HomeMy WebLinkAbout066002 - General - Contract - Health Centers of the Southwest, P.A. dba Concentra Medical CentersDocusign Envelope ID: 1F779008-4347-8FEC-830D-645347CE6D0D
66002
City Secretary Contract No.
FORT WORTH®
PROFESSIONAL SERVICES AGREEMENT
This PROFESSIONAL SERVICES AGGREEMENT ("Agreement") is made and entered into
by and between the CITY OF FORT WORTH ("City"), a Texas home rule municipal corporation, and
OCCUPATIONAL HEALTH CENTERS of the SOUTHWEST, P.A., DBA CONCENTRA
MEDICAL CENTERS ,("Vendor"), each individually referred to as a "party" and collectively referred
to as the "parties."
1. Scope of Services. Vendor shall provide City a full range occupational health care services
("Services"), as set forth in more detail in Exhibit "A," attached hereto and incorporated herein for all
purposes.
2. Term. This Agreement begins on January 01, 2027 ("Effective Date") and expires on
December 31, 2027 ("Expiration Date"), unless terminated earlier in accordance with this Agreement
("Initial Term"). City will have the option, in its sole discretion, to renew this Agreement under the same
terms and conditions, for up to six (6) one-year renewal option(s) (each a "Renewal Term").
3. Compensation. City will pay Vendor in accordance with the provisions of this Agreement,
including Exhibit "B," which is attached hereto and incorporated herein for all purposes. Total
compensation under this Agreement will not exceed Six -Hundred Thousand Dollars ($600,000.00).
Vendor will not perform any additional services or bill for expenses incurred for City not specified by this
Agreement unless City requests and approves in writing the additional costs for such services. City will not
be liable for any additional expenses of Vendor not specified by this Agreement unless City first approves
such expenses in writing.
3.1 Suppliers are required to submit all invoices electronically to
supplierinvoicesgfortworthtexas.gov. Each invoice must include the purchase order number
(if applicable), a detailed description of services or goods provided, and a total amount due.
Invoices should be submitted in PDF format, clearly legible, and include vendor contact
information. Incomplete or non -compliant invoices may be returned for correction and may
delay processing and payment.
4. Termination.
4.1. Written Notice. City or Vendor may terminate this Agreement at any time and for
any reason by providing the other party with 30 days' written notice of termination.
4.2 Non -appropriation of Funds. In the event no funds or insufficient funds are
appropriated by City in any fiscal period for any payments due hereunder, City will notify Vendor
of such occurrence and this Agreement will terminate on the last day of the fiscal period for which
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
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appropriations were received without penalty or expense to City of any kind whatsoever, except as
to the portions of the payments herein agreed upon for which funds have been appropriated.
4.3 Duties and Obligations of the Parties. In the event that this Agreement is terminated
prior to the Expiration Date, City will pay Vendor for services actually rendered up to the effective
date of termination and Vendor will continue to provide City with services requested by City and
in accordance with this Agreement up to the effective date of termination. Upon termination of this
Agreement for any reason, Vendor will provide City with copies of all completed or partially
completed documents prepared under this Agreement. In the event Vendor has received access to
City Information or data as a requirement to perform services hereunder, Vendor will return all City
provided data to City in a machine-readable format or other format deemed acceptable to City.
5. Disclosure of Conflicts and Confidential Information.
5.1 Disclosure of Conflicts. Vendor hereby warrants to City that Vendor has made full
disclosure in writing of any existing or potential conflicts of interest related to Vendor's services
under this Agreement. In the event that any conflicts of interest arise after the Effective Date of this
Agreement, Vendor hereby agrees immediately to make full disclosure to City in writing.
5.2 Confidential Information. Vendor, for itself and its officers, agents and employees,
agrees that it will treat all information provided to it by City ("City Information") as confidential
and will not disclose any such information to a third party without the prior written approval of
City.
5.3 Public Information Act. City is a government entity under the laws of the State of
Texas and all documents held or maintained by City are subject to disclosure under the Texas Public
Information Act. In the event there is a request for information marked Confidential or Proprietary,
City will promptly notify Vendor. It will be the responsibility of Vendor to submit reasons objecting
to disclosure. A determination on whether such reasons are sufficient will not be decided by City,
but by the Office of the Attorney General of the State of Texas or by a court of competent
jurisdiction.
5.4 Unauthorized Access. Vendor must store and maintain City Information in a secure
manner and will not allow unauthorized users to access, modify, delete or otherwise corrupt City
Information in any way. Vendor must notify City immediately if the security or integrity of any
City Information has been compromised or is believed to have been compromised, in which event,
Vendor will, in good faith, use all commercially reasonable efforts to cooperate with City in
identifying what information has been accessed by unauthorized means and will fully cooperate
with City to protect such City Information from further unauthorized disclosure.
6. Right to Audit. Vendor agrees that City will, until the expiration of three (3) years after
final payment under this Agreement, or the final conclusion of any audit commenced during the said three
years, have access to and the right to examine at reasonable times any directly pertinent books, documents,
papers and records, including, but not limited to, all electronic records, of Vendor involving transactions
relating to this Agreement at no additional cost to City. Vendor agrees that City will have access during
normal working hours to all necessary Vendor facilities and will be provided adequate and appropriate work
space in order to conduct audits in compliance with the provisions of this section. City will give Vendor
reasonable advance notice of intended audits.
Independent Contractor. It is expressly understood and agreed that Vendor will operate
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as an independent contractor as to all rights and privileges and work performed under this Agreement, and
not as agent, representative or employee of City. Subject to and in accordance with the conditions and
provisions of this Agreement, Vendor will have the exclusive right to control the details of its operations
and activities and be solely responsible for the acts and omissions of its officers, agents, servants,
employees, Vendors, and subcontractors. Vendor acknowledges that the doctrine of respondeat superior
will not apply as between City, its officers, agents, servants and employees, and Vendor, its officers, agents,
employees, servants, contractors, and subcontractors. Vendor further agrees that nothing herein will be
construed as the creation of a partnership or joint enterprise between City and Vendor. It is further
understood that City will in no way be considered a Co -employer or a Joint employer of Vendor or any
officers, agents, servants, employees, contractors, or subcontractors. Neither Vendor, nor any officers,
agents, servants, employees, contractors, or subcontractors of Vendor will be entitled to any employment
benefits from City. Vendor will be responsible and liable for any and all payment and reporting of taxes on
behalf of itself, and any of its officers, agents, servants, employees, contractors, or contractors.
8. Liability and Indemnification.
8.1 LIABILITY - VENDOR WILL BE LIABLE AND RESPONSIBLE FOR ANY
AND ALL PROPERTY LOSS, PROPERTY DAMAGE AND/OR PERSONAL INJURY,
INCLUDING DEATH, TO ANY AND ALL PERSONS, OF ANY KIND OR CHARACTER,
WHETHER REAL OR ASSERTED, TO THE EXTENT CAUSED BY THE NEGLIGENT
ACT(S) OR OMISSION(S), MALFEASANCE OR INTENTIONAL MISCONDUCT OF
VENDOR, ITS OFFICERS, AGENTS, SERVANTS, EMPLOYEES, CONTRACTORS, OR
SUBCONTRACTORS.
8.2 GENERAL INDEMNIFICATION - VENDOR HEREBY COVENANTS AND
AGREES TO INDEMNIFY, HOLD HARMLESS AND DEFEND CITY, ITS OFFICERS,
AGENTS, SERVANTS AND EMPLOYEES, FROM AND AGAINST ANYAND ALL CLAIMS
OR LAWSUITS OF ANY KIND OR CHARACTER, WHETHER REAL OR ASSERTED, FOR
EITHER PROPERTYDAMAGE OR LOSS (INCLUDINGALLEGED DAMAGE OR LOSS TO
VENDOR'S BUSINESS AND ANY RESULTING LOST PROFITS) AND/OR PERSONAL
INJURY, INCLUDING DEATH, TO ANY AND ALL PERSONS, ARISING OUT OF OR IN
CONNECTION WITH THIS AGREEMENT, TO THE EXTENT CAUSED BY THE
NEGLIGENT ACTS OR OMISSIONS OR MALFEASANCE OF VENDOR, ITS OFFICERS,
AGENTS, SERVANTS, EMPLOYEES, CONTRACTORS, OR SUBCONTRACTORS.
8.3 INTELLECTUAL PROPERTY INDEMNIFICATION — Vendor agrees to
defend, settle, or pay, at its own cost and expense, any claim or action against City for
infringement of any patent, copyright, trade mark, trade secret, or similar property right
arising from City's use of the software and/or documentation in accordance with this
Agreement, it being understood that this agreement to defend, settle or pay will not apply if
City modifies or misuses the software and/or documentation. So long as Vendor bears the cost
and expense of payment for claims or actions against City pursuant to this section, Vendor
will have the right to conduct the defense of any such claim or action and all negotiations for
its settlement or compromise and to settle or compromise any such claim; however, City will
have the right to fully participate in any and all such settlement, negotiations, or lawsuit as
necessary to protect City's interest, and City agrees to cooperate with Vendor in doing so. In
the event City, for whatever reason, assumes the responsibility for payment of costs and
expenses for any claim or action brought against City for infringement arising under this
Agreement, City will have the sole right to conduct the defense of any such claim or action
and all negotiations for its settlement or compromise and to settle or compromise any such
claim; however, Vendor will fully participate and cooperate
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with City in defense of such claim or action. City agrees to give Vendor timely written notice
of any such claim or action, with copies of all papers City may receive relating thereto.
Notwithstanding the foregoing, City's assumption of payment of costs or expenses will not
eliminate Vendor's duty to indemnify City under this Agreement. If the software and/or
documentation or any part thereof is held to infringe and the use thereof is enjoined or
restrained or, if as a result of a settlement or compromise, such use is materially adversely
restricted, Vendor will, at its own expense and as City's sole remedy, either: (a) procure for
City the right to continue to use the software and/or documentation; or (b) modify the
software and/or documentation to make it non -infringing, provided that such modification
does not materially adversely affect City's authorized use of the software and/or
documentation; or (c) replace the software and/or documentation with equally suitable,
compatible, and functionally equivalent non -infringing software and/or documentation at no
additional charge to City; or (d) if none of the foregoing alternatives is reasonably available
to Vendor terminate this Agreement, and refund all amounts paid to Vendor by City,
subsequent to which termination City may seek any and all remedies available to City under
law.
Assignment and Subcontracting.
9.1 Assignment. Vendor will not assign or subcontract any of its duties, obligations or
rights under this Agreement without the prior written consent of City. If City grants consent to an
assignment, the assignee will execute a written agreement with City and Vendor under which the
assignee agrees to be bound by the duties and obligations of Vendor under this Agreement. Vendor
will be liable for all obligations of Vendor under this Agreement prior to the effective date of the
assignment.
9.2 Subcontract. If City grants consent to a subcontract, the subcontractor will execute
a written agreement with Vendor referencing this Agreement under which subcontractor agrees to
be bound by the duties and obligations of Vendor under this Agreement as such duties and
obligations may apply. Vendor must provide City with a fully executed copy of any such
subcontract.
10. Insurance. Vendor must provide City with certificate(s) of insurance documenting
policies of the following types and minimum coverage limits that are to be in effect prior to commencement
of any Services pursuant to this Agreement:
10.1 Coverage and Limits
(a) Commercial General Liability:
$1,000,000 - Each Occurrence
$2,000,000 - Aggregate
(b) Automobile Liability:
$1,000,000 - Each occurrence on a combined single limit basis
Coverage will be on any vehicle used by Vendor, or its employees, agents, or
representatives in the course of providing Services under this Agreement. "Any
vehicle" will be any vehicle owned, hired and non -owned.
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(c) Worker's Compensation:
Statutory limits according to the Texas Workers' Compensation Act or any other
state workers' compensation laws where the Services are being performed
Employers' liability
$100,000 -
Bodily Injury by accident; each accident/occurrence
$100,000 -
Bodily Injury by disease; each employee
$500,000 -
Bodily Injury by disease; policy limit
(d) Professional Liability (Errors & Omissions):
$1,000,000 - Each Claim Limit
$1,000,000 - Aggregate Limit
Professional Liability coverage may be provided through an endorsement to the
Commercial General Liability (CGL) policy, or a separate policy specific to
Professional E&O. Either is acceptable if coverage meets all other requirements.
Coverage must be claims -made, and maintained for the duration of the contractual
agreement and for two (2) years following completion of services provided. An
annual certificate of insurance must be submitted to City to evidence coverage.
10.2 General Requirements
(a) The commercial general liability and automobile liability policies must
name City as an additional insured thereon, as its interests may appear. The term
City includes its employees, officers, officials, agents, and volunteers in respect to
the contracted services.
(b) The workers' compensation policy must include a Waiver of Subrogation
(Right of Recovery) in favor of City.
(c) A minimum of Thirty (30) days' notice of cancellation or reduction in
limits of coverage must be provided to City. Ten (10) days' notice will be
acceptable in the event of non-payment of premium. Notice must be sent to the
Risk Manager, City of Fort Worth, 200 Texas Street, Fort Worth, Texas 76102,
with copies to the Fort Worth City Attorney at the same address.
(d) The insurers for all policies must be licensed and/or approved to do
business in the State of Texas. All insurers must have a minimum rating of A- VII
in the current A.M. Best Key Rating Guide, or have reasonably equivalent financial
strength and solvency to the satisfaction of Risk Management. If the rating is below
that required, written approval of Risk Management is required.
(e) Any failure on the part of City to request required insurance
documentation will not constitute a waiver of the insurance requirement.
(f) Certificates of Insurance evidencing that Vendor has obtained all required
insurance will be delivered to the City prior to Vendor proceeding with any work
pursuant to this Agreement.
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11. Compliance with Laws, Ordinances, Rules and Regulations. Vendor agrees that in the
performance of its obligations hereunder, it will comply with all applicable federal, state and local laws,
ordinances, rules and regulations and that any work it produces in connection with this Agreement will also
comply with all applicable federal, state and local laws, ordinances, rules and regulations. If City notifies
Vendor of any violation of such laws, ordinances, rules or regulations, Vendor must immediately desist
from and correct the violation.
12. Non -Discrimination Covenant. Vendor, for itself, its personal representatives, assigns,
contractors, subcontractors, and successors in interest, as part of the consideration herein, agrees that in the
performance of Vendor's duties and obligations hereunder, it will not discriminate in the treatment or
employment of any individual or group of individuals on any basis prohibited by law. IF ANY CLAIM
ARISES FRO AN ALLEGED VIOLATION OF THIS NON-DISCRIMINATION COVENANT
BY VENDOR, ITS PERSONAL REPRESENTATIVES, ASSIGNS, CONTRACTORS,
SUBCONTRACTORS, OR SUCCESSORS IN INTEREST, VENDOR AGREES TO ASSUME
SUCH LIABILITY AND TO INDEMNIFY AND DEFEND CITY AND HO D CITY HARMLESS
FRO SUCH CLAIM.
13. Notices. Notices required pursuant to the provisions of this Agreement will be conclusively
determined to have been delivered when (1) hand -delivered to the other party, its agents, employees,
servants or representatives or (2) received by the other party by United States Mail, registered, return receipt
requested, addressed as follows:
To CITY:
City of Fort Worth
Attn: Assistant City Manager
100 Fort Worth Trail
Fort Worth, TX 76102
Facsimile: (817) 392-8654
With copy to Fort Worth City Attorney's Office at
same address
To VENDOR:
Concentra Health Services, Inc.
Attn: Legal Department
5080 Spectrum Drive, Suite 1200W
Addison, Texas 75001
Facsimile: (972)720-7770
Email: legalcontracts@concentra.com
14. Solicitation of Employees. Neither City nor Vendor will, during the term of this
Agreement and additionally for a period of one year after its termination, solicit for employment or employ,
whether as employee or independent contractor, any person who is or has been employed by the other
during the term of this Agreement, without the prior written consent of the person's employer.
Notwithstanding the foregoing, this provision will not apply to an employee of either party who responds
to a general solicitation of advertisement of employment by either party.
15. Governmental Powers. It is understood and agreed that by execution of this Agreement,
City does not waive or surrender any of its governmental powers or immunities.
16. No Waiver. The failure of City or Vendor to insist upon the performance of any term or
provision of this Agreement or to exercise any right granted herein does not constitute a waiver of City's or
Vendor's respective right to insist upon appropriate performance or to assert any such right on any future
occasion.
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17. Governing Law / Venue. This Agreement will be construed in accordance with the laws
of the State of Texas. If any action, whether real or asserted, at law or in equity, is brought pursuant to this
Agreement, venue for such action will lie in state courts located in Tarrant County, Texas or the United
States District Court for the Northern District of Texas, Fort Worth Division.
18. Severability. If any provision of this Agreement is held to be invalid, illegal or
unenforceable, the validity, legality and enforceability of the remaining provisions will not in any way be
affected or impaired.
19. Force Maieure. City and Vendor will exercise their best efforts to meet their respective
duties and obligations as set forth in this Agreement, but will not be held liable for any delay or omission
in performance due to force majeure or other causes beyond their reasonable control, including, but not
limited to, compliance with any government law, ordinance, or regulation; acts of God; acts of the public
enemy; fires; strikes; lockouts; natural disasters; wars; riots; epidemics or pandemics; government action
or inaction; orders of government; material or labor restrictions by any governmental authority;
transportation problems; restraints or prohibitions by any court, board, department, commission, or agency
of the United States or of any States; civil disturbances; other national or regional emergencies; or any other
similar cause not enumerated herein but which is beyond the reasonable control of the Party whose
performance is affected (collectively, "Force Majeure Event"). The performance of any such obligation is
suspended during the period of, and only to the extent of, such prevention or hindrance, provided the
affected Party provides notice of the Force Majeure Event, and an explanation as to how it prevents or
hinders the Party's performance, as soon as reasonably possible after the occurrence of the Force Majeure
Event, with the reasonableness of such notice to be determined by the City in its sole discretion. The notice
required by this section must be addressed and delivered in accordance with Section 13 of this Agreement.
20. Headings not Controlling. Headings and titles used in this Agreement are for reference
purposes only, will not be deemed a part of this Agreement, and are not intended to define or limit the scope
of any provision of this Agreement.
21. Review of Counsel. The parties acknowledge that each party and its counsel have
reviewed and revised this Agreement and that the normal rules of construction to the effect that any
ambiguities are to be resolved against the drafting party will not be employed in the interpretation of this
Agreement or its Exhibits.
22. Amendments / Modifications / Extensions. No amendment, modification, or extension
of this Agreement will be binding upon a party hereto unless set forth in a written instrument, which is
executed by an authorized representative of each party.
23. Counterparts. This Agreement may be executed in one or more counterparts and each
counterpart will, for all purposes, be deemed an original, but all such counterparts will together constitute
one and the same instrument.
24. Warranty of Services. Vendor warrants that its services will be of a high quality and
conform to generally prevailing industry standards. City must give written notice of any breach of this
warranty within thirty (30) days from the date that the services are completed. In such event, at Vendor's
option, Vendor will either (a) use commercially reasonable efforts to re -perform the services in a manner
that conforms with the warranty, or (b) refund the fees paid by City to Vendor for the nonconforming
services.
25. Immigration Nationality Act. Vendor must verify the identity and employment eligibility
of its employees who perform work under this Agreement, including completing the Employment
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Eligibility Verification Form (I-9). Upon request by City, Vendor will provide City with copies of all I-9
forms and supporting eligibility documentation for each employee who performs work under this
Agreement. Vendor must adhere to all Federal and State laws as well as establish appropriate procedures
and controls so that no services will be performed by any Vendor employee who is not legally eligible to
perform such services. VENDOR WILL INDEMNIFY CITY AND HOLD CITY HARMLESS FROM
ANY PENALTIES, LIABILITIES, OR LOSSES DUE TO VIOLATIONS OF THIS PARAGRAPH
BY VENDOR, VENDOR'S EMPLOYEES, CONTRACTORS, SUBCONTRACTORS, OR
AGENTS. City, upon written notice to Vendor, will have the right to immediately terminate this Agreement
for violations of this provision by Vendor.
26. Ownership of Work Product. City will be the sole and exclusive owner of all reports,
work papers, procedures, guides, and documentation that are created, published, displayed, or produced in
conjunction with the services provided under this Agreement (collectively, "Work Product"). Further, City
will be the sole and exclusive owner of all copyright, patent, trademark, trade secret and other proprietary
rights in and to the Work Product. Ownership of the Work Product will inure to the benefit of City from the
date of conception, creation or fixation of the Work Product in a tangible medium of expression (whichever
occurs first). Each copyrightable aspect of the Work Product will be considered a "work -made -for -hire"
within the meaning of the Copyright Act of 1976, as amended. If and to the extent such Work Product, or
any part thereof, is not considered a "work -made -for -hire" within the meaning of the Copyright Act of 1976,
as amended, Vendor hereby expressly assigns to City all exclusive right, title and interest in and to the Work
Product, and all copies thereof, and in and to the copyright, patent, trademark, trade secret, and all other
proprietary rights therein, that City may have or obtain, without further consideration, free from any claim,
lien for balance due, or rights of retention thereto on the part of City.
27. Signature Authority. The person signing this Agreement hereby warrants that they have
the legal authority to execute this Agreement on behalf of the respective party, and that such binding
authority has been granted by proper order, resolution, ordinance or other authorization of the entity. This
Agreement and any amendment hereto, may be executed by any authorized representative of Vendor. Each
party is fully entitled to rely on these warranties and representations in entering into this Agreement or any
amendment hereto.
