PAPEER Public Employees for Environmental Responsibility P.O. Box 14463 * Tallahassee, FL 32317-4463 tel: 850-877-8097 » fax: 850-942-5264 website: ifaw. pee.org ® e-nal:ipeer@peet.org Mareh 18, 2015 Via Email to candie.fuller@dep.state.fl.us & Hard Copy Candie Fuller Inspector General Florida, Department of Environmental Protection Office of the Inspector General 3800 Commonwealth Boulevard Ms 40 Tallahassee, FL 32399-3000 Re: Request for Investigation into the Suspension of Barton L. Bibler & Invocation of Florida Whistle-blower Act, § 112.3187, Fla. Stat. Dear Ms. Fuller: ‘As you are no doubt aware, over the past several weeks an issue has arisen concerning efforts by senior administration officials to ban the use of the terms “climate change” and “global warming” from the FDEP’s lexicon. This ludicrous ban has permeated the rank and file of the agency's personnel who have, by now, gotten the message that if they are to keep their jobs they should not seriously suggest that climate change exists. While the Office of the Governor and senior FDEP officials continue to deny that this is, in fact, the policy of the agency, it has come to our attention that earlier this month one employee, Mr. Barton L. Bibler, was — ‘© Served with an Official Written Reprimand concerning his discussion of climate change, together with his position that the Keystone XL Pipeline would further aggravate this environmental problem; © Summarily placed on personal leave and told to stay away from the office for two days; and " 4 copy of that reprimand is enclosed herewith. Headquarters: 2001 § Street, NW e Sut 670 « Washington,DC, 20009» 202-265-PEER (7337) » fx 202-265-4102 emai: fo@peerorg © webs tn peer org @ aesMs, Candie Fuller, Inspector General Florida, Department of Environmental Protection. Re: Request for Investigation into the Suspension of Barton L. Bibler & Invocation of Florida Whistle-blower Act March 18, 2015, ‘* Directed to seek what appears to be a mental health evaluation from his doctor to verify his “fitness for duty.” Mr. Bibler is the current Land Management Plan Coordinator in the Division of State Lands and has a long history of exemplary performance with the FDEP. In his current position he was asked to, and did, attend a Florida Coastal Managers Forum that was held on February 27, 2015. During the course of the meeting each participant was introduced and provided a discussion on ‘topics of interest to them. Towards the end of the meeting on the 27", after the meeting agenda had been largely discussed by every other participant, Mr. Bibler was asked to introduce himself and provide an agency update, He provided that update and also expressed his opinion that the Keystone XL Pipeline, if built, would further jeopardize the stability of our climate, which would also negatively impact the State of Florida. ‘The forum’s meeting moderator, Ann Lazar, then expressed her concem that Mr. Bibler’s statements about the Keystone XL. Pipeline because she felt that they could be interpreted as FDEP"s official opposition to the same. She was also afraid that the mention of the Keystone XL Pipeline could jeopardize the ability to hold future Coastal Management Forum conference calls. Mr. Bibler readily confirmed that his position regarding the Keystone XL Pipeline is not the official position of the FDEP. ‘After the forum was held Mr. Bibler provided a summary of the meeting. He drafted the summary and utilized the forum header and agenda topics as the blueprint for the document. In doing so he inadvertently left the word “agenda” in the heading. The summary notes included references to discussions of climate change and sea level rise. It did not mention the Keystone XL Pipeline. Mr. Bibler’s supervisors apparently took umbrage with two aspects of the summary. First, the summary that he provided left the term “Agenda” in the header. The second issue was the fact that he left intact references to discussions about climate change. Marianne Gengenbach, Chief of the Office of Environmental Services, therefore instructed him to change the summary, which he did by eliminating the word “Agenda” from the header and replacing it with “Meeting Summary (Partial).” He left the remainder of his summary as originally written. When he ‘emailed the revised summary back to his supervisor he attached to the email a symbol that simply means the equivalent of “Stop the Keystone XL Pipeline.” This was not acceptable either, at which point he was asked to provide yet another summary of the meeting - supposedly one that was thoroughly devoid of any hot button issues, especially explicit references to climate change. That