The Contractor shall, as needed, perform (1) Pre-Employment Physicals, which includes a follow-up Hepatitis-B vaccination for successful candidates; (2) Commercial Driver’s License Medical Card Physicals; and (3) Fit for Duty Physicals. The Contractor must be a Federal Motor Carrier Safety Administration certified Medical Examiner. Attached as Exhibit A are the forms that the contractor must complete in their entirety for each associated medical test/examination. The Pre-Employment Physical of a candidate must include medical history, physical exam, vision exam, essential function, physical ability testing and audiogram. The contractor must complete the Pre-Employment Physical Report, Form No. A-1011, and forward it to Department on the same day of the pre-employment physical. The form must be filled in its entirety. No substitution paperwork is acceptable other than the hearing test results as printed by the audiogram equipment. The Department will establish a secure method of transferring the form to the appropriate office. Upon hiring, the contractor must provide the Hepatitis-B vaccination to the new employee. Commercial Driver’s License Medical Card certification examination must be conducted by a medical examiner listed on the National Registry of Certified Medical Examiner as required by 49 CFR 391.43. The physical exam must be conducted pursuant to 49 CFR 391.41 to 391.49. The contractor must complete the Medical Examination Report Form, MCSA-5875. The Contractor shall issue a Medical Examiner’s Certificate (Medical Card), (49 CFR 391.41-391.49) after the Driver Fitness Determination on the Medical Examination is completed and approved. Fit for Duty Physical, will be requested, as needed. The contractor will receive a written request from the Employee Relations Bureau that will include the employee’s job description and the applicable pre-employment physical report. The Contractor must complete in its entirety the Medical Certification of Fitness for Duty Form, (Form A967a), using accepted medical techniques to answer the questions as requested. For all physicals identified above attached is sample paperwork for familiarity, Form 649-F (6045) in its entirety, Paperwork for the Commercial Driver Fitness Determination on the Medical Examination Report shall be the same as Form 649-F (6045), also attached in Sample Paperwork, as provided by the Federal Motor Carrier Safety Administration. Comparable paperwork provided by the vendor on their letterhead is acceptable if the content is the same as Form 649-F (6045).