28. Change in Company Name or Ownership. Vendor must notify City's Purchasing
Manager, in writing, of a company name, ownership, or address change for the purpose of maintaining
updated City records. The president of Vendor or authorized official must sign the letter. A letter indicating
changes in a company name or ownership must be accompanied with supporting legal documentation such
as an updated W-9, documents filed with the state indicating such change, copy of the board of director's
resolution approving the action, or an executed merger or acquisition agreement. Failure to provide the
specified documentation so may adversely impact future invoice payments.
29. No Boycott of Israel. If Vendor has fewer than 10 employees or this Agreement is for
less than $100,000, this section does not apply. Vendor acknowledges that in accordance with Chapter
2271 of the Texas Government Code, the City is prohibited from entering into a contract with a company
for goods or services unless the contract contains a written verification from the company that it: (1) does
not boycott Israel; and (2) will not boycott Israel during the term of the contract. The terms "boycott Israel"
and "company" has the meanings ascribed to those terms in Section 2271 of the Texas Government Code.
By signing this Agreement, Vendor certifies that Vendor's signature provides written verification to
the City that Vendor: (1) does not boycott Israel; and (2) will not boycott Israel during the term of
the Agreement.
30. Prohibition on Boycotting Energy Companies. Vendor acknowledges that in accordance
with Chapter 2276 of the Texas Government Code, City is prohibited from entering into a
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contract for goods or services that has a value of $100,000 or more that is to be paid wholly or partly from
public funds of the City with a company with 10 or more full-time employees unless the contract contains
a written verification from the company that it: (1) does not boycott energy companies; and (2) will not
boycott energy companies during the term of the contract. To the extent that Chapter 2276 of the
Government Code is applicable to this Agreement, by signing this Agreement, Vendor certifies that
Vendor's signature provides written verification to City that Vendor: (1) does not boycott energy
companies; and (2) will not boycott energy companies during the term of this Agreement.
31. Prohibition on Discrimination Against Firearm and Ammunition Industries. Vendor
acknowledges that except as otherwise provided by Chapter 2274 of the Texas Government Code, City is
prohibited from entering into a contract for goods or services that has a value of $100,000 or more that is
to be paid wholly or partly from public funds of the City with a company with 10 or more full-time
employees unless the contract contains a written verification from the company that it: (1) does not have a
practice, policy, guidance, or directive that discriminates against a firearm entity or firearm trade
association; and (2) will not discriminate during the term of the contract against a firearm entity or firearm
trade association. To the extent that Chapter 2274 of the Government Code is applicable to this
Agreement, by signing this Agreement, Vendor certifies that Vendor's signature provides written
verification to City that Vendor: (1) does not have a practice, policy, guidance, or directive that
discriminates against a firearm entity or firearm trade association; and (2) will not discriminate
against a firearm entity or firearm trade association during the term of this Agreement.
32. Electronic Signatures. This Agreement may be executed by electronic signature, which
will be considered as an original signature for all purposes and have the same force and effect as an original
signature. For these purposes, "electronic signature" means electronically scanned and transmitted versions
(e.g. via pdf file or facsimile transmission) of an original signature, or signatures electronically inserted via
software such as Adobe Sign.
33. Entirety of Agreement. This Agreement contains the entire understanding and agreement
between City and Vendor, their assigns and successors in interest, as to the matters contained herein. Any
prior or contemporaneous oral or written agreement is hereby declared null and void to the extent in conflict
with any provision of this Agreement.
(signature page follows)
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ACCEPTED AND AGREED:
CITY OF FORT WORTH:
0 OUV►�I6�
Dianna Giordano (Oct 6, 2026 15:08:26 CDT)
ame: Dianna Giordano
itle: Assistant City Manager
10/06/2026
Date: , 2026
AL RECOMMENDED:
ame: Kristen Smith
itle: Human Resources Director
TTEST.
i°Rr4°°a
va\2:--
9 f_Fpnd
8SD
c#.C. /JaPQr� �d
ad4nnnEXo5oa
ame:
Jannette Goodall
VENDOR:
CONTRACT COMPLIANCE MANAGER:
By signing, I acknowledge that I am the person
responsible for the monitoring and administration of
this contract, including ensuring all performance and
reporting requirements.
Peter Bernard
Safety Manager, Human Resources
APPROVED AS TO FORM AND LEGALITY:
Name: Jordan P. Alvarez
Title: Assistant City Attorney II.
CONTRACT AUTHORIZATION:
M&C: 26-758 : 8/25/26
Form 1295: 2025-1302529
OCCUPATIONAL HEALTH CENTERS of the SOUTHWEST, P.A.,
DBA CONCENTRA MEDICAL CENTERS
9/24/2026
Date:
ed by:
[��
G. (kasst {}�By189CF3"24a6._
Name: Robert G. Hassett, DO, MPH
Title: President, Treasurer & Corporate
Secretary
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
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EXHIBIT A
SCOPE OF SERVICES
The Contractor shall provide comprehensive Occupational Health and Safety Services to support the
City's workplace health, safety, and regulatory compliance initiatives. Services may include, but are not
limited to, the following:
• Provide consultation and technical expertise to City departments regarding occupational health
and safety matters and compliance with applicable federal, state, and local regulations, including
Occupational Safety and Health Administration (OSHA) standards.
• Develop, review, update, and assist with the implementation of occupational health and safety
policies, programs, procedures, and best practices.
• Conduct workplace hazard assessments, safety audits, inspections, and program evaluations, and
provide recommendations for corrective actions and continuous improvement.
• Develop and deliver training, educational materials, and safety awareness programs related to
OSHA standards, workplace safety, environmental health, regulatory compliance, and City
policies and procedures.
• Provide occupational health medical services, including but not limited to:
o Fitness -for -duty evaluations;
o Pre -employment, post -offer, and periodic medical examinations;
o Drug and alcohol testing;
o Respiratory medical evaluations;
o Clinical testing and laboratory services;
o Commercial Driver's License (CDL) medical examinations and compliance support;
o Exposure monitoring and medical surveillance programs;
o Vaccination and immunization programs, as requested;
o Return -to -work and medical clearance evaluations.
• Assist the City with exposure control plans, bloodborne pathogen compliance, respiratory
protection programs, hearing conservation programs, and other occupational health initiatives.
• Maintain documentation, medical records, and reporting in accordance with applicable OSHA
regulations, HIPAA requirements, and other applicable federal and state laws.
• Provide consultation regarding workplace injuries, illness prevention, workers' compensation
coordination, and regulatory compliance.
• Assist the City during OSHA inspections, investigations, audits, and compliance reviews,
including preparation of documentation and corrective action recommendations.
• Provide additional occupational health and safety services as requested by the City to support
regulatory compliance and employee health and safety objectives.
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City Secretary Contract No.
Table of Contents
1. Executive Summary................................................................................................. 13
2. Understanding City of Fort Worth's Requirements................................................... 15
3. Performing the Scope of Work................................................................................. 16
4. Key Personnel.......................................................................................................... 59
5. Concentra's Qualifications........................................................................................ 61
6. Pricing........................................................................ Error! Bookmark not defined.
7. Comparable Clients...................................................................................................18
Attachments.................................................................. Error! Bookmark not defined.9
Page 13 of 67
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1. Executive Summary
Concentra recognizes City of Fort Worth's unique service specifications. We can deliver customized
clinical solutions to help you achieve your program goals. We maintain policies to ensure ongoing
compliance with standard regulating bodies, including the Occupational Safety and Health Administration
(OSHA), the U.S. Department of Transportation (DOT), the Americans with Disabilities Act (ADA), the
Family and Medical Leave Act (FMLA), the National Fire Protection Association (NFPA), police officer
standards, and many others.
Concentra played a significant role in creating the workplace health industry model that exists today. We
apply our proven methodologies to occupational medicine and workers' compensation to help improve
treatment and overall outcomes.
Our approach successfully combines evidence -based medicine with our clinical
expertise and superior service discipline to deliver convenient access to quality
care and measurable cost savings.
Innovation
Concentra HUB is a self-service, online tool that brings your employees' test results, reporting, and
authorization online — making it easier and more convenient to get needed Concentra account information
when it is needed. Concentra HUB includes patient -specific clinical case views for easier injury case
management, online treatment authorizations, online support requests for customers to communicate with
Concentra medical centers, 24/7 access to results and reports for work injury and non -jury services, and a
message center for important updates.
Unmatched Access
With Concentra, your employees have access to our extensive network of more than 600 Concentra
medical centers nationwide. Our Concentra Telemed° and Concentra Telerehab® extend access to care
beyond the centers' walls and standard working hours. In addition, Concentra's Transportation Solution
provides injured employees with scheduled and real-time rides to and from Concentra medical centers.
Available nationwide, our transportation solution is provided free of cost after initial injury, for follow-up
appointments, and for scheduled physical therapy visits.
Our Mission
Our company mission is to improve the health of America's workforce, one patient at a time. We attribute
our success to our commitment to put our customers' people first, delivering personalized attention that
optimizes employee health and productivity.
1 out
of 5 ff1�ff
work injuries treated in the US
3 million
drug screens annually
50,000+
patients seen each day
900K+ •
injured employees
treated annually
2+ million
physicals annually
200,000+
employer customers nationwide,
including 85% of the Fortune 500
With a clear vision and a notable record of accomplishments, we offer the best -in -class solution for
occupational health care.
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About Concentra
Concentra was founded by physicians as a medical practice in 1979 and the delivery of high -quality
medical care continues to be our core competency to this day. Our footprint includes more than 600
medical centers in the United States with unmatched occupational health expertise and clinicians. We
know how to deliver care that works for companies and their employees.
Concentra is a leading health care company focused on improving the health of America's workforce, one
patient at a time. Through its affiliated clinicians, we provide occupational medicine, urgent care, physical
therapy, and wellness services from more than 45 states nationwide. In addition to these medical center
locations, Concentra currently serves employers by providing a broad range of health advisory services
and operating more than 100 onsite clinics.
Concentra offers an extensive suite of services, categorized as follows:
Concentra's Suite of Services
Occupational Health Care
• Pre -placement services, including
examinations, substance abuse testing, etc.
• Regulatory and employer mandated physicals
• Medical surveillance examinations
• Clinical testing (X-ray, audiograms, PFT,
EKG)
• Work -related vaccinations and infectious
disease screenings
• Travel health
• Functional capacity evaluations
• Human performance evaluations
• Office and industrial ergonomic evaluations
• Occupational therapy
• Medical advisory services
• Utilization review services (Medical
ReviewStream TM )
Urgent Care
• Diagnosis and treatment of minor non -work -
related illnesses and injuries, such as colds,
flu, skin conditions, back pain, and sprains
• Over 350 different types of laboratory tests
• X-rays
• Immunizations
• Infectious disease tests and screenings
Pharmacy Services*
• Pre-packaged formulary
• Medication dispensing for occupational
medicine and travel health*
• E -prescribing
• Mail-order prescribing
*Where allowed by state law.
Injury Care
• Primary work -related injury care (workers'
compensation)
• Workplace injury medication dispensing* and
prescribing
• Physical therapy
• Specialist care
• Return -to -work examinations
• COVID-19 evaluation for return to work
*Where allowed by state law.
Preventive Care
• Biometric screenings
• Vaccinations/immunizations
• Immigration examinations
• School and sports physicals
Training and Education
• General injury prevention education
• Job -specific injury prevention education
• Workplace Office and Industrial stretching and
exercise programs
• Back care and back injury prevention
• Wellness and illness prevention education
• Online drug and alcohol training (CMCA)
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2. Understanding City of Fort Worth's Requirements
Concentra understands that City of Fort Worth is seeking a qualified vendor to provide Occupational
Health Services consisting of a minimum of the following program components:
• Pre -Placement I Post -Job Offer Physical Exam, Department of Transportation (DOT) Physical
Exam, Physical Fitness Assessment.
• Physical Demand Job Assessment.
• Fitness for Duty Exam, Physical Ability Testing I Medical and Work History Questionnaire.
• Human Performance Evaluations (HPE).
o Provide essential job functions by a licensed physical therapist with certification from the
American Disabilities Act, (ADA).
• Medical Surveillance Exam
• Respirator Fit Testing Clearance
• Clinical Testing Services
• Immunization and Infectious Disease Screening
Concentra's Solution
Concentra would successfully perform the requested scope of services proficiently and in the most cost-
effective manner. We are confident our experience and expertise will make us the right company to assist
City of Fort Worth in meeting your program objectives.
We assure City of Fort Worth that we would:
• Use company best practices that are compliant with the DOT, OSHA, and other regulated
examinations
• Maintain policies and procedures to ensure ongoing compliance with ADA, FMLA, NFPA, police
officer standards, and many others
• Conduct drug screenings in accordance with DOT standard, 49 CFR Part 40
• Utilize a SAMHSA-certified, CAP-FDT accredited, and CLIA-certified laboratory for specimen analysis
• Employ only properly certified and trained staff to perform the scope of work
• Assign a designated team of qualified professionals to oversee City of Fort Worth's program and
ensure continued compliance
• Document patient visits and generate meaningful reports
• Maintain records securely to ensure confidentiality of personal health information in accordance with
the guidelines outlined by the Health Insurance Portability and Accountability Act (HIPAA)
We have the experience and resources, and qualified personnel, and are readily able to serve City of Fort
Worth efficiently and professionally.
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3. Performing the Scope of Work
Concentra medical centers offer a full complement of health care services, including, but not limited to,
substance abuse testing, physical examinations, clinical services, vaccinations, injury care, physical
therapy, and wellness screenings. Our centers offer convenient weekday operational hours, and many
locations also offer evening and weekend hours.
Our centers average between 3,100 and 9,000 square feet in size. The centers maintain security
services, and most offer free parking on the center property or adjacent to the center. All facilities are
accessible (ADA-compliant) and conform to all applicable federal, state, and local safety and disability
laws.
Each center's layout consists of support/common areas and clinical areas:
Support/Common Areas
• Waiting room — seating for
patients with a television and
magazine/coffee bar
• Business office — work area for
clerical staff
Clinical Areas
• Procedure rooms (for minor
procedures)
• Examination rooms
• Lab area — separate restrooms
(ADA-compliant) for drug and
alcohol collections
• Breath analysis/exam room —
to maximize privacy for
federally mandated testing
Service Sites
• Manager office
• Break room
• Marketing office
• Audio testing room — a single -
person booth
• Physician office
• Physician station — with X-ray
viewing areas and privacy to
enter patient data into
computer system
• X-ray facilities — a full -service
X-ray room and digital file
storage
• Restroom
• Records storage area
• Telephone/electrical area
• Storage area — for patient
charts
• Physical therapy area with
whirlpool, treatment areas,
strength and flexibility
equipment,
hydrocollator/freezer, and a
wide variety of therapy
modalities
Concentra proposes that our center closest to City of Fort Worth, the Fort Worth Forest Park center,
serve as the primary site for your employees. While the [Fort Worth Forest Park center is fully capable of
providing all required services in one facility, all Concentra medical centers are available to [City of Fort
Worth ] as is convenient.
Please note that medical center hours are subject to change, and some select services may vary from
center to center.
Concentra Medical Centers in Your Area
Forest Park
2500 W. Frwy 130
Suite 100
Fort Worth, Texas 76104
M -F: 8:00am — 5:00pm
Sat.: 8:00am — 4:00pm
(817) 882-8700
Rosedale
1106 Alston Ave.
Suite 160
Fort Worth, TX 76104
M -F: 9:00am — 6:00pm
(817) 332-0660
Docusign Envelope ID: 1 F779008-4347-8FEC-830D-645347CE6D0D
Multilingual Support
Concentra offers remote translation services through our preferred provider, Voiance, to accommodate
multiple language requirements. Voiance's 24/7 service supports more than 200 languages and dialects,
including American Sign Language. In addition, many Concentra centers are staffed with clinician's and
office staff who are bilingual, and recruiting bilingual staff is another option, where a specific engagement
requires.
Telemedicine
Concentra Telemed is the first telemedicine platform designed for the treatment of work -related injuries
and illnesses. Since its launch in 2017, thousands of employees nationwide have trusted Concentra
Telemed clinicians to provide the right care at the right time — no need to leave work or home. Using a
smartphone or computer, an employee can connect with a licensed Concentra clinician and receive
immediate attention to minor medical issues, work injury care rechecks, physical therapy, and more.
In addition, Concentra has recently expanded its offering. If you and/or your employees have an existing
relationship with a center and want to continue working with the team you know and trust, telemedicine
visits can be arranged by calling the center directly. Contact information for all Concentra medical centers
is available on Concentra.com. Services will be provided during current hours of operation and include:
• Initial treatment of minor, work -related injuries and illnesses
• Rechecks for employees who were previously seen at a Concentra medical center
• Concentra Telerehab® for employees who were previously seen at a Concentra medical center and
want to continue physical therapy regimens at home
• Return -to -work evaluations for asymptomatic employees with possible exposure to COVID-19
Concentra Telemed and Concentra medical centers use the same patient management system and
electronic medical record allowing employees to experience a continuity of care regardless of the access
point of care. In addition, utilizing the same patient management system that holds the employer's
existing account and service instructions, allows for the expedited exchange of information for accurate
and timely reporting, claim management, and billing.
Occupational Health Services
We provide the following service descriptions for [City of Fort Worth ]'s requested scope of work. While
these service descriptions highlight our standard approach, we would render all services to your
specifications and in full compliance with all applicable regulatory requirements.
Functional Evaluations
Ergonomic Services
City of Fort Worth has identified ergonomics as a key factor in the health and safety program of the organization.
Concentra knows effective ergonomic programs can benefit employee health and we offer several types of
ergonomic services. For City of Fort Worth , we recommend a program that combines evaluation with analysis.
Following is a brief overview of our program components:
Ergonomic Education — An ergonomic training session, usually an hour long, tailored to address
supervisors, employees, or both. Prior to the session, an ergonomic specialist tours the
workplace to develop an appropriate program.
Ergonomic Evaluation — A more comprehensive service that provides written recommendations
to help minimize risk factors and prevent injuries and disorders that result from the overuse of
muscles, poor posture, and repetitive movements.
Ergonomic Analysis — The most in-depth ergonomic service Concentra provides; an ergonomic
analysis would be performed if City of Fort Worth requests the development of a custom
workstation or other ergonomic solution for an employee.
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Concentra would appreciate the opportunity to discuss the implementation of an effective workplace
ergonomic program with City of Fort Worth . We believe we could develop a program that provides
numerous benefits, including improved productivity, reduced absenteeism, and lower health care costs.
Human Performance Evaluation/Job-specific Functional Testing
Following the job -site evaluation, our specialist develops an ADA-compliant, job -specific functional test
that we refer to as a human performance evaluation (HPE). The HPE assesses individuals on the ability
to perform the essential job functions (EJFs) and can be used for pre -employment and return -to -work
testing.
The Concentra physical therapist begins by defining each physically distinguishable task involved in the
job (i.e., lifting, carrying, pushing, pulling, etc.), including those tasks that have a definitive starting and
ending point, occur with regularity, and require a level of quantifiable physical exertion. For each qualified
biomechanical functional requirement, the physical therapist uses a force gauge to measure external
weights, starting and ending heights, task frequencies, forces produced or overcome, climbing
requirements, and more. This process adheres strictly to evaluation techniques that have a direct
correlation to the functional requirements.
HPE Components
Once the therapist has measured the EJFs, an HPE is developed to recreate the exact physical demands
of the job as measured in the biomechanical evaluation. The job -specific functional test may include
assessing any combination of the tasks listed below. However, this is not an all-inclusive list.
• Lift/Carry: "Vertically translating" or moving an object from a definitive starting height to a definitive
ending height; start/end heights are measured at location of hands
• Push/Pull: Total body push/pull; manual or using assistive device (i.e. pallet jack)
• UE PU/PL: Upper extremity push/pull; no lower extremity involvement; manual or using assistive
device
• Couple: True "grip" force required to perform action (e.g., activate power tool)
• CLIMBL: Accessing a ladder to perform job task
• CLIMBS: Accessing stairs/steps to perform job task
• Walk: Distance traveled during shift
• Confined Access (Con Acc): Dimensions of a space to be accessed (e.g., maintenance hole)
• Repetitive Posture Assumption (Rep Pos): To access specified distance from ground
• Limited Headroom (Lim Hdr): Dimensions of a space that does not permit standing to perform task
• Height Tolerance (Ht Tol): The highest vertical distance from the ground (e.g., putting shingles on a
roof)
• Sit: Amount of continuous time sitting
• Stand: Amount of continuous time standing
• Vision: Type of vision required to perform the essential tasks of the job
• Temperature: The environmental conditions present while performing the job
Validation of Testing Methodology
Our methods of validation and examination techniques follow ADA requirements for pre-
employment/post-offer testing and are the most defensible under ADA guidelines. Standard 29 CFR
1630.10 states, "The Uniform Guidelines on Employee Selection Procedures do not apply to the
Rehabilitation Act and are similarly inapplicable to this part." However, 29 CFR 1630.15 holds the
defenses of such screening techniques to the same means as other claims under Title VII. When there is
a need for screening techniques to be adapted to a disabled population, Concentra uses techniques that
are "job -related and consistent with business necessity," in accordance with ADA guidelines.
