+-----------------------+-------------------------------+--------------+
| **STANDARDS FOR BASIC | #                             | Check here   |
| LEVEL OF READINESS**  |  **OFFICER RESPONSIBILITIES** |              |
|                       |                               |              |
|                       | Reference:                    |              |
|                       | <http://dcp.psc.gov/e         |              |
|                       | ccis/documents/PPM06_007.pdf> |              |
|                       |                               |              |
|                       | <http://dcp.psc               |              |
|                       | .gov/PDF_docs/04-003_PPM.pdf> |              |
+-----------------------+-------------------------------+--------------+
| 1)  Possess a current | \(a\) Ensure that information | License Exp. |
|     valid and         | is on file with the Office of | Date         |
|     unrestricted      | Commissioned Corps Operations |              |
|     professional      | (OCCO). Fax: 240-453-6142     |              |
|     license,          |                               |              |
|     certification,    |                               |              |
|     and/or            |                               |              |
|     registration      |                               |              |
|     appropriate for   |                               |              |
|     officer's         |                               |              |
|     category or       |                               |              |
|     discipline.       |                               |              |
+-----------------------+-------------------------------+--------------+
| 2)  Complete AHA      | (a) Record information on     | Exp. Date:   |
|     Basic Life        |     CCRF web site             |              |
|     Support for       |                               |              |
|     Healthcare        | > <http://ccrf.hhs.gov/ccrf>  |              |
|     Providers or ARC  |                               |              |
|     CPR/AED for the   | (b) Ensure that information   |              |
|     Professional      |     is in OPF.                |              |
|     Rescuer.          |                               |              |
|                       | > Fax: 301-480-1407 or        |              |
|                       |                               |              |
|                       | 301-480-1436                  |              |
|                       |                               |              |
|                       | (c) Renew Every 2 Years       |              |
+-----------------------+-------------------------------+--------------+
| 3)  Complete all      | Login to                      | Cross off as |
|     readiness         | <h                            | completed:   |
|     training for the  | ttp://learn.centrelearn.com/> |              |
|     BASIC level of    | complete all eight of         | 110 140 141  |
|     readiness.        | mandatory Web-based training  | 142 180 182  |
|                       | modules:                      | 183 217      |
|                       |                               |              |
|                       |   ----- --------------------- | **Plus**     |
|                       |   110   Disaster Response     |              |
|                       |                               | IS-100       |
|                       |   140   Preventive Medicine   | IS-200       |
|                       |         for Field Operations  |              |
|                       |                               | IS-700       |
|                       |   141   Health Consequences   | IS-800       |
|                       |         and Response          |              |
|                       |                               |              |
|                       |   142   Disaster Triage       |              |
|                       |                               |              |
|                       |   180   Infectious Disease    |              |
|                       |         Management            |              |
|                       |                               |              |
|                       |   182   Terrorism             |              |
|                       |                               |              |
|                       |   183   ABCs of Bioterrorism  |              |
|                       |                               |              |
|                       |   217   Safety and Security   |              |
|                       |         Awareness             |              |
|                       |   ----- --------------------- |              |
|                       |                               |              |
|                       | ### Plus                      |              |
|                       |                               |              |
|                       | ##                            |              |
|                       | # Click the four links below  |              |
|                       |                               |              |
|                       | ### (Four                     |              |
|                       |  required FEMA EMI Courses):  |              |
|                       |                               |              |
|                       | [IS-100 Introduction to       |              |
|                       | Incident Command              |              |
|                       | System](http://www.training.  |              |
|                       | fema.gov/EMIWeb/IS/is100.asp) |              |
|                       |                               |              |
|                       | [IS-200 ICS for Single        |              |
|                       | Resources and Initial Action  |              |
|                       | Inci                          |              |
|                       | dents](http://www.training.fe |              |
|                       | ma.gov/EMIWeb/IS/is200.asp)\* |              |
|                       |                               |              |
|                       | [IS-700 National Incident     |              |
|                       | Management System (NIMS), An  |              |
|                       | Intro                         |              |
|                       | duction](http://www.training. |              |
|                       | fema.gov/EMIWeb/IS/is700.asp) |              |
|                       |                               |              |
|                       | [IS-800 National Response     |              |
|                       | Plan (NRP), An                |              |
|                       | Intro                         |              |
|                       | duction](http://www.training. |              |
|                       | fema.gov/EMIWeb/IS/is800.asp) |              |
+-----------------------+-------------------------------+--------------+
| 4)  Achieve currency  | Record clinical hours on the  | Total Hours: |
|     in clinical role  | CCRF web site (if applicable) |              |
|                       | -- <http://ccrf.hhs.gov/>.    | Date:        |
| > (If applicable.)    |                               |              |
|                       | minimum number of hours =     |              |
|                       |                               |              |
|                       | 80 hours on an annual basis.  |              |
+-----------------------+-------------------------------+--------------+

+------------------------+-----------------------------+---------------+
| **STANDARDS FOR        | **OFFICER                   | Check here    |
| BASIC**                | RESPONSIBILITIES**          |               |
|                        |                             |               |
| **LEVEL OF READINESS** |                             |               |
+------------------------+-----------------------------+---------------+
| 5)  Have a current     | Ensure a current medical    | Date of last  |
|     Physical           | exam is on file with the    | Physical      |
|     Examination and    | Medical Affairs Branch.     | Exam:         |
|     Medical History on | Every 5 years.              |               |
|     file.              |                             | Date of last  |
|                        | **Mail only (no faxes)**:   | Medical       |
| **[DD-2807-1](ht       |                             | History:      |
| tp://www.dior.whs.mil/ | OCCSS/MAB, 5600 Fishers     |               |
| FORMS/DD2807-1.pdf),** | Lane,                       |               |
| [**\"Disclosure        |                             |               |
| Statem                 | Room 4C-04, Rockville, MD   |               |
| ent\"**](https://dcp.p | 20857                       |               |
| sc.gov/PDF_docs/A-GenI |                             |               |
| nst_DD2807-1_2808.pdf) |                             |               |
|                        |                             |               |
| <https://d             |                             |               |
| cp.psc.gov/opffaq.asp> |                             |               |
+------------------------+-----------------------------+---------------+
| 6)  Pass Annual        | Enter APFT results in CCRF  | Date of APFT: |
|     Physical Fitness   | website, mail PHS-7044 with |               |
|     Test (APFT),       | results to MAB.             | Date of P.C.  |
|     <http://ccrf.hhs.  | <http://dcp.psc             | Award:        |
| gov/ccrf/physical.htm> | .gov/PDF_docs/PHS-7044.pdf> |               |
|                        |                             |               |
| #### OR                | Within Past 12 Months and   |               |
|                        | Yearly:                     |               |
| > Participate in the   |                             |               |
| > President's          | ### OR                      |               |
| > Challenge Annually   |                             |               |
| > earning a Minimum of | Enter President's Challenge |               |
| > a Active Lifestyle   | using the USPHS Group and   |               |
| > or Bronze award.     | your PHS #,                 |               |
| >                      | <http://ccrf.hhs.gov/cc     |               |
| > [http:/              | rf/Readiness/PC_SignUp.htm> |               |
| /www.presidentschallen | Within Past 12 Months and   |               |
| ge.org](http://www.pre | Yearly:                     |               |
| sidentschallenge.org/) |                             |               |
+------------------------+-----------------------------+---------------+
| 7)  Identify response  | Record a response role from | Deployment    |
|     role.              | those listed on the CCRF    | Role:         |
|                        | web site --                 |               |
|                        | [http://ccrf.hhs.           |               |
|                        | gov](http://ccrf.hhs.gov/). |               |
+------------------------+-----------------------------+---------------+
| **STANDARDS FOR BASIC  |                             | Check here    |
| LEVEL OF READINESS**   |                             |               |
|                        |                             |               |
| # **OFFIC              |                             |               |
| ER RESPONSIBILITIES**  |                             |               |
+------------------------+-----------------------------+---------------+
| 8)  Immunizations:     |                             | All           |
|                        |                             | Immunizations |
| > Officers are         |                             | Complete:     |
| > required to obtain   |                             |               |
| > the following        |                             | Yes           |
| > immunizations and/or |                             | \_\           |
| > boosters:            |                             | _\_\_\_\_\_\_ |
| >                      |                             |               |
|  Measles/Mumps/Rubella |                             | Documentation |
| > (MMR), Varicella,    |                             | sent to MAB:  |
| > Tetanus/Diphtheria   |                             |               |
| > (Td), Influenza      |                             | Yes\_\        |
| > (annually), and      |                             | _\_\_\_\_\_\_ |
| > complete the         |                             |               |
| > Hepatitis A and B    |                             | Immunizations |
| > series. Officers are |                             | recorded on   |
| > also to be screened  |                             | OFRD website: |
| > having Two negative  |                             |               |
| > tuberculin skin test |                             | Yes\          |
| > (TST) results no     |                             | _\_\_\_\_\_\_ |
| > greater than 12      |                             |               |
| > months apart or a    |                             |               |
| > single negative      |                             |               |
| > interferon-gamma     |                             |               |
| > release assay (IGRA) |                             |               |
| > test. Submit proof   |                             |               |
| > of immunizations to  |                             |               |
| > OCCSS/MAB. See MC-   |                             |               |
| > 377, PPM 06-007 for  |                             |               |
| > details.             |                             |               |
| >                      |                             |               |
| > **YOU may fax        |                             |               |
| > immunization         |                             |               |
| > information to MAB:  |                             |               |
| > 301-594-3299**       |                             |               |
| >                      |                             |               |
| > Officers MUST also   |                             |               |
| > record their         |                             |               |
| > immunizations        |                             |               |
| > information online   |                             |               |
| > using the OFRD       |                             |               |
| > website              |                             |               |
| >                      |                             |               |
|  [http://ccrf.hhs.gov] |                             |               |
| (http://ccrf.hhs.gov/) |                             |               |
| >                      |                             |               |
| > OFRD immunization    |                             |               |
| > matrix:              |                             |               |
| > <http://ccrf.hhs.    |                             |               |
| gov/ccrf/immuniza.htm> |                             |               |
| >                      |                             |               |
| > <http://ccrf.hhs.gov |                             |               |
| /ccrf/immun_guide.htm> |                             |               |
+------------------------+-----------------------------+---------------+
| > **Hepatitis A #1**   |                             | Date:         |
| > (2^nd^ immunization  |                             | #1\_\         |
| > in series or         |                             | _\_\_\_\_\_\_ |
| > Positive Titer       |                             |               |
| > required after 1 MAY |                             | Positive      |
| > 2005)                |                             | Titer:        |
|                        |                             | \_\_\_\_\_\_  |
|                        |                             | #2\_\_\       |
|                        |                             | _\_\_\_\_\_\_ |
+------------------------+-----------------------------+---------------+
| > **Hepatitis B #1**   |                             | Date:         |
| > (2^nd^ and 3^rd^     |                             | #1\_\         |
| > immunization in      |                             | _\_\_\_\_\_\_ |
| > series, or Positive  |                             |               |
| > Titer required after |                             | Positive      |
| > 1 MAY 2005)          |                             | Titer:        |
|                        |                             | \_\_\_\_\_\_  |
|                        |                             | #2\_\_\       |
|                        |                             | _\_\_\_\_\_\_ |
+------------------------+-----------------------------+---------------+
| > **MMR #1 and #2**    |                             | Date:         |
| > (Medically           |                             | #1\_\         |
| > documented history   |                             | _\_\_\_\_\_\_ |
| > of infection,        |                             |               |
| > positive antibody    |                             | #2            |
| > titers confirming    |                             | \_\           |
| > natural or acquired  |                             | _\_\_\_\_\_\_ |
| > immunity are also    |                             |               |
| > acceptable proof of  |                             | Positive      |
| > immunity).           |                             | Tit           |
| > Accompanying medical |                             | er:\_\_\_\_\_ |
| > documentation must   |                             | \_\           |
| > be submitted to      |                             | _\_\_\_\_\_\_ |
| > OCCSS/MAB for        |                             |               |
| > confirmation.        |                             | History:      |
|                        |                             | \_\_\_\_\_\_\ |
|                        |                             | _\_\_\_\_\_\_ |
+------------------------+-----------------------------+---------------+
| > **Tetanus/Diphtheria |                             | Date:         |
| > (Td)** (within the   |                             | \_\_\_\_\     |
| > last ten years)      |                             | _\_\_\_\_\_\_ |
+------------------------+-----------------------------+---------------+
| > **Varicella**        |                             | Immunization  |
| > Immunization         |                             | date:         |
| > (Medically           |                             | \_\_\         |
| > documented history   |                             | _\_\_\_\_\_\_ |
| > of infection,        |                             |               |
