The name of this presentation is A Culture of Safety. In addition, we'll be talking about physical examination in regards to a post-offer, not a pre-employment physical exam. I'm Dr. Keri Roop, I'm a clinical professor at the University of Iowa College of Nursing. My background has been in occupational health for the past 30 years. I was the nursing director of the Heartland ERC MSN program through the College of Nursing in conjunction with the College of Public Health. I have worked in both employee health within a hospital setting and in occupational health for businesses and industry across southern Iowa. I feel pretty prepared to do this lecture in that I have done physical examinations for many years and I think I can give you some best practice. I have nothing to disclose, I have no potential conflicts of interest with this presentation and I look forward to getting any feedback that you might have regarding it. The objectives of this presentation include describing the characteristics of a culture of safety, explaining the importance of post-offer physical assessments and evaluations that are based on job functions, list recommended evaluations that may be included in a comprehensive post-offer physical assessment based on the job described, highlight the rules and regulations that are relevant to post-offer physical examinations within a culture of safety and health, discuss the documentation requirements associated with a post-offer physical examination including what information may and may not be released to the employer without a written release. First of all, we'll talk about the culture of work. The first thing you have to realize when you're working in occupational health is that work has value. Work is important to human beings. We have a belief that it is an important part of who we are. Our identity is often related to our work or what we do for a living. In addition, many of our social relationships often relate around our workplace and those interactions are important in keeping us healthy and well balanced. It is meaningful for people to work. It has meaning to the person and it has meaning to society. It also is valued by the person and society. We have to feel like what we do matters and that what we do matters enough to give us compensation or to give us the type of lifestyle that we'd like to aspire to, that we take care of ourselves, that we take care of our families. A lack of work is often related to a decrease in self-worth. It's not uncommon for people who lose their job or lose their ability to work to have difficulties coming to grips with the idea that they are valuable as a human and not just as a working human. Every person should be able to work at the workplace and expect to return safely home every single day. This is the basic premise for occupational health. People go to work, they do their jobs, they get in the car and they come home safely every day and we must do everything we can to ensure that. The culture of safety is based on an expectation in the workplace from the bottom up to the top down and no one can be exempted, not the CEO, not the board of directors, not the maintenance man. Anyone needs to be involved in a safe culture. Responsibility for safety is written into every single job description. It's written into every part of what the work does, the mission statement, the vision statement should all involve the safety of the workplace. Failure to incorporate safety into a normal job tasks cannot be tolerated. If someone is not wearing their hearing protection, is not wearing their safety glasses, isn't wearing gloves, then it's our responsibility within the workplace to be sure that we bring that to someone's attention, that we actually intervene immediately. If we don't, then someone definitely can be at risk and in the end, someone will be harmed. It may not be this time, it may not be 10 times from now, but eventually the possibility for being harmed exists. After each accident or injury, we must examine the causation of that accident or injury. Now it could be an accident, oops, didn't mean to, my left foot was in front of my right foot, didn't mean to do it, but we need to evaluate whether that's happened more than once. Is it possible that that could happen a million times? Is it possible that somebody could hit their head on a piece of machinery when they fell? All of those things need to be assessed incrementally and improvement should be mandated. Something needs to have happened as a result of this accident or potential accident. It's each and every person's responsibility. We are responsible for everyone in the workplace. We are responsible for the safety of ourselves, we're responsible for the safety of everyone else and if we believe that and internalize that, we will develop a culture of safety. Along with the culture of safety is putting the right worker in the right job and that's the purpose of our employment examination. It's not just to say is everybody okay, it's to say is this person capable of doing the work that we need them to do. So what's the big deal? What's the difference between a pre-employment or post-offer examination? Well a pre-employment examination, you don't know what the person is going to be doing. They're just going to be doing something in the company. Could be maintenance, could be production, could be CEO, we're not sure. We just want to know can they do it? Well we don't have a job description so we don't know what the essential functions of that job will entail. We just know they'll be doing something. We're unable to assess an ability to perform a job task that's based on any form of evidence. They just look healthy enough to me. This goes against what we know about the Americans with Disabilities Act, Equal Employment Opportunity Commission and it goes against everything we know about safety in the work environment. We want to put the right people in the right job so they don't get hurt. If people are not capable of lifting 40 pound boxes then they