We evaluate tasks that:
• Meet the definition of "essential function"
• Are sufficiently quantifiable to be functionally tested by trained individuals
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HPE Testing Process
The physical therapist instructs the applicant of the goals of each testing service package included in the
HPE and allows the applicant to perform one trial of a specific task as he/she deems most appropriate. If
the applicant demonstrates poor knowledge of proper body mechanics and lifting technique during the
first trial, the physical therapist instructs the individual by demonstrating good body mechanics and
technique prior to proceeding with test.
The test is terminated if the applicant:
• Represents a significant threat or risk to self
• Requests to discontinue for any reason
HPE Results Reporting
Once the individual has completed the required functional tests, the physical therapist documents the
"pass/fail" results and gives them to the clinician. If the individual fails, the physical therapist documents
the reason and records observations on the testing form. The clinician combines the medical results with
the functional test results to render an overall "pass/fail" result for the individual.
Concentra Incumbent Experience
Concentra has direct experience serving as City of Fort Worth 's preferred occupational health provider
and we are prepared to leverage our existing insight to develop a physical ability testing program that
exceeds program expectations. We are confident that our current relationship, expertise, and best
practice approach make us the right company to assist City of Fort Worth in meeting its physical ability
testing needs and objectives.
Referrals and Care Management
If our clinician determines an employee's medical condition requires specialty care or testing, he/she puts
Concentra's efficient referral management process into action. Our streamlined approach helps ensure
prompt and appropriate treatment and continuity of care for better clinical and cost containment
outcomes.
While Concentra operates an extensive national medical center network, we are independent of hospital
systems and physician groups. This allows our clinicians to make referral decisions from a patient -
focused perspective, selecting appropriate clinical resources to deliver quality care. In addition, we are
committed to shared decision -making. This means we would include the employee as an active
participant in the referral management process. We would focus on education, decision aids, and
transparency to create a partnership between our clinician, the employee, City of Fort Worth , and other
relevant parties for effective care management and early case resolution.
Specialist Selection
Concentra involves specialists in the patient's care plan when:
• The medical issue extends beyond the skills and capabilities of our center staff
• Medical evidence exists of a condition that cannot be treated within the center
• Specialty diagnostic testing is required
We refer to specialists who share our commitment to evidence -based medicine. In doing so, we base
specialist selection on the following provider attributes:
• Successful medical outcomes and reputation within the community
• Ability to schedule timely appointments
• Willingness to collaborate with the center staff
• Ability to provide cost efficient services
• Identified as an authorized provider
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Please note that state workers' compensation laws and the carrier's requirements may preclude
Concentra from selecting specialist providers. However, when Concentra has a choice, we prefer to use
in -network providers of the employer's health plan as appropriate.
Concentra Advanced Specialist Network
Through Concentra Advanced Specialist Network (CAS), we developed direct relationships with local
specialists who offer surgical and non -surgical treatment for orthopedic and musculoskeletal injuries,
acute work -related conditions, and other disabling injuries. In many Concentra markets, these specialists
maintain weekly office hours at our medical centers, providing an added level of convenience.
Our CAS network spans the following surgical and non -surgical medical disciplines:
• Orthopedic surgery
• Pain management
• General orthopedics
• General surgery
• Foot and ankle orthopedics
• Hand surgery
• Spine orthopedics
• Podiatry
• Neurology
• Neurosurgery
• Physiatry
• Psychiatry
• Plastic surgery
• Chiropractic care
• Acupuncture
Docusign Envelope ID: 1 F779008-4347-8FEC-830D-645347CE6D0D
Third Party Specialists
In addition to our CAS network, Concentra has established relationships with local providers and hospital
systems to ensure seamless referral management, timely appointments, and continuity of care.
We refer to specialists who share our commitment to evidence -based medicine. In doing so, we base
specialist selection on the following provider attributes:
• Successful medical outcomes and reputation within the community
• Ability to schedule timely appointments
• Willingness to collaborate with the center staff
• Ability to provide cost efficient services
• Identified as an authorized provider
Ongoing Care Management
Concentra works to ensure we provide proactive, collaborative service that promotes quality, cost-
effective health care for all your employees. Our clinicians use a patient -centered model to monitor the
ongoing care of every injured or ill employee treated, from the first visit until return to full duty or reaching
maximum medical improvement (MMI). We establish preferred Health Insurance Portability and
Accountability Act (HIPAA)-compliant communication processes with specialists, appropriate client
departments (i.e., safety, human resources, etc.), and other entities involved in the patient's care plan to
ensure optimum recovery. We also track all specialty referrals, percentage of patients referred, the type of
referral, and the medical outcome of each referral to ensure successful resolution of the case.
Physical Examinations
Concentra has comprehensive policies and procedures outlining examination requirements in accordance
with DOT, OSHA, ADA, and general occupational health. We assure City of Fort Worth that a trained and
appropriately licensed medical professional would perform the required examinations and adhere to all
applicable regulations and guidelines specific to the examination.
Concentra would provide physical examinations according to City of Fort Worth 's requirements.
However, it is customary for the standard examination to include the following components:
• Medical history • Evaluation of the respiratory system
• Occupational history • Gastrointestinal examination
• Vital signs • Musculoskeletal examination
• Vision acuity (far distance) • Neurological evaluation
• Examination of head, eyes, ears, nose, and throat • Skin and lymphatic examination
• Evaluation of the cardiovascular system
We would also perform other ancillary testing as requested and/or indicated, upon City of Fort Worth 's
approval and consistent with evidence -based medical standards and regulatory requirements.
Medical and Work History Questionnaire
Prior to any physical examination, an employee completes a thorough medical history questionnaire that
includes personal, occupational, family, and medication history. Our comprehensive medical and work
history questionnaires ensure your employees are compliant with all federal, state, and local mandates
specific to their job category.
After reviewing the questionnaire, Concentra's clinician performs a comprehensive physical examination
and reviews the questionnaire in conjunction with the employee's test results to make the appropriate
medical recommendations. Concentra immediately addresses any findings that pose immediate danger to
the life or health of the employee.
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Electronic Forms
Concentra uses the TouchWorks EHR to electronically capture the employee's medical history and
questionnaire. The employee completes the form online before coming to the clinic/medical center, or
upon arrival, thus ensuring legibility and completeness (the system prevents skipping sections).
For DOT physicals, if the driver is certified, the medical examiner's certificate (MEC) is provided in the
center post -visit. All determinations are reported to the National Registry of Certified Medical Examiners
(NRCME) per regulations.
Custom and Spanish Forms
Concentra has custom medical and work history questionnaires in both English and Spanish and can
provide an array of comprehensive and mandated questionnaires necessary to maintain compliance.
Pre-placement/Post-offer Physical Examinations
Concentra realizes that any medical examination must be "job -related and consistent with business
necessity" (29 CFR 1630.14(b)). Pre-placement/post-offer physical examinations help ensure employees
or prospective employees do not have a medical condition that:
• Prevents safe performance of the essential job duties
• Can be exacerbated by the job duties
• Affects the safety of the employee, co-workers, or others in the workplace
Fitness -for -Duty Examinations
Fitness -for -duty examinations help ensure that employees can safely perform their job functions.
Concentra therapists and clinicians are specifically trained to assess fitness for duty for injured
employees and for employees who have medical conditions that could limit their ability to perform
essential job functions.
A fitness -for -duty examination is performed when an employee:
• Has observable difficulty performing work duties in a manner that is safe for the employee, his/her
coworkers, the employer, or the public, as determined by the employee's supervisor
• Poses an imminent and serious safety threat to self or others
• Returns to work from a non -work -related illness or injury
When an employee meeting the above conditions is referred to Concentra, our clinicians begin to
implement our well -coordinated evaluation to identify issues that may be affecting performance. This
begins with a comprehensive evaluation and communication with the employer to determine if the
employee can return to his/her normal job or if a limited -duty arrangement is indicated. Our clinicians
apply a three-phase methodology:
Phase 1: Our clinicians work to understand the various jobs in the workplace and perform evaluations
to ensure the employee can meet the essential job functions. We educate the employee on how to
enhance function and encourage support from his/her supervisor.
Phase 2: The employee undergoes a clinical examination to determine if he/she is medically able to
perform his/her job; this may include a job -specific functional test. Once the medical evaluation is
complete, Concentra's physical therapist conducts functional testing. In cases where the employee
has other medical conditions (e.g. recent surgery or a cardiac condition), we seek clearance from the
employee's primary care physician to proceed.
Phase 3: Upon completion of the functional testing, our physical therapist provides the results to our
physician, who combines the medical and functional test results and renders an overall "able to" or
"not able to" return -to -work decision. If our clinicians believe additional testing is required to render a
proper medical decision, we would seek City of Fort Worth 's authorization to proceed.
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Return -to -Work Examinations
Concentra's longstanding methodology and practices expedite employees' safe and sustainable return to
work. Our process includes immediate communication with the employer, careful job analysis, and a
focus on avoiding or limiting an employee's lost time from work.
During a return -to -work physical examination, in addition to a review of the employee's medical history
and existing documentation, the clinician performs a basic medical examination. The clinician determines
if the employee is medically able to proceed with the functional performance evaluation. If the employee
has a medical condition that precludes participation in a functional performance evaluation (e.g., recent
back/knee/shoulder surgery, an active hernia, a cardiac condition), we require clearance from the
employee's personal physician prior to the functional evaluation.
Once the employee has completed the required functional tests, the Concentra therapist documents a
"pass/fail" result and the results are given to the clinician. The clinician then combines the medical results
with the functional test results to render an overall "pass/fail" result for the employee. In some cases, our
examining clinician may require additional testing to render a medical decision. However, we do not
conduct any additional testing without authorization by the designated employer contact.
Medical Surveillance Examinations
Concentra performs medical surveillance examinations for employees who may be exposed to potentially
hazardous substances and conditions. Our medical surveillance services include Baseline Surveillance
Examination, Baseline Follow Up, Periodic Surveillance Examination, Biologic Monitoring, and Exit
Surveillance Examination. These exams vary by the type of exposure, as every kind of exposure has
specific requirements defined by the Occupational Safety and Health Administration (OSHA). We
maintain medical surveillance exam clinical guidelines for the most common exposure types and employ
skilled personnel trained in examination components. Concentra assures that all exam components and
results reposting are in accordance with current OSHA regulations.
Regarding medical surveillance examinations, Concentra:
• Renders medical services and abides by the reporting standards in accordance with OSHA
requirements including, but not limited to, the following:
• 1910.120. Hazardous waste operations and emergency response
• 1910.134. Respiratory protection
• 1910.1001. Asbestos exposure
• 1910.1024. Beryllium
• 1910.1030. Bloodborne pathogens
• 1910.1053. Respirable crystalline silica
Follows the recommendations of the Centers for Disease Control and Prevention (CDC)
Ensures all personnel who perform associated clinical testing maintain the appropriate certifications
from National Institute for Occupational Safety and Health (NIOSH) and Council for Accreditation in
Occupational Hearing Conservation (CAOHC) to perform such testing (e.g., audiograms, pulmonary
function tests, etc.)
Department of Transportation (DOT) Physical Examinations
Concentra has been performing Department of Transportation (DOT) physical examinations for
employers for more than 45 years. Annually, we perform more than 1,000,000 DOT physicals. We
maintain comprehensive policies and procedures for these examinations and thoroughly train our staff on
each testing component. The Federal Motor Carrier Safety Administration (FMCSA) provides the physical
requirements for commercial motor vehicle (CMV) drivers in 49 CFR 391.41. (Other DOT agencies may
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have prescribed different physical standards for their safety sensitive roles, such as pilots, rail conductors,
etc.)
The purpose of the DOT examination is to detect the presence of physical, mental, or organic conditions
of such a character and extent as to affect the driver's ability to safely operate a commercial motor
vehicle. The examination must be conducted carefully and include (at least) all information requested in
the applicable form. A history of certain conditions may lead to a disqualification or indicate the need for
further testing and/or an evaluation by a specialist.
DOT Exam Details
Components the ME will typically examine include the following:
• General appearance and development. Note marked overweight. Note any postural defect,
perceptible limp, tremor, or other conditions that might be caused by alcoholism, thyroid intoxication,
or other illnesses.
• Head -eyes. When charts other than the Snellen chart are used, the results must be expressed in
values comparable to the standard Snellen test. If the driver wears corrective lenses for driving, these
should be worn while driver's visual acuity is being tested. If contact lenses are worn, there should be
sufficient evidence of good tolerance of and adaptation to their use.
• Ears. Note evidence of any ear disease, symptoms of aural vertigo, or Meniere's disease. When
recording hearing, record distance from patient at which a forced whispered voice can first be heard.
If the individual fails the whispered voice test, the audiometric test should be administered. For the
audiometric test, record decibel loss at 500 Hz, 1,000 Hz, and 2,000 Hz. Average the decibel loss at
500 Hz, 1,000 Hz, and 2,000 Hz and record as described on the form. If the individual fails the
audiometric test and the whispered voice test has not been administered, the whispered voice test
should be performed to determine if the standard applicable to that test can be met.
• Throat. Note any permanent deformities likely to interfere with breathing or swallowing.
• Heart. Note murmurs and arrhythmias, and any history of an enlarged heart, congestive heart failure,
or cardiovascular disease that is accompanied by syncope, dyspnea, or collapse. Indicate onset date,
diagnosis, medication, and any current limitation. An electrocardiogram is required when findings so
indicate.
• Blood pressure (BP). If a driver has hypertension and/or is being medicated for hypertension, he or
she should be recertified more frequently. An individual diagnosed with Stage 1 hypertension (BP is
140/90-159/99) may be certified for one year. At recertification, an individual with a BP equal to or
less than 140/90 may be certified for one year; however, if his or her BP is greater than 140/90 but
less than 160/100, a one-time certificate for three months can be issued. An individual diagnosed with
Stage 2 hypertension (BP is 160/100-179/109) should be treated and a one-time certificate for three-
month certification can be issued.
• Lungs. Note abnormal chest wall expansion, respiratory rate, breath sounds including wheezes or
alveolar rales, impaired respiratory function, dyspnea, or cyanosis. Abnormal finds on physical
examination may require further testing, such as pulmonary tests and/or chest X-rays.
• Abdomen and viscera. Note enlarged liver, enlarged spleen, abnormal masses, bruits, hernia, and
significant abdominal wall muscle weakness and tenderness. If the diagnosis suggests that the
condition might interfere with the control and safe operation of a commercial motor vehicle, further
testing and evaluation are required.
• Genital -urinary and rectal examination. A urinalysis is required. Protein, blood, or sugar in the
urine may be an indication for further testing to rule out any underlying medical problems.
• Neurological. Note impaired equilibrium, coordination, or speech pattern; paresthesia; asymmetric
deep tendon reflexes; sensory or positional abnormalities; abnormal patellar and Babinski's reflexes;
ataxia. Abnormal neurological responses may be an indication for further testing to rule out an
underlying medical condition. Any neurological condition should be evaluated for the nature and
severity of the condition, the degree of limitation present, the likelihood of progressive limitation, and
the potential for sudden incapacitation.
• Spine, musculoskeletal. Previous surgery, deformities, limitation of motion, and tenderness should
be noted. Findings may indicate additional testing and evaluation should be conducted.
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Extremities. Carefully examine upper and lower extremities and note any loss or impairment of leg,
foot, toe, arm, hand, or finger. Note any deformities, atrophy, paralysis, partial paralysis, clubbing,
edema, or hypotonia.
Laboratory and other testing. Other test(s) may be indicated based upon the medical history or
findings of the physical examination.
Diabetes. If insulin is necessary to control the condition of a driver who has diabetes, the driver is
required to submit an Insulin -Treated Diabetes Mellitus Assessment Form MCSA-5870, obtained from
their treating physician. If mild diabetes is present and it is controlled by use of an oral hypoglycemic
drug and/or diet and exercise, it should not be considered disqualifying; however, the driver must
remain under adequate medical supervision.
Medical Examiner's Certificate
The DOT physical exam is performed by a certified medical examiner listed on the National Registry of
Certified Medical Examiners. The exam includes a review of the employee's medical history; a physical
exam with vital signs, vision, and hearing testing; and a urine test for blood, protein, and sugar to look for
conditions that may impact a driver's ability to safely operate a vehicle. Following the examination, the
results are automatically reported to the National Registry and state motor vehicle agencies, as required.
If the driver passes, the ME provides the required Medical Examiner's Certificate (MEC). The certificate
may be issued for up to 24 months; however, the Concentra ME may limit certification based on a driver's
medical history.
DOT Policy Development
Concentra can support the development and maintenance of a workplace drug and alcohol program that
is DOT compliant. We provide education and training for DOT -regulated employees. We also offer a full
range of work site assessments to identify opportunities to improve employee health, safety, and
compliance and reduce workplace injuries and illnesses and their associated costs. Our DOT policy
development services cover periodic, post -accident, and random drug and alcohol testing, and pre-
employment testing.
DOT Policies and Procedures
In addition to our full suite of preventive and treatment services, Concentra has experience and expertise
to assist employers with developing written drug and alcohol policies needed to adhere to DOT
regulations.
Firefighter Physical Examinations
Concentra conducts comprehensive physical examinations of firefighters. To begin, we require firefighters
to complete a medical history questionnaire, which includes medical, personal, occupational, family, and
medication history. A Concentra clinician reviews the questionnaire and performs a thorough physical
examination, which focuses on the firefighter's ability to meet the physical demands required to perform
the essential job functions identified by the fire department. The clinician also performs a medical
examination to reveal any health conditions that could adversely affect job performance.
Examples of essential functions tested include:
• Lifting/carrying — Simulates the height/weight of a fan, jaws of life, chain saw, or portable ladder
• Pushing/pulling — Simulates the pulling/carrying the hose off the truck to the scene/fire hydrant
• Upper body push/pull — Simulates coupling the hoses to the hydrant/truck, using hand tools, and
opening doors
• Climbing — Simulates accessing the fire ladder to reach victims and climbing stairs in structures
In addition, clinicians assess the firefighter for aerobic capacity, muscular strength and flexibility, and
cardiovascular endurance. Concentra offers a variety of assessment testing including, but not limited to,
the following:
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• Body fat composition
• Sit/reach flexibility test
• Maximum muscular upper and lower body strength (hand -grip strength, pushups, curl -up muscle
endurance)
Please note, assessment testing components may not be included if the individual has already passed a
physical abilities test.
NFPA Standard 1582
Concentra performs National Fire Protection Agency (NFPA) and International Association of Fire
Fighters (IAFF) examinations for hundreds of municipalities across the United States. We maintain written
protocols on all NFPA and IAFF standards and ensure that all personnel who deliver services have the
appropriate certifications to perform audiograms, pulmonary function tests, and stress testing.
Furthermore, we have physical conditioning protocols and perform job site analyses, physical fitness
testing, and more to meet NFPA requirements for our clients.
Concentra recognizes that appropriate physical condition is essential to a firefighter's safety, as well as
the public's safety. As such, we share City of Fort Worth 's responsibility to ensure firefighters have the
requisite physical and cardiac fitness to perform the essential job functions. Understanding the
environmental conditions (including required use of personal protective equipment) in which firefighters
perform, we assess their cardiovascular and muscular fitness, and follow fitness guidelines that address
the physiological and psychological demands they face on the job.
Our Clinicians' NFPA Expertise
Concentra clinicians are experts in their field and go through extensive occupational health care training
specific to firefighters, in accordance with National Fire Protection Agency (NFPA) guidelines. They:
• Understand the physiological, psychological, and environmental demands placed on fire fighters
• Evaluate fire department candidates and employees to identify medical conditions that could affect
their ability to safely respond to emergency operations
• Utilize the essential job task descriptions provided by the fire department to determine a candidate's
or member's medical certification
• Identify and report the presence of disqualifying medical conditions
• Inform the fire department chief or designee if/when a candidate or current member is assessed as
medically fit to safely perform the essential job functions
Confidentiality
Concentra maintains the confidentiality of all medical data. Information firefighters provide to our clinician
would not be inappropriately shared. No fire department supervisor or manager shall have access to
medical records without the express written consent of the employee. There are occasions, however,
when specific medical information is required to make decisions regarding placement, return to work, and
so forth. In these cases, written consent shall be obtained from the employee prior to release of specific
medical information.
Police Officer Physical Examinations
Concentra conducts police officer examinations according to the employing agency's examination
requirements. In addition, for identified safety -sensitive positions, Concentra performs a medical history
and physical examination designed to detect any of the following outlined conditions that may affect the
individual's job function:
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• Angina pectoris
• Asthma
• Cancer -metastatic or leukemia
• Cardiac arrhythmias or murmurs
• Cerebral vascular accident
• Chest pains of unknown origin
• Contagious hepatitis
• Contagious tuberculosis
• Chronic respiratory disease
• Diabetes, insulin -dependent or ketosis -prone
• Fixation of major joint
• Hearing
• Herniated lumbar disc
• Hypertension, uncontrolled
• Inguinal hernia
• Liver or renal dysfunction
• Migraine headache
• Myocardial infarction, history of
• Paralysis
• Prosthetic device, e.g., limbs, hearing aid,
colostomy
• Recurrent dislocation of a major joint
• Schizophrenia or manic-depressive psychosis
• Scoliosis greater than 15 degrees
• Seizure disorders
• Current substance abuse
• Valvular heart disease, uncorrected
• Vision
• Wasting disease, chronic, such as multiple
sclerosis, myasthenia gravis, or amyotrophic
lateral sclerosis
The examining physician records the findings of the medical examination on the prescribed form, and
indicates whether a limiting medical, physical, or mental circumstance exists — describing how the
circumstance affects the officer's ability to perform his/her duties, and specifying the type and duration of
treatment required. Infectious disease screenings and immunizations are completed, as needed, based
on the individual's health history.
