FLORIDA DEPARTMENT OF ENVIRONMENTAL PROTECTION MARJORY STONEMAN DOUGLAS 3900 COMMONWEALTH BOULEVARD TALLAHASSEE, FLORIDA 3239965000 March 11, 2015 Mr. Barton L. Bibler 3673 Mossy Creek Lane Tallahassee, Florida 32311 Dear Mr. Bibler: Based upon Personnel Rules regarding Attendance and Leaving, speci?cally, Compulsory Disability Leave and also information we have received regarding your medical condition and behavior, we have attached a Medical Release Form you will need to have your doctor complete before you will be able to return to work. The Department of Environmental Protection (DEP) is requesting your physician?s professional opinion concerning your ability to return to work and to perform the duties and responsibilities. of your position on a full time basis. A copy of your position description and the form are attached for the doctor?s completion and return. You will need to sign the form authorizing your physician to release your medical information. DEP has no Wish to violate your privacy by requesting the result of any medical test or diagnosis. We must, however, ascertain your ability to return to work and perform your job duties as a Government Operations Consultant Ill on a full time basis. We have enclosed your current position description. We would appreciate your physician?s professional opinion regarding your ability to perform the essential functions of your job on a full time schedule of 8 hours per day 5 consecutive days per week. Based on the information we have provided and your signed consent to release information to us, we request that your physician complete the attached form and return it to us as soon as possible so that you may be able to return to work. Please share this letter with the physician. Please forward this completed information to my attention via fax number (850) 412-0710 oremailittomeat-=. . . Mr. Barton Bibler March ll, 2015 Page 2 If additional information is needed please contact me at (850) 245-2532. Sincerely, own/AIL Drew Meehan Human Resource Of?cer DM/gba Enclosures: (1) Evaluation Form (2) Position Description 37001192 c: Mr. Bibler?s Physician Florida Department of Environmental Protection MEDICAL CERTIFICATION If there is a pattern of absence by an employee that appears to be inappropriate or abusive, the supervisor should consult with the Bureau of Human Resource Management, Employee Relations Section for guidance. Name of Employee: People First ID: Division/District: Please Indicate Reason for Leave Request: Employees Serious Health Condition Birth ofa Child Placement of a child with you for Adoption or Foster Care [3 Serious Health Condition of youerouse child parent (list child?s Date of Birth) [1 Military Family Leave (NOTE: Qualifying Exigency Leave requires completion of Form 84 and Military Caregiver Leave requires completion of Form WEI-385) Authorization to Release Medical Information I hereby speci?cally authorize the release of any information contained in all records regarding any and all of my medical treatment in order to complete this questionnaire. Employee?s Signature: Date: CONFIDENTIAL MEDICAL INF ION EXEMPT FROM PUBLIC RECORDS DISCLOSURE, CHAPTER 119, RS This part of the form is to be completed by the attending physician) Health Care Provider The Genetic Information Nondiscrimination Act of 2008 (GINA) prohibits employers and other entities covered by GINA Title II from requesting or requiring genetic information of an individual or family member of the individual, except as speci?cally allowed by this law. To comply with this law, we are asking that you not provide any genetic information when responding to this request for medical information. ?Generic information, as de?ned by GINA, includes an individual is family medical history, the results of an individual is or family member ?5 genetic tests, the fact that an individual or an individual ?s family member sought or received genetic services, and genetic information of a fetus carried by an individual or an individual ?5 family member or an embryo lawfully held by an individual or family member receiving assistive reproductive services. Employee?s Name (Print): BHRM - DEP 54?202 (Effective l.0-30-2013) Page 1 of3 MEDICAL CERTIFICATION ?w BHRM DEP 54-202 (Effective 10450?2013) continued Patient?s Name: (if different from employee) Last day patient was seen: Absence necessary from work beginning through Is patient able to perform all regular duties: YES NO If YES, how many hours per day? (please specify time rames or working hours if required due to medical reason) Please provide an explanation for any restrictions or limitations. What date (or projected date) will the patient be able to perform their regular duties? Is the patient able to perform light of?ce duties? I: YES [1 NO Additional Comments: If additional treatments will be required for the condition, please provide an estimate of the probable number of such treatments: If a regimen of continuing treatment by the patient is required under your supervision, provide a general description of such regimen prescription drugs, physical therapy requiring special equipment). If the patient Wiil need care only intermittently or on a part~time basis, please indicate the probable duration of this need: if the condition is a chronic condition or pregnancy, state whether the patient is presently unable to perform theirjob duties and the likely duration and frequency of episodes of the patient?s inability to perform their jobs: If leave is required to care for a family member of the employee with a serious health condition, does the patient require assistance for basic medical or personal needs or safety, or for transportation? YES NO If NO, would the employee?s presence, to provide comfort, be beneficial to the patient or assist in the patient?s recovery? YES NO [3 BHRM - DEE (Effective Page 2 of3 MEDICAL CERTIFICATION BHRM - DEP 54-?202 (Effective 10-30-2013) continued i understand that this information will be kept con?dential and is required by the Department of Environmental Protection?s