| > positive antibody    |                             | Positive      |
| > titers confirming    |                             | Titer:        |
| > natural or acquired  |                             | \_\_\_\_\_\   |
| > immunity are also    |                             | _\_\_\_\_\_\_ |
| > acceptable proof of  |                             |               |
| > immunity).           |                             | History:      |
| > Accompanying medical |                             | \_\_\_\_      |
| > documentation must   |                             | \_\_\_\_\_\_\ |
| > be submitted to      |                             | _\_\_\_\_\_\_ |
| > OCCSS/MAB for        |                             |               |
| > confirmation.        |                             |               |
+------------------------+-----------------------------+---------------+
| > **Influenza**        |                             | Date:         |
| > (Annual)             |                             | \_\_\_\_\     |
| >                      |                             | _\_\_\_\_\_\_ |
| > **Officers are       |                             |               |
| > required to obtain   |                             |               |
| > an influenza         |                             |               |
| > vaccination between  |                             |               |
| > 1 October and 31     |                             |               |
| > December of each     |                             |               |
| > calendar year.       |                             |               |
| > However, compliance  |                             |               |
| > with this            |                             |               |
| > requirement will be  |                             |               |
| > determined on 31     |                             |               |
| > December of each     |                             |               |
| > year and not on the  |                             |               |
| > anniversary date of  |                             |               |
| > the officer's last   |                             |               |
| > influenza            |                             |               |
| > vaccination.**       |                             |               |
+------------------------+-----------------------------+---------------+
| > **Tuberculosis       |                             | Date­:         |
| > Screening** (within  |                             | \_\_\_\_\_\_\ |
| > the last 12 Months)  |                             | _\_\_\_\_\_\_ |
| >                      |                             |               |
| > **Two negative       |                             | If            |
| > tuberculin skin test |                             | applicable:   |
| > (TST) results no     |                             |               |
| > greater than 12      |                             | Positive      |
| > months apart or a    |                             | Test:         |
| > single negative      |                             | \_\_\_\_\_\_\ |
| > interferon-gamma     |                             | _\_\_\_\_\_\_ |
| > release assay (IGRA) |                             |               |
| > test (e.g.,          |                             | Negative      |
| > QuantiFERON -- TB    |                             | Chest x-ray:  |
| > Gold Test) result is |                             | \_\_\_\_\_\_  |
| > sufficient evidence  |                             |               |
| > of the absence of    |                             |               |
| > infection with       |                             |               |
| > *Mycobacterium       |                             |               |
| > tuberculosis* (TB)   |                             |               |
| > and no additional    |                             |               |
| > annual TB screening  |                             |               |
| > is required. In the  |                             |               |
| > absence of two       |                             |               |
| > negative TSTs within |                             |               |
| > 12 months, the       |                             |               |
| > officer must         |                             |               |
| > continue annual TST  |                             |               |
| > screening until this |                             |               |
| > requirement is met   |                             |               |
| > or obtain a single   |                             |               |
| > IGRA result.**       |                             |               |
| >                      |                             |               |
| > Officers             |                             |               |
| > demonstrating a      |                             |               |
| > history of positive  |                             |               |
| > **TST result** and   |                             |               |
| > who have submitted   |                             |               |
| > supporting           |                             |               |
| > documentation to the |                             |               |
| > Office of            |                             |               |
| > Commissioned Corps   |                             |               |
| > Support Services,    |                             |               |
| > Medical affairs      |                             |               |
| > Branch, indicating   |                             |               |
| > absence of active TB |                             |               |
| > disease (i.e.        |                             |               |
| > medical evaluation   |                             |               |
| > including chest      |                             |               |
| > radiograph) are not  |                             |               |
| > required to comply   |                             |               |
| > with this TB         |                             |               |
| > screening            |                             |               |
| > requirement.         |                             |               |
+------------------------+-----------------------------+---------------+