ADA Compliant Examinations
Concentra developed ADApt®, a pre -placement and return -to -work process, in response to our clients'
needs to make objective employment decisions, retain healthy and physically adept employees, and
maintain compliance with the Americans with Disabilities Act (ADA).
The ADA does not prevent employers from obtaining medical and related information necessary to
evaluate the ability of an applicant or employee to perform essential job functions or to promote health
and safety on the job. However, to protect individuals with disabilities from employment actions based on
information that is not job -related and consistent with business necessity, the ADA imposes specific
obligations on the employer at the following three stages of the employment process:
Prior to making a job offer, an employer may not make any medical inquiry or conduct any medical
examination.
Following a job offer, an employer may make unrestricted medical inquiries, but may not refuse to
hire an individual with a disability based on results of such inquiries, unless the reason for rejection is
job -related and justified by business necessity.
After employment, any medical examination or inquiry required of an employee must be job -related
and justified by business necessity; exceptions are voluntary examinations conducted as part of
employee health programs and examinations required by other federal laws.
Challenges of ADA compliance for the employer and occupational medicine provider include:
• The essential functions of each job must be determined.
• Any examination performed to provide recommendations regarding employment must be job -related
and consistent with business necessity.
• All recommendations and resulting employment decisions must be consistent for all job applicants.
• The confidentiality of medical information must be maintained.
The ADApt program:
• Ensures the pre -placement medical examination tests for the essential job functions
• Provides documentation of readiness of an applicant being placed in the appropriate job (and/or an
injured employee being able to return to work)
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• Furnishes the medical provider and employer with definitive information regarding essential functions
of each job with measured criteria
• Assists in the reduction of workers' compensation costs by identifying employees who can safely
perform the essential functions of the job
Therapist Therapist
Employee
Therapist
Task resultsnrender
defines and creates HPE
completes
documents
combined
measures
tasks
pass/fail
and
essential job
included in
result for
submitted to
functions
HPE
each task
clinician
Together, the human performance evaluation (HPE) and medical exam allow the clinician to determine a
person's ability to perform essential job functions, which is critical to the client when making objective
employment decisions.
ADApt consists of the following components:
Component
Purpose
Job -site Evaluation
Assist the employer in defining the physical abilities necessary to perform
essential functions of specific jobs
Pre -placement/
Correlate the worksite evaluation information with a clinical evaluation that is
Return -to -work Evaluation
"job related and consistent with business necessity"
This evaluation allows the employer to medically determine a person's ability
to perform the essential job functions and objectively assess risk or direct
threat
Education and Installation
Establish the ADApt compliance program for the employer
Analysis and Compliance
Provide the employer with the necessary consistency of employment actions
resulting from medical recommendations, and ensure confidentiality of medical
information
Job -site Evaluation
When performing the job -site evaluation, the physical therapist:
• Defines the physical abilities necessary to perform essential functions of the job with the employer
supervisor
• Measures all physical abilities necessary to perform essential functions of the job
• Verifies with employees that the functions are essential
• Submits the job -site evaluation to the employer supervisor for confirmation
The job -site evaluation results in the following:
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Task Description
The task description is a detailed listing of the
functional and non-functional requirements and
associated tasks involved in job performance.
Task descriptions can be created in
approximately 14 to 21 days, depending on the
volume of jobs to be constructed. Task
descriptions are reviewed and approved by client
management.
Executive Physical Examinations
Human Performance Evaluation (HPE)
The HPE is the job -related functional test used in
the pre -placement or return -to -work exam
process. The physical therapist requires seven to
10 days to create the HPE. Testing can
commence within one week of the client's
approval of the task description.
Concentra would partner with City of Fort Worth and enhance your efforts to protect the health of your
top-level team members. We perform executive physicals to help determine your executives' ability to
meet the medical and physical demands of their jobs.
Our process is comprehensive and begins with our clinician's careful review of the executive's medical
history. This is followed by a thorough medical examination, which includes, but is not limited to the
following:
• Musculoskeletal examination
• Evaluation of the respiratory system
• Gastrointestinal examination
• Examination of head, eyes, ears, nose, and throat
• Skin and lymphatic examination
• Neurological evaluation
• Evaluation of the cardiovascular system
• Visual acuity and vital signs, including, but not limited to blood pressure, and urine dip test
City of Fort Worth 's executives have many demands on their time. As such, we would recommend your
executives schedule an examination appointment. In this way, we could perform all examination
components required by City of Fort Worth , and schedule any additional screenings or laboratory
services.
When all physical testing, laboratory services and screening studies are complete, a follow-up
consultation would be recommended. This allows our clinician to discuss test results with the executive,
provide personalized guidelines, and make specific recommendations to help the executive maintain
optimal health. A written report would be provided to the executive, as well.
HazMat Physical Examinations
Concentra has been performing physical examinations for four decades, and we affirm our ability to
perform Hazardous Materials (HazMat) physicals. We maintain written clinical guidelines on Occupational
Safety and Health Administration (OSHA) and other regulatory standards, including the required testing.
Our clinicians are properly licensed, and all testing is performed in accordance with the applicable
regulations.
Regarding HazMat examinations, Concentra:
• Renders services and abides by the recordkeeping standard in accordance with OSHA requirements
including, but not limited to, the following:
• 1910.95 Occupational noise exposure
• 1910.120 Hazardous waste operations and emergency response
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• 1910.134 Respiratory protection
• 1910.1030 Bloodborne pathogens
• Follows Centers for Disease Control and Prevention (CDC) recommendations
• Ensures that all personnel who perform associated clinical testing (e.g., audiograms, pulmonary
function tests, etc.) maintain the appropriate certifications for such testing.
Respirator Fit Testing Regulation
The Occupational Safety and Health Administration (OSHA) outlines the required fit testing process for
employees who may wear a respirator due to environmental contaminants in Respiratory Protection
Standard 29 CFR 1910.134(f). Respirators must be fitted to the employees to ensure an effective seal
and performance. Prior to fit testing, employees must be medically cleared to use a respirator. This is
documented on the physician's or other licensed health care provider's written medical opinion to the
employer. The Qualitative (QLFT) and Quantitative (QNFT) Fit Test processes are as follows:
Fit testing. This paragraph requires that, before an employee may be required to use any respirator with
a negative or positive pressure tight -fitting facepiece, the employee must be fit tested with the same
make, model, style, and size of respirator that will be used. This paragraph specifies the kinds of fit tests
allowed, the procedures for conducting the tests, and how the results of the fit tests must be used.
• 1) The employer shall ensure that employees using a tight -fitting facepiece respirator pass an
appropriate qualitative fit test (QLFT) or quantitative fit test (QNFT) as stated in this paragraph.
• 2) The employer shall ensure that an employee using a tight -fitting facepiece respirator is fit tested
prior to initial use of the respirator, whenever a different respirator facepiece (size, style, model or
make) is used, and at least annually thereafter.
• 3) The employer shall conduct an additional fit test whenever the employee reports, or the employer,
physician or other licensed health care provider (PLHCP), supervisor, or program administrator
makes visual observations of, changes in the employee's physical condition that could affect
respirator fit. Such conditions include, but are not limited to, facial scarring, dental changes, cosmetic
surgery, or an obvious change in body weight.
• 4) If after passing a QLFT or QNFT, the employee subsequently notifies the employer, program
administrator, supervisor, or PLHCP that the fit of the respirator is unacceptable, the employee shall
be given a reasonable opportunity to select a different respirator facepiece and to be retested.
• 5) The fit test shall be administered using an OSHA -accepted QLFT or QNFT protocol. The OSHA -
accepted QLFT and QNFT protocols and procedures are contained in Appendix A of this section.
• 6) QLFT may only be used to fit test negative pressure air -purifying respirators that must achieve a fit
factor of 100 or less.
• 7) If the fit factor, as determined through an OSHA -accepted QNFT protocol, is equal to or greater
than 100 for tight -fitting half facepieces, or equal to or greater than 500 for tight -fitting full facepieces,
the QNFT has been passed with that respirator.
• 8) Fit testing of tight -fitting atmosphere -supplying respirators and tight -fitting powered air -purifying
respirators shall be accomplished by performing quantitative or qualitative fit testing in the negative
pressure mode, regardless of the mode of operation (negative or positive pressure) that is used for
respiratory protection.
i) Qualitative fit testing of these respirators shall be accomplished by temporarily converting the
respirator user's actual facepiece into a negative pressure respirator with appropriate filters, or by
using an identical negative pressure air -purifying respirator facepiece with the same sealing
surfaces as a surrogate for the atmosphere -supplying or powered air -purifying respirator
facepiece.
ii) Quantitative fit testing of these respirators shall be accomplished by modifying the facepiece to
allow sampling inside the facepiece in the breathing zone of the user, midway between the nose
and mouth. This requirement shall be accomplished by installing a permanent sampling probe
onto a surrogate facepiece, or by using a sampling adapter designed to temporarily provide a
means of sampling air from inside the facepiece.
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• iii) Any modifications to the respirator facepiece for fit testing shall be completely removed, and
the facepiece restored to NIOSH-approved configuration, before that facepiece can be used in
the workplace.
Respirator Medical Clearance Evaluation
We summarize our capabilities to perform respirator medical clearance evaluations for an employer's
occupational health services program in the following table.
Component
Details
OSHA Respirator
Concentra uses the required OSHA Respirator Medical Clearance Evaluation Questionnaire
Medical Clearance
(questionnaire) when rendering an evaluation. Concentra asks the employer to provide the
Evaluation
following information:
Questionnaire
• Type and weight of respirator to be worn
• Exposures encountered with respirator use
• Duration and frequency of respirator use
• Physical effort expected while wearing the respirator
• Temperature and humidity extremes during wear
• Other personal protective equipment to be worn while wearing the respirator
• Any subsequent medical information
If the employee provides a positive response to any of questions one through eight of the
questionnaire, a follow-up exam and ancillary tests (such as spirometry, resting EKG, and CXR)
may be required at the discretion of the evaluating clinician. The evaluating clinician reviews the
responses, performs a focused physical exam, reviews any test results, then provides a written
medical opinion to the employer regarding the employee's ability to use the respirator.
Physical A follow-up medical exam may be required based on questionnaire responses. The exam includes
Examination all components as applicable and medically appropriate. We conduct the evaluations in
accordance with OSHA standards, as outlined in 29 CFR 1910.134.
Clinical Testing As appropriate, Concentra performs spirometry, Chest X-rays, and resting EKGs.
Fit Testing Concentra has comprehensive policies and procedures for training our medical support specialist
(additional fee) on respirator fit testing in accordance with OSHA regulation 29 CFR 1910.134. We regularly
provide qualitative fit testing at Concentra medical centers and perform quantitative fit testing at
select locations.
Respirator Fit Testing
Concentra offers respirator fit testing through our nationwide footprint of medical centers. Our clinical
experts work to ensure comprehensive training for our employees, and adherence to fit testing policies
and procedures in accordance with Occupational Safety and Health Administration (OSHA) regulation 29
CFR 1910.134.
We regularly provide qualitative fit testing at our centers and perform quantitative fit testing in select
markets. The qualitative fit test checks an employee's response to chemicals introduced outside the
respirator. The response may be voluntary or involuntary, depending on the substance used. (Concentra
typically uses BitrexTM or saccharin.) The quantitative fit test uses a fit test machine that measures the
particle concentration both inside and outside of the respirator. Quantitative fit testing is primarily for full -
face respirators but can be used for all tight -fitting respirators. For City of Fort Worth 's program,
Concentra proposes to perform Qualitative fit testing.
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Leave -of -Absence Assessments
Concentra can provide leave -of -absence assessments/examinations to determine the cause, validity,
extent, and permanency of a disability absence. The results report includes a list of limitations/restrictions,
expected duration of those limitations/restrictions, and temporary/permanent accommodations needed.
Under the Family and Medical Leave Act (FMLA), a Certification of Health Care Provider form verifies that
the employee's health care provider signed the form to document that there is information to support the
recommendation for time off work on an intermittent or continual basis.
Concentra's review process is as follows:
• The physician receives a completed FMLA form with medical records (via fax, mail, hand delivery,
or email)
• Physician reviews form and contacts the employer for clarification or additional information
• Physician reviews form for completeness. Medical records are reviewed to support the medical
necessity of the FMLA request (i.e., the establishment of a serious health condition as defined
under the Act)
• If request is appropriate, physician provides supporting documentation
• If request is not appropriate, physician makes two attempts to contact the provider to discuss
medical necessity
An employer or employer -assigned medical provider who has reason to doubt the validity of a medical
certification may require the employee to obtain a second opinion at the employer's expense. Pending
receipt of the second (or third) medical opinion, the employee is provisionally entitled to the benefits of the
Act. Concentra's physician would determine the need for the second opinion. Under the Act, the employer
is permitted to designate the health care provider to furnish the second opinion, but the selected health
care provider may not be employed on a regular basis by the employer. The employer may not regularly
contract with or otherwise regularly utilize the services of the health care provider furnishing the second
opinion unless the employer is located where access to health care is extremely limited. In these cases,
Concentra would suggest the appropriate medical referral.
Drug and Alcohol Testing
DOT -Compliant Urine Drug Screens
Concentra conducts urine drug testing in full compliance with Department of Transportation (DOT) rule 49
CFR Part 40 (Procedures for Transportation Workplace Drug and Alcohol Testing) and adheres to all
Substance Abuse and Mental Health Services Administration (SAMHSA) policies and procedures to
ensure appropriate chain of custody. By following these procedures in both federal and non-federal
testing, Concentra simplifies the collection process, offers the most defensible procedures for our
collectors and clients, and provides the optimal level of confidentiality for the donors.
Our typical process includes:
• Certified staff to perform collections
• Use of split specimen collection method as required by DOT
• Use of the proper custody and control forms (CCF) for regulated and non -regulated testing, using
electronic CCFs when possible
• Proper specimen containment
• Shipment of specimen, within 24 hours, to a SAMHSA-certified laboratory for analysis
• Involvement of a Medical Review Officer (MRO) for follow-up review, as appropriate
• Utilization of Quest Diagnostics, SAMHSA, CAP-FDT, and CLIA certified, for laboratory analyses
Concentra Collectors
Concentra's collector certification course meets and exceeds the DOT training model. To help ensure
consistency among all Concentra markets in adhering to DOT regulations, we developed a three-phase
Collector Certification Program. Our policy is that all collectors (new hires and existing) successfully
complete each phase of the program prior to Concentra certifying the individual to perform drug screen
collections. Concentra's intention is to maintain high standards and quality throughout the collection
process. To that end, although DOT regulations require refresher training to occur within five years,
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Concentra requires refresher training for all collectors every 2.5 years. If the collector does not complete
refresher training within the designated timeframe, we do not allow him/her to perform DOT collections.
We summarize each phase of our Collector Certification Program in the following table.
Phase One: Study Guide and Quiz
• Intranet study guide and quiz (required prior to attending Phase Two)
Phase Two: Classroom Instruction
• Interactive instruction • Written examination (85 percent pass rate required
• Hands-on collection training for certification)
• Completion of Collector Acknowledgement Form
• Five consecutive, error -free mock • One "temperature out -of -range" scenario
collections • One scenario in which the donor refuses to sign the CCF and
• Two uneventful collection scenarios initial the specimen bottle's tamper -evident seal
• One "insufficient quantity of urine" scenario
Collection Area Security and Measures to Ensure Valid Samples
Concentra takes measures to secure the collection area, prevent unauthorized access, and ensure the
collection of valid specimen samples. Examples of these measures include, but are not limited to, the
following:
• We confirm the donor's identity twice (by front desk personnel, then by the collector)
• Once in the designated area, the collector is limited to conducting one collection at a time to avoid
possible distractions that could compromise security and the integrity of the sample
• As required, we perform observed collections in accordance with all state and federal regulations
• Items in the collection area (i.e., trash receptacles, paper towel holders, under -sink areas, etc.) are
secure to avoid the concealment of contaminants
• Concentra facilities are equipped with a private, single -toilet room
• Water sources are unavailable to donors to avoid specimen dilution
• Water in the toilet is blue, and there is no access to soap, disinfectants, cleaning agents, or other
possible adulterants
• Prior to the collection, the collection site is inspected to ensure no foreign or unauthorized substances
are present
Collection Process
Concentra uses the DOT -required split specimen collection method, when possible. DOT collection
specimens are tested for substances outlined in the most recent regulations. The certified collector and
appropriate laboratory adhere to the following guidelines:
• Collect a minimum of 45 milliliters (ml.) of urine
• Divide the specimen into two bottles, 30 ml. in one and 15 ml. into a second bottle
• Seals the specimen appropriately
• Transport each specimen to the laboratory within 24 hours
• Once received, the lab analyzes the primary 30 ml. bottle while the second bottle is held pending a
request from the employee for a second test in the event of a verified positive of the primary test
result
Observed Collections
We acknowledge that in certain instances, direct observation may be required, and Concentra can meet
this requirement.
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Chain of Custody
When collecting urine specimens, Concentra adheres to all SAMHSA policies and procedures to ensure
appropriate chain of custody to document the integrity and security of the specimen from the time of
collection until receipt by the laboratory. For DOT collections, we use the federal chain of custody and
control form (CCF); for non -regulated drug screens, we use the non-federal CCF.
Specific to DOT testing, Concentra completes the federal CCF in accordance with SAMHSA guidelines,
as we outline below:
• Collector check the donor's driver's license or state identification card to verify identity
• Collector ensures that the name and address of the drug testing laboratory appears on the top of the
CCF and that the specimen ID number on the top of the CCF matches the specimen ID number on
the labels/seals
• Collector provides the required information in step 1 on the CCF and provides a remark in step 2 if
the donor refuses to provide his/her Social Security or employee ID number
• Collector gives a collection container to the donor to provide specimen
• After the donor gives the specimen to the collector, the collector checks the temperature of the
specimen within four minutes, marks the appropriate temperature box in step 2 on the CCF, and
provides a remark if the temperature is outside the acceptable range
• Collector checks the split or single specimen collection box:
• If no specimen is collected, the collector checks that box, provides a remark, discards Copy 1,
and distributes the remaining copies as required
• If it is an observed collection, the collector checks that box and provides a remark
• Donor watches as the collector pours the specimen from the collection container into the specimen
bottle(s), places the cap(s) on the specimen bottle(s), and affixes the label(s)/seal(s) on the specimen
bottle(s)
• After affixing the labels/seals, the collector dates the specimen bottle label(s)
• Donor initials affixed and dated specimen bottle label(s)
• Collector turns to Copy 2 (MRO Copy) and instructs the donor to (1) read the certification statement in
step 5 and (2) sign, print name, date, provide phone numbers, and date of birth; if the donor refuses
to sign the certification statement, the collector provides a remark in step 2 on Copy 1
• Collector completes step 4 (i.e., provides signature, printed name, date, time of collection, and name
of delivery service), immediately places the sealed specimen bottle(s) and Copy 1 of the CCF in a
leak -proof plastic bag, releases specimen package to the delivery service, and distributes the other
copies as required
Shy Bladder
Department of Transportation (DOT) rule 49 CFR Part 40.19 addresses procedures to be followed if an
employee does not provide sufficient urine for a drug test. Shy Bladder evaluations should be handled
within five days of the initial test. It is the employee's responsibility to provide evidence of a medical
condition that prevents urine testing. Below, we summarize 49 CFR Part 40.19.
When an employee does not provide sufficient urine for a drug test (45 mL of urine), collectors must:
• Discard the insufficient specimen, except where the insufficient specimen was out of temperature
range or showed evidence of adulteration or tampering
• Urge the employee to drink up to 40 ounces of fluid, distributed reasonably through a period of up to
three hours, or until the individual has provided a sufficient urine specimen, whichever occurs first
• It is not a refusal to test if the employee declines to drink
• Document on the "Remarks" line of the custody and control form (CCF), and inform the employee
of, the time at which the three-hour period begins and ends
• If the employee does not attempt to provide an adequate urine specimen and/or leaves the collection
site before the collection process is complete, collectors must discontinue the collection, note the fact
Docusign Envelope ID: 1 F779008-4347-8FEC-830D-645347CE6D0D
on the "Remarks" line of the CCF, and immediately notify the Designated Employer Representative
(DER); this is a refusal to test
If the employee has not provided a sufficient specimen within three hours of the first unsuccessful
attempt to provide the specimen, collectors must discontinue the collection, note the fact on the
"Remarks" line of the CCF, and immediately notify the DER
Send Copy 2 of the CCF to the medical review officer (MRO) and Copy 4 to the DER
■ Send or fax these copies to the MRO and DER within 24 hours of the collection attempt
When the collector informs the DER that the employee has not provided a sufficient sample, the DER
must, after consulting with the MRO, direct the employee to obtain, within five days, an evaluation from a
licensed physician acceptable to the MRO, who has expertise in the medical issues raised by the
employee's failure to provide a sufficient specimen. (With the appropriate expertise, the MRO may
perform this evaluation.)