Bureau of Human Resource Management for determining eligibility under the Family and Medical Leave Act and leave usage. Name of Physician: Mailing Address: City: State: Zip: Area Code/Phone Number: Signature of Attending Physician Date BHRM DEP (Effective Page 3 of3 STATE OF FLOREDA rnkr?m wig"? i" it aw Ej?maa?rwri?w? a? 2m? CAREER r33 SFLECTED SERVICE srammz 0mm [3 POSWIGW LOCATEON {?anaqeriat 11020? Coridentiai? Smenisoryf? ?3!th NAME OF Org; :nizar?m Lei. eE: sf Protec?cn CI 'rr? 7:1; ?ropOSed; Position Number: FTE: - $ecurity .le Cutie: State ands 37901192 111 Curran: Broadb? r323 Currer Hie: Carma: class Of?ce of Ervironmentai Sr: vim-s Levci Codr: Government Operations Code: 2238 134111-94 Consultant ll: Preposrd Broadband Pronosed Cfaw Tit?e: proposed Lave! Code: '355 Code: CODE: Tail.3hassea?37 Type of Transaction. Mirror u; i ta dunes rusponsibxmies VCUMBENT APPROVAL AUTHOQWY USE ONLY POSWON Brogadband Ciass Approved By Effec: ge Daze EEO 31/: can: 01302303344305 1'1? ogmorfjosfjegkj 1M3 ca /o $10 Specia! Risi: No E1 Overtime: Yes {3 No CAD: Yes [1 ma i3 ?anagemmt Ana?yst3 BROADBANE) OCCUPATEONZ 573$ '1 Gowmment Operations Consuitrsm fix I. This pos?iion reports directiy to: Position Number 37001074 this position: Broadband Level Code 11~1021??3 Broadband Occupa?on Generai angi Operations Mars. Class Code 8841 V'Ciass Title Program Administrator- Broad?nand .evel code, class titie. class code, pasi?on number, and headquarters Eocation of each which reports directEy to 3. What statutes estab?sh or de?ne {he work performed? Chapters 253 and 259, F.S. 4. This posifion has ?nanc?ai disc?osum may :1 in accordance with 85,31 12314;), F, 8: Yes No 5. Current budget for which ihiS posi?on is accmumreble (if appiicame}: NA Safares 3 Bi: 35:25 0.93 Expenses Data: Prove-serif 3 TOTAL if {he current budgst inciudes other areas of accauntabiliiy inciudu them in the TOTAL ALLOTMENT and provide a brief expianation. Page 1 of 2 DMS 3/29/04 POSSTION NUMBER: Q7001192 6. Duties and Responsibilities Describe in detail the speci?c duties and responsibilities assigned to this position and the percentage of time for each. indicate the role of this in accomplishing the unit and agency mission. If applicable, include examples of independent, ?nal policy decisions made and show their effect on the agency. the public. Or other state agencies. of Duties and Responsibilities Time 1 75 Coordinates all aspects of for: Board land management plan prognm and evaluation program i for osc lands. including :valuating cnvironmco?? values. pmnoscd public uses. public and recommendations (especially those of advisory groups and review teams). and compliance with rule, statutes, and the purposes for which the proporty was; acquired. We:er to compliance among lessees of conservation lands. and present all pmgram information to the Acquisition and Rostoration Council as required. l0 Coordinates and works towards cooscmus with division staff. other state and local agencies and stakeholders in making and policy?rulcmakiug Develop: and provich reports as needed, 5 Coordinates research and analysis of original project boundaries, conservation objectives, and project evaluation reports for existing state-owned lands to determine if any can be recommended for surplusing. 5 Reviews, analyzes and (31131}qu appropriate content of each land management prospectus provided as part of the Project Evaluation Report as required in s. 259.032, RS. 5 Performs other related duties. 7. Knowledge. skills and including utilization of equipment. required for the position: Knowledgect basic management principles and practices. Knowledge of the methods of data collection and analysis. Ability to manage a consultative program designed to ensure the resolution of managerial and operational problems. Ability to determine work priorities. assign work and ensure proper completion of work assignmentd. Ability to communicate effectively. Ability to establish and maintain effective working relationships with others. Ability to assess budgetary needs. Ability to formulate policies and proceduros. to understand and apply applicable rules. regulations. policies and procedures relating to operational and management analysis activities. Ability to organize data into logical format for presentation in reports. documents and other materials. Ability to collect. evaluate and analyze data to develop alternative recommendations. solve problems. document work and other activities relating to the ol operational and management practices. Ability to conduct fact-finding research. Abtlity to work independently. Ability to solve problems and make decisions. Ability to maintain a valid driver's license. to demonstrate teamwork. Ability to exercise common sense. 8. requirements (If applicable, list the appropriate Florida Statute or federal regulation cite): Valid Driver?s License 9. Other joburelaled requirements for this position; incumbent has vendor lnvoicelWarrant Processing responsibility and is subject to the provisions of Section 215.422. FS. 10- Working hours: Daily from 8:00 am. to 5:09 pm. (B) Total hours in workweek 40 (C) Explain any variation in Work (split shift. rotation, etc.) Flextime allowed. ?11. Agency Use Only Check thoswa?_gp?ly: Uniform Allowance Bond indicator Drug Screening Re-smeening Security Check: No Seourih/ soreen required Background investigation required Background fingerprint required [3 Fingerprint investigation required CI Access to abuse records El Caretaker Financial Law enforcement Management [3 Sensitive [3 Agency security check Other: Vendor Invoice. Chapter 215.422 PS. The following have acknowledged that the statements above, to the best of their knowledge, accurately describe the duties and responsibilities of the position. Incumbent signaturc: Date: Discussed with employee: Yes [3 No Title: Bale: Supenrisol?s signature: Approval of Reviewing Authority: Title: Date: (Division Director. Agency lead or other) Ill. . fix.? i \g Agehgl? Porgogoel Of?cer: Date; w- ow? of . fit-??s??cf4Page 2 cl 2 EMS 3/29/?84