shouldn't be placed in the position to begin with or they may get hurt and the answer is more likely to be hurt. So if we have a post-office examination, we have a job description, we know what they're going to be doing. They're going to be working production. It's detailed. The essential functions of the job is outlined. It includes all the needed requirements to perform the job. Some examples include lifting 25 pounds from the waist to the shoulders frequently, engage in phone usage for prolonged periods of time. They need to be able to squat to the ground and stand up 10 times every hour. They need to be able to work in a cold environment, zero degrees, for two hours at a time. These are very precise functions and this will allow us then as a health care provider to make an assessment of whether this person in front of us that we're doing an employment examination on is capable of performing the job. In addition, we can validate with the employee that they can perform those jobs, that they want to perform that job, that they're being hired for the job as they understand it and that's important. So what is it that must be done in this job? What is the reason the job exists? That's what the job description tells us. We just don't interchange people from one thing to the other. We want them to fit the work that they're expected to do. I made up the idea of a box mover. So that's my job. I'm a box mover. I have to move boxes from point A to point B. That's what they hired me to do. What the job description should tell the employee as well as the health care provider are things like what's in the boxes, what's the weight of the boxes, what's the size of the boxes, are there variability between boxes. Do some boxes very heavy, very small or some boxes very big and very light? Do I have to lift them from the floor to the table, from the floor to over my shoulders? That's a very different expectation. How often do those boxes need to be moved? Do I have to move one every minute or just once every hour? Do I do it all by myself, my hands, my arms, my legs, my feet? Or can I rely on co-workers to help me with that? Can I use a dolly? Can I use lift helpers? How long at a time? Do I do it for two hours to four hours a day? Do I do it for an hour and then go do something else? Do I need to be able to see the boxes? Do I need to be able to hear them? Do I need to be able to talk to my co-worker who's across the line from me? Do I need to be able to speak? Are there prolonged shifts? Do I have to work nights? Do I work evenings? Do I work days alternating with nights? Do I work 12-hour shifts? Do I work four-hour shifts? It makes a big difference in the requirements, the physical requirements of that job. The more information the employer gives to the health care provider, the better the job can fit the employee and the employee can fit the job. The mistakes that are made putting people in jobs that they're not capable of performing or that they get hurt in is preventable at times. If we can foresee what the job requires and foresee problems that the person already has, perhaps we can prevent injury. I've given you three websites here for the Bureau of Labor Statistics at .gov that will actually tell you a little bit more about job descriptions. We'll go through each of them, but I want you to feel free to get in there and explore the information that's available on these websites. Each of these websites will describe what frequently is, what moderate or heavy labor is. They have job descriptions available for you. There are different types of jobs listed, and we'll go through each of them. This is the first link that I mentioned in the last slide. This will outline for you what a sedentary job would amount to, what light work would be, what does a very heavy job entail. A heavy job could be considered lifting 25 pounds constantly, or it could be lifting 50 pounds frequently, or 100 pounds occasionally. All of those could be considered heavy work. You have to consider things like standing. Anything that's less than a pound, is that really lifting? Sedentary lifting for more than a third of the workday kind of tells you exactly how that measures up, if you will, from a medium job to a heavy work job. There are lots of places in this website that will tell you how to perceive a heavy job versus light work. It's most important, however, to get that information from the employer themselves, or if you can, to actually visualize the job yourself so that you know what the jobs are like, so that you know what the space requirement is, so that you can actually help the employee get a feeling for what the work requirements are going to be, and are they able then legitimately to do the work without getting hurt. That is our ultimate goal. The next link will tell you about some of the requirements of an Occupational Requirements Survey. In other words, is the job physically demanding? Do they sit, stand, climb, reach, keyboard, lift, carry, or is it cognitively demanding? Do they have to have a lot of people skills? Do they work at a fast pace? Do they have a lot of problems that they have to solve? Then do they have to control over their workload? That makes a big difference when you're looking at the worker and the fit to the job. Does the worker have the education, training, and experience to do the job? And then the environmental conditions cannot be ignored. Is there extreme heat? Do they work outside on a construction crew in the middle of summer all day long? Or do they have a heavy vibration, such as a drill? Are they exposed to hazardous contaminants, heavy noise? Are they in a wet environment, a humid environment, a foggy environment, or a cold environment? Makes a big difference. The last link that I gave you will actually show you what the occupational requirements of certain jobs based on the Survey Occupational Requirements Survey that has been done, such as janitors, or computer system analysis, or software developers, or lawyers, or construction laborers. All of