbreaks;

d. Automatic External Defibrillator (AED) use and outcome;

e. Quality of care issues;

f. Workplace violence;

g. Regulatory Agency (e.g., Occupational Safety and Health Administration, Nuclear Regulatory Agency) inspection/investigation; and

h. Medical incident or evacuation of civil service employees on official Government foreign travel.

NOTE: All mishaps must be reported in accordance with NPR 8621.1, NASA Procedural Requirements for Mishap Reporting, Investigating, and Recordkeeping and the appropriate

NPR 1800.1D -- Chapter2 This document does not bind the public, except as authorized by law or as incorporated into a contract. This document is uncontrolled when printed. Check the NASA Online Directives Information System (NODIS) Library to verify that this is the correct version before use: https://nodis3.gsfc.nasa.gov.

NPR 1800.1D -- Chapter2 Page 13 of 207

Center Mishap Preparedness and Contingency Plan.

2.1.3.2 Center OM physicians and other healthcare providers (e.g., nurse practitioners, physician assistants) shall be appropriately credentialed and privileged in compliance with the requirements of the NASA Medical QA program.

2.1.3.2.1 The OM staff shall be trained for the tasks they are required to perform and meet all regulatory and NASA training requirements.

2.1.3.3 Center CORs shall be responsible for advocating adequate budget and resources for OM clinics to provide services.

2.1.3.3.1 If a reduction in budget is anticipated to have a significant impact on the delivery of OM services, the OCHMO shall be informed.

2.2 Medical Quality Assurance

2.2.1 General

2.2.1.1 All NASA OM clinics shall establish a medical quality assurance program that meets these requirements and all of the requirements found in NPD 1850.1, NASA Medical System Quality Assurance; NPR 1850, Quality Assurance of the NASA Medical Care System; and the NASA Medical QA Program Desk Guide found on the Agency OH Web site.

2.2.2 Responsibilities

2.2.2.1 The CHMO shall set medical quality assurance program policy.

2.2.2.2 The Director of Health and Medical Systems shall ensure compliance with OH medical QA policy through regular periodic reviews.

2.2.2.3 The COR is responsible for advocating for sufficient resources to implement a medical quality assurance program.

2.2.2.4 The Center's medical staff is responsible for developing the Center policies and procedures and implementing a medical QA program.

2.2.3 Process Description

2.2.3.1 A comprehensive set of policies and procedures shall be developed to meet the quality of care standards.

2.2.3.1.1 The policies and procedures shall meet all the requirements of the Employee-Directed Principles (Managing Employee Assessment, Employee Care Process, Coordinating Employee Care, Employee Care Rights, and Employee Healthcare Education) and Management-Directed Principles (Facility and Safety Management, Governance, Information Management Services, Infection Control Services, Performance Improvement Management, and Staff Qualifications and Competency) as found on the Agency OH Web site.

2.2.3.2 The OM clinics shall establish and monitor medical QA program metrics to evaluate the program effectiveness.

2.3 Disease and Primary Injury Prevention

NPR 1800.1D -- Chapter2 This document does not bind the public, except as authorized by law or as incorporated into a contract. This document is uncontrolled when printed. Check the NASA Online Directives Information System (NODIS) Library to verify that this is the correct version before use: https://nodis3.gsfc.nasa.gov.

NPR 1800.1D -- Chapter2 Page 14 of 207

2.3 Disease and Primary Injury Prevention

2.3.1 General

2.3.1.1 NASA OH programs shall encompass primary prevention, health promotion, and a comprehensive safety program that impacts both individual health and Agency wellness.

2.3.2 Responsibilities

2.3.2.1 Center Occupational Health Program (OHP) personnel shall provide a variety of prevention services such as medical examinations, health and wellness promotions, immunizations, food safety and sanitization services, assorted health screenings, and control of chemical and physical hazards.

2.3.3 Process Description

2.3.3.1 Health Promotion Programs shall be implemented through both Agency-directed and Center-planned activities.

2.3.3.2 The efficacy of primary prevention activities shall be documented with appropriately selected metrics for benchmarking, continuous improvement of programs, and resource allocation.

2.4 Diagnosis and Treatment of Occupational Illness or Injury

2.4.1 General

2.4.1.1 NASA Centers shall ensure timely diagnosis and treatment of occupational injuries and illnesses and act to minimize the recurrence of a similar problem in other coworkers and those in similar jobs.

2.4.2 Responsibilities

2.4.2.1 The CHMO shall set policy and provide oversight of clinical activities.

2.4.2.2 The Director of Health and Medical Systems ensures the appropriate delivery of diagnostic and treatment service through regular periodic reviews.

2.4.2.3 The Medical Director at each NASA Center is responsible for accurate diagnosis, timely treatment, and appropriate follow up of all occupational injuries and illnesses in employees and for reporting all work-related injuries and illnesses to Center personnel responsible for OSHA record keeping.

2.4.2.4 The Medical Director shall monitor occupational injuries and illnesses for trends and provide statistics to Center management for analysis and corrective action, as appropriate.

2.4.2.4.1Any developing trends in occupational injury and illness shall be reported by Center management to the CHMO.

2.4.2.5 Medical staff shall coordinate and communicate with NASA Federal Workers' Compensation injury compensation specialists in providing claim-related documents generated at the Clinic, assisting with an explanation of occupational-related illnesses and injuries for which a claim is being made, and making recommendations about employee return-to-work options.

2.4.3 Process Description

NPR 1800.1D -- Chapter2 This document does not bind the public, except as authorized by law or as incorporated into a contract. This document is uncontrolled when printed. Check the NASA Online Directives Information System (NODIS) Library to verify that this is the correct version before use: https://nodis3.gsfc.nasa.gov.

NPR 1800.1D -- Chapter2 Page 15 of 207

2.4.3.1 The following steps shall be followed by all Centers in diagnosing and treating occupational illnesses and injuries.

a. The occupational health history shall be conducted for the assessment of work-related health problems and include total employment and general health histories, with a review of systems and determination of any preexisting conditions to achieve an accurate medical diagnosis.

b. After a health history is taken, an appropriate physical examination is performed with a detailed specific organ or system examination as related to the chief complaint. Laboratory and radiological testing may be used to complement the history and physical examination and to aid in the diagnosis and treatment of the condition.

NOTE: Pre-approval may be required for procedures not routinely performed in the clinic.

c. The Medical Director, or qualified designee, when the Medical Director is unavailable, shall review the care of patients for appropriateness with current standards of care, utilizing published clinical practice guidelines.

d. The Medical Director, or qualified designee, shall document any inconsistencies with a work-related injury or illness and report these to a safety representative for further evaluation of the injury mechanism and circumstances.

e. An assessment of the workplace shall be performed by medical, environmental health, and/or safety personnel to reinforce the importance of injury prevention and implementation of approved reasonable accommodation.

2.4.3.2 All occupational health practitioners shall become familiar with employees' work and the environment in which they work. In order to better understand specific medical issues and cases, it may be necessary for the medical staff to visit the workplace to better understand the mechanism of injury and evaluate health, safety, and ergonomic concerns.

2.5 Immunizations

2.5.1 General

2.5.1.1 Maintaining immunity shall be an integral part of NASA's disease prevention and infection control programs to reduce potential health effects related to exposure to vaccine-preventable infectious agents.

NOTE: The number and types of immunizations required per employee will vary based upon exposure risk.

2.5.2 Responsibilities

2.5.2.1 The CHMO shall establish an Agency immunization policy.

2.5.2.2 The Director of Health and Medical Systems ensures Center immunization policies are in place and the medication management process is sound, properly documented, and meets NASA quality assurance program elements through regular, periodic reviews.