summary was never provided because it would have been untrue. ‘The Written Reprimand and Involuntary Leave On March 9, 2015, Mr. Bibler was subsequently given a Written Reprimand (Reprimand). The Reprimand erroneously states that he was told to attend the Coastal Managers Forum on March 2, 2015 (the meeting was held on February 27, 2015), Itis also erroneously dated March 4, 2015, ‘when it was actually delivered to Mr. Bibler on the 9". In the Reprimand Mr. Bibler’s actions ‘were somehow magnified to be tantamount to insubordination. Ironically, the reprimand also Page 2 of 5Ms. Candie Fuller, Inspector General Florida, Department of Environmental Protection Re: Request for Investigation into the Suspension of Barton L. Bibler & Invocation of Florida Whistle-blower Act ‘March 18, 2015 noted that Mr. Bibler’s performance in the position has been “exceptionally good” and that he is “valued employee in many respects.” These observations were made before culminating in the official Reprimand which was followed by a threat of termination. Mr. Bibler was then ordered to leave the office and to stay away for 2 days. He was told that the agency would charge his annual leave for the time away. ‘The episode underlines the extent to which it demonstrates the fear that employees have in being ‘made to appear as though they wish to discuss climate change or global warming. A close reading of the Reprimand reveals that Mr. Bibler’s supposed offense was to give the impression that the meeting’s moderator, Ann Lazar, had actually called a meeting to discuss climate change and apparently that the meeting had included a discussion of climate change and the Keystone XL Pipeline. This directly contradicts the Governor's recent claims that climate change is freely discussed in his administration. But equally important, it reveals the lengths that one manager in EDEP will travel in order to distance herself from any implication that she held a meeting on the topic. Moreover, it reveals the lengths to which other managers will go in order to ensure that references to climate change are exorcised from the agency's records. ‘At first blush Ms. Gengenbach’ s actions in telling Mr. Bibler to revise his notes to eliminate the word “Agenda” would appear to be innocent enough. However, she admits in the Reprimand that she went further and ordered him to delete references to climate change and, by inference, the Keystone XL Pipeline, issues that were, in fact, raised in the meeting. Thus, itis apparent that the true concern was whether or not Ms. Lazar could face repercussions if a public record was allowed to show that that she held a meeting with an agenda that included climate change as a topic, especially if there was any discussion of the Keystone XL Pipeline. Fearing those repercussions, management twice embarked upon the task of trying to force Mr. Bibler to sanitize his summary so that no mention of climate change or the Keystone XL Pipeline was included. Ms. Gengenbach’s actions appear to solicit Mr. Bibler to commit a crime. Her actions were supported by her supervisor, Kelley Boree, the Director of the Division of State Lands. Section 839.13(1), Fla. Stat., concerns the act of falsifying and/or altering records by a public ‘employee. This section clearly states that such records are not to be altered or falsified and that ‘one may not procure the offense to be committed, lest one commit a misdemeanor of the frst degree. Accordingly, Mr. Bibler was absolutely correct in refusing to alter his notes to suggest that the topic had not been raised in the meeting. The fact that FDEP is now calling this “insubordination,” “poor performance,” and “conduct unbecoming a public employee” is abhorrent and those officials who are participating in this personnel action should be disciplined. htp//archive,flsenate.gov/ (0899/0839/Sections/0839, tatutes/index.cfin?Ap_mode=Display Statute&Search, Str ‘html 0800. Page 3 of 5Ms. Candie Fuller, Inspector General Florida, Department of Environmental Protection Re: Request for Investigation into the Suspension of Barton L. Bibler & Invocation of Florida Whistle-blower Act March 18, 2015, Orders to See a Doctor ‘The FDEP did not end its crusade against Mr. Bibler there, however. Two days later Drew Meehan, FDEP’s Human Resource Officer, authored a letter dated March 11, 2015. Ms. Gengenbach hand delivered this letter to Mr. Bibler that same day. It is a notice that the agency ‘was now demanding that he submit a form, signed by his doctor, stating that he is fit to return to work. Despite the fact that he has always been available to work he will not be allowed to return