these are available on the BLS link. And I think it's important that you spend some time looking through it. You're not out there trying to judge on your own. You can use the resources that are readily available to you anytime, anywhere. And I would spend some time going over it if you're new to this type of work or to this type of physical exam. One of the things you have to be aware of are the rules and regulations and other stuff that make doing post-office employment physicals important. We want people to be able to work if they're capable of performing the essential functions of the job. That's the basic premise with the Americans with Disabilities Act, that anybody can do a job if we know what the essential functions of the job are, and we can fit the person with a disability into the job. Now, that doesn't mean we have to remake the work site or redesign, but we have to rethink. We have to get rid of our biases and start thinking about how people can work. As I said, it's important for people to work, so it's critical that we find ways for people who are able to work to find a way to get into the workplace to work or to perform the essential functions of the job that are truly essential and not just the periphery of the job. Equal Employment Opportunity Commission also is very important in that they actually keep an eye on things that allow all of us to do the type of work that we're capable of doing. That includes women, that include different genders, different race, different types of workplaces that some of us are not typically used to, and I think this is an important concept. I'm a nurse, a nurse practitioner, and I think it's important that we open up nursing to anybody who is capable of performing the work, be they nontraditional students, be nontraditional types of nursing. I think we've got to open it up to nurses at large, and we do that by outlining the job and then making sure people can do that job. The Bureau of Labor, as I mentioned, gives a lot of guidance as far as rules and regulations and types of things that we need to be thinking about when we're doing pre-employment physicals or working with people at the work site. Center for Disease Control has been critical in the pandemic era and will be in the future as well, as far as giving guidance as to what workplaces need to be aware of. The Department of Homeland Security can also be important when we're working with populations that are migrant or mobile workforces. I think it's important that we keep in mind that we have a broad workforce, a broad perspective, and there are rules and regulations accordingly. We also work with the Department of Health and Human Services to get people to work, back to work, into the workplace, and that is an important concept. It's very difficult to get a job if you're homeless. It's very difficult to maintain work if you're not mobile, so we really need to look at the full scope of access to jobs, the full scope of getting people into the workplace from all of these different regulatory and rule-setting organizations. It is most important that we define the essential functions of every job. What is this job supposed to do? Yeah, we're supposed to take out the trash and mop the floor, but is that why this job was created? Is my box mover job the best job to be mopping the floor and taking the trash out? If that's not the essential function of the job, then how can we make the essential functions of the job known and critical to the worker? And those are the things that the employer and the medical providers can help discuss, talk through, work through. We need also to take out all the discriminatory language and practices from the job descriptions. Is it really necessary for a, you know, a fullback to be the one lifting a 20-pound box, or can anybody who's capable of lifting 20 pounds do that job? Do we really need the person on the maintenance force to be mopping the floor when we have the automated cleaners? What else can we do to make the job safer, easier, less burdensome for the worker? And then we must remember not to let personal issues get in the way of good employment practices. When you go back to the safety of culture, it's critical that every time you see somebody without earplugs, you you mention it. You write them up if you have to. You make sure everybody is wearing their safety glasses, and if they're not, you make sure they know that that's not acceptable and that is an expectation. That includes the president, that includes the maintenance workers, that includes the people who are working on the heating and air conditioning system. It is absolutely critical that everybody perform safely, and if they don't, somebody needs to call them out. Oftentimes, personnel issues get involved in safety issues, and that's just not acceptable. If it's a personnel issue, if this person isn't following the rules, then that needs to be dealt with from a human resource perspective. If we don't like George, the reason to get rid of him isn't because he's not wearing his hearing protection. We have to separate those issues out and make them very clean so that we're not unintentionally biasing against people in the workforce or we're not intentionally, you know, we all like Joe, so we'll put up with whatever Joe puts out. That's not acceptable either. There are certain elements of the post-offer assessment that we have to be aware of. As part of the Americans with Disabilities Act and as part of bad faith practice in the past, we are not allowed to collect any genetic information. That means that family history questions need to be avoided. We need to ask the same questions of all employees without bias. We need to be aware of any previous health issues. We need to be aware of any medication usage. We need to have the job description, and we need to review it with the client, and that is critical. There should be no surprises here. When he gets to the post-offer employment physical, it shouldn't be a surprise that he's going to be working in the