JOB DEMANDS CHECKLIST. The purpose of this section is to describe the physical and psychological risk factors associated with the job. Applicants must review this form to ensure they can comply with these requirements and successful applicants will be required to sign an acknowledgment of their ability to perform the job demands of the position. This form is to be completed by the Manager / Supervisor of the position being recruited xx. Position: Director of Medical Governance Department / Unit: Medical Services Facility / Site: Albury and Wodonga Campus TASKS PERFORMED: Nature of Tasks to be undertaken (Collective description as best describes tasks).

JOB DEMANDS CHECKLIST. Bairnsdale Regional Health Service endeavours to provide a safe working environment for all staff. The table below describes the demands and risk factors associated with this job. Applicants must review this information to ensure they can comply with these requirements. Successful applicants will be required to sign the acknowledgment at the end of the position description to confirm their ability to perform the job demands of this position. Frequency definitions: I = Infrequent Activity may be required very infrequently O = Occasional Activity required occasionally, not necessarily all shifts F = Frequent Activity required most shifts, up to 50% of the time C = Constant Activity that exists for the majority of each shift and may involve repetitive movement for prolonged periods N/A = Not Applicable Activity not performed Aspects of Normal Workplace Frequency Demands Description I O F C N/A Physical Demands Sitting Remain seated to perform tasks x Standing Remain standing to perform tasks x Walking Periods of walking required to perform tasks x Bending Forward bending from waist to perform tasks x Kneeling Remaining in a kneeling position to perform tasks x Lifting/Carrying Light lifting and carrying x Moderate lifting and carrying x Assisted lifting (mechanical, equipment, person assist) x Climbing, Working at Heights Ascending and descending ladders, stools, scaffolding x Pushing/ Pulling Moving objects e.g. trolleys, beds, wheelchairs and floor cleaning equipment x Reaching Arms fully extended forward or raised above shoulder x Crouching Adopting a crouching posture to perform tasks x Foot Movement Use of leg and/or foot to operate machinery x Head Postures Holding head in a position other than neutral (facing forward) x Fingers/Hand/ Arm Movement Repetitive movements of fingers, hands and arms e.g. computer keyboarding x Grasping/Fine Manipulation Gripping, holding, clasping with fingers or hands x Driving Operating a motor powered vehicle e.g. Use of hospital cars, deliveries, visiting clients, tractor, ride on mower, forklift, bus etc. x Aspects of Normal Workplace Frequency

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Checklist The Service will be able to respond more quickly to a VCP request if the request is carefully prepared and complete. The checklist in Appendix C is designed to assist Plan Sponsors and their representatives in preparing a submission that contains the information and documents required under this revenue procedure. The checklist in Appendix C must be completed, signed, and dated by the Plan Sponsor or the Plan Sponsor's representative, and should be placed on top of the submission. A photocopy of this checklist may be used.
IN CHECKLIST At the time of taking possession of the Premises by the Sublessee, the Sublessor and Sublessee: (check one) ☐ - WILL be required to complete a move-in checklist that provides a detailed account of the condition of the Premises including, but not limited to, repairs needed, water damage, or material defects. ☐ - Will NOT be required to complete a move-in checklist that provides a detailed accounting of the condition of the Premises, unless otherwise required by law.
Inspection Checklist (check one) ☐ In order to avoid disagreements about the condition of the Premises, at the time of accepting possession of the Premises, Tenant will complete the Inspection Checklist incorporated herein by reference and attached hereto as Exhibit B and record any damage or deficiencies that exist at the commencement of the Term. Landlord will be liable for the cost of any cleaning or repair to correct damages found at the time of the inspection. Tenant will be liable for the cost of any cleaning and/or repair to correct damages found at the end of the Term if not recorded on the inspection checklist, normal wear and tear excepted. ☐ The Tenant is NOT required to complete an inspection checklist.
Exhibit D - Debarment Certification By signing and submitting this Contract, the Contractor is agreeing to abide by the debarment requirements as set out below. • The certification in this clause is a material representation of fact relied upon by County. • The Contractor shall provide immediate written notice to County if at any time the Contractor learns that its certification was erroneous or has become erroneous by reason of changed circumstances. • Contractor certifies that none of its principals, affiliates, agents, representatives or contractors are excluded, disqualified or ineligible for the award of contracts by any Federal agency and Contractor further certifies to the best of its knowledge and belief, that it and its principals: • Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded by any Federal Department or Agency; • Have not been convicted within the preceding three-years of any of the offenses listed in 2 CFR 180.800(a) or had a civil judgment rendered against it for one of those offenses within that time period; • Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State, or Local) with commission of any of the offenses listed in 2 CFR 180.800(a); • Have not had one or more public transactions (Federal, State, or Local) terminated within the preceding three-years for cause or default. • The Contractor agrees by signing this Contract that it will not knowingly enter into any subcontract or covered transaction with a person who is proposed for debarment, debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction. • Any subcontractor will provide a debarment certification that includes the debarment clause as noted in preceding bullets above, without modification.
Invoice Certification When and if requested by DXC, as a condition precedent to payment thereof, Supplier shall separately certify each invoice as follows: “We certify that contract deliverables listed hereon were produced in compliance with all applicable requirements of Sections 6, 7, and 12 of the Fair Labor Standards Act, as amended, and of regulations and orders of the U.S. Department of Labor issued under Section 14 thereof. We further certify that any and all additional contract deliverables will be produced in compliance with same.”
ATTACHMENT B Applicable California Vehicle Code and Civil Code Provisions Note: Many California laws, which govern a tow Operator’s business and vehicle operations, are included in this attachment. The is list of California statutes included herein is intended as a general guide only and is not meant to be considered all-inclusive. It is the tow Operator’s responsibility to know and comply with all federal and state statutes and all local ordinances relating to his/her business operations, including those that are referred to in this document and those that are not; any new statutes or ordinances that are subsequently adopted; and any amendments, repeals, or modifications of existing statutes and ordinances, including but not limited to those described in this attachment.
ATTACHMENT C STANDARD STATE PROVISIONS FOR CONTRACTS AND GRANTS
Instructions for Certification 1. By signing and submitting this CONTRACT, the prospective lower tier participant is providing the certification set out below.
Project Reports; Completion Report 1. The Recipient shall monitor and evaluate the progress of the Project and prepare Project Reports in accordance with the provisions of Section 2.06 of the Standard Conditions and on the basis of indicators agreed with the World Bank. Each Project Report shall cover the period of one (1) calendar semester, and shall be furnished to the World Bank not later than one (1) month after the end of the period covered by such report.
Sick Leave Reporting and Verification Employees must promptly notify their supervisor on their first day of sick leave and each day after, unless there is mutual agreement to do otherwise. If an employee is in a position where a relief replacement is necessary if they are absent, they will notify their supervisor at least two (2) hours prior to their scheduled time to report to work (excluding leave taken in accordance with the Domestic Violence Act). Unless otherwise precluded by law, the Employer has reason to suspect abuse, the Employer may require a written medical certificate for any sick leave absence. An employee returning to work after any sick leave absence may be required to provide written certification from their health care provider that the employee is able to return to work and perform the essential functions of the job with or without reasonable accommodation.

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