to ‘work prior to the submission of this form. This has effectively turned his original two-day “suspension” into an indefinite suspension. The basis for this personnel action is supposedly found in Rule 60L-34, F.A.C., together with “information {the FDEP] have received regarding [Mr. Bible's] medical condition and behavior, . ..” The specific information is not included in the letter. Neither did the agency disclose who submitted this information about Mr. Bibler, or to ‘whom they submitted it. But this specious information is now being used to foree him to prove that he remains fit for work. The fact of the matter is that Mr. Bibler is ready, willing and able to return to work. In fact, he ‘was not previously unable to do so, nor did he ever indicate anything to the contrary. Given that there are no allegations on the part of FDEP that Mr. Bibler is physically unable to work, the only inference that can therefore be drawn from the FDEP’s March 11 notice is that FDEP expects him to see a psychologist. ‘Thus, it appears, is because the FDEP is convinced that his concern about climate change and the Keystone XL Pipeline (something that environmental scientists in other less political agencies routinely discuss) somehow makes him mentally unfit to work in an environmental public agency that is supposed to be working to find solutions to a myriad of environmental issues— climate change included. It is beyond comprehension that a public agency such as the FDEP ‘would be acting in such an infantile way in the twenty-first century. Requested Relief With this correspondence we are asking that your office: 1. Investigate the full circumstances surrounding the personnel action that was taken against Mr. Bibler on March 4, 2015 (signed on March 11, 2015) and the subsequent personnel action that was taken against Mr. Bibler on March 11, 2015, including — © The true basis of the reprimand issued; © The propriety of placing him on involuntary leave; and ‘© The appropriateness of ordering a medical fitness for duty certification. > A copy of the notice is enclosed herewith Page 4 of 5Ms. Candie Fuller, Inspector General Plorida, Department of Environmental Protection Re: Request for Investigation into the Suspension of Barton L. Bibler & Invocation of Florida Whistle-blower Act March 18, 2015 2. Determine whether FDEP employees perceive that they are not allowed to use the terms “climate change” and “global warming” during the course of their official duties; and if so, why did this perception arise; and 3. Consider the referral of a criminal case to the Office of the State Attorney, 2" Judicial Circuit, due to the efforts by Mr. Bibler’s superiors, Ms. Gengenbach and Ms. Boree, to procure the alteration of public records. Finally, on Mr. Bibler’s behalf, we request that your office ensure that Mr. Bibler suffers no further retaliation in connection with this request and/or your investigation. The revelations made herein, we maintain, concen actions on the part of FDEP employees that ‘© Create a substantial and specific danger to the public’s health, safety, or welfare—namely the attempts by said employees to alter the public record in order to bring the same in line with political positions. The public is entitled to an honest record on a subject as important as climate change. These employees are trying to thwart that record. ‘© Involve gross mismanagement, malfeasance, misfeasance, and or gross neglect of duty. ‘Accordingly, Mr. Bibler is invoking his rights under Florida's Whistle-blower’s Aet, § 112.3187, Fla, Stat. This correspondence, together with the copy that is being forwarded directly to FDEP Secretary, Jonathan P. Steverson, shall serve as FDEP’s notice of Mr. Bibler’s action pursuant to § 112.3187. Please notify us immediately concerning the results of your investigation. Should you need any additional information please do not hesitate to contact us. wile Jerry Phillips Director Florida PEER Enel ce: Mr, Barton L. Bibler (w/encl.) Jonathan P. Steverson (w/encl.) Secretary Florida, Department of Environmental Protection 3800 Commonwealth Boulevard Tallahassee, FL 32399-3000 Page $ of 5RICK SCOTT State of Florida GOVERNOR Department of Environmental Protection (CARLOS LOPEZ-CANTERA LT.GOVERNOR OFFICIAL WRITTEN REPRIMAND JONATHAN P. STEVERSON SECRETARY Date: March 4, 2015 TO: Barton Bibler, Land Management Plan Coordinator Division of State Lands FROM: Marianne Gengenbach, Chief, Office of Environmental Services ‘Through Kelley Boree, Director, Division of State Lands SUBJECT: — Official Written Reprimand Standards of Conduct Violated: DEP Directive 435, Conduct of Employees, specifically: Poor Performance which states in part: :mployces shall strive to perform at the highest level of efficiency and effectiveness, for example: (b) Employees are expected to be effective, for example: to organize their work: to stay focused on job-related activities during work hours; to provide the level of effort necessary to get the job done; to demonstrate willingness and ability 1o make decisions and exercise sound judgment; to produce work that consistently meets expectations; to accept responsibility for their actions and decisions; to adapt to changes in work assignments, procedures and technology; and to be committed to improving individual performance insubordination which states: Employees shall follow lawful orders and carry out the directives of persons with duly delegated authority. Employees shall resolve any differences with management in a constructive manner. £, Conduct Unbecoming a Public Employee (2) Employees shall maintain high standards of honesty, integrity and impartiality. Employees shall place the interests of the public ahead of personal interests, Employees shall not use or attempt to use their official position for personal gain or confidential information for personal advantage Dates and Circumstances of Violations: On March 2, 2015, you were asked by me to attend the Coastal Managers Forum. During the meeting you engaged in personal political advocacy related to the Keystone XL Pipeline. After ewe dep. state fueBarton Bibler Division of State Lands Page2 the meeting, | asked you to provide a summary of the meeting. You first provided a takeaway summary of the meeting, but had provided that summary in a document that used the agenda header from Ann Lazar, the meeting moderator. which gave the appearance that this was Ann’s official meeting agenda that included climate change. This was not part of the original agenda developed by Ann, and resulted in a complaint of mistepresentation. | then indicated that this ‘was not appropriate and asked you to revise your summary of the meeting. You then emailed what you said was an attached agenda of your notes of agency reports on climate change. The attachment was of the words Keystone XL Pipeline with a red circle and a cross through it. ‘After you sent this email, Marianne indicated that this type of response is not appropriate and asked you to again provide your summary of the meeting. Your actions were disrespectful, unprofessional and represent insubordination. Further occurrences of a personal agenda or unwillingness to perform duties assigned will not be tolerated. You are to comply with directives as assigned. Your job performance is essential to the function of our Division and, with the exception of this very serious infraction, has been exceptionally good. This makes you a valued employee in many respects, but your inappropriate behavior must be permanently changed in order to re-establish a relationship of trust between you and your supervisors, Correetive Ac pected: ‘You are not to insert any personal agenda or political advocacy into the work you perform. You are to complete assignments that are provided to you in a timely manner. Additionally, you are not to use work computers for inappropriate means. While in the workplace and/or representing the agency, all interactions and communications with everyone are to be professional, courteous and cooperative at all times. When performing work assignments and discussing issues with coworkers or supervisors, you must remain unbiased and impartial, and focused on the issues at hand. ‘These corrective actions are effective immediately. THIS IS AN OFFICIAL WRITTEN REPRIMAND. FUTURE VIOLATIONS MAY RESULT IN FURTHER OR MORE SEVERE DISCIPLINARY ACTION UP TO AND INCLUDING DISMISSAL. St Zl, ALS Employee Signature Date ce: Drew Meehan, Human Resource Officer Bureau of Human Resource Management Thomas Klein, Senior Attorney Office of General CounselDEP Employee Handbook: Political Activities Our employees are encouraged to register and vote their preference at election time. This is an exercise of constitutional rights and a responsibility of citizenship. However, any other political activitieson your part may be limited while you are employed with the Department. The Federal Hatch Act and Florida law both provide for such restrictions. ‘You may express political opinions by wearing badges or buttons, displaying posters or bumper stickers in or on your privately-owned vehicle(s), and other means stipulated by the Department of Management Services. When authorized by the Secretary and approved by the Department of Management Services, you may be a candidate for