freezer. We have to be aware of whether this is a safety sensitive position. It may be production, but if he's part of the EMS response team, that also has to be taken into consideration. Are there any current health issues? Is he having difficulty with dizziness, lightheadedness? Is he being evaluated for blood pressure issues? We cannot ask about possible genetically linked issues, and we shouldn't. We can ask about all medications, including anything over-the- counter, and any possible side effects that may be occurring as a part of that usage. I have people that tell me Tylenol makes me sleepy, and there are other people that can take a boatload of it and not have any side effects, but it's important that you ask. And then standard assessment scales like a sleepiness assessment or a vision screening, height, weight, BMI, pulse, blood pressure, respirations, all of those are standard screening procedures. However, you need to use them consistently. You don't pick on a group of people or a certain person unless you're suspicious, unless there is a reason to assess that. If a person falls asleep in your waiting room while waiting to come back into the exam room or falls asleep in the exam room while waiting for you to come in, that would be a key for me to say you seem more sleepy than normal. I'm going to give you this scale, and then we're going to assess whether there's an issue with your sleepiness. I do a complete review of systems with each client that comes through the door. A review of systems is subjective information from head to toe, system by system, asking people directly about any problems with XYZ. I think this is much more effective than just saying or just filling out a form with all the, you know, have you ever had this, have you ever had that. A lot of people don't understand the terminology with a lot of those forms. It may expedite your process, but you may actually miss some important pieces because of a lack of understanding on the client's part. We have to remember that people don't read as well as we like to think they do, and some people don't read at all. So it's important that we go over item by item past history with the client so that we can identify potential problems before we get to the physical examination. So I go system by system. I start with the skin. Do you have a history of any dermatitis, dermatosis, eczema, which is a rash, hives, allergic responses, itches, anything like that. Responses that are uncharacteristic can be problematic. I'm allergic to, you know, tomatoes or whatever. That's something that you may want to know, may not need to know, but but certainly you want to go through that with the client. Any vision problems, do they wear contacts, wear glasses, do they have a history of eye injuries. These are important when you're talking about their visual acuity as well as their potential for problems down the road. Their hearing, do they use hearing aids, do they have any difficulty hearing, were there any injuries to their ears, have they had a history of repeated infections where they've had tubes put in their ears, do they have exposure to loud noises, do they use hearing protection when they're operating their hobbies such as race cars or shooting. All of those things need to be addressed and certainly a hearing test may be appropriate as part of the job requirement. You also want to ask do they get dizzy, do they get lightheaded, do they have any problems with height, do they have any problems being on ladders. That can be a potential problem if the requirement is that they're on a ladder most of the day. A history of Meniere's disease, I always ask specifically most people who have Meniere's disease have been told that, but any abnormality regarding dizziness, lightheadedness, those kinds of things should be noted. Nose and throat issues, history of nose bleeds, problems breathing out of one side of their nose, any sore throats, difficulty swallowing, any problems chewing, swallowing, grinding their teeth, broken teeth, any tobacco or other substance abuse or abuse such as cocaine or snuff. All of those things need to be addressed. A, from a preventive perspective, you know, advise against the use of tobacco, advise against the use of cocaine. Prevention is part of our job and I think that's essential. Let them know that they're increased risk as related to their tobacco to grade it to their use or substance. Additionally, when you're thinking about throat irritation, voice clarity, some people have abnormalities of speech. They have polyps on their vocal cords that make their speech sound gruff or rough. I always note that because if they're in an irritation environment, a smoky environment or a dusty environment, that can actually get worse and you want to make sure that you note it up front. Any problems with their neck, history of neck injuries, surgeries, swelling in the neck, pain in the neck, any difficulty with range of motion of their neck. All of that should be just, you know, do you have any problems, have you had any problems, that kind of thing. Chest, do they have difficulty breathing, any history of asthma, smoking, smoking tobacco and smoking other products, coughing, coughing up blood, any respirator use in the history, mask problems, inhaler use, including for asthma or over-the-counter primatine, and vaping, as well as any pain in the chest, which I think is critical, and then pain in the chest with activity. While at rest, they wake up at night with their heart pounding, do they wake up in the middle of night gasping for air, have they had any surgeries. All of those things can clue you into what may be going on from a bigger perspective, from a bigger picture. And then of course, have you ever had a heart attack, any heart surgeries. I think it's important to ask specifically, have you had any heart procedures, because a lot of patients will tell you, I've never had surgery, I've never had heart surgery, don't have any heart problems, but I've had stents put in, because they just