Preplacement examination

HEALTH SURVEILLANCE LOR CHEMICAL WORKERS Preplacement Examination Baseline Data for Future Exposures Periodic Medical Examinations Termination Examination... 

Preplacement examination has two major functions (1) determination of an individual s fitness for duty, including the ability to work while wearing protective equipment, and (2) provision of baseline medical surveillance for comparison with future medical data.4 The chemical agent worker must be evaluated to ensure that he is not predisposed to physical, mental, or emotional impairment, which may result in an increased vulnerability to chemical warfare agent exposure. This examination is performed at no cost to the applicant. Abnormalities identified during the course of the... 

Iv) The employee s anticipated or estimated exposure level (for preplacement examinations or in cases of exposure due to an emergency) ... 

A cohort study of 5668 NG-exposed workers found an increased standardized mortality ratio for deaths from ischemic heart disease. The increase was more pronounced for those with 10 or more years of exposure and was statistically significant for the 40- to 49-year age group, whereas a deficit of cardiovascular mortality had been anticipated because of preplacement and annual medical examinations designed to exclude persons with cardiovascular abnormalities. These results were confirmed in a retrospective cohort mortality study that found a significant excess of ischemic heart disease mortality among workers actively exposed to NG and under the age of 45. ° (Note this study failed to detect a chronic cardiovascular effect as excess risk was only associated with workers actively exposed to NG.)... 

The frequency and extent of the periodic medical examination will be determined by the toxicity of the potential or actual exposures, frequency and duration of contact, and the information obtained in the preplacement history and physical examination. The data obtained from these periodic examinations can serve as a guide to the future frequency of physical examinations or tests. Data consistently within acceptable limits for several months may indicate that the frequency can be safely decreased, provided that the work situation remains constant. 

The preplacement physical examination is designed for workers who have not been employed in areas exposed to heat extremes. It should be assumed that such individuals are not acclimatized to work in hot climates. The physician should obtain the following information6 ... 

Title I of the Americans with DisabUity Act (ADA, 1990) prohibits discrimination with regard to any aspect of the employment process. Thus, the development of preplacement tests has been impeded by the possibility of discrimination against individuals based on gender, age, or medical condition. The ADA requires physical tests to simulate the essential functions of the task. In addition, one must be aware of reasonable accommodations, such as lifting aids, that may make an otherwise infeasible task possible for a disabled applicant to perform. Healthcare providers who perform physical examinations and provide recommendations for job apphcants must consider the rights of disabled applicants. It is extremely crucial to quantify the specific physical requirements of the job to be performed and to examine an applicant s capabilities to perform those specific tasks, taking into account any reasonable accommodations that may be provided. Hence, task analysis and functional capacity assessment are truly intertwined. 

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... 

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. 

Medical Surveillance Preplacement and periodic evaluations should include a complete history with emphasis on the history of fainting spells that may be a result of a cardiovascular or a nervous disorder and also notations of those conditions that may create a susceptibility to the effects of anoxia or anemia. Physical examinations should emphasize the cardiovascular, nervous, and upper respiratory systems, along with the thyroid. Because cyanide is a defatting agent and can cause dermatitis on prolonged exposure, the skin should also be examined during these evaluations. 

Work with the provider to help give good service to employees. It is not advantageous to send someone for a preplacement physical and then have them spend a half-day or more getting a physical examination completed. If there are busy times or slow times at the physician s office, find that out. Work with the provider to arrange for appointments (at offpeak times) for preplacement physicals. The type of service and the time it... 

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