Employee physical examination

Physical examinations, employee training and educational programs, medical protection, and record keeping, among others, are required. The regional OSHA office should be consulted for the latest rules and regulations. 

Pre-employment instruction and pre-employment physical examinations are of critical importance in most work situations involving hazardous chemicals. The former should make clear the hazards involved, the need to avoid exposure under normal working conditions, and the mechanisms by which exposure is limited. Furthermore employees should understand how and when to contain spills and how and when to evacuate the area around the spill. Locations and use of emergency equipment, showers, eye washes, and so on, should also be given, and the most important procedures should be posted in the work area. 

Medical surveillance—A general physical examination, with specific attention to detecting enlargement of the liver, spleen, or kidneys, must be provided to employees without cost every 6 mo when the employee has been employed in VCM of PVC manufacture for 10 yr or longer, and annually for all other employees. 

The Americans with Disabilities Act permits an employer to require prospective employees to take a genetic test as a condition of employment, just as they permit requiring a physical examination for certain jobs. Present laws do not prevent private insurance companies from denying insurance, or setting high premiums on the basis of genetic information, but 47 states offer some degree of protection from insurance discrimination. 

Reproductive Effects. Another clinical study, this one designed to assess reproductive function, involved a fumigant, 1, 2-dibromo-3 chloropropane (DBCP). In 1977, Whorton and Milby investigated the testicular function of 145 employees of a plant which formulated DBCP. They used a questionnaire, physical examination which focused on the reproductive system, sperm counts and blood tests to determine the level of the hormones that stimulate and maintain sperm production. 

A large facility usually has an infirmary with medical staff for treating injuries and performing physical examinations at the beginning and end of employment, and at regular intervals. The type and frequency of routine physicals may depend on the probability of adverse effects associated with the work environment. Employee medical records should be maintained to track the occurrence or absence of health effects due to the work environment. 

Section 4.6 consolidates the requirements for medical support for chemical emergencies. It includes requirements for medical plarming and treatment for mass casualty situations immediate medical consultation and surveillance baseline physical examinations for hazardous materials response team members and hazardous materials specialists specifications for the treatment of emergency response employees and other detailed requirements for emergency response personnel and other employee medical programs and records. 

The settlement houses developed and became models that inspired some companies to initiate some occupational health and safety activities. In 1907, a group of cotton mills in the South employed trained nurses to attend persons who were sick in the mill community (to get them well as quickly as possible). At the New York Telephone Company, there was a retiring-room for operators who felt indisposed. The National Cash Register Company began giving physical examinations to applicants for work as early as 1901. Examinations were introduced at Sears, Roebuck, and Company in Chicago in 1909. By 1914, physical examinations of employees were a fixture in many large companies. 

Additionally, under Title I, Section 102(c)(2), safety professionals should be aware that conducting preemployment physical examinations of applicants and asking prospective employees if they are qualified individuals with disabilities is prohibited. Employers are further prohibited from inquiring as to the nature or severity of the disability, even if the disability is visible or obvious. Safety and loss prevention professionals should be aware that individuals may ask whether any candidates for transfer or promotion who have a known disability can perform the required tasks of the new position if the tasks are job related and consistent with business necessity. An employer is also permitted to inquire about the applicant s ability to perform the essential job functions prior to employment. The employer should use the written job description as evidence of the essential functions of the position. ... 

It is recommended, as a minimum, that permanent employees working with mercury or mercury compounds be provided with periodic physical examinations with a test protocol selected specifically for mercury poisoning. Women who may be pregnant should be especially careful and encouraged to participate in the medical surveillance program if they cannot avoid exposure entirely. 

Where the physical examination reveals a medical condition which may be job related or is aggravated by the duties of the person s job or the environment in which the individual works, steps should be taken to protect the employee s health. One of the first things to consider is to confirm that the condition exists or to obtain additional data to better understand the problem by seeking additional tests, obtaining a second opinion, or referring the patient to a specialist. These options should be discussed with the patient. In some cases, the situation is sufficiently straightforward so that these follow-up steps would not be necessary. 

Physical deficiencies Poor eyesight, defective hearing, heart trouble, hernia, etc. Preplacement physical examination periodic physical examination proper placement of employees identification of workers with temporary bodily defects... 