don't consider that to be the type of, you know, heart surgery that they've had in the past. And they would tell you, I don't have cardiovascular disease, I had a stent. Heart murmurs, if they were diagnosed with heart murmurs as a child, any palpitations, do they wake up with their heart pounding, do they have rib pain, any history of rib fractures, all of that should be noted. And of course, back pain, any history of injuries, any problems with their back, have they ever been down quote-unquote with their back. A lot of people have had back spasms and spent a couple of days on the floor, but it healed, they didn't have any problems with it after that. Do they have any difficulty bending over, standing, twisting, standing on a ladder, standing on a stepstool, do they have any restrictions from a provider previously for lifting, pushing, pulling, have they had any surgical interventions. All of those things can lead you down the road of we need to do a better, a really good assessment of back. As well as abdominal surgeries, hernias, have they had any bowel or bladder difficulties in the past. And then extremities, do you have any problems with your joints, do you have any problems with your hands, your fingers, your elbows, your feet, your knees, your hips, do you have any problems squatting, standing, bending, walking up a ladder, walking downstairs, all of that is critical when you're looking at joint health and joint expectation. Can you grip with both hands, can you hold on to a steering wheel without difficulty, can you turn the steering wheel on the steering column without difficulty, do they have any problems making a fist or opening in their hands completely. Those are, sometimes you get some interesting answers when you ask them if they can close and extend their hand. Neurologically, you want to make sure that they have no history of major head injury, surgery, concussions, seizures, loss of consciousness or lack of awareness for any length of time, do they have any coordination issues, have they ever been forbidden from driving for any reason, do they have any weakness in their legs or their feet or their hands for any reason at all. And then any other issues, I always like to end with, is there anything else you want to tell me, anything else that I need to know before I do your physical exam about your health. Are you sleeping okay, do you fall asleep easily when you're watching television, do you feel depressed, are you colorblind, you know things like that are really, it's the opportunity for the person to tell you their story, you've asked them everything you want to know, but it's also important that they have an opportunity to tell you their story, you know they may have, this may be the most important job they've ever had in their life or this may not be something they want to do but they were talked into it or they were, you know, whatever and that may be a red flag for you, that may be something that you want to really think about when you're talking with them about their mental ability or their emotional stability to do the job. And then remember, anticipatory guidance is part of what we do and I think it's one of the most important things we do. If someone is 50, has a BMI of 50 or better, it's not okay not to mention that. Their weight is putting them at risk and it certainly is going to put them at risk in the job, so I don't, you know, you don't necessarily browbeat them over their weight but you do make it known that it's going to be very difficult to lift when your BMI is 50, it's going to be very difficult on your knees to stand all day and I want to make sure that if there's anything I can do to help with that or we can get you some help with that, that would be great. Clarify with the employee all the positive responses that you have. So you told me that you have trouble hearing but you wear hearing aid, you wear hearing protection at home when you're using your drill or your saw. You told me that you've had heart surgery before and you followed that up and haven't had any problems since then and currently you have no restrictions as a result of that surgery and that surgery was approximately five years ago. You're following up with your cardiologist now and he has no concerns about you returning to a different job or going back to work. You understand the job description. So all of that you've gone over with the client. Everything's above board. There's no pulling punches here. You're basically just honest, upfront, straightforward, so that we all know where we stand. Now we're ready for the physical examination. As you probably noted, it takes longer to do a review of systems appropriately, adequately, than it is to do the physical exam and that's the way it should be. Ninety percent of your time should be spent talking to the patient, exploring problems, possibilities, and then the rest of the time should be spent doing an overview of their physical health and I think you have less oopses in that type of an exam. Again, as I'm going through the head-to-toe exam, I'm also reiterating what they've told me. So I always do a physical exam with skin exposed so that I can see scars and possible skin problems. I review all systems and functions and observe gait, coordination, flexibility, their ability to follow instructions, their ease of movement. It's very important that I observe normal activity. If they're short with me, if they're irritated, if they're in a hurry, if they're, you know, yelling at the front desk people, all of this makes a difference in my assessment of their mental health and their emotional stability. I check all joints. I look at all muscle groups for comparison, left compared to right. I look for strength, flexion, extension, rotation, abduction, adduction of all the joints and I note any incongruencies. So if the right hand is very weak and the left hand is very strong, I want to know why. What happened to the right hand that didn't happen to the left hand? And of course you do a hernia examination. I