If another physician will perform the evaluation, the MRO must provide the other physician with the
following information and instructions:
• The employee was required to take a DOT drug test, but was unable to provide sufficient urine to
complete the test
• The consequences of the appropriate DOT agency regulation for refusing to take the required drug
test
• That the referred physician must agree to follow the requirements outlined in the following paragraphs
The physician conducting this evaluation must recommend that the MRO make one of the following
determinations:
• A medical condition has, or with a high degree of probability could have, precluded the employee
from providing sufficient urine. If the MRO accepts this recommendation, the MRO must:
• Check "Test Cancelled" (Step 6) on the CCF
• Sign and date the CCF
• There is not an adequate basis for determining that a medical condition has, or with a high degree of
probability could have, precluded the employee from providing sufficient urine. If the MRO accepts
this recommendation, the MRO must:
• Check the "Refusal to Test" box and "Other" box in Step 6 on Copy 2 of the CCF and note the
reason next to the "Other" box and on the "Remarks" lines, as needed
• Sign and date the CCF
For purposes of this paragraph, a medical condition includes an ascertainable physiological condition
(e.g., a urinary system dysfunction) or a medically documented pre-existing psychological disorder but
does not include unsupported assertions of "situational anxiety" or dehydration.
• The physician performing the evaluation must provide a written statement of his/her
recommendations and the basis for them to the MRO.
■ The physician performing the evaluation must not include in this statement detailed information
on the employee's medical condition beyond what is necessary to explain the conclusion.
• If the physician is performing this evaluation in the case of a pre -employment test, the physician must
determine that the candidate's medical condition is a serious and permanent or long-term disability
that is highly likely to prevent the candidate from providing sufficient urine for a very long or indefinite
period, and must set forth his/her determination and the reasons for it in the written statement to the
MRO.
■ The MRO, upon receiving such a report, must follow the requirements of 49 CFR Part 40:195,
where applicable.
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• The MRO must seriously consider and assess the referred physician's recommendations in
determining whether the employee has a medical condition that has, or with a high degree of
probability could have, precluded the employee/candidate from providing sufficient urine.
■ The MRO must report his/her determination to the DER in writing as soon as it is made.
• The employer, when receiving a report from the MRO indicating that a test is cancelled, takes no
further action with respect to the employee.
■ The employee remains in the random testing pool.
After -Hours Collection Service
Concentra would provide City of Fort Worth with drug and alcohol collection services outside of our
normal center operating hours. We would use our preferred vendor, StepOne for after-hours and onsite
collection services.
Specimen Transport
Once the specimen is sealed, a courier picks up the specimen from the collection site via automobile. The
collector or collection site must ensure that each specimen collected is shipped to a laboratory as quickly
as possible, but in every case, within 24 hours. Specimens are picked up one to two times per day
depending on the volume of drug tests being administered at the center location.
Laboratory Urine Drug Screening
Initial Screening Test
A high -sensitivity enzyme immunoassay (EIA) screens for the presence of commonly abused drugs. At
this stage, test results equal to or greater than a calibrated immunoassay cutoff concentration identify
presumptively positive specimens. Each batch contains both negative and positive quality control
samples along with one blind quality control sample that is inserted into the batch in a random position.
Confirmation Test
For specimens that do not screen negative initially, confirmatory drug testing is performed by gas
chromatography/mass spectrometry (GC/MS), liquid chromatography/mass spectrometry (LC/MS), or any
other technique recognized by the U.S. Department of Health and Human Services (DHHS) and
Substance Abuse and Mental Health Services Administration (SAMHSA).
The concentration of drug or drug metabolite in each donor specimen is determined by comparison of the
response of the specimen to the response of calibrators of known concentration. As with the screening
test, each batch contains both negative and positive quality control samples along with one blind quality
control sample that is inserted into the batch in a random position. If required, confirmation testing for
specimen validity is performed by the same or, if available, a second definitive method that can be utilized
to identify specimens as adulterated, substituted, or invalid. Each confirmation test is performed on a
second aliquot that is obtained from the original specimen container and all confirmation batches contain
appropriate quality control samples to verify the performance of the procedure.
• If a donor specimen has a concentration of drug that is less than the employer -specific cutoff, the
specimen is determined to be negative for the confirmation test.
• If a donor specimen has a concentration of drug that is greater than or equal to the employer -specific
cutoff, the specimen is determined to be positive for the specific test.
Laboratory positives are transmitted to the Medical Review Officer (MRO.) The MRO gathers all test data,
interviews the donor, and confirms the result as positive or negative. The result is posted only after MRO
verification.
Docusign Envelope ID: 1 F779008-4347-8FEC-830D-645347CE6D0D
Urine Specimen Storage
Within its processing department, Quest Diagnostics, our vendor for clinical laboratory services, maintains
a designated, secured -access, storage room equipped with refrigerators and a back-up power source.
Specimens that are not tested within two days of receipt are kept in refrigerated storage where maximum
temperature does not exceed 6°C. Specimens that screen non -negative on the initial test are immediately
placed in refrigerated storage to be maintained until the laboratory's certifying scientist confirms the
results. All specimens are stored and tested under strict chain of custody.
The following table outlines Quest's standard storage and retention guidelines.
Category
Negative
Presumptive
Confirmed Positive
Adulterated, Substituted, Invalid
At request of client
Storage Period
5 to 7 days
13 months - minimum
13 months - minimum
1 year
Extended period determined by
client; additional fees may apply
Temperature
Refrigerated (2 to 8° C)
Frozen (-20°C or colder)
Frozen (-20°C or colder)
Frozen (-20°C or colder)
Frozen (-20°C or colder)
Quest retains a urine specimen for a minimum of one year if it was reported positive, adulterated,
substituted, or invalid. Quest retains a negative urine specimen for five to seven days. A retained
specimen must be kept in a secured location that is appropriate for that type of specimen (e.g., frozen
storage for urine) to ensure its availability for any necessary re -testing during an administrative or judicial
proceeding. Within the one-year storage period, a federal agency or MRO may request a laboratory to
retain a specimen for an additional period, for a fee. If no such request is received, a specimen may be
discarded.
Rapid Urine Drug Screen
Concentra's rapid drug screens use eCup and xCup, which are patented urine collection devices
designed to allow for rapid, under -seal screening. The "smart" cup produces results that are objective, not
subjective, which means human intervention and interpretation are not required, eliminating the risk of
incorrectly reading a result.
The use of rapid drug screens is limited to those circumstances and states where Concentra and the
employer determine they are appropriate and authorized. Not every service offered is appropriate for use
by all employers in every state. Employers should always consult their legal or human resources advisers
to determine which services are appropriate for their specific circumstances.
5 -Panel vs. 10 -Panel Rapid Drug Tests
5 -panel rapid tests include the five drug classes tested on most standard panels, including Department of
Transportation (DOT). 10 -panel Rapid Tests are expanded to combine tests in 6, 7, 8, 9, and 10 panel
options. Results indicate a positive or negative status for each class of drug.
5 -panel Rapid Test 10 -panel Rapid Test
• Marijuana (THC) • Marijuana (THC) * • Barbiturates
• Cocaine • Cocaine • Benzodiazepines
• Amphetamines • Amphetamines • Methadone
• Phencyclidine (PCP) • Phencyclidine (PCP) • Oxycodone
• Opiates • Opiates • Methamphetamine
Docusign Envelope ID: 1 F779008-4347-8FEC-830D-645347CE6D0D
10 -panel also available without THC
Rapid Drug Screen Process
The rapid drug screen process is as follows:
• An electronic chain of custody and control form (eCCF) is used, eliminating the expense and delays
typically associated with incomplete paper forms and fax/mail paper chains. The paperless trail
accompanies the specimen throughout the process — from the initial order, through the testing
process, and to the result's electronic storage, distribution, and reporting.
• Once the donor's urine is in the specimen cup, the lid is affixed and sealed. This creates a completely
self-contained unit that does not require the collector to pour, transfer, or pipette the specimen into
any other container.
• The cup, in combination with the patented electronic reader appliance, analyzes the specimen. The
cup's lid contains several embedded reagent test strips that are sensitive to the five -test SAMHSA
profile cutoff levels. (SAMHSA is Substance Abuse and Mental Health Services Administration.) The
lid's test strips also detect instances in which a specimen may be adulterated or diluted.
• When the cup is placed into the electronic reader device, its test strips are digitally screened for the
absence of illicit or abused drugs specified in the requested test. The electronic reader uses bar code
technology, coupled with optical imaging, to electronically capture the drug test results.
• Tests that screen negative are reported to the employer, via the Concentra HUB, within 15 minutes of
the test.
• Any result that cannot be screened out as negative is shipped to the SAMHSA-certified laboratory for
complete analysis and confirmation testing.
Rapid Screen Confirmation Test
Tests that do not screen negative are sent to the laboratory for confirmation testing. Confirmatory drug
testing is performed by gas chromatography/mass spectrometry (GC/MS), liquid chromatography/mass
spectrometry (LC/MS), or any other technique recognized by the U.S. Department of Health and Human
Services (HHS) and Substance Abuse and Mental Health Services Administration (SAMHSA). If required,
confirmation testing for specimen validity is performed by the same or, if available, a second definitive
method that can be utilized to identify specimens as adulterated, substituted, or invalid. Each confirmation
test is performed on a second aliquot that is obtained from the original specimen container, and all
confirmation batches contain appropriate quality control samples to verify the performance of the
procedure.
Specimens with a concentration of drug greater than or equal to the established cutoff level are reported
as a laboratory positive. Laboratory positives are transmitted to the Medical Review Officer (MRO.) The
MRO gathers all test data, interviews the donor, and confirms the result as positive or negative. The result
is posted only after MRO verification.
DOT Compliance Services
The U.S. Department of Transportation (DOT) requires that companies implement training initiatives,
testing standards, and regulations for drivers of commercial motor vehicles, as well as personnel in other
safety -sensitive roles. Concentra helps employers by offering a wide variety of DOT services to support
their compliance efforts. These include DOT substance testing, supervisory training, DOT compliance
policy development, and DOT physicals.
Concentra's DOT compliance services include:
• DOT Testing: DOT substance screenings test for the presence of illegal drugs, alcohol, and other
substances, helping to create a safer work environment.
• Physicals: Concentra conducts physicals for drivers, aviators, conductors, or other employees
regulated by DOT, Federal Aviation Administration (FAA), and other federal agencies.
Docusign Envelope ID: 1 F779008-4347-8FEC-830D-645347CE6D0D
• DOT Policy Development: Concentra can help employers develop written drug and alcohol
policies in accordance with DOT regulations.
Wellness and Screening Programs or Strategies
At Concentra, we believe there is power in the prevention of chronic health conditions that could
negatively impact your employees' health and productivity. Keeping in mind that 70 percent of chronic
health conditions are related to lifestyle, we typically advocate a comprehensive employee health
approach that includes identification of potential health issues, intervention, monitoring, educational
services, and other activities. Our goal is to help employees understand the potential implications of
chronic conditions and to encourage them to make changes that can have a positive impact on their
overall health and productivity.
Before recommending specific strategies for City of Fort Worth , we would like to review City of Fort Worth
's health insurance claims to identify population health trends.
Drug and Alcohol Alternative Sample Testing
Breath Alcohol Testing
Concentra conducts breath alcohol testing using an evidential breath testing (EBT) device selected from
the National Highway Traffic Safety Administration (NHTSA) Conforming Products List for both screening
and confirmation testing. To ensure quality results, we calibrate each EBT device daily and after every
positive result, without exception. Records of the calibration are filed with a retention period of five years.
In addition, personnel performing breath alcohol testing are trained and certified as breath alcohol
technicians (BAT) in accordance with Department of Transportation (DOT) guidelines.
Initial Test
Typically, breath alcohol tests that register less than 0.02 g/210 L are reported as negative (for the
purposes of DOT) and no additional testing is required. Breath alcohol tests that register 0.02 g/210 L or
greater require a second confirmatory test.
Breath Alcohol Confirmation Test
If the confirmatory test is less than 0.02 g/21 0 L, the results are reported as negative. Breath alcohol
results that register 0.04 g/21 0 L or greater on the confirmation test are immediately reported to the
employer. A result that registers 0.04 g/210 L or greater is considered a DOT positive result.
Hair Sample Testing
Psychemedics Corporation ("Psychemedics') is Concentra's preferred vendor for hair follicle testing.
Psychemedics possesses the first internationally patented technology for analyzing hair for evidence of
drug abuse. Their method produces an individual drug history for a period of several months.
Collector Training
Concentra hair collectors must complete and successfully pass the Psychemedics Hair Collection
Training Course and demonstrate proficiency prior to performing any hair collections.
Hair Sample Collection
Drugs deposited in hair can be measured using radioimmunoassay and ultra -sensitive gas
chromatograph/mass spectrometry procedures. All initial positives are confirmed using gas
chromatography/mass spectrometry (GC/MS). Concentra's collectors perform all hair sample collections
based on guidelines provided by Psychemedics.
Docusign Envelope ID: 1 F779008-4347-8FEC-830D-645347CE6D0D
Hair Sample Collection
Head hair • The preferable area for hair sample collection is the crown of the head. Head hair can be
gathered from multiple locations on the head to obtain a suitable volume. However, the
collection can never be a combination of head and body hair.
• If using head hair, the collector ensures the collection will be cosmetically undetectable.
• If the donor has no head hair or the head hair is very sparse and collecting it would leave a
visible spot, hair should be collected from an alternate area of the body.
Body hair • Body hair may be collected from the legs, underarms, chest, and arms. Body hair collected
from any of these areas may be combined into a single sample submitted to the laboratory.
• The collector should ensure the collection areas are as undetectable as possible.
Hair Sample Chain of Custody
Specific to hair sample testing, Concentra completes the chain of custody and control form (CCF)
electronically. Results of hair testing are typically available in 48-72 hours for negative specimens.
Blood Sample
While Concentra can perform blood sample drug and alcohol testing, we are confident in our policy to
conduct urine testing according to the DOT guidelines. [We propose urine drug testing for City of Fort
Worth , as it is less intrusive and less expensive.]
Saliva Sample
The Q.E.D.® Saliva Alcohol Test can be used to screen for the presence of alcohol in the body. The
collector obtains a saliva sample from the patient via a cotton swab, which is then introduced into the
Q.E.D. unit. The device is similar to a mercury thermometer in that a color bar indicates the level of
alcohol present. This device is to be used only as a screening tool. Confirmation tests must be completed
by using a special unit (DOT Conforming Products list). Per Concentra policy, only BAT -certified staff
members are authorized to complete Q.E.D. Saliva Alcohol Tests. BAT certification is also required to
perform confirmatory testing.
Medical Review Officer (MRO) Services
When the laboratory confirms a non -negative result, Concentra enlists a Medical Review Officer (MRO)
through our preferred vendor for review of the result. An MRO assistant ensures the MRO copy and the
laboratory copy of the chain of custody and control form (CCF) are transmitted timely, as the MRO does
not initiate a donor interview until receiving the MRO copy of the CCF and does not transmit verified
results until receiving the laboratory copy. If the MRO is unable to obtain either copy, the MRO reports a
"canceled" test.
The MRO makes three or more attempts in a three-day period to reach the donor (barring unforeseen
circumstances, such as donor's phone disconnected). The MRO interviews the donor to determine if
there is a legitimate medical explanation for the non -negative result. The MRO can ask medically related
questions (which the donor's employer cannot ask under the Americans with Disabilities Act) to validate
or invalidate a non -negative laboratory result.
The MRO's standard responsibilities include:
• Conform to DOT Regulation 49 CFR Part 40 in the performance of all services and data
transmissions for DOT and non -DOT drug tests
• Provide an MRO assistant to review all test results and CCFs under the MRO's direct supervision
• Receive appropriate copies of the CCF within 24 hours of the collection; if collection sites do not
adhere to this requirement, Concentra provides appropriate follow up and training
• Store MRO records within regulatory requirements and best practices to maintain confidentiality
• Facilitate blind sampling for all laboratories, per DOT regulations
• Adhere to federal guidelines when coordinating the collection site process
Docusign Envelope ID: 1 F779008-4347-8FEC-830D-645347CE6D0D
• Transmit results via a secured network; SAMHSA-certified laboratories produce an export file from
their information management system and send it across their internal network in an encrypted file,
restricting access
Concentra Medical Compliance Administration
To supplement Concentra's comprehensive occupational medicine capabilities, we have a dedicated
internal unit to manage drug and alcohol testing programs for our clients nationwide. The Concentra
Medical Compliance Administration (CMCA) department delivers integrated substance abuse program
management. CMCA utilizes proven processes, specialized technology, and expertise in DOT and other
mandated substance abuse program requirements to assist our clients in maintaining compliance with
state and federal regulations.
CMCA offers the following services:
• Drug screens and breath alcohol testing
• Collection site management
• Complete substance abuse program management
• Data storage
• Laboratory analysis of the specimen
• Medical review officer (MRO) services
• Random selection program management
• Results reporting and web -based report generation
Benefits we offer City of Fort Worth include:
• Accessible facilities via our extensive network of freestanding Concentra medical centers and non-
Concentra network sites
• Fully equipped collection facilities
• Trained, qualified personnel to perform the services
• Proper documentation
• Confidential and timely reporting
• Compliant service delivery
• Resources to oversee and support program operations to ensure continued compliance
Collection Site Network
CMCA supplies each client with a list of collection site facilities near their worksite(s). We make every
effort to designate afacility within a 30 -minute, one-way drive time. Additionally, CMCA offers clients
the option of designating a preferred facility. If not currently within the CMCA collection site network, we
make every reasonable effort to secure a contract with the client -preferred facility.
In addition to Concentra's footprint of local community based medical centers, CMCA maintains a network
of qualified, non-Concentra providers to provide as donor collection sites. We identify and select these
network providers based on their service capabilities and ability to communicate results to Concentra
within an identified timeframe.
Random Selection Program Management
CMCA's random selection program eliminates manipulation of the selection process and adheres to DOT
regulations. We use a pool management feature in our drug testing program to capture information
needed to schedule random pool selections within the required time frame, including:
• Name of pool
• Selection interval — monthly or quarterly
• Last selected — indicates period the last pool was selected
• Scheduled — indicates pool has been scheduled
Docusign Envelope ID: 1 F779008-4347-8FEC-830D-645347CE6D0D
Website users are able to view the employee list for each random pool group, add and remove members
from the random pool group, and view the current random selection 24 hours a day, seven days a week.
Once pools are established, City of Fort Worth 's random selection process is conducted. To proceed:
• City of Fort Worth 's contact updates additions and deletions of pool employees via the web, or via
email if web is not available
• CMCA imports records from the client database and creates pool groups to meet specified criteria
• Once the pool has been created, employees have been imported to the pool, and year-to-date
statistics are verified, random selection is electronically run
• CMCA prints a master random selection list and sends employee notification and instruction letters to
City of Fort Worth 's contact
• CMCA reports whether an employee has completed his/her drug test and reports on outstanding tests
Random Pool Manager
[Random pool lead name, random pool lead title] would serve as City of Fort Worth 's random pool
manager. [Mr./Ms. Random pool lead last name] would maintain City of Fort Worth 's random drug testing
programs as well as database and reports on drug and breath alcohol test results.
Data Management System
We utilize a comprehensive drug screening application that tracks and manages our client's screening
activities and compliance. The system offers a client web portal that allows users to view the status and
results of all drug screening activities.
The data management system offers real-time results reporting. In the following table, we identify
several of the management reports available as part of [ClientShort>'s program.
Report
Management Information System
(MIS) Report
Statistical Reports
Positive Rate Summary Report
Random Scheduling History
Report
CMCA Consolidated Billing
Description
MIS report for companies regulated by DOT
Laboratories provide statistical reports on a semi-annual basis,
which allow for cross-referencing data in correlation with
laboratory data to ensure accuracy
Statistical numbers for positive rates
Provides an accounting of random pool activity for the specified
time frame
CMCA invoices monthly including invoices from our network of subcontractor collection sites, allowing for
consolidated billing and management reports for our clients. Our data management system tracks test
event data and includes several organizational levels, such as company, location, and division. Each test
event has its own billing detail.
CMCA Results Reporting
Results Turnaround Time
Upon laboratory receipt of a Concentra Medical Compliance Administration (CMCA) drug screen, average
turnaround time for a negative result is 24 to 48 hours. Turnaround time for a non -negative result varies
for Department of Transportation (DOT) vs. non -DOT tests. Non -negative results, including medical
review officer (MRO) review, take 48 to 72 hours depending on the MRO verifications. CMCA reports
results daily.
Docusign Envelope ID: 1 F779008-4347-8FEC-830D-645347CE6D0D
Reporting Options
CMCA has drug test result downloads established with all federally regulated laboratories. The MRO
reviews all drug testing results prior to reporting the results to the designated employer representative.
The following table identifies options for report delivery.
Option Details
Internet We report drug test results via a secure website. An assigned access code and
password must be used to access the website. Multiple users within a company can
obtain results.
Email Concentra sends drug test notifications to the designated contact's direct email address.
Drug and Alcohol Training
Experience tells us conducting substance abuse prevention training on site in the workplace can be time-
consuming and expensive. Concentra drug and alcohol awareness training is web -based, and it
effectively conveys important information to an employer's supervisors and other employees. Our online
training program is a convenient, fast, and economical way to train employees on workplace substance
abuse prevention.
The table below provides an overview of our online training program:
Concentra Drug and Alcohol Awareness Training
Meets the latest federal training requirements: Our training program will keep your company fully
compliant with the latest training requirements mandated by federal agencies such as the Department
of Transportation (DOT).
Helps eliminate the burden of cost while removing logistical challenges: Scheduling professional
trainers and coordinating groups from many locations can be difficult and expensive. Our training
program delivers the appropriate training immediately, whether for new hires or newly promoted
supervisors. The supervisory training specifically instructs supervisors to identify, document, and
address employee performance problems that could be an indication of drug- or alcohol -related
problems. The result is a safer and more productive workplace.
Fully Interactive: Our web -based training is more than a simple presentation of information; it is
interactive computer training. It requires regular input from the user. Concepts are presented through
reading and responding, and the user must respond accurately to continue to the next idea. Our
interactive training modules enhance the learning environment, enabling faster and higher
comprehension.
How simple is it? The supervisor or employee self -administers the training through web -based point -
and -click presentations. Training fits around an employee's schedule, is completely self -paced, and
each user learns according to his or her specific needs.
Course List:
• Non -DOT courses
• Reasonable Suspicion Training for
Supervisors (25 Minutes)
• Drug Free Workplace Training for
Supervisors (120 Minutes)
• DOT courses
DOT Reasonable Suspicion Training for
Supervisors (120 Minutes)
DOT Drug & Alcohol Awareness for
Employees (60 Minutes)
Docusign Envelope ID: 1 F779008-4347-8FEC-830D-645347CE6D0D
Concentra Drug and Alcohol Awareness Training
■ DOT (FMCSA) Designated Employer
Representative (DER) Training (Self -
paced)
Medical Review Officer (MRO) Services
When the laboratory confirms a non -negative result, Concentra enlists a Medical Review Officer (MRO)
through our preferred vendor for review of the result. An MRO assistant ensures the MRO copy and the
laboratory copy of the chain of custody and control form (CCF) are transmitted timely, as the MRO does
not initiate a donor interview until receiving the MRO copy of the CCF and does not transmit verified
results until receiving the laboratory copy. If the MRO is unable to obtain either copy, the MRO reports a
"canceled" test.
The MRO makes three or more attempts in a three-day period to reach the donor (barring unforeseen
circumstances, such as donor's phone disconnected). The MRO interviews the donor to determine if
there is a legitimate medical explanation for the non -negative result. The MRO can ask medically related
questions (which the donor's employer cannot ask under the Americans with Disabilities Act) to validate
or invalidate a non -negative laboratory result.
The MRO's standard responsibilities include:
• Conform to DOT Regulation 49 CFR Part 40 in the performance of all services and data
transmissions for DOT and non -DOT drug tests
• Provide an MRO assistant to review all test results and CCFs under the MRO's direct supervision
• Receive appropriate copies of the CCF within 24 hours of the collection; if collection sites do not
adhere to this requirement, Concentra provides appropriate follow up and training
• Store MRO records within regulatory requirements and best practices to maintain confidentiality
• Facilitate blind sampling for all laboratories, per DOT regulations
• Adhere to federal guidelines when coordinating the collection site process
• Transmit results via a secured network; SAMHSA-certified laboratories produce an export file from
their information management system and send it across their internal network in an encrypted file,
restricting access
Clinical Screenings
A range of clinical screening services are offered at Concentra centers. We perform screenings on
equipment that has been thoroughly examined and calibrated so that results are as timely and accurate
as possible. The following list of services can be customized as determined by the employer.
Docusign Envelope ID: 1 F779008-4347-8FEC-830D-645347CE6D0D
Type of Test Details
Audiometric All audiometric screening conforms to the Occupational Safety and Health Administration
Screening (OSHA) standard 29 CFR 1910.95. We have Council for Accreditation in Occupational Hearing
Conservation (CAOHC)-certified technicians to perform the tests, and we would provide all
certifications upon request. Concentra's services specific to audiometric screening include:
• Audiometers that pause screening if ambient sound levels temporarily exceed OSHA
levels
• Immediate Standard Threshold Shift (STS) identification and retest capability
• CAOHC-certified hearing specialists
• Acoustic Systems audio booth professionally designed and installed in each clinic
• Daily equipment calibration
• Microprocessor audiometers
Please note: Concentra cannot test hearing in people who wear hearing aids as this requires
specialized equipment. People with hearing aids need to be tested by an audiologist and then
submit the results.
EKG (resting) Concentra performs a 12 -lead EKG that measures the electrical activity of the heart, read by a
center clinician.
Pulmonary A technician performs all pulmonary function testing that allows real-time graphic and numeric
Function data to verify the test validity. Data returns of VC, FEVI, PEFR, FEF 25 percent -75 percent,
Testing and FEVI/FVC are required.
Vision A trained technician performs a vision test that meets OSHA standards for visual acuity. The
technician screens for visual acuity with corrective lenses, lateral and vertical phorias, stereo
depth perception, and color discrimination.
For visual acuity testing, we utilize the Snellen chart for distance vision, and the Ishihara book
to assess color vision.
Vitals A trained technician records resting pulse rates and blood pressure using a hospital grade
sphygmomanometer and stethoscope. Any person who does not meet normal pulse rate or
blood pressure criteria is re -tested.
X-rays All posterior -anterior X-rays are performed by registered X-ray technicians and certified B -
readers review selected chest X-rays in accordance with OSHA regulations.
Vaccination Services and Infectious Disease Screenings
Concentra offers vaccination services and screening/testing for infectious disease to assist employers in
maintaining a healthy workforce. We administer vaccinations and infectious disease screenings per
regulatory requirements and recommendations from leading health organizations, including the
Occupational Safety and Health Administration (OSHA), Centers for Disease Control and Prevention
(CDC), and the World Health Organization (WHO).
Vaccinations / Immunization
The vaccinations we offer for immunization vary by clinic location including travel health vaccinations,
such as those required and/or recommended for a traveling workforce. The list of vaccines offered across
various clinic locations includes but is not limited to:
• Hepatitis A vaccine
• Hepatitis B vaccine
• Japanese encephalitis vaccine
• Meningococcal vaccine
• Rabies vaccine
• Tetanus/diphtheria vaccine
• Hepatitis B immune globulin (HBIG)
• Influenza vaccine
• Measles, mumps, rubella (MMR) vaccine
• Polio vaccine
• Tetanus, diphtheria, pertussis (Tdap) vaccine
• Typhoid vaccine
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• Varicella (chickenpox) vaccine • Yellow fever vaccine
Other vaccinations (such as shingles vaccine, human papillomavirus (HPV), cholera, pneumococcal
disease, and others) are administered at Concentra facilities upon request and clinical approval.
The following table describes common vaccinations we administer for immunization.
Vaccine
Hepatitis A Vaccine
Comments
The hepatitis A vaccine should be offered when a high occupational risk for infection is
present (e.g., travel to a developing country or working with hepatitis A in a research
laboratory). Consideration may be given to vaccination of employees who work in areas
where community -wide outbreaks are occurring, sewage workers, and workforces where
state and local health authorities or private employers determine that such vaccination is
cost-effective or desired. The hepatitis A vaccine is also indicated for post -exposure
prophylaxis.
Hepatitis B Vaccine OSHA requires the hepatitis B vaccine be offered to employees at risk for bloodborne
pathogen (BBP) exposures through contact with blood or other potentially infectious
material (OPIM) (e.g., health care personnel, emergency responders, first -aid personnel,
correctional officers, laundry workers in hospitals, and morticians). The vaccination must
be offered post -exposure if the employee is not already immune. Within 15 days of the
completed evaluation, the clinician completes a health care professional's written opinion
for the employer indicating whether the hepatitis B vaccine is indicated for an employee
and if the employee has received the vaccination. The hepatitis B vaccine is also
recommended for many international travelers.
In addition to the three -dose hepatitis B vaccine (Engerix-B or Recombivax), we offer the
new hepatitis B vaccine, Heplisav-B, which is a two -dose series over one month, instead
of three doses over four to six months.
Hepatitis A and B For individuals who need immunity to both hepatitis A and hepatitis B, Concentra offers
combined the Twinrix vaccine, which is a combined hepatitis A and hepatitis B vaccine.
Hepatitis B Immune HBIG is recommended after certain exposures to blood or other potentially infectious
Globulin material (OPIM) if the source is unknown (e.g., needle stick from a sharps container) or is
positive for hepatitis B and the exposed employee is not immune.
Influenza Vaccine The influenza vaccine is recommended annually for all individuals aged six months and
older as it is the best way to prevent the flu. The flu can significantly affect productivity
and increase absenteeism among workers. As appropriate, Concentra discusses with the
employer the specifics regarding administering the shots and anticipated volumes.
Japanese The Japanese encephalitis vaccine is recommended for certain travelers to endemic
Encephalitis Vaccine areas of Asia
Measles, Mumps, Per CDC recommendations, all health care personnel should have presumptive evidence
Rubella (MMR)
of immunity to measles, mumps, and rubella. Those without presumptive evidence (i.e.,
Vaccine
documentation of receiving the vaccine or laboratory evidence of disease or immunity)
should be vaccinated. Screening bloodwork (titers) prior to vaccination may be cost-
effective but is not required. Other indications for MMR vaccine include international
travel.
Meningococcal
This vaccine is recommended or required for certain international travelers and laboratory
Vaccine
personnel who are routinely exposed to meningococcal bacteria. College first -year
student living in dormitories, military recruits, and people with certain medical conditions
are also recommended for vaccination. There are two types of meningitis vaccines: the
quadrivalent meningococcal ACWY and the meningitis B vaccine. The latter is not
routinely indicated for international travel.
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Vaccine Comments
Polio Vaccine The polio vaccine may be recommended or required for certain international travelers.
Rabies Vaccine People at high risk of exposure to rabies (e.g., veterinarians, animal handlers, rabies
laboratory workers, spelunkers, and rabies biologics production workers) should be
offered pre -exposure rabies vaccine. Rabies vaccine is also recommended for pre -
exposure for certain international travelers. The rabies vaccine may also be
recommended after being bitten or scratched by an animal or otherwise exposed to
rabies. In the case of post -exposure, rabies immune globulin (RIG) is also recommended
if the person had not completed the rabies vaccine series for pre -exposure.
Tetanus, Diphtheria,
A one-time dose of Tdap is recommended for all adults and adolescents. The CDC
Pertussis (Tdap)
recommends all health care personnel receive a single dose of Tdap as soon as feasible
Vaccine
if they have not previously received Tdap, regardless of the time since their most recent
Tetanus/diphtheria (Td) vaccination. Tdap is also recommended for women during every
pregnancy.
Typhoid Vaccine
Typhoid vaccine is often recommended for international travelers to the developing world.
Typhoid fever is spread by the fecal -oral route, such as ingesting contaminated food or
water. There are two forms of the vaccine: an injectable vaccine that lasts for two years
and an oral vaccine that lasts for five years.
Varicella
Per CDC recommendations, all health care personnel without evidence of immunity (e.g.,
(chickenpox)
written documentation of two doses of vaccine or laboratory evidence of immunity) should
Vaccine
be vaccinated. Screening bloodwork (titers) prior to vaccination may be cost-effective but
is not required.
Yellow Fever
The yellow fever vaccine is recommended or required for certain travelers to Africa and
Vaccine
South America. This vaccine can only be administered in a facility where a physician has
applied for state authorization. On certain itineraries, an employee may be denied entry if
proof of yellow fever vaccine is not presented to local officials.
Other Vaccines
Other vaccinations, including but not limited to vaccines to prevent shingles, human
papillomavirus (HPV), cholera, pneumococcal disease, and immune globulin may be
administered at Concentra facilities upon request and clinical approval.
Infectious Disease Screenings
Infectious disease screening includes testing for disease and/or for immunity. Infectious disease
screening includes testing for disease and/or for immunity. Screenings we offer include (but are not
limited to):
• Hepatitis B virus • Hepatitis C virus
• HIV • Influenza
• Measles, mumps, rubella • Tuberculosis (TB)
• Varicella (chicken pox) •
The following table describes infectious disease screenings we offer.
Screening Comments
COVID-19 Return- Following a suspected or confirmed COVID-19 illness or exposure; includes return -to -work
to -Work Clearance evaluation, screening, and testing for active COVID-19 infection. COVID-19 test -based
return -to -work option is available to meet state requirements or employer protocol.
Your employees' COVID-19 status will be assessed by qualified experienced workers'
compensation clinicians who can apply their medical knowledge and experience to
evaluate the risk of each individual employees and the risk of your workforce at large.
Docusign Envelope ID: 1 F779008-4347-8FEC-830D-645347CE6D0D
Screening
Comments
Hepatitis B Virus
Hepatitis B antibody screening is recommended for health care personnel one to two
months after completing a hepatitis B vaccine series to confirm immunity. For new hires
who have completed the hepatitis B vaccine series but have no evidence of immunity, an
employer may decide to test for vaccine -induced immunity or test after a possible
bloodborne pathogens (BBP) exposure. An individual is considered immune once he/she
has a positive hepatitis B titer after one month of completing the hepatitis B vaccine series.
No further hepatitis B testing is required even if the individual is exposed to hepatitis B
because of BBP exposure. According to the CDC, testing for hepatitis B surface antibody
on an individual who has not completed the hepatitis B vaccine series should not be
performed, as the results could be misleading. Health care personnel who are tested
before receiving a documented completion of hepatitis B vaccine series should not be
considered immune because a positive hepatitis B titer is a known correlate of protection
only when testing follows a documented hepatitis B vaccine series.
Hepatitis C Virus
Hepatitis C testing is recommended after an employee has an exposure to blood or other
potentially infectious material (OPIM). Testing for hepatitis C disease may be also indicated
in the source person.
HIV
Testing for HIV is indicated after an employee is exposed to blood or OPIM. Testing is
indicated in both the exposed and source person. Some countries require HIV testing for
business visas. There are other indications for HIV testing. Concentra offers rapid HIV
tests and the newer, fourth -generation HIV test.
Influenza
Testing for influenza as part of an acute care visit could be performed to help guide clinical
decisions.
Measles, Mumps,
Testing for immunity to measles, mumps, and/or rubella is an option instead of vaccination
Rubella
for employees (e.g., health care personal) when immunity to these diseases is
recommended or required and proof of vaccination or disease is not available.
Tuberculosis (TB)
TB is a disease spread through the air from one person to another. It is recommended
and/or required that all health care personnel be screened for TB before employment and
patient interaction. Some health care personnel are recommended or required to be
screened for TB annually (varies by state). TB screening may be recommended and/or
required for correctional facility workers, first responders, teachers, daycare workers,
homeless shelter staff, and others.
Screening for TB can be performed by skin testing or blood testing. A chest X-ray should
be performed if the blood or skin test is positive or if there are symptoms consistent with
TB disease. Concentra can offer either a skin test or a blood test, depending on the
employer's needs. Both options are outlined below.
• Skin Test - Tuberculin Skin Test (TST): Requires that the employee return within
48-72 hours after its administration to have it read. 2 -step skin testing (i.e.,
administering and reading the TST twice within three weeks) is recommended or
required for the initial skin testing of adults who may be retested periodically.
• Blood Tests - T -Spot® TB (T -Spot) and QuantiFERON®-TB Gold Plus (QFT-
Plus): A less time-consuming option for TB screening. Both blood tests only
require one patient visit to perform the test, and 2 -step testing is not needed.
Varicella (chicken Testing for immunity to varicella is an option instead of vaccination for employees (e.g.,
pox) health care personnel) when immunity to these diseases are recommended or required
and proof of vaccination or disease is not available. For individuals born before 1980, when
natural infection provided immunity to most people, checking a varicella titer instead of
vaccinating may be cost effective.
Other Many other tests for infectious diseases are available upon request and clinical approval.
This includes tests for screening and treating infectious diseases as part of acute care
visits.
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Bloodborne Pathogen (BBP) Exposure
Concentra realizes that people working in certain occupational settings may have the potential for
bloodborne pathogen (BBP) exposure through contact with blood or other potentially infectious materials
(OPIM). OPIM includes cerebrospinal fluid, synovial fluid, vaginal secretions, semen, pleural fluid,
pericardial fluid, peritoneal fluid, amniotic fluid, or any bodily fluid that is visibly contaminated with blood.
BBP exposure can lead to many serious diseases, including HIV, hepatitis B, and hepatitis C.
BBP Exposure Control Plan
Concentra can assist in developing a BBP Exposure Control Plan — often required by the Occupational
Safety and Health Administration (OSHA) — to help employers minimize the probability of exposures
occuring.
An Exposure Control Plan includes, but is not limited to:
• Engineering and work practice controls
• Standard precautions
• Hand hygiene
• Needle usage/disposal
• Personal protective equipment (PPE)
• Decontamination procedures
• Sharps containers and bio-hazard bags
• Hepatitis B vaccine program
• Post -exposure response plan
BBP Exposure Protocol
Despite adherence to preventive strategies, occupational exposures to bloodborne pathogens may occur
and Concentra can evaluate and treat the exposed employees. Our protocol for managing exposures to
potential BBP was developed by our Travel Health and Infectious Disease Medical Expert Panel. It is
consistent with updated national guidelines, such as "Guidance for Evaluating Health -Care Personnel
(HCP) for Hepatitis B Virus Protection and for Administering Post -Exposure Management" and "Updated
U.S. Public Health Service Guidelines for the Management of Occupational Exposures to Human
Immunodeficiency Virus," published by the Centers for Disease Control and Prevention (CDC) in
December 2013 and August 2013, respectively.
Our BBP protocol includes, but is not limited to:
• Determination of risk of exposure
• Decontamination
• Obtain (or test) source individual's HIV, hepatitis B, and hepatitis C results, when applicable
• Determine hepatitis B immune states of exposed employee and obtain baseline labs
• Counsel on the risks of infection and the benefits and risks of post -exposure prophylaxis
• Administer hepatitis B post -exposure prophylaxis when indicated
• Administer first dose and/or prescribe HIV PEP when indicated
• Follow up visits at three -to -four days, six weeks, four months, and six months after exposure for
evaluation, laboratory testing, and treatment as indicated; closer follow-up is indicated if the employee
is on HIV PEP
Concentra understands that time is of the essence when the decision is made to start HIV PEP.
Therefore, we train our staff to prioritize individuals presenting with potential BBP exposures from the time
they register at the Concentra clinic or center. From the initial encounter to the final six-month visit,
employees who sustain a possible BBP exposure receive best -in -class care based on national guidelines
and experts in the field.
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Evaluating and Treating BBP Exposures
In the following narrative, we outline some of the main components of Concentra's protocol for evaluating
and treating bloodborne pathogen exposures by visit. While it is beyond the scope of this synopsis to go
over every possible scenario and corresponding evaluation and treatment, the most common course of
action is presented here. The protocol is subject to change based on CDC and other national guideline
updates.
Initial Visit
During the initial evaluation with an exposed employee, the clinician gathers information regarding the
exposure and medical history and performs a physical examination. If indicated, decontamination of the
area of exposure occurs. The hepatitis B vaccine history and post -vaccination immune response of the
exposed employee as well as the HIV and hepatitis C status of the exposed employee is ascertained. If
the source individual is known, but has not been tested, source individual testing is pursued when
possible and permitted by state law. Our clinician then counsels the employee on the risks associated
with the specific exposure as well as the risks and benefits of taking HIV post -exposure prophylaxis
(PEP). Currently, the recommended HIV PEP in most cases is Truvada and either Isentress or Tivicay. If
the exposed employee decides to start HIV PEP, we prefer to dispense the initial dose at the center and
write a prescription for at least enough medication until the recheck visit (generally in three to four days).
In complex cases (for example, when the source individual is known to have HIV or is pregnant), we may
obtain immediate consultation with an infectious disease specialist.
Additionally, during this initial visit, we draw blood from the exposed employee to perform baseline
laboratory studies including hepatitis B, hepatitis C, and HIV. If the employee decides to begin HIV PEP,
additional baseline blood work is necessary. If the exposed employee has not completed the hepatitis B
vaccine series, hepatitis B vaccine, as well as hepatitis B immune globulin (HBIG), is administered unless
the source individual is negative for hepatitis B. If the exposed employee has had the vaccine series, but
has no documented evidence of a positive post -vaccination titer, hepatitis B surface antibody is tested
and vaccination and HBIG are administered if negative. If the exposed employee has had the vaccine
series and a previous positive titer, no hepatitis B testing nor hepatitis B PEP would be indicated
regardless of the status of the source individual. Regardless of whether any PEP is administered or
prescribed, the employee would follow up with the clinician in three to four days.
Three -to -Four Day Follow-up Visit
At the first recheck visit, Concentra's clinician reviews with the employee all lab results from both the
exposed employee and the source individual, if known and available. If the source individual is negative
for HIV, hepatitis B, and hepatitis C, no further testing or follow up is indicated in most cases. However, if
the exposed employee has started the hepatitis B vaccine series, it should be completed, and a post -
vaccination titer performed one to two months after final dose. If the source individual is not known or
cannot be tested, and the exposed employee has been started on HIV PEP and is tolerating them, a two-
week follow-up appointment is scheduled for further testing and evaluation. If the exposed employee is
not on HIV PEP, the next clinician follow-up visit is six weeks from the time of exposure. In some cases,
hepatitis B vaccine and/or lab testing may be indicated at four weeks from exposure. The health care
professional's written opinion, which is required by OSHA, is completed by the treating clinician and sent
to the employer.
Two-week and Four -week Clinician Visits
These visits are indicated only if the exposed employee has been started on HIV, due to possible side
effects of the medications. The visits include lab testing and a symptom screen. Unless the source
individual is negative for HIV or the exposed employee has discontinued the medication due to side
effects, the clinician ensures that the exposed employee receives a prescription for HIV PEP medications
to complete a four -week course. A clinician visit is scheduled for six weeks post -exposure.
