Occupational and Environmental Medicine Work Fitness Evaluation Guidelines
Occupational and Environmental Medicine Work Fitness Evaluation Guidelines
1. Interview of the employee’s supervisor
2. Interview of the employee
3. Allergies
4. Current medication(s)
— Prescribed
— OTC
— Natural remedies
— Other people’s
5. Inquiry of what has been eaten today
— When and what
6. Inquiry of amount of sleep
— When and how much
7. Past medical history
8. Social history
— Drugs, ETOH, other
— Social support and living conditions
— Hobbies or home activities
9. Occupational history
— How long
— Hours, schedule, shift
— Concurrent employment
10. Review of systems
— If condition reported, when and reason for last visit with treating health care provider
11. Physical examination
— Height, weight, oral temperature, blood pressure
— General demeanor and appearance
• Eyes (sclera, conjunctiva, fundoscopy exam, horizontal and vertical gaze nystagmus, optional pupillary response dark room examination)
• Ears (auditory canal, tympanic membranes)
• Nose (septum, erythema, hair)
• Throat/Mouth (pharynx, teeth, gums, burns, injection sites, debris, lips)
• Neck (thyroid, lymphadenopathy, bruits, range of motion, tenderness)
• Lungs (effort, auscultation)
• Cardiovascular (rhythm, rate, heart sounds, peripheral pulses)
• Abdomen (bowel sounds, tenderness, masses, etc.)
• Upper extremities (range of motion, muscle strength, tone, grips)
• Lower extremities (range of motion, muscle strength, tone)
• Back (deformities, tenderness, range of motion)
• Neurological (CN II-XII, station and gait, reflexes, romberg, heel and toe walking, divided attention tests such as finger-to-nose, heel to shin, rapid alternating movements)
• Integumentary (color, texture, temperature, lesions, eccymosis/edema, needle marks/tracks)
12. Differential diagnosis
13. Order appropriate testing including alcohol and drug screening as appropriate
14. Disposition
— Referral to Employee Assistance Program
— Other healthcare providers
— Home (arranged ride)
— Return to work
15. Return to work
— Medical clearance
— Contract with human resources and supervisor
— Random drug and alcohol screening as appropriate
Source: Kathleen Golden McAndrew, Dartmouth Hitchcock Medical Center, Lebanon, NH. Reprinted with permission.
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