note any abnormalities. I discuss all the findings of both the physical examination and the previous review of systems again with the client and I discuss any concerns that I have regarding the variation of job description and his ability or her ability to perform that job based on data. If there's a concern that there's an ability to meet an essential function of the job, I need to address this with the client specifically. I am concerned that you will not be able to squat and stand for eight hours a day with this job. Are you concerned? Is this a concern that you would have? Well they tell me I won't need to do that. The job description says you have to be able to do that. If you're not able to do that, I need to be sure that I write that into the examination results. Anytime there is an inability to perform the following function, I need to be very specific. So if the job description says he's supposed to work above the ground on a platform, I'm going to have to limit that due to his dizziness. He's unable to climb ladders due to dizziness. Be very very specific about the duties that would be potentially dangerous. One of the things that I'm often asked is what can you give the employer? The employer wants everything back. They want the physical form, they want the pulmonary function test, they want everything. The information that is obtained during a physical examination belongs to the clinic and to the employee. The employer is entitled to a medical opinion about the client's ability to perform the essential functions of the job. That is what the employer can require. The employer can ask the employee for a copy of that physical examination and if the employee has decided to release that information, they can sign a release to release the physical exam to the employer. Again, the physical exam is kept by the provider. It can be released to the employer if the employee signs a release of information for that information and that information should be specific. I release the information for the physical exam done on such-and-such a date by such-and-such a dot and I think that's important. Anything else could be considered a HIPAA violation so you must be very very clear about what you're releasing to the employer if the employee allows you to do that. I am NOT a big fan of having employees sign a release when they come in and I'm NOT a fan of releasing everything to everybody so I think you have to be very conscientious about HIPAA and you have to be very conscientious with the employee about what he is releasing. There is a health history part of that physical exam that the employer does have access to so if the person is on you know antidepressant medication, the employer certainly can look at that. They're not supposed to and are supposed to be kept in in human resources in a locked area however I just like to make sure the employee knows what they're releasing to the employer. Again don't don't routinely give physical examinations to employers unless the employee finds a release and they understand what they're signing and when you're restricting any parts of a person's job you need to be very specific about what those restrictions are with the employee and I go through it very clearly. I'm putting here that you have a 20 pound weight restriction as far as lifting from the ground to your waist or above your head. This was from your previous back surgeon and he felt those were permanent restrictions therefore we'll continue with those restrictions and the employee should have a very clear idea that that is what is being restricted. Misunderstandings I didn't hear you say that I didn't think you said that can all be avoided by giving it to him in writing allowing them to read it and then sign it and I think that's the safest and best proposition from the perspective of an employee health provider. There are many types of physical exams that are much more complex than just deciding whether someone can move a box from point A to point B. There are positions that require personal safety concern or a public safety concern and I think it's very important that everyone be aware of the public safety and personal safety concerns when they're doing an exam for a job. There are lots of specific tests and requirements that different organizations have that we may be involved in. Some specific ones that I see quite regularly are the OSHA rules for personal protective equipment. Can this employee use a respirator? Is this person capable of performing his job with personal protective equipment in place? Federal Motor Safety Carrier Federal Motor Carrier Safety Act is the DOT physical exams for drivers, semi drivers, transporting goods across the country. These are done regularly in my office and it's very important that we are aware of what the requirements of the job are for those people who drive semis. Semis are huge, they drive a long time, they drive lots of hours, they carry big loads and as a result it's a public safety concern if there's an issue related to their ability to drive. Now on the other hand to perform these physicals I need to be certified and registered with the Federal Motor Carrier Safety Administration and I needed to take a training course and pass a test to be able to do these examinations and that's important because it allows me the opportunity to stay current, to stay pertinent in this type of examination and to make sure I understand the requirements of the job. There's also several other types of examinations that require certification or registration. Federal Aviation Administration for Pilot Safety, Federal Railroad Administration for Engineers, Vision Requirements and Hearing Requirements, the Federal Transit Administration, International Hazardous Materials Management, the National Highway Traffic Safety Administration, Pipeline and Hazardous Materials Safety Administration, the OSHA rules that I mentioned, the National Air and Space Administration, NASA, the National Oceanic and Atmospheric Association, scuba divers, people