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Six -week Clinician Visit
At this visit, in addition to a symptom screen and review of previous lab results and vaccines, the fourth -
generation HIV blood test and the hepatitis C RNA PCR test are ordered, in most cases. If either test is
positive, the employee is referred to an appropriate specialist.
Four -month Clinician Visit
At this visit, the clinician screens the employee for symptoms and orders the fourth -generation
antibody/antigen HIV test. With the newer fourth -generation HIV test, no further testing for HIV is needed
if this test is negative. The third hepatitis B vaccine may be administered at this time.
Six-month Clinician Visit
At the six-month visit, hepatitis C antibody is drawn from the employee. Testing for hepatitis B infection
may be indicated in some employees. If either test result is positive on the follow-up visit, the employee
would be referred to a specialist.
If the hepatitis B vaccine was initiated but not completed, the final hepatitis B vaccine may be
administered at this visit. If the series had been completed at least one month prior, a post -vaccination
titer may be performed. The case is closed at this time.
Laboratory Services
Preferred Lab Vendor
Concentra would utilize our preferred vendor, Quest Diagnostics Incorporated (Quest) for laboratory
analyses.
Established in 1990, Quest possesses more than 30 years of experience providing exceptions services in
the field of laboratory testing. Quest Diagnostics Clinical Laboratories, Inc., a subsidiary of the parent
company, has four forensic drug testing laboratories certified by the Substance Abuse and Mental Health
Services Administration (SAMHSA) and accredited by the College of American Pathologists -Forensic
Drug Testing (CAP-FDT); three of the labs are also Clinical Laboratory Improvement Amendments
(CLIA)-certified.
Each of Quest's forensic toxicology laboratories is certified by the Department of Health and Human
Services (DHHS)/SAMHSA to perform urine drug testing under the federal program. The four SAMHSA
certified laboratories are compliant with SAMHSA guidelines as detailed in the Federal Register 73 (228):
71858-71907 (11-25-2008) and the DOT's 49 CFR Part 40 rules, detailed in Federal Register 65 (244):
79462-79579 (12-19-2000), and any subsequent revisions. The DOT, Nuclear Regulatory Commission
(NRC), Federal Railroad Administration (FRA), Pipeline and Hazardous Materials Safety Administration
(PHMSA), and the FMCSA all require this certification.
Each laboratory is licensed by the state where the laboratory is located. Quest's drug testing procedures
and laboratories are also fully certified and accredited by federal government agencies, and professional
organizations such as the Agency for Health Care Administration (AHCA) Florida and CLIA.
We outline Quest's capabilities in the following table.
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Substance Abuse Testing Clinical Testing
A comprehensive menu of both standard and
customized panels
Specialized test panels and adulterant testing,
including expanded opiate and DOT and HHS
panels
A range of specimen options, including urine, oral
fluid, hair testing, and breath alcohol testing
A national network of laboratories with locations in
or near all major cities, so there is always a lab
nearby
Two full -service, bicoastal, esoteric testing
laboratories for fast turnaround on specialized
testing
Additional clinical laboratory testing options
including, but not limited to: OSHA, industrial,
heavy metals, esoteric testing, and executive
health panels
Blood Specimen Collection
Concentra team members who perform blood specimen collections are properly certified, follow all
applicable laws and regulations, and adhere to standard medical practices to perform safe specimen
collection, safeguard the donor, and obtain a quality sample. We adhere to best practices in phlebotomy,
including:
• Planning ahead
• Using an appropriate location that is quiet, clean, and well -lit
• Adhering to quality control measures, such as proper education and training, standard operating
procedures, correctly identifying the donor, and ensuring the satisfactory quality of the sample and its
safe transportation
• Following standards for the quality care of donors and health care workers — collectors are provided
ample hand -hygiene materials, well -fitting gloves, single -use disposable needles, syringes or lancing
devices, and laboratory sample tubes
In addition, Concentra team members demonstrate care and professionalism when collecting blood
specimens to help put the donor at ease and elicit cooperation.
After the specimen is properly collected and each laboratory tube labeled, the Concentra collector
discards disposable equipment and other items into the appropriate containers; double-checks to ensure
the donor feels satisfactory; records the procedure; and places the samples in designated, leak -proof
containers with lab forms for safe transport.
Lead and Heavy Metal Exposure Testing
Concentra provides blood lead -level tests to screen individuals for exposure to lead. The test determines
the concentration of lead in the blood. Concentra also offers baseline and periodic assessments for those
at potential risk of hazardous occupational exposures. Laboratory and monitoring services are provided
by our preferred vendor, Quest Diagnostics (Quest).
Our trained clinicians collect specimens which Quest analyzes for any of the following heavy metal and
special exposure screening components:
• Arsenic (urine)
• Mercury (urine)
• Lead (urine and blood)
• Aluminum
• Antimony
• Bismuth
• Cadmium (urine, blood, and urine beta 2
microglobulin)
• Chromium
• Copper
• Nickel
• Zinc
• Organophosphates (RBC cholinesterase)
• Polychlorinated Biphenyls (blood)
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Comprehensive Metabolic Panel
As required or indicated, Concentra performs a comprehensive metabolic panel (CMP). Primarily, the
CMP screens for kidney function, liver function, glucose, and electrolyte and fluid balance. The CMP
includes the following testing:
• Albumin
• Alkaline Phosphatase
• AST
• Calcium
• Chloride
• Globulin (calculated)
• Potassium
• Total Bilirubin
• Urea Nitrogen
Technology
• Albumin/Globulin Ratio (calculated)
• ALT
• BUN/Creatinine Ratio (calculated)
• Carbon Dioxide
• Creatinine with GFR estimated
• Glucose
• Sodium
• Total Protein
Altera TouchWorks® Electronic Health Record (EMR) enables our clinicians to access patient records
from any Concentra medical center, onsite clinic, Concentra Telemed, or Concentra TeleRehab site in the
country. Our EMR integrates with practice management systems and supports continuity of patient care
and an exceptional customer experience. TouchWorks provides:
• Computerized order entry and management with electronic integration with laboratory and X-ray
vendors
• Supports both onsite dispensing and pharmacy e -prescribing
• Customized clinical documentation templates to support clinical operations
• Best practice, evidence based, diagnosis specific care guides
• Integrated tasking and communication function
TouchWorks supports all clinical operations, improves clinical quality, and streamlines the information
exchange process to afford our clinicians the ability to quickly and accurately communicate information to
[City of Fort Worth ] and your employees. The system also provides data -driven insights, allowing us to
apply population management principles for measurable trend management. Our ability to capture
member data in real time from multiple sources helps us learn the health and social behavior patterns
unique to each individual and [City of Fort Worth ]'s population in the aggregate.
Concentra HUB
Concentra HUB is an online self-service tool for [City of Fort Worth ] to conveniently access and manage
account information, authorize treatment, and obtain test results and reporting.
Online account management
• Access to make edits to your company and location addresses and contacts
• View capabilities of all service packages, components, and payors, third -party administrators, and
medical review officers (MROs)
• Access non -injury invoices and payment status online with option to pay online
• Timely delivery of your employees' non -injury and injury visit results including work restrictions
• Customizable result delivery
• Email notifications for visit results
• Search and export functionality
• Scheduled visit information for injury care cases
• Ability to create, manage, and review employee authorizations online
• Electronic creation and transmission of authorization to medical centers (no need for employee to
bring form)
Docusign Envelope ID: 1 F779008-4347-8FEC-830D-645347CE6D0D
• Option to email authorization to employee is available but not required
• Option to send online registration link using SMS text or email to employee for faster registration
at center
• Authorize up to 20 employees for same services at once
• Search, edit, revoke, and copy authorization functions
Security features to protect your information
• Access control
• Database monitoring
Malware and virus protection
Intrusion detection and prevention
Standard Reporting
With Concentra HUB, employers can designate access for different report types, as desired. Our system
creates the relevant reports for each employee seen at Concentra based on the services performed and
makes them available to [City of Fort Worth ] via the Concentra HUB. If desired, [City of Fort Worth ] could
each contact to receive summary email notifications of results delivered.
Sample Reports and Communications
Activity Status
• Generated after each injury visit
Report
• Includes the employee's name, company department, date of visit, check-in/check-out
time, diagnosis, treating provider, restrictions on duty, next scheduled appointment
Non -Injury Status
• Generated after each non -injury visit
Report
• Includes the employee's name and demographics, date seen, time checked in and out
of the center, results, and remarks
Patient Referral
• Generated when a referral to a specialist takes place
• Includes basic demographics, billing information, specialist information, and referrals
details (i.e., type of referral, recommendations, priority, notes)
Toxicology Result
• Generated when a client is leveraging Concentra for specimen collection and is
Certificates
utilizing our selected lab and medical review officer (MRO) to process the toxicology
screen.
• Includes employer and donor information, specimen summary, service performed,
substances tested, specimen status history, the results, and MRO remarks in
accordance with DOT Rule 49 CFR Part 40 Section 40.163.
Utilization Reporting
Concentra offers utilization reports that share key injury information. These reports capture all injuries
treated at Concentra for each employer, and provides information specific to injury care services
including, but not limited to, the following:
• Number of employees treated
• Distribution of body category injured
• Number and percentage of cases closed
• Average visits per case
• Percentage of cases referred to a
specialist provider
• Percentage of cases referred to physical
therapy
• Average days to discharge
• Percentage of cases with off -duty and limited -
duty days
• Average number of off -duty and limited -duty
days
• Average cost per case
• Comparisons of the project data to the entire
client market for the same period
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Results Reporting
Physical Examinations
Concentra reports all medical information back to the employer's designated representative within 24
hours of receiving relevant data. These reports provide recommendations based on the results, (e.g.
cleared or not cleared for job placement and/or additional testing may be required). If the exam results
require supplemental testing, Concentra would notify [City of Fort Worth ]'s designated representative
prior to performing any additional testing. Depending on the specific components tested for (i.e., blood or
urine analysis), results may take up to five days to report.
Drug and Alcohol Testing
• Negative lab -based drug screen results are reported within 24 to 48 hours upon receipt at the
laboratory
• Negative rapid (e.g., eCup and/or mCup) results are reported on average within one hour of collection
• Non -negative* drug test results may take an average of 5 to 7 business days to report results to
employers
* Note: This timeframe is dependent upon lab factors such as confirmation testing, MRO confirmation,
donor outreach, etc.
• MRO certification is required for all Concentra drug screens
* Note: Non -negative is defined as a specimen requiring additional confirmation testing from the lab
Breath alcohol test results are reported the same day that the specimen is obtained.
Injury Care
For injury care, we provide employers an activity status report immediately upon employee checkout that
includes:
• General employee demographics
• Basic employer information
• Visit information, including name of treating provider and diagnosis
• Employees' status, including any restrictions, and return -to -work status
• Name of treating provider
• Date, time, and provider for next scheduled appointment
We also notify the employer of any issues or concerns regarding an employee's return -to -work status.
Administrative and Support Services
Appointment Scheduling
Concentra would provide [City of Fort Worth ]'s employees with prompt service. Although our medical
centers are primarily "first come, first serve," Concentra can accommodate scheduled appointments if
requested, with 24 hours' advance notice. In addition, our medical centers implement Fast Track
drug/alcohol testing services where employees experience a 30 -minute -or -less wait time for drug
specimen collection and/or breath alcohol testing.
Billing and Invoicing
Concentra's Central Business Offices (CBO) maintain responsibility for all aspects of revenue billing and
collection within their designated regions, including bill production, cash receipt, payment posting, and
account receivable management services. We outline our standard billing process in the following table.
Service Type Billing/Invoicing Details
Injury Care • Invoices generated the following business day by the market
• Utilize standard first report of injury to bill injury care services
Docusign Envelope ID: 1 F779008-4347-8FEC-830D-645347CE6D0D
Service Type Billing/Invoicing Details
• Term is net 45 days
Non -Injury Care • Invoices generated weekly by market
• Includes a minimum of the following for each line item: patient name, date of service,
employee's department location (if provided), complete list of services performed
• Term is net 30 days
Patient Confidentiality
Concentra takes the privacy, security, and protection of confidential and personal information very
seriously and we have enterprise -wide strategies and industry leading technologies to maintain
compliance with the HIPAA Privacy and Security Regulations.
Concentra's Compliance Department incorporates all aspects of HIPAA, information security, privacy, and
compliance into our initial colleague training upon hire and annually thereafter. New privacy and security
policies including high profile topics such as phishing, social engineering, and data handling procedures
are communicated through corporate communications (e.g., Concentra intranet, internal newsletters, and
face-to-face educational programs) on a quarterly basis. We have HIPAA policies in place to ensure
ongoing compliance with the HIPAA Privacy and Security Regulations.
We also employ:
• A HIPAA-compliant Business Associate Agreement (BAA) with any third -party whose services and
data provided are subject to the HIPAA regulations
• Concentra-owned, internal documentation systems on our servers, all of which are protected by
firewalls and anti -virus technologies that are monitored daily
• A secured intranet for all internal documents and a secured virtual private network (VPN) for
authorized remote access
• HIPAA policies and procedures that outline the required privacy and security requirements for
handling, maintaining, and disposing of personal health information (PHI)
• Contracted service with a bonded (HIPAA-compliant) vendor to manage the shredding and recycling
of paper documents located internally in locked cabinets within our office space (as per the HIPAA
guidelines). Our vendor provides an approved form of identification, picks up and removes all
materials from our offices, and obtains required signatures from our bonded workers
• Password protected access to all sensitive client files and access only to those staff members with a
need -to -know, who require the files to support direct client services
• HIPAA compliance for all employees within new -hire and annual training
• HIPAA regulations regarding proper consent prior to sharing individual PHI with any party, i.e., client
(employer), insurance company, or other provider(s), as required
Commitment to Service Excellence
Concentra's customer service philosophy is focused on going above and beyond to deliver a superior
patient experience. This philosophy is at the root of our core values and motivates Concentra team
members in their ongoing pursuit of excellence.
Our medical center teams follow what we call "Orange Book" values. Concentra's Orange Book is a little
book that outlines our principles to ensure a quality patient experience by performing welcoming,
respectful, and skillful service every day in every location.
The impact of this effort and our commitment to delivering a superior experience is evident in our patient
and customer satisfaction scores even today.
Docusign Envelope ID: 1 F779008-4347-8FEC-830D-645347CE6D0D
4. Key Personnel
Concentra carefully considers each project and its unique goals when assigning an account management
team. We take a collaborative approach that combines operational and clinical support to ensure quality
of service. The people we select bring valuable, relevant experience to the program and provide ongoing
support.
Initial Contact
Gary Beck, Key Account Manager would ensure Concentra colleagues understand your program
requirements and would be available to answer your questions throughout the solicitation and initial
phase of engagement.
Operational Oversight
Center Operations Director (COD), Brooke Fowler would serve as the day-to-day contact for program
operations. The COD regularly monitors procedures to ensure ongoing compliance with applicable
regulations and program specifications. The COD:
• Serves as the liaison between Concentra and [City of Fort Worth]
• Oversees day-to-day medical center operations
• Ensures ongoing compliance with operational policies, procedures, and training programs within the
center
• Manages patient care issues
• Establishes a clear understanding of contract objectives
• Collaborates with center, area, and regional leadership teams to ensure we effectively deliver the
stipulated scope of work, monitors program outcomes, and maintains [City of Fort Worth ]'s account
Medical Oversight
Center Medical Director (CMD), would provide primary oversight for clinical practices, ensuring
continuous compliance. The CMD ensures that medical interpretations and associated clearances comply
with current medical standards and adhere to applicable regulations.
• Reviews medical history and performs medical physical examinations
• Reviews medical evaluations conducted by other center clinicians
• Understands all medical surveillance requirements of the Occupational Safety and Health
Administration (OSHA), the U.S. Department of Transportation (DOT), the National Fire Protection
Association (NFPA), police officer standards, the Americans with Disabilities Act (ADA), the Family
and Medical Leave Act (FMLA), and other regulated examinations
• Reports the results of the medical evaluation to the employee
• Provides the recommendation as to whether the employee is medically certified to safely perform the
essential job tasks
• Forwards copies of any abnormal results, along with instructions regarding primary care follow-up
• Provides, or arranges for, a prescriptive rehabilitation and/or fitness program, when indicated, to aid
in an employee's recovery from illness or injury
• Reviews individual medical evaluations and aggregate data for evidence of occupational exposure(s)
or clusters of occupational disease
Physical Therapy and Functional Testing Oversight
Center Therapy Director (CTD), would provide oversight for the physical therapy and functional testing
services rendered as part of the program. Using their expertise, the CTD delivers services that assess an
employee's functional abilities and expedite the return -to -work process.
• Conducts an initial evaluation on clinician referrals and develops appropriate treatment plans
Docusign Envelope ID: 1 F779008-4347-8FEC-830D-645347CE6D0D
Communicates with all clinicians and with the employer regarding an employee's diagnoses, sets
expectations for return -to -work
Utilizes knowledge of best demonstrated practices to evaluate program effectiveness, and
implements methods to improve processes and outcomes
Ensures compliance with guidelines and regulations established by the Americans with Disabilities
Act (ADA) and by the relevant licensing, certification, and accrediting bodies
Center Staff
Concentra employs experienced health care professionals to deliver services relevant to our offering.
Center staff includes an appropriate combination of physicians, mid -levels, nurses, physical therapists,
radiology technicians, and medical assistants.
Clinical Professionals
Concentra utilizes qualified and licensed clinical professionals to serve the occupational health needs of a
client's workforce. Our clinical professionals undergo extensive annual training. They regularly monitor
OSHA, DOT, NFPA, police officer standards, ADA, and other applicable federal and state regulations to
ensure all associated services remain compliant.
Support Staff
Concentra employs qualified support personnel whom we train and fully certify to perform their associated
tasks. Specifically, our center support staff includes drug specimen collectors certified to perform DOT
collections, certified breath alcohol technicians, National Institute for Occupational Safety and Health
(NIOSH)-certified pulmonary function testers, Council for Accreditation in Occupational Hearing
Conservation (CAOHC)-certified personnel to perform audiometric testing, certified radiologic
technologists, certified medical assistants, and certified phlebotomists.
Credentialing Practices
All Concentra clinicians undergo a stringent credentialing process. Once the Credentials Committee
Chair/Medical Advisor clears the candidate for hire/credentialing, we follow National Committee for
Quality Assurance (NCQA) guidelines for credentialing, which require primary source verification of
licensure, education and training, board certifications, and any provider sanctions. In addition, we perform
a System for Award Management (SAM) query to identify if a candidate is barred from contracting with
the federal government and use secondary sources (copies of documentation) to verify Drug Enforcement
Administration (DEA) and state-controlled substance certifications. Finally, we check the National
Practitioner Databank for malpractice history and the Office of Inspector General (OIG) for
Medicare/Medicaid sanctions. We re -credential our clinicians every three years and, in the interim, we
monitor clinicians' licensures to ensure that they remain active.
All Concentra personnel, regardless of position, are required to have a background check consisting of a
felony/misdemeanor check, Social Security validation and trace, national sex offender check (for staff
rendering patient care), national criminal search, drug screen, and a check against the Office of Foreign
Assets Control list.
Docusign Envelope ID: 1 F779008-4347-8FEC-830D-645347CE6D0D
5. Concentra's Qualifications
Medical Expertise
Concentra's Clinical Advisory Board (CAB) oversees company clinical operations in all Concentra medical
centers and onsite clinics. The CAB's goal is to develop and disseminate guidance and policies for all
Concentra clinicians.
Patient Care
Therapy
Regulatory
Transportation Testing and
Pharmacy and
Therapeutics
Examinations
Concentra has developed national medical expert panels to serve as resources to clinicians, clients, and
patients. The clinicians on these panels work to identify health trends, research the latest developments,
and develop policies, procedures, clinical guidance documents, and processes to ensure Concentra's
treatment and service philosophy adhere to established industry best practices. These clinical experts
research the latest medical literature and recommendations of national industry groups. Information is
combined and integrated, then forwarded to our CAB for review and approval. Once approved, the
information is disseminated via continuing medical education courses, clinical bulletins, and direct review
with the clinician's supervisor depending on the topic and relevance to the practice. [City of Fort Worth]
and its employees would benefit from this process which helps to ensure continual clinical program
improvement.
Clinical Experience
Injury Experience
Concentra's injury treatment experience informed our process management approach. We monitor and
direct the processes that make up the structure of an individual case, all with the focus of achieving the
optimal outcome. These processes include many variables, such as frequency and timing of injured
employee visits, communication with the employer, and referral patterns for consultations and diagnostic
testing.
Our analysis of comprehensive outcomes data proves that the following factors have a considerable
impact on the clinical and cost outcomes:
• Treating the injured employee at frequent intervals in the initial period following an injury
• Communicating with the employer about the activity/duty status of the injured employee
• Monitoring referrals to ensure that the injured employee is evaluated in a timely manner
• Paying attention to case closure following release to full -duty activity
Non -injury Experience
Concentra has been performing physical examinations, conducting drug and alcohol testing, and
administering immunizations and vaccinations since our inception 45 years ago. We maintain written
guidelines on all relevant regulatory standards and create client -specific service packages tailored to
meet the unique needs of each client's program requirements. Furthermore, we assure that only qualified
individuals perform the requested services, in accordance with all local, state, and federal guidelines.
Docusign Envelope ID: 1 F779008-4347-8FEC-830D-645347CE6D0D
Department of Transportation Experience
Annually, Concentra performs more than 800,000 DOT examinations, making us the nation's largest
provider of screening services for drivers of commercial motor vehicles. We provide DOT physical
examinations for employers who operate in various industries, including, but not limited to:
• Aviation — Federal Aviation Administration
• Trucking — Federal Motor Carrier Safety Administration
• Railways — Federal Railroad Administration
• Public Transit — Federal Transit Administration
• Maritime — The United States Maritime Administration
• Pipelines and Hazmat — Pipeline and hazardous Materials Safety Administration
Concentra maintains current, comprehensive knowledge of DOT regulations. We require all Concentra
physicians performing DOT examinations to be Federal Motor Carriers Safety Administration (FMCSA)
National Registry certified. In addition, Concentra offers the FMCSA curriculum as part of our training
program to educate medical examiners on multiple topics within 13 different training modules on FMCSA
regulations. Concentra's participants who complete the program are prepared to:
• Apply knowledge of FMCSA's driver physical qualification standards and advisory criteria to findings
gathered during the driver's medical examination
• Make sound determination of the driver's medical and physical qualifications for safely operating a
commercial motor vehicle (CMV) in interstate commerce
• Complete the Medical Examination Report Form
As a recognized expert in DOT regulations, Concentra also provides a suite of DOT -related services to
keep employers and their drivers safe and compliant, including:
DOT Drug Testing — DOT drug screenings test for the presence of illegal drugs, alcohol, and other
substances
Concentra's Sleep Evaluation Program — Objective and consistent evaluation of drivers who are at a
risk of collision due to excessive sleepiness
Due to our vast experience and relationship with the FMCSA, Concentra published a book,
"Concentra Guide to Medical Certification of Commercial Drivers," to create consistent medical
interpretations for Concentra physicians. The Concentra Guide integrates and defines the federal
standards, medical guidelines, recent literature, and opinion, thereby providing a consistent
framework for the medical examiner's assessment of the DOT -covered participant and determination
of fitness.
Concentra's vast experience in maintaining the health and safety of commercial drivers would be a
benefit to [City of Fort Worth ].
Firefighter Examination Experience
Concentra has created physical conditioning procedures and performed job site analyses, physical fitness
testing, and more for hundreds of fire departments nationwide. We follow local, state, and federal
guidelines, including NFPA and International Association of Fire Fighters / International Association of
Fire Chiefs (IAFF/IAFC) standards, to ensure individuals in these positions are fit to perform their
essential job functions.
Police Officer Examination Experience
Concentra performs police officer examinations for hundreds of police departments and other law
enforcement agencies across the country to help ensure their officers are fit to perform their essential job
functions. We adhere to all local, state, and federal guidelines, as well as each agency's unique
standards.
Docusign Envelope ID: 1 F779008-4347-8FEC-830D-645347CE6D0D
EXHIBIT B
PAYMENT SCHEDULE
Concentra appreciates the opportunity to present our proposed fee schedule for City of Fort Worth's
Request for Qualification Occupational HealthTitle program. We include City of Fort Worth's required
Pricing form as part of our proposal. We affirm all information contained herein is current, complete,
accurate, and remains valid for [90 days following the due date, July 13th, 2026.
Contract Year
Year 1
2026-
2027
Year 2
2027-
2028
Year 3
2028-
2029
Year 4
2029-
2030
Year 5
2030-
2031
Year 6
2031-
2022
Year 7
2032-
2033
Component
Breath Alcohol Test
$22
$23
$23
$24
$25
$26
$26
Non Reg UDS 19023 -10 Panel
$81
$83
$85
$88
$91
$93
$96
Regulated UDS 65304
$48
$49
$51
$52
$54
$56
$57
Hair Sample 501-5 Panel
Psychemedics (ME Only)
$36
$37
$38
$39
$41
$42
$43
Physical Exam Concentra
Standard
$48
$49
$51
$52
$54
$56
$57
DOT Physical
$48
$49
$51
$52
$54
$56
$57
Respirator Physical
$42
$43
$45
$46
$47
$49
$50
HPE Concentra-Level 5
$250
$258
$265
$273
$281
$290
$299
Fitness for Duty Physical -Level
2
$46
$47
$49
$50
$52
$53
$55
Medical Surveillance Physical
Baseline
$120
$124
$127
$131
$135
$139
$143
Return to Work Physical
$48
$49
$51
$52
$54
$56
$57
Blood Collect CYP2C9
Genotype
$282
$290
$299
$308
$317
$327
$337
Non -Regulated UDS Collect
$198
$204
$210
$216
$223
$230
$236
Blood Drug Screen Collect
$210
$216
$223
$229
$236
$243
$251
Hemoccult FOBT FIT Test
$10
$10
$11
$11
$11
$12
$12
Blood Glucose -Finger Stick
$16
$16
$17
$17
$18
$19
$19
Complete Blood Count (CBC)
w/Diff 6399
$36
$37
$38
$39
$41
$42
$43
Chemistry 23 Screen 307818
$46
$47
$49
$50
$52
$53
$55
Hemoglobin A1C (HA1)-Blood
496SB
$70
$72
$74
$76
$79
$81
$84
U/A Manual Microscopic 8563
$40
$41
$42
$44
$45
$46
$48
Lead & ZPP-Whole Blood
22996
$87
$89
$92
$95
$97
$100
$103
Formaldehyde Formalin IgE
17075
$120
$124
$127
$131
$135
$139
$143
Venipuncture
$45
$46
$48
$49
$51
$52
$54
Polychlorinated Biphenyls
(PCB) 93277
$156
$161
$166
$170
$176
$181
$186
Docusign Envelope ID: 1 F779008-4347-8FEC-830D-645347CE6D0D
Hepatitis A Antibody IgG 508SB
$78
$80
$83
$85
$88
$90
$93
Hepatitis B Surface Antigen
498SB
$108
$111
$115
$118
$122
$125
$129
Hepatitis B Surface Antibody
Quant 8475
$78
$80
$83
$85
$88
$90
$93
Hepatitis C Antibody 8472 w
reflex RNA
$118
$122
$125
$129
$133
$137
$141
HIV 1/2 Ag/Ab Fourth gen
w/Reflexes 91431
$90
$93
$95
$98
$101
$104
$107
Rabies Vaccine -1st Injection
$468
$482
$497
$511
$527
$543
$559
Rabies Vaccine -2nd Injection
$468
$482
$497
$511
$527
$543
$559
Rabies Vaccine -Booster
$468
$482
$497
$511
$527
$543
$559
QuantiFERON Gold Plus 36970
$90
$93
$95
$98
$101
$104
$107
TB Skin Test
$18
$19
$19
$20
$20
$21
$21
Tetanus Antibody IgG
4862RAMD/RXE
$24
$25
$25
$26
$27
$28
$29
Influenza (Flu Shot)
$54
$56
$57
$59
$61
$63
$64
Hepatitis A & B Vaccine Twinrix
$144
$148
$153
$157
$162
$167
$172
Hepatitis A Vaccine -1st
Injection
$78
$80
$83
$85
$88
$90
$93
Hepatitis A Vaccine -2nd
Injection
$78
$80
$83
$85
$88
$90
$93
Heplisav-B (2 shot series) #1
$90
$93
$95
$98
$101
$104
$107
Heplisav-B (2 shot series) #2
$90
$93
$95
$98
$101
$104
$107
Hepatitis B Surface Antigen
498SB
$108
$111
$115
$118
$122
$125
$129
Varicella-Zoster IgG Antibody
4439SB
$99
$101
$104
$108
$111
$114
$118
HIV RNA Quantitative Viral
Load 40085
$44
$45
$46
$48
$49
$50
$52
Rapid HIV Test
$136
$140
$144
$149
$153
$158
$162
MMRTiter5259
$177
$182
$187
$193
$199
$205
$211
Rabies Titer 5789
$114
$117
$121
$125
$128
$132
$136
Hepatitis A Antibody IgG 508SB
$78
$80
$83
$85
$88
$90
$93
Hepatitis B Surface Antibody
Quant8475
$66
$68
$70
$72
$74
$77
$79
Audiogram
$24
$25
$25
$26
$27
$28
$29
X -Ray Chest -1 View
$63
$64
$66
$68
$70
$72
$75
X -Ray B-Read/Interpretation
$42
$43
$45
$46
$47
$49
$50
EKG Resting
$36
$37
$38
$39
$41
$42
$43
FCE - 15 Minutes
$44
$45
$46
$48
$49
$50
$52
OSHA Respirator
Questionnaire
$30
$31
$32
$33
$34
$35
$36
Respirator Fit Test Qualitative
$46
$47
$49
$50
$52
$53
$55
Medical Questionnaire Review
$18
$19
$19
$20
$20
$21
$21
Tdap Vaccine
$84
$87
$89
$92
$95
$97
$100
MMR Vaccine
$114
$117
$121
$125
$128
$132
$136
Docusign Envelope ID: 1 F779008-4347-8FEC-830D-645347CE6D0D
Varicella Vaccine $150 $155 $159 $164 $169 $174 $179
Pulmonary Function Test $26 $26 $27 $28 $29 $30 $30
Note regarding any applicable immunization services: After the first twelve months of an executed
agreement, if the current market price for the above Services changes due to market conditions,
demands, and/or shortages, City of Fort Worth will be billed current market rates.
Docusign Envelope ID: 1 F779008-4347-8FEC-830D-645347CE6D0D
6. Comparable Concentra Clients
City of Grand Prairie
City of Mesquite
City of Carrollton
City of Irving
City of Denton
Tarrant County
City of Wichita Falls
City of El Paso
City of San Antonio
City of Corpus Christi
City of Waco
City of Arlington
City of Lubbock
City of Plano
City of Dallas
Additional Comparable Clients and References are available upon request.
Docusign Envelope ID: 1 F779008-4347-8FEC-830D-645347CE6D0D
7. Pricing
Concentra appreciates the opportunity to present our proposed fee schedule for City of Fort Worth's
Request for Qualification Occupational HealthTitle program. We include City of Fort Worth's required
Pricing form as part of our proposal. We affirm all information contained herein is current, complete,
accurate, and remains valid for 90 days following the due date, July 13e, 2026.
Contract Year
Year 1
2026-
2027
Year 2
2027-
2028
Year 3
2028-
2029
Year 4
2029-
2030
Year 5
2030-
2031
Year 6
2031-
2022
Year 7
2032-
2033
Component
Breath Alcohol Test
$22
$23
$23
$24
$25
$26
$26
Non Reg UDS 19023 -10 Panel
$81
$83
$85
$88
$91
$93
$96
Regulated UDS 65304
$48
$49
$51
$52
$54
$56
$57
Hair Sample 501-5 Panel
Psychemedics (ME Only)
$36
$37
$38
$39
$41
$42
$43
Physical Exam Concentra
Standard
$48
$49
$51
$52
$54
$56
$57
DOT Physical
$48
$49
$51
$52
$54
$56
$57
Respirator Physical
$42
$43
$45
$46
$47
$49
$50
HPE Concentra-Level 5
$250
$258
$265
$273
$281
$290
$299
Fitness for Duty Physical -Level
2
$46
$47
$49
$50
$52
$53
$55
Medical Surveillance Physical
Baseline
$120
$124
$127
$131
$135
$139
$143
Return to Work Physical
$48
$49
$51
$52
$54
$56
$57
Blood Collect CYP2C9
Genotype
$282
$290
$299
$308
$317
$327
$337
Non -Regulated UDS Collect
$198
$204
$210
$216
$223
$230
$236
Blood Drug Screen Collect
$210
$216
$223
$229
$236
$243
$251
Hemoccult FOBT FIT Test
$10
$10
$11
$11
$11
$12
$12
Blood Glucose -Finger Stick
$16
$16
$17
$17
$18
$19
$19
Complete Blood Count (CBC)
w/Diff 6399
$36
$37
$38
$39
$41
$42
$43
Chemistry 23 Screen 307818
$46
$47
$49
$50
$52
$53
$55
Hemoglobin A1C (HA1)-Blood
496SB
$70
$72
$74
$76
$79
$81
$84
U/A Manual Microscopic 8563
$40
$41
$42
$44
$45
$46
$48
Lead & ZPP-Whole Blood
22996
$87
$89
$92
$95
$97
$100
$103
Formaldehyde Formalin IgE
17075
$120
$124
$127
$131
$135
$139
$143
Venipuncture
$45
$46
$48
$49
$51
$52
$54
Vendor Services Agreement Page 67 of 67
Docusign Envelope ID: 1 F779008-4347-8FEC-830D-645347CE6D0D
Polychlorinated Biphenyls
(PCB)93277
$156
$161
$166
$170
$176
$181
$186
Hepatitis A Antibody IgG 508SB
$78
$80
$83
$85
$88
$90
$93
Hepatitis B Surface Antigen
498SB
$108
$111
$115
$118
$122
$125
$129
Hepatitis B Surface Antibody
Quant 8475
$78
$80
$83
$85
$88
$90
$93
Hepatitis C Antibody 8472 w
reflex RNA
$118
$122
$125
$129
$133
$137
$141
HIV 1/2 Ag/Ab Fourth gen
w/Reflexes 91431
$90
$93
$95
$98
$101
$104
$107
Rabies Vaccine -1st Injection
$468
$482
$497
$511
$527
$543
$559
Rabies Vaccine -2nd Injection
$468
$482
$497
$511
$527
$543
$559
Rabies Vaccine -Booster
$468
$482
$497
$511
$527
$543
$559
QuantiFERON Gold Plus 36970
$90
$93
$95
$98
$101
$104
$107
TB Skin Test
$18
$19
$19
$20
$20
$21
$21
Tetanus Antibody IgG
4862RAMD/RXE
$24
$25
$25
$26
$27
$28
$29
Influenza (Flu Shot)
$54
$56
$57
$59
$61
$63
$64
Hepatitis A & B Vaccine Twinrix
$144
$148
$153
$157
$162
$167
$172
Hepatitis A Vaccine -1st
Injection
$78
$80
$83
$85
$88
$90
$93
Hepatitis A Vaccine -2nd
Injection
$78
$80
$83
$85
$88
$90
$93
Heplisav-B (2 shot series) #1
$90
$93
$95
$98
$101
$104
$107
Heplisav-B (2 shot series) #2
$90
$93
$95
$98
$101
$104
$107
Hepatitis B Surface Antigen
498SB
$108
$111
$115
$118
$122
$125
$129
Varicella-Zoster IgG Antibody
4439SB
$99
$101
$104
$108
$111
$114
$118
HIV RNA Quantitative Viral
Load 40085
$44
$45
$46
$48
$49
$50
$52
Rapid HIV Test
$136
$140
$144
$149
$153
$158
$162
MMRTiter 5259
$177
$182
$187
$193
$199
$205
$211
Rabies Titer 5789
$114
$117
$121
$125
$128
$132
$136
Hepatitis A Antibody IgG 508SB
$78
$80
$83
$85
$88
$90
$93
Hepatitis B Surface Antibody
Quant 8475
$66
$68
$70
$72
$74
$77
$79
Audiogram
$24
$25
$25
$26
$27
$28
$29
X -Ray Chest -1 View
$63
$64
$66
$68
$70
$72
$75
X -Ray B-Read/Interpretation
$42
$43
$45
$46
$47
$49
$50
EKG Resting
$36
$37
$38
$39
$41
$42
$43
FCE 15 Minutes
$44
$45
$46
$48
$49
$50
$52
OSHA Respirator
Questionnaire
$30
$31
$32
$33
$34
$35
$36
Docusign Envelope ID: 1 F779008-4347-8FEC-830D-645347CE6D0D
Respirator Fit Test Qualitative
$46
$47
$49
$50
$52
$53
$55
Medical Questionnaire Review
$18
$19
$19
$20
$20
$21
$21
Tdap Vaccine
$84
$87
$89
$92
$95
$97
$100
MMR Vaccine
$114
$117
$121
$125
$128
$132
$136
Varicella Vaccine
$150
$155
$159
$164
$169
$174
$179
Pulmonary Function Test
$26
$26
$27
$28
$29
$30
$30
Note regarding any applicable immunization services: After the first twelve months of an executed
agreement, if the current market price for the above Services changes due to market conditions,
demands, and/or shortages, City of Fort Worth will be billed current market rates.
Docusign Envelope ID: 1F779008-4347-8FEC-830D-645347CE6D0D
rvRT WORTH:
MAYOR AND COUNCIL COMMUNICATION
7.2.2 OCCUPATIONAL HEALTH AND SAFETY SERVICES
DATE: 08/25/2026 M&C FILE NUMBER: M&C 26.758
DEPARTMENT: HUMAN RESOURCES DEPARTMENT
SUBJECT
(ALL) Authorize Professional Services Agreement with Occupational Health Centers of the
Southwest, P.A., DBA Concentra for Occupational Health and Safety Services for Up to an
Annual Amount of $600,000.00 with a One -Year Initial Term and Authorize Four One -Year
Renewal Options, Each in an Annual Amount Up to $600,000.00 for the Human Resources
Department
RECOMMENDATION
It is recommended that the City Council authorize the City Manager to execute a Professional
Services Agreement with Occupational Health Centers of the Southwest, P.A., DBA Concentra
in an annual amount up to $600,000.00 with renewal options for occupational health and
safety services.
DISCUSSION
The purpose of this Mayor and Council Communication (M&C) is to take actions associated
with engaging Occupational Health Centers of the Southwest, P.A., DBA Concentra in an
annual amount up to $600,000.00 to provide the City with occupational health and safety
services.
The services include pre -employment and post -offer medical evaluations, fitness -for -duty
examinations, drug and alcohol testing, medical surveillance, immunizations, workers'
compensation -related medical services, return -to -work evaluations, respiratory and hearing
conservation programs, and other occupational health services as requested by the City.
These services support departments in meeting regulatory requirements, reducing workplace
risk, minimizing employee downtime, and ensuring employees are medically qualified to
safely perform the essential functions of their positions.
Upon City Council approval and execution of the agreement, the initial contract term shall
commence. The agreement may be renewed for additional terms each up to $600,000.00 at
the City's sole discretion, subject to the availability of appropriated funds. No guarantee is
1 of 3
Docusign Envelope ID: 1F779008-4347-8FEC-830D-645347CE6D0D
i uRT WORTH!.
made that a specific quantity or dollar amount of services will be requested under this
agreement.
TERM: Following approval of this M&C, this agreement will begin upon execution and will end
on December 31, 2027 (Initial Term). Fees will not accrue until billing services begin in January
of 2027.
RENEWALS: The agreement may be renewed for up to four (4), successive one-year renewal
terms following the end of the Initial Term.
EXEMPT PROCUREMENT: The City Attorney's Office has determined that these professional
occupational health and safety services are governed exclusively by Chapter 2254 of the
Texas Local Government Code. Accordingly, the procurement of these services is exempt
from competitive bidding requirements, and the City is authorized to negotiate and enter into
the agreement in accordance with applicable law.
This M&C does not request approval of a contract with a business entity.
FISCAL INFORMATION/CERTIFICATION
The Director of Finance certifies that upon approval of the above recommendation and
adoption of the Fiscal Year 2027 Budget by the City Council, funds will be available in the
Fiscal Year 2027 operating budget, as appropriated, in the Risk Fund. Prior to an expense
being incurred, the Human Resources Department has the responsibility to validate the
availability of funds.
SUBMITTED FOR CITY MANAGER'S OFFICE BY: Giordano, Dianna, # 7783
ORIGINATING BUSINESS UNIT HEAD:
ADDITIONAL INFORMATION CONTACT:
ATTACHMENTS
FID Table [7.2.2.1 - 1 page]
Kristen Smith, #2697
Heather Wiggins, #7230
2 of 3
Rec # Fund Dept # Account Project Activity Budget CF 2 Program Amount Purpose Xfer
ID Year
FIDs (Actual)
Rec # Fund Dept # Account Project Activity Budget CF 2 Program Amount Purpose Xfer
ID Year
FIDs (REVENUE or EXPENSE - No KK or GL Entries Needed)
Rec # Fund Dept # Account Project Activity Budget CF 2 Program Amount Purpose Xfer
ID Year
Docusign Envelope ID: 1F779008-4347-8FEC-830D-645347CE6D0D
FORT WORTH,)
City Secretary's Office
Contract Routing & Transmittal Slip
Contractor's Name: Occupational Health Centers of the Southwest PA dba Concentra
Subject of the Agreement: to provide the City with occupational health and safety services
NA
NA
NA
M&C Approved by the Council? * Yes 8 No ❑
If so, the M&C must be attached to the contract.
Is this an Amendment to an Existing contract? Yes ❑ No II NA
If so, provide the original contract number and the amendment number.
Is the Contract "Permanent"? *Yes ❑ No
If unsure, see back page for permanent contract listing.
Is this entire contract Confidential? *Yes ❑ No 8 If only specific information is
Confidential, please list what information is Confidential and the page it is located.
NA
NA
Effective Date: 01/01/2027
If different from the approval date.
Expiration Date: 12/31/2027 + 6 renewals
If applicable.
Is a 1295 Form required? * Yes ❑ No 8
*If so, please ensure it is attached to the approving M&C or attached to the contract.
Project Number: If applicable. NA
*Did you include a Text field on the contract to add the City Secretary Contract (CSC)
number? Yes 0 No 0
Contracts need to be routed for CSO processing in the following order:
1. Katherine Cenicola (Approver)
2. Jannette S. Goodall (Signer)
3. Allison Tidwell (Form Filler)
*Indicates the information is required and if the information is not provided, the contract will be
returned to the department.