Section J 2K Form CSO012a CSO Medical Qualification Reevaluation Decision.pdf

PDF 34 KB Posted

Attached to
USMS CSO 8(a) Federal contract opportunity
Solicitation number
15M10523RA4700003-0001
Issued by
Department of Justice US Marshals Service

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Form CSO-012A Rev. 01/18 Page of Note: Completed forms containing personally identifiable information (PII) must be encrypted and include the appropriate marking (U/FOUO) in the SUBJECT line of the message prior to dissemination via email.

UNCLASSIFIED // FOUO

UNCLASSIFIED // FOUO

Court Security Officer's Medical Qualification Reevaluation Decision U.S. Department of Justice United States Marshals Service

REVIEWING MEDICAL OFFICER (RMO) CERTIFICATION

Based on the company's personal observation and the information provided herein, it is the company's opinion that this individual meets all of the Court Security Officer medical standards.

I agree / disagree with the attending physician's recommendation regarding the individual's ability to safely perform Court Security Officer duties.

Additional documentation regarding my decision is attached/ not attached.

CONTRACTOR REPRESENTATIVE CERTIFICATION

Based on the company's personal observation and the information provided herein, it is the company's opinion that this individual meets all of the Court Security Officer medical standards.

I agree / disagree with the attending physician's recommendation regarding the individual's ability to safely perform Court Security Officer duties.

Additional documentation regarding my decision is attached/ not attached.

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