2.5.2.3 The Center Medical Director shall establish immunization policy and procedures and ensure immunization services are available in such areas as international travel, medical surveillance/job

NPR 1800.1D -- Chapter2 This document does not bind the public, except as authorized by law or as incorporated into a contract. This document is uncontrolled when printed. Check the NASA Online Directives Information System (NODIS) Library to verify that this is the correct version before use: https://nodis3.gsfc.nasa.gov.

NPR 1800.1D -- Chapter2 Page 16 of 207 certification, occupational injuries/illnesses, and preventive medicine.

2.5.2.4 The Center Medical Director shall ensure the medication management process is sound, properly documented, and meets NASA QA Program elements, and is in compliance with the most current Centers for Disease Control and Prevention (CDC) recommendations.

2.5.3 Process Description

2.5.3.1 Employees with a reasonable risk of occupational exposure to vaccine-preventable diseases such as tetanus, Hepatitis A, or B shall be offered appropriate vaccinations if they lack documented immunity. A declaration form, signed by each employee who declines the Hepatitis B vaccination, is required as an element of prevention against exposure to bloodborne pathogens.

2.5.3.2 Tetanus and diphtheria status shall be reviewed during each patient encounter and immunization given, if the time since the last immunization exceeds the current guidelines, for all employees with tetanus prone injuries at work and those requiring routine boosters.

2.5.3.3 The patient shall be provided an opportunity to discuss any questions about the immunization procedure prior to vaccine administration.

2.5.3.4 An immunization record shall be maintained for each employee and reviewed as part of each patient encounter.

2.5.3.4.1 The record shall reflect documented disease and immunization histories, as well as immunizations administered during employment, and updated at each immunization encounter.

2.6 Medical Support to Emergency Preparedness Planning

2.6.1 General

2.6.1.1 The exact roles and responsibilities of Center OH disciplines shall be determined by the specific needs at each of the NASA Centers and Facilities.

2.6.1.2 In addition to the Center-wide plan, each clinic shall address emergency preparedness specific to their structure and operations.

2.6.2 Responsibilities

2.6.2.1 The CHMO shall provide technical support and policy guidance to the Center Medical and Environmental COR to effectively negotiate and delineate the roles and responsibilities of NASA OH in relation to the Center-specific Emergency Management Plan.

2.6.2.2 The Director of Health and Medical Systems ensures clinics have addressed emergency preparedness specific to their structure and operations through regular periodic reviews.

2.6.2.3 The COR, or designee, shall keep the Director of Health and Medical Systems current on any Center specific emergency events or any significant modifications to the Emergency Preparedness plan as they relate to OH roles and responsibilities.

2.6.2.3.1 The COR shall serve as an advocate for OH disciplines to ensure assigned roles and responsibilities are sound, obtain management support as needed, and keep the lines of communication viable between the stakeholders. In essence, the COR serves as a liaison between the Center Emergency Operations and the OH team.

NPR 1800.1D -- Chapter2 This document does not bind the public, except as authorized by law or as incorporated into a contract. This document is uncontrolled when printed. Check the NASA Online Directives Information System (NODIS) Library to verify that this is the correct version before use: https://nodis3.gsfc.nasa.gov.

NPR 1800.1D -- Chapter2 Page 17 of 207

2.6.2.4 The Center Medical Director, depending on the extent of medical operations engagement in the Center-wide response plan, shall ensure that the clinic staff is appropriately trained and adequate supplies are readily available.

2.6.2.5 Center OM clinics shall have emergency preparedness policies and procedures in place for emergency operation of the clinic and support of the Center Emergency Management Plan.

2.6.2.5.1 The OM clinic roles and responsibilities shall be integrated into the Center Plan.

2.6.3 Process Description

2.6.3.1 The CHMO shall provide guidance documents and contribute suggestions to improve the medical response.

2.6.3.2 The Center Medical Director shall:

a. Establish procedures to meet the medical expectations of the EP plan including, but not limited to, skill mix and number, personnel training and drills, equipment, and supplies.

b. Establish measures to safeguard and retrieve medical records in paper or electronic format as per…