who work in very hazardous types of work environments, but also there's training requirements for respirator assessment, for hearing protection, for infectious material handling. So all of those things require updates and ongoing certifications for the health care provider to be competent to provide these examinations and whatever the follow-up that would be required with these physical examinations. Anytime that you are doing a physical examination and the job description requires abnormal evaluation such as hearing protection, a respirator usage, certification of some sort, it's your responsibility to find out exactly what those requirements are and if you're competent and qualified to perform those physical exams and what you need to do to become competent to perform those physical exams. Each one is different, each one has a different requirement, each one has a recertification requirement or an evaluation process, but they're all important from a public safety or personal safety concern. So other types of examinations include semi-drivers through the Federal Motors Carrier Safety Act for the Department of Transportation. You need to be a certified medical examiner to perform these physical examinations. That involves taking a course and then taking a test and then recertifying regularly to keep up to date on the examinations. There's also reporting requirements to the DOT. All of those are part of the certification course and the reason that's important is because these people drive very big trucks and very busy highways and they can cause a great deal of damage and death to the public if there's an accident. So it's important that we try to assess their ability to stay healthy and be healthy. Pilots, of course, you need to be a federal aviation medical examiner for that and all the information about that is available online. It's important that if you're seeing that population that you get as much information, as much education as you can about their work environment, their stress levels, their requirements, and their potential for having sudden difficulty. Also with railroad engineers, things like vision, hearing, those are tested regularly. Transit authority workers and hazardous material handlers have a whole different set of criteria and all of those can be accessed through the governmental agencies overseeing them. It's important to be aware of those types of evaluations when you're performing physical examinations for employers. These are not your typical run-of-the-mill head-to-toe assessments. Typically there are specific testing that needs to be done, specific evaluations that need to be performed, and a certification or evaluation that you'll need to complete to perform these testing procedures. Most of these require additional training, certification, specific skills or a specific skill set that you'll need to be evaluated on, and they're easily accessible if you're performing those kinds of physical exams. In addition, the medical examination criteria and the rules and regs you need to be very familiar with. The FMSCADOT physical exam is one of those examinations that are commonly done in workers clinics, and you need to be very aware of what the work of a semi driver is, what you're certifying them to be capable of doing. They need to be able to climb on the rig, they need to be get into the semi, they need to be get out of the semi, they need to be able to get under the rig and check the fasteners and cinches and the load, make sure the load doesn't shift. All of that is a requirement of the DOT driver. However, it may not be part of their quote-unquote job description for a specific employer. If you are certifying somebody as a DOT driver, then you basically are saying that they are able to meet all the standards as they are outlined by the Federal Motor Carrier Safety Administration. If they are not capable of fulfilling those standards, then they're disqualified. They're not allowed to just do X or just do Y. There is no modifications in the job of truck driver for the FMSCA. So if you're doing an FMSCA physical exam, they are required to do all the essential functions that are listed in that certification, and if they're not able to do that, then they're not certifiable. And that's an important concept for you to be aware of. A lot of drivers will tell you, I don't do anything but drive from the gate to the parking lot and back. That's not what a DOT physical requires. And if they need to be certified, and they may not need to be, but if they do need to be certified for an FMSCA certification, then they must meet all of the requirements as outlined in the criteria. I have listed my resources here. I would strongly encourage you to take every opportunity to read as much as you can on each of the types of physical exams you perform, and stay up to date. Things change daily, weekly, monthly, and it's important that we stay up to date on the current information on the types of jobs and the workforces that we work with. I'd like to thank each of you for listening to this presentation. If you have any questions, don't hesitate to email me. My email address is there, and I will get back to you as soon as possible. My goal today was to begin the process for you as a novice. I realize some of you have been doing physical exams for a lot longer than I have, but keep in mind each area requires their own specific needs, and it's important that you identify the needs of your populations and become aware of what their concerns are. The easiest way to do this is to meet with the employers in your area. The job sites often are willing and able to allow you to look at the job and the jobs you're evaluating for, and they can give you input into specific concerns that they have. I'd like to thank you all, and good luck to all of you.

culture of safety

workplace

post-offer physical assessments

job-specific physical examinations

job functions

safety in the workplace

Americans with Disabilities Act

Equal Employment Opportunity Commission