1. Prof. F. Omokhodion Dept of Community Medicine U.C.H., Ibadan
Fitness to work and other Occupational health examinations Return to work examination
Prof. F. Omokhodion
Dept of Community Medicine
U.C.H., Ibadan

2. Fitness to work Definition
Objective assessment of health of employee to determine whether he/she is able to carry out work without being a hazard to self or others
It is not the intention to exclude a person from a job but to make any necessary reasonable modifications or adjustments to the job to allow the person to work efficiently and safely.

3. Fitness for work
If fitness to work control is utilized by a company, it is mandatory for employees to comply.
Fitness to work:
For task
For location-e.g, cold climate, remote location

4. Fitness to work Based on risk assessment of jobs
Which task is associated with specific physical and psychological risk
Which tasks has direct safety implications if employee is incapacitated
What are the potential consequences
Can risk be reduced by redesign

5. Risk matrix

6. Fitness to work-key information reqiured
Knowledge of workplace hazards
Job demands and special requirements e.g working in isolation, driving
Current job description
Legislative requirements for the job e.g commercial driving, airline pilot etc.
Company or industry guidelines

7. Fitness to work- indications
Pre-placement
Return to work/ Post sickness absence-assessment of disability
Continuing disability
Performance initiated review-to rule out health reasons as a cause of failing job performance
Job transfer
Promotion
Change in work conditions of existing job
Change in health status in existing job
Periodic, statutory eg food handlers, drivers

8. Fitness to work -Objectives
To identify physical and psychological limitations which may be incompatible or cause a problem with performing a task
Involves functional capacity tests where work tasks are simulated to test strength, endurance, range of movement etc.
To achieve the best job- person fit
Helps employee get to work as early as possible

9. Fitness to work- process
Find relevant legislation and guidance
Questionnaires
Occupational history, present and previous jobs, job description
Hobbies
Systemic review, especially systems specific for the job
Mental health status
Current signs of disease

10. Fitness to work-process
Physical examination
General and Specific for the job
Investigations
Basic FBC, E&U, Liver FT and Lung FT
Requirements for the job e.g audiometry
Others e.g Cxray, ECG

11. Fitness to work- reports
Employer should be informed in writing of the decision
Fit
Unfit
Fit, subject to modifications
Last 2 may be temporary or permanent
No information regarding the underlying medical condition should be disclosed, except with employee’s consent and where disclosure is necessary for health and safety reasons
Records should be kept of report, questionnaires used and physical examinations done
Validity of fitness to work certificate

12. Fitness to work-what to do with report
If fit, okay
Validity of the certification ie- when to repeat it
If unfit, recommendations for
Accommodation-allocate some of the job to others
job placement
Termination/ early retirement- Medical Board review

13. Fitness to drive- medical assessment
Specific issues
Employee has the responsibility to declare any condition that may make him unfit
Any condition likely to cause sudden incapacity, heart attack, epilepsy etc
Conditions associated with inability to control the vehicle

14. Examples – fitness to drive
Legislative guidance- At a glance guide to the current medical standards of fitness to drive- a guide for medical practitioners- available on line

15. Fitness to drive Medical assessment Height Weight Smoking history
Alcohol consumption, other psychoactive drugs
Current medication
Medical history of epilepsy, other neurological conditions, diabetes, psychiatric illness, hypertension, respiratory,cardiovascular diseases, sleep disorders, musculoskeletal diseases sufficient to interfere with vehicle control

16. Fitness to drive Physical examinations Investigations;
Height and weight
Visual acuity, visual fields, colour blindness
neck movements; ability to look over his shoulder
Investigations;
Audiometry
Blood sugar
Blood alcohol
ECG

17. Fitness to drive Assessment frequency At pre employment
Every 5 years from age 40
Every year after 65 years
More regular review if he has made a medical condition e.g diabetes

18. Fitness to work –Food handlers
Questionnaire
history of typhoid,
septic or inflammatory disease of eyes, nose, ears and mouth,
persistent chest disease with sputum,
General Physical Examination
Investigations
stool examination for parasites(3 consecutive daily specimens)
CXray

19. Pre-employment medical examination
Health questionnaire and physical examination carried out to ascertain general health of applicant before employment.
Sometimes a precondition of job offer

20. Pre-placement medical examination
Carried out after job offer
To ascertain fitness for work
Statutory
Baseline medical examination
Physician should be conversant with physical, mental and psychological demands of the job

21. Pre-placement medical examination
Use of general questionnaire- administered by nurse
Occupational history- previous jobs and exposures
Review of systems
History of chronic disease e.g hypertension, diabetes
Family history of disease
Current drug use
Past medical history
Sickness absence record for last 2 years

22. Pre-placement medical examination
Physical examination
Laboratory investigations, general and specific for job description
FBC, LFT, E&U, CXray etc
Spirometry-detergent workers,
visual acuity and visual fields-drivers,
exercise tests-firemen,
Audiograms-workers with heavy machinery

23. Periodic medical examination for occupational diseases
Objectives: Health surveillance at work
Identify early signs of occupational disease
Monitor personal exposure
Check effects of control measures
Frequency depends on the nature of exposure and biological response
Routine examination for specific groups
lead exposed workers- blood, urine
Dust exposure- lung function tests, CXray
Noise exposure- audiograms

24. Periodic examination for non- occupational diseases
Routine examination for non- occupational disease/ well person screening
Hypertension
Diabetes
Ischaemic heart disease – Cardiovascular risk can be calculated and rated based on risk factors such as,
diastolic blood pressure,
weight,% of predicted weight,
cigarette smoking,
physical activity,
cholesterol levels

25. Periodic examination for non- occupational diseases
Cancers-
Cervix-Pap smear,
Breast- mammography
Prostate-PSA,
Colon-occult blood

26. Pre-retirement
Preparation for retirement after service for a mandatory number of years
Detect effects of adverse exposures at work
Compensation plