HomeMy WebLinkAbout1996-001 Agreement - RVMC Small Business Consortia ~..~,i~ .~ ,~_
Professional Services Agreement
This agreement is entered into this 1st day of January, 1996, by and
between Rogue Valley Medical Center, and City of Ashland, hereby referred to as
the Participating Organization.
Whereas, the Participating Organization has need of an employee
assistance program, and Whereas, Rogue Valley Medical Center administers the
Employee Assistance Program/Small Business Consortia, it is therefore agreed
between the parties as follows:
The terms for the first year of service are that the Small Business
Consortia will match funds from the Participating Organization to cover the
services for up to 100 employees enrolled in the program at a rate of $10.30
per year per employee (full fee $20.60 as of 1~_[~96 After the first year of
service, the full enrollment fee will be paid by the Participating
Organization. In consideration of these terms, Rogue Valley Medical Center
agrees to provide the following professional services through the Employee
Assistance Program/Small Business Consortia. Services will begin January 1,
1996.
1. Consultation regarding EAP and drug-free workplace
policy, procedures and program planning, not to exceed
four hcurs during the first year, specifically
implementing programs to comply with the U.S.
Department of Transportation regulations.
Employee education covering U.S. Department of
Transportation regulations part 382, employer's policy
for compliance with these regulations, and signs &
symptoms of abuse of alcohol and controlled substances.
Supervisory training to include one hour on alcohol
misuse and one hour on abuse of controlled substances.
These events will be conducted at the employer's
designated site within 30 days of initiating the
program.
Assessment, brief treatment and referral services for
covered employees, .i.e., drivers performing safety-
sensitive duties, and immediate family members for
various personal or family problems (refer to RVMC EAP
brochure). RVMC Employee Assistance Program will
provide timely access and appropriate levels of care,
dependent on individual needs of the employee or family
member. All assessment, counseling and referral
services will be provided at no charge to the employee
or family member. The E.A.P. providers are qualified
S~b~tance ~-bus~ Professionals (S.A.P.'s) .
Semi-annual utilization reports to the Participating
Organization documenting program utilization and
services delivered.
Payment for services under this agreement shall be made in advance on a
quarterly basis and are due and payable by the 10th day of the month following
receipt of the invoice. It is agreed that the procedure for termination of
this agreement by either party will be written notification 30 days before the
date of termination, and any account balance will be reimbursed from the date
of termination.
In Witness Whereof, the parties
cited above:
The Participatinq 0rqanization
City of Ashland
0T f icial Represent at i~ignature
20 E. Main S~e~et, Ashland, OR
Address with City, State & Zip Code
97520
sign ~s document on the day and year
Rogue ¥allev ~i~al Center ~
OH]D Director, Dennis Ray Olson
EAP Representative, Keith Breswick
Telephone
OCC~PATIONAL HEALTH DEPT. MARKETING CONTACT SHEET
COMPANY:
ADDRESS:
CONTACT:
PHONE ~:
City of Ashland
20 East Main Street, City Hall
Ash]and, Oregon 97520
Janice Alderman, Personnel A~iqf~nt
(541) 488-6002
OP/EXT/DFTA
INJURIES:
(OJI) CARRIER:
PHYSICAL EXAMINATIONS: TO Be Conducted By Own Medical Contractor
( ) ABB ( ) FULL
( ) HAZMAT ( ) EXECUTIVE ( ) RETURN TO WORK
( ) ICC ( ) FAA RELEASE CARD: ( ) YES ( ) NO
( ) ?RE-FLACEMENT
TYPE OF D/S: All D.0.T. under S.A.M.S.H.A.
LAB: 0ML
SHIPPED:
FORMS:
PArgEL ~: SPLIT: ( D YES ( ) NO
( ) FEDEX ( ) AIRBORNE ( ) COURIER
( ) IN OFFICE ( ) FORMS BROUGHT
D/S SCREENING REQUESTS; TO Be Conducted Primarily By Ashland Community
Hdspital, contact Rick Hendricks, Lab, 482-5811
(X) AFTER HOURS (ER)( ) OJI's (X) REQUEST
(X~ RANDOM (X) NIDA ( ) NON-NIDA
PAYMENT DUE BY: ( D COMPANY (X) PRE-HIRE
AUDIOMETRIC EXAM: ( ) BASELINE
( ) ANNUAL
EAP: ( ) PER HR (XD PER EMPLOYEE Enrolled in the 0SB/EAP Small Business
Consortia effective 1/1/96, at a annual cost of $10.30 for the first year,
LAB WORK: per employee. 0n]y for CDL, Safety - Sensitive Employees and
their supervisors.
( ) SCREEN ~
( ) x-RaY
( ) EKG ( ) W/TREADMILL
( ) CRLP
OTHER:
( ) BLOOD B PATH
( ) HIV
( ) HEP S
( ) MICRO UA
COPIES TO CO:
( ) COMPLETE
( ) D/S
( ) ICC
( ) AUDIO
( ) wPc
MEDIC/FIRST AID TRAINING: ( )
STAFF MEMBER: Keith Breswick, Small Business EAP Consortia
DATE: - January 17, 1996 NEXT CONTACT:
# OF EMPLOYEES: 39 drivers (REG) 14 Supervisors(SEASONAL) Total= 53
NOTES:
Bill in advance on a quarterly basis at a rate of 53 employeesx
$10.30 per year= $~a~.90, $116.475 per quarter. Company will
call quarterly with any revision to the number of enrolled
employees, any revise billing accordingly.