Because most healthcare workers wear the very light disposable half-mask respirator, recommend that a health questionnaire be the initial step in the evaluation process. Refer to OSHA 29 CFR 1910.134 paragraph e for guidance on medical evaluation. Appendix B of the Standard contains a sample medical questionnaire. If results from this evaluation are essentially normal, the employee can be cleared for respirator wear. Further evaluation, possibly including a directed physical examination and/or spirometry, should be considered in cases in which potential problems are suggested on the basis of the questionnaire results. 

Medical exams In general industry, exposed employees must have a preplacement physical examination before being assigned to an occupation exposed to airborne concentrations of asbestos at or above the action level or the excursion level. The physical examination must include chest x-ray, medical and work history, and pulmonary function tests. Subsequent exams must be given annually and upon termination of employment, although chest x-rays are required annually only for older workers whose first asbestos exposure occurred more than 10 years ago. In construction, examinations must be made available annually for workers exposed above the action level, or excursion limit, for 30 or more days per year, or who are required to wear negative pressure respirators chest x-rays are at the discretion of the physician. 

Written medical opinions, (i) For each physical examination required by this section, the employer shall ensure that the physician or other licensed health care professional provides to the employer and to the affected employee a written opinion regarding the results of that examination within 15 days of completion of the evaluation of medical and laboratory findings, but not more than 30 days... 

The employer ensures that the employee receives additional medical surveillance, including a physical examination at least every 60 days until transfer or removal occurs and... 

The complete physical examination, when coupled with the medical and occupational history, assists the physician or other licensed health care professional in detecting pre-existing conditions that might place the employee at increased risk, and establishes a baseline for future health monitoring. These examinations should include ... 

A physician was consulted to help develop a cumulative trauma disorder (CTD) surveillance program. As one result, the physician made the portion of the pre-placement physical examination that dealt with the upper extremities and the back more detailed for the employees in the slaughter department and the division where carcasses are dismantled. At the 1-month and 1-year anniversary dates, randomly selected employees are invited back to be reexamined. Examination results that indicate early development of CTD are reported to the employees. In addition, management is informed about positions that need further evaluation. However, no personal information that identifies particular employees is released to management. 

The initial class was provided at the janitorial service company s central office. Since then, new employees have been instructed at the clinic as part of their pre-placement physical examination and orientation. Finally, the owner received booklets promoting safe defensive driving and the use of seat belts from the Automotive Occupant Restraint Council. These booklets were distributed to all current employees and are included in the orientation materials for all new employees. The employer plans to develop and distribute to all employees a brief self-test based on the booklet. 

Enforce the organization s/site s medical recommendations with respect to an employee s physical limitations. Report on employee s apparent physical limitations to their manager and request physical examination of the employee. 

Some factors an employer might consider when determining whether physicians or licensed health care professionals are examining the same condition might include, for example whether the examination of the injured or ill employee is in person (i.e., review of documents only is generally not a substitute for a physical examination) whether the examinations were conducted on the same day whether the employee was subjected to additional events or exposures between the examinations and, whether medical treatment, restricted work activity, or days away from work occurred between the examinations. 

Based on the information described in the question, the two physical examinations were conducted in person it appears that the physicians evaluated the injury on the same day (day of injury) and in the same condition and, the employee was not subjected to additional events or exposures between the examinations. Also, no medical treatment was provided or days away from work or work restriction occurred between the two examinations. Accordingly, the employer in this scenario may rely on the first medical opinion if they determine the opinion is the most authoritative. OSHA considers a contemporaneous medical opinion that is best documented, best reasoned and most persuasive as the most authoritative. Finally, please be aware that OSHA would consider the medical treatment and days away from work directed by the second physician as necessary unless the employer can document that the first opinion is most authoritative. 

Official auditors conduct a thorough physical examination of the entire work area. Relevant control documents are scrutinized, activities are monitored, and safety systems tested. The auditors critically examine each item of the safety program, test the system, interview employees, and quantify the work being done to control loss. The NEMIRR system would be audited for the following (Model 8.1) ... 

The employer must take action to ensure the employee understands the questionnaire. The employer may have the PLHCP assist the employee in filling out the medical questionnaire or go directly to a physical examination. 

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