CCC Los Padres Center: Pre-Enrollment Physicals Services

Contractor agrees to provide all labor, materials, tools, and incidentals necessary to provide physical examinations for Corpsmember Trainees of the California Conservation Corps, in accordance with the attached Participant Position Analysis and the Health Questionnaire completed by the Trainee. Contractor is to evaluate all Corpsmembers on-site for both, CCC Fire Crew Corpsmember and CCC Standard Corpsmember positions, regardless of the Corpsmembers program interest within CCC. Firefighter physical examinations may differ in cost compared to standard physical examinations.

Guidelines to the Examining Physician/Physician¿s Assistant/Nurse Practitioner

All services must be performed by a physician who shall be properly licensed by the Medical Board of California or the Osteopathic Medical Board of California as a Medical Doctor or by a Physician¿s Assistant, currently licensed by the California Physician¿s Assistant Committee, or by a contract nurse practitioner, who shall be properly licensed by the California Board of Registered Nurses as a nurse practitioner.

In the case of a firm/medical group, services must be performed by a physician who is properly licensed by the Medical Board of California or the Osteopathic Medical Board of California as a Medical Doctor or by a nurse practitioner who is properly licensed by the California Board of Registered Nurses as a Nurse Practitioner or a Physician¿s Assistant, currently licensed by the California Physician¿s Assistant Committee.  The contracted firm/group shall submit a list of physicians or nurse practitioners and their license numbers to the CCC prior to commencing services under any resulting contract from the bid process.  Names of new physicians, nurse practitioners or physician¿s assistants and license numbers must be submitted to CCC for verification and approval prior to physicians, nurse practitioners or physician¿s assistants commencing services under a contract.

PHYSICAL EXAMINATION
SPECIFICATIONS

The Physician, Physician¿s Assistant, or Nurse Practitioner will be expected to:

1.         Exhibit E to use the CCC¿s Secure File Transfer Service to upload physical examination information.  The secure upload function will not be available until the CCC Information Systems Branch (ISB) completes their process.  A staff member from ISB will give the log-in and password information to the contractor by telephone. Update: Secure file transfer service is no longer being utilized. All physicals must be sent to the secure Health & Safety Fax line at: 877-269-1532 or by mail to: 1719 24th Street, Sacramento, CA 95816; Attention: Health & Safety Unit.

2.        Conduct a physical exam using the essential job functions detailed in the Corpsmember Position Analysis (CCC248) located Page 1-4 of Exhibit E, and the information provided by the Trainee in the Health Questionnaire (CCC126), Located Page 5-6 of Exhibit E, completing all sections of the Medical Examination Report (CCC126-A) Page 7.  The exam should include a verification of the accuracy of the information provided in the Health Questionnaire (CCC126).

3.        Complete the Pre-Enrollment Exam Summary (CCC126-B) Page 12-13 Exhibit E, providing an overall determination of the applicant¿s ability to perform the essential functions of the Corpsmember position.  Clarify the nature of any disability (temporary or permanent) the long-term impact and limitations.

4.        Return a copy of the completed Pre-Enrollment Exam Summary (CCC126-B) to the individual Trainee sealed in the attached envelope or return all copies of all Pre-Enrollment Exam Summary forms (CCC 126-B) in a single sealed confidential envelope addressed to the Center Director.

5.        Submit the completed Health Questionnaire (CCC126), CCC Medical Report (CCC126-A), and the Pre-Enrollment Exam Summary (CCC126-B) to the CCC¿s Health & Safety Unit using one of following systems:

Via electronic upload using the CCC¿s Secure File Transfer Service at: https://sftp.ccc.ca.gov.  (For contracts out to bid, the CCC Secure File Transfer Service instructions and the CCC required computer authorization form are attached; for Service Orders, the form will be provided to the contractor by the Contract Manager.);
By fax at the number 877-269-1532; or
By certified mail

The CCC prefers that documents are electronically uploaded.  If certified mail is used, the address is:
California Conservation Corps
Health and Safety Unit
1719 24th Street, Sacramento, CA 95816

Ensure to mark the envelope ¿confidential¿.
6.        Understand that an applicant can only be screened out when the essential functions of the Corpsmember position are not met.  The California Conservation Corps may be able to accommodate an applicant based on the individual¿s disability and restrictions or limitations.

7.        Maintain all the original completed examination forms for a period of seven (7) years from the date of examination.
Please check attachments for more scope of work and forms.
Thank you,