Attachment_7_Technical_Packet_Checklist.docx

ATTACHMENT 7 Technical Packet Checklist

KIRK U.S.ARMY HEALTH CLINIC (KUSAHC), Aberdeen Proving Ground, MD ATTN: KIRK HRP COR Mr. Robert Hess, Logistics Division, Kirk HRP, Aberdeen Proving Ground, MD 21005, 410-278-1893

Employees will be considered eligible to perform under the contract only if the COR/ACOR reviews and approves the following documents for completion prior to the individual reporting to the worksite:

|_| Current BLS and/or ACLS Certification Only through American Heart Assn

|_| Criminal History Background Check Local background check completed by the vendor

- or - signed affidavit of completion, (Form I-9)sent to COR.

|_| PSIP sheet, OF 306, OFI Form 86C COR will send the vendor the forms DA FM 5018-R, and Consent to Release Information form

|_| Current Certificate of Health (signed by physician) Medical Evaluation within 45 days of prior to reporting

|_| PPD Test (Mantoux only) Test results within 45 days prior to reporting

|_| Chest X-Ray Interpretation (Only if positive PP) Test results within 1 year prior to reporting

|_| Immunization Documentation

|_| Tetanus & Diphtheria Vaccination Current booster given within past 10 years

|_| Recombivax (Hepatitis B Vaccine) 3 dose series – or- Positive Antibody Titer w/Values

|_| Measles, Mumps, and Rubella (MMR) 2 dose series or Positive Antibody Titer w/Values

|_| Varicella Immunization - Or - Positive Antibody Titer w/Values

|_| Influenza Immunization (unless contraindicated) - Or – Physician statement that local supply is exhausted

|_| Proof of Citizenship – Original Birth Certificate, Employee hand-carries when reporting on the first day valid Passport, -or- Green Card

TO ORDER ONLINE:

Maryland: http://www.vsa.state.md.us/html/birth.html Other States: http://www.vitalchek.com/agency_locator.asp

|_| Social Security Card Employee hand-carries when reporting on the first day

|_| Driver’s License Employee presents at Visitor Center to enter Post

|_| Vehicle Registration Employee presents at Visitor Center to enter Post

|_| Proof of Auto Insurance Employee presents at Visitor Center to enter Post

|_| Two (2) Valid Forms of Identification See: https://www/dmdc.osd.mil/cvs/docs/List_Of_Valid)IDs.pdf

|_| Current License, Certification, Training, and Send copy with packet, Employee to hand carry original

|_| Education license/certification when reporting the first day