certain elected public offices involving no conflicting or interfering interest with state government. If your position is subject to the Federal Hatch Act as determined by the Department, you may not become a candidate in a partisan election. Approval to be a candidate for local office shall be requested in writing through normal supervisory channels to the Secretary, no later than 45 days prior to the deadline of qualifying for the office. Each request must show the title and summary of the duties for local public office to be sought, the hours of work involved in campaigning for or holding office, what effect, if any, the campaign or office duties may have on your regular duties with the Department, and the amount of remuneration, if any, which will be received if elected. Ifyou qualify for the campaign or hold public office without obtaining prior approval as required, you will be ineligible for continued state employment and shall be deemed to have resigned your job. We recommend that you seek guidance from the Bureau of Personnel Services if you decide to run for public office or participate actively in any political campaign. Failure to comply with rules governing this issue could cause you to forfeit your employment without appeal rights. For more information, consult DEP Directive 490 and Section 110.233, FS. 110.233 Political activities and unlawful acts prohibited. — (1) _ No person shall be appointed to, demoted, or dismissed from any position in the career service, or in any way favored or discriminated against with respect to employment in the career service, because of race, color, national origin, sex, handicap, religious creed. or political opinion or affiliation. (2) No person shall use or promise to use, directly or indirectly, any official authority or influence, whether possessed or anticipated, to secure or attempt to secure for any person an appointment or advantage in appointment to a position in the career service, or an inerease in pay or other advantage in employment in any such position, for the purpose of influencing the vote or political action of any person or for any consideration; however, letters of inquiry, recommendations, and references by public employees or public officials shall not be considered political pressure unless any sueh letter contains a threat, intimidation, or irrclevant, derogatory,or false information. For the purposes of this section, the term “political pressure,” in addition to any appropriate meaning which may be ascribed thereto by lawful authority, includes the use of official authority or influence in any manner prohibited by this chapter. (3) No person shall, directly or indirectly, give, render, pay, offer, solicit, or accept any money, service, or other valuable consideration for or on account of any appointment, proposed appointment, promotion or proposed promotion to, or any advantage in, a position in the career service. The provisions of this subsection do not apply to a private employment agency licensed pursuant to the provisions of ‘chapter 449 when the services of such private employment agency are requested by a state ageney, board, department, or commission and neither the state nor any political subdivision pays the private employment agency for such services. (4) Asan individual, each employee retains all rights and obligations of citizenship provided in the Constitution and laws of the state and the Constitution and laws of the United States. However, no employee in the career service shall: (a) Hold, or be a candidate for, public office while in the employment of the state or take any active part in a political campaign while on duty or within any period of time during which the employee is expected to perform services for which he or she receives compensation from the state. However, when authorized by his or her agency head and approved by the department as involving no interest which conflicts or activity which interferes with his or her state employment, an employee in the career service may be a candidate for or hold local public office. The department shall prepare and make available to all affected personnel who make such request a definite set of rules and procedures consistent with the provisions herein, (b) Use the authority of his or her position to secure support for, or oppose, any candidate, party, or issue in a partisan election or affect the results thereof, (5) No state employee or official shall use any promise of reward or threat of loss to encourage or coerce any employee to support or contribute to any political issue, candidate, ot party. (6) The department shall adopt by rule procedures for Career Service System employees that require disclosure to the agency head of any application for or offer of employment, gift, contractual relationship, or financial interest with any individual, partnership, association, corporation, utility, or other organization, whether public or private, doing business with or subject to regulation by the agency. History.—s. 21, ch. 79-190; s. 2, ch. 80-207; s. 1, ch. 84-125; s. 5, ch. 89-277; s. 1, ch. 91-164; s. 21, ch. 91-431; s. 34, ch. 92-279; s. 55, ch, 92-326; s. 668, ch. 95-147; s. 23, ch. 2001-43. ‘Note.—The provisions comprising chapter 449 were repealed by ch. 81-170. 11.062. Use of state funds for lobbying prohibited; penalty.- (1) No funds, exclusive of salaries, travel expenses, and per diem, appropriated to, or otherwise available for use by, any executive, judicial, or quasi-judicial department shall be used by any state employee or other person for lobbying purposes, which shall include the cost for publication and distribution of each publication used in lobbying; other printing; media: advertising, including production costs; postage; entertainment; and telephone and telegraph. ‘Any state employee of any executive, judicial, or quasi-judicial department who violates the provisions of this section shall have deducted from her or his salary the amount of state moneys, spent in violation of this section. (Q2)a)_A department of the executive branch, a state university, a community college, or a ‘water management district may not use public funds to retain a lobbyist to represent it before thelegislative or executive branch. However, full-time employees of a department of the executive branch, a state university, a community college, or a water management district may register as lobbyists and represent that employer before the legislative or executive branch. Exeept as a full- time employee, a person may not accept any public funds from a department of the executive branch, a state university, a community college, or a water management district for lobbying (b) A department of the executive branch, a state university, a community college, or a water management district that violates this subsection may be prohibited from lobbying the legislative or executive branch for a period not exeeeding 2 years. (©). This subsection shall not be construed to prohibit a department of the executive branch, a state university, a community college, or a Water management district from retaining a lobbyist for purposes of representing the entity before the executive or legislative branch of the Federal Government. Further, any person so retained is not subject to the prohibitions of this subsection. (d) A person who accepts public funds as compensation for lobbying in violation of this subsection may be prohibited from registering to lobby before the legislative or executive branch for a period not exceeding 2 years. (c) A person may file a written complaint with the Commission on Ethics alleging a violation of this subsection. The commission shall investigate and report its finding to the President of the Senate, the Speaker of the House of Representatives, and the Governor and Cabinet. Based upon the report of the Commission on Ethics or upon its own finding that a violation of this subsection has occurred, a house of the Legislature may discipline the violator according to its rules, and the Governor or the Governor and Cabinet, as applicable, may prohibit the violator from lobbying before the executive branch for 2 period not exceeding 2 years after the date of the formal determination of a violation. The Commission on Ethics shall adopt rules necessary to conduct, investigations under this paragraph. History.—s. 2, ch. 74-161; s. 4, ch, 93-1215 . 10, eh, 95-147.Il. IV, Florida Coastal Managers Forum February 27, 2015 1:00 - 3:00 p.m. E.S.T. Douglas Building, Rm 829, Tallahassee Conference # 1-888-670-3525 Participant’s code: 959 355 5203 Meeting Summary (Partial) Welcome Marine Planning on the Outer Continental Shelf Offshore Florida Shana Kinsey, Outer Continental Shelf Program, FL Coastal Office, DEP FWC Integrating Adaptation into Natural Resource Management Whitney Gray, Sea Level Rise Coordinator, FWC Agency Updates: Coastal priorities, challenges, and opportunities FWC ~ Integrating Climate Change Vulnerability Assessments into Adaptation Plans DEO — Community Resiliency Initiative DOT ~ Sea Level Rise Impacts to Transportation CEQ — Draft Guidance on Climate Change Considerations FEMA Floodplain — Climate Change Guidance Vv. Next meetingFrorwa DEPARTMENT OF ENVIRONMENTAL PROTECTION MARJORY STONEMAN DOUGLAS BUILDING 3900 COMMONWEALTH BOULEVARD "TALLAHASSEE, FLORIDA 32399-3000 March 11,2015 Mr. Barton L. Bibler 3673 Mossy Creek Lane Tallahassee, Florida 32311 Dear Mr. Bibler: Based upon Personnel Rules 60L-34 regarding Attendance and Leaving, specifically, 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 conceming 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 II] 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. 