The URL can be used to link to this page

Home My WebLink About1996-032 Agreement - RVMC CITY OF ASHLANr This AGREEMENT is made between Rogue Valley Medical Center Occupational Health (clinic) and City of Ashland (clJcnt)a licensed business located at 20 E. Hain Street, ^~hland, Oregon 97520 WItEREAS: A. Clinic is a licensed medical facility with medical providers to provide medical care, treatment and administrative services to Clients in support of the health, well being and productivity of Client's workforce. B. Client, as a licensed business, has need for the services provided by Clinic as outlined in Addendum A attached. In consideration of mutual covenants and promises set forth, the parties enter ~nto this agreement, terms and conditions of which shall apply from the execution date. FEES: A. Fees are the direct result of the services identified in Addendum A and will be charged as outline in Addendmn B. B. Payment terms are net thirty (30) days after the date of Clinic's invoice. Overdue payments are subject to an interest and/or service charge. RESPONSIBILITY: A. Client and Clinic are independent contractors and this agreement shall not be construed to place the parties in the relationship of partners, joint venture, pnncipal-agent or employer-employee. B. Client and Clinic as independent contractors are not responsible for any damages resulting from acts or omissions of the other under the terms of this agreement and/or respective policy, procedures and programs. Page 2. C~ Client shall indemnity Clinic, it's directors, officers, agents and employees from and against claims, suits, and damages of any nature made or asserted by a present or former employee, agent or applicant for employment of the client or ifs affiliates arising out of the performance of the this agreement. IN WITNESS WHEREOF, the parties hereto have caused this agreement to be executed as of the date of signature below. Rogue Valley Medical Center ()ccupa/t, f6nal Heath Title: [)ate: Client: City of Ashland Title: Citv a~ ,jx(istrator Date:_ 1996 Addendum A Services provided 1. Employee Assistance Program (EAP) Services: The following professional services RVMC EAP and the OSB Consortia Grant: A. go Go Fo will be provided through the Assessment & referral services for all covered employees, i.e. employees performing safety-sensitive duties, and their immediate family members. Brief treatment for each presenting problem or incident, as appropriate, up to five sessions. Employee education, orientation & supervisory training on topics related to realizing the benefits of an EAP. Policy & procedure development to assist in drafting policies covering referral and services of an Employee Assistance Program, and substance abuse policy. Supervisory & management consultation to assist with addressing personnel, program or organizational issues. Promotional materials including posters, pamphlets, brochures and newsletter articles upon request. 2. Drug Free Transportation Alliance(DFTA) services: Services will be provided through RVMC Occupational Health to meet compliance with Federal Highway Administration Motor Carrier Safety Regulations defined in 49 CFR part 40 & 49 CFR subpart 382 related to the Omnibus Employee Testing Act. FHWA required: · SAMHSA/DHHS drug testing · Supervisory training · Consultation services The DFTA will provide the following · record keeping · laboratory quality assurance · Random selection for alcohol & controlled substances testing Collection procedures for the necessary drug screens will be as specified below. The collection site will be Ashland Community Hospital with RVMC facilities available as back up if needed. The specimen processing will be through Oregon Medical Laboratory(OML), a SAMHSA certified laboratory. mo go Co Employees will be randomly selected by the Clinic through the DFTA, at a rate equal to: 50% of the total enrolled members for controlled substances and 25% of the total enrolled members for alcohol. Notification will be made by the Clinic to the designated Client representatives, with a timely response from the employee/member. Pre-employment drug testing on all covered individuals given conditional job offers will be scheduled by appointment and conducted at Ashland Community Hospital. Reasonable suspicion testing will be conducted at Client's request during normal office hours, or after hours with prior arrangements for facility availability. o MRO Services: A. The Medical Review Officer will be responsible for overseeing and interpreting all lab positive drug test results. As appropriate under the Client's and MRO's direction, referral for further assessment through the Employee Assistance Program will be made. B. All test results, positives and negatives, will be communicated between the Client and the MRO in accordance with federal guidelines established by the Omnibus Transportation Employee Testing Act. Addendum B Fee Schedule 1. Employee Assistant Program services through the Oregon Small Business Consortia Grant. $10.30 per employee per year as outlined in the Professional Service agreement. Drug Free Transportation Alliance participation. $25.00 per driver per year for the first 5 drivers. $20.00 per driver per year for the next 10 drivers. $15.00 per driver per year for the next 10 drivers. $10.00 per driver per year for additional drivers. 3. Drug testing fee collection and lab processing. $51.50 per screen. 4. Medical Review Officer review of positive drug screen result. $150.00 per hour, pro-rated in 15 minute increments. OCCUPATIONAL HEALTH DEPT. MARKETING CONTACT SHEET OP/EXT/DFTA COMPANY: ADDRESS: CONTACT: PHONE #: INJURIES: City of Ashland 20 East Main Street, City Hall Ashland, 0reqon 97520 Janice Alderman, Personnel A~i~ant (541) 488-6002 Sharlene Stephens, Legal Assistant (541) 482-3211 (OJI) CARRIER: PHYSICAL EXAMINATIONS: To Be Conducted By Own Medical Contractor ( ) ABB ( ) FULL ( ) HAZMAT ( ) EXECUTIVE ( ) RETURN TO WORK ( ) ICC ( ) FAA RELEASE CARD: ( ) YES ( ) NO ( ) PRE-PLACEMENT TYPE OF D/S: All D.0.I. under S.A.M.$.H.A. LAB: 0Mr PANEL #: SPLIT: ( ~ YES ( ) NO SHIPPED: ( ) FEDEX ( ) AIRBORNE ( ) COURIER FORMS: ( ) 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) ( ) 0JI's (X) REQUEST (X~ RANDOM (X) NIDA ~( ) NON-NIDA PAYMENT DUE BY: ( D COMPANY (X) PR£-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 WO~K: per employee. 0nly for CDL, Safety - Sensitive Employees and their supervisors. ( ) SCREEN # ( ) BLOOD B PATH ( ) X-RAY ( ) HIV ( ) EKG ( ) W/TREADMILL ( ) HEP B ( ) CRLP ( ) MICRO UA OTHER: COPIES TO CO: ( ) COMlmLE?E }LX ( ) D/S ( )~CC ( ) AUDIO ( ) wPc MEDIC/FIRST AXD TRAXNING: ( ) STAFF _M~ER: Keith Breswick, Small Business EAP Consortia DATE: January 17, 1996 NEXT CON?ACT: # OF EMPLOYEES: 39 drivers (REG) 14 Supervisors(sEASONAL) Total= 53 NOTES: Bill in advance on a quarterly basis at a rate of 53 emp]oyeesx $10.30 per year: $~.qO. $136.475 per quarter. Company will call quarterly with any revision to the number of enrolled employees, any revise billing accordingly.