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 or email it to me atMr, Barton Bibler March 11, 2015 Page 2 If additional information is needed please contact me at (850) 245-2532. Sincerely, Dem Med Drew Meehan Human Resource Officer DMigba Enclosures: (1) Evaluation Form (2) Position Description # 37001192 c: Mr. Bibler’s PhysicianFlorida Department of Environmental Protection MEDICAL CERTIFICATION Required Signatures: 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 I Division/District: Please Indicate Reason for Leave Request: Employees Serious Health Condition Birth of a Child Placement of a child with you for Adoption or Foster Care Serious Health Condition of your se child parent (ist child’s Date of Birth Military Family Leave (NOTE: Qualifying Exigency Leave requires completion of Form WH-384 and Military Caregiver Leave requires completion of Form WH-385) Authorization to Release Medical Information hereby specifically 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 INFORMATION EXEMPT FROM PUBLIC RECORDS DISCLOSURE, CHAPTER 119, FS (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 Il from requesting or requiring genetic information of an individual or family member of the individual, except as specifically 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, “Genetic information,” as defined by GINA, includes an individual's family medical history, the results of an individual's or family member's 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's 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 10-30-2013) Page 1 of 3MEDICAL CERTIFICATION — BHRM - DEP 54-202 (Effective 10-30-2013) continued Patient's Name: Gf 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 timetrames for 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 office duties? YES [~]NO Additional Comments: If additional treatments will be required for the condition, please provide an estimate of the probable number of such treatments: Ifa regimen of continuing treatment by the patient is required under your supervision, provide a general description of such regimen (c.g., prescription drugs, physical therapy requiring special equipment) If the patient will need care only intermittently or on a part-time basis, please indicate the probable duration of this need: If the condition is @ chronic condition or pregnancy, state whether the patient is presently unable to perform their job duties and the likely duration and frequency of episodes of the patient's inability to perform their jobs: Ifleave is required to care for a family member of the employce with a serious health condition, does the patient require assistance for basic medical or personal needs ot safety, or for transportation? YES NO IFNO, would the employce’s presence, to provide psychological comfort, be beneficial to the patient or assist in the patient’s recovery? YES NO [BHRM - DEP H-f## (Effective MM-DD-YYYY) Page 2 of 3MEDICAL CERTIFICATION ~ BHRM - DEP 54-202 (Effective 10-30-2013) continued understand that this information will be kept confidential and is required by the Department of Environmental Protection’s Burcau of Human Resource Management for determining eligibility under the Family and Medical Leave Act and leave usage. Name of Physician: Be Mailing Address: City: State Zip: Area Code/Phone Number: Signature of Attending Physician Date BHRM - DEP fif.t8¥ (Effective MM-DD-YYYY) Page 3 of 3STATE OF FLORIOA POSIT {OWN DESCRIPTION ETC TT smn TANAGEMT NT SRVICEL] OTHER] POSITION LOCATION INFORMATION Posen FremsiUnd OAS CF YES ote WATE OF AGENCY. Deparment ot Envacrnene rorecton ee pu: or 202 0) 98D cs 05 FO C07 Qos Doe C1 HO eC wOND sor Geoeocn DISIONCOUPATABLE: Fe [enone Site re Soon io [ BUREADICOMPARASLE Caren rosdbend—] Carer Cont eae Oftes of Ervronmental Ses tna ener ‘Government Operations sates Eovautant th TORTS OIT Papers OTS | Posse Car Te TEXSGUARTERSCOUNTY CODE “Fe of Transacion Minor 177 ans 8 apne Tatrassee3? NeaBENT ‘APPROVAL AUTHORITY USE ONLY | PoRTON ATTA or Coe “aiered By | Eas oa 2€0 01 Doz (00 1 ve 71 06 I o7 Coe ee 238 Te ile "APPRL VED BRONDBAND OCCUPATION: aragement Anais Seca Ral: Yee C] NOB = oce-foS ovetie:Yes) Not = worenne - P-j0 PEAS | 1. This postion pons crt to: Poston Neher aZOB107# this postion: ‘Brosdbond Occupaton General ard Operations Mars, Class Code 8841 Clase Tilo Prosram Administrator~ Broachand evel code, dass te, clase code, prion number, and headquarters !ocation of eas Fositon which reports direct; to ‘What staules establish or define the work performed? Chapters 259 and 259, F.S. “This postion has fancial disclosurn rerp +My in gssordance wth Sc: RPRROTE © ASS TALE CGowumment Onrations Consent ye — Broadband Level Code 11-1021.08 =~ cr 423145, FS: Yes) Nob ‘Carrant buat Yor which Ths poslion fs cocountsble(Wapplinby NA Sne e 6: os Bares FEO Dats Prosens te the current budget incudes other areas of accountabity include hem in the TOTA! ALLOTMENT snd provide a brief exptenation, TOTAL ALLOTNENT age 1 0F2 ws 3725/08POSITION NUNBLR: 37001102 Datos and Rosmspabilis - Doscbordeial he sods dts and responsive aesgned Gis poalon and te poranaae tra for eat indeat rer. of hs postion n acrorhing te unt and agency mission. If appteaDo, include example of Independent inal oly decions made so show her alec on the agency the Pub. or other tne agencion. seed Dues and Responstltis Time | "15" | Coordinates all aspects of tie Board of Trees land management plan progrm and the evalvation program | for use of eons2ration lands, inluding evaluating environmen’ values. pronosed public uses, public comments aud recommendstions (especialy those of advisory groups and review teams), and compliance with rule statutes, andthe purposes for which the property was aoquired. Works to inererts compliance among lessees of conservation lands, and prosent all program information to the Acquisition and Restoration Council. as required \ 10 | Coordinates and works towards consensus wth division staff. ther slate and local agencies and stakeboders in | © | aang and peeing pole akiakingeeommendatos, Develops and proves eps as nde 5 | Coordinates research and analysis of original project boundaries, conservation objectives, and project | Ssstion repos fo existing state-owned Inds to determine if any an be recommended for supusing. 5. | Reviews, analyzes and ensures appropriate content of each land management prospectus provided as part of the Project Hvaluation Report as required ins. 259.032, FS. 5-_| Performns other related duties. 7. Knowledge, skils and ables, including utlzation of equipment, required fr the postion: Knowledge of basic managoment principles and precioes. Knowsed0 of the methods of data collection and analysis. Abiy to manage a consultative program Sesgned to ensure the resolition of managerial ard operational problers. Abily to determine work priors, assign work and fenaute proper completion of work assignments. Aaity to communicate effactwely. Abily to estab ané maintain effective \woikng relationships with others. Abily to assess budgetary needs. Ability to formulate policies and procedures, AbIiy to Understand ond apply appicatle rules, egulatons, coicies and procedures relating to operational end management analysis ‘elves. Abit io organiza dat ino logical forma for presentation in reporie, documents and other materials. Abit to coach ‘evaluate and analyze dota to develop alternative recommendations, solve problems. document work and other activi relating to {he improvement of operalonal and manegemient pracicas. Abily io conduct fact-finding research. Abiy to work independent Abit to solve problems and make decisions. Abily to maintain a valid driver's conse. Ability to demonstrate tearm, Abiy to oxarcige common sence. 8. _Licensuretegisrationfcetfication requirements (Wf eppscabe, list the appropiate Florida Statute or federal rogutation ete): Vaid Drivers License Other job-elated requirements for this postion: Incumbent hs vender InvlcaWatrant Processing reap.nsiby ane subject tothe ‘proidons of Scion 215-422, FS. 10. Werkng hours: (A) Dally ‘rom 8:00 a.m. to 5:00 pm. (B) Total hours in workwoek 40 (C) Explain any valalion in work (spl shi, rotation, te) Flexime alowed, TH. Agency Use Only — ‘hose et aooly Uniform Alewence [] CPC] Bond ixicatorL} Ory Screning 1) Re-sereening (J Secu Check No secuy saree equred-] Sockyoundiwestzaton rea [1 Background & Sort requred Frgerpt Evexigoton regard L] Accesso abuverecos [1 CoreiterL) Fanci (Law enresmert} Managenent Serle] Agonoy soos check C) OMe: Vendor invoice, Chapter 215.422 FS. ‘The following have scknowledged that the slaiements above, o the best of thelr knowledge, accuratoly Geacribe the Gues and resaonsibiltes ofthe position. ada — Discussed with employee: Yes(] Nol] Tithe: Date: See sped eng — =. eer " Elia ea (oxemara 3g ol aitteneucns ve os Woe Of F225 _ |F/ Ww Page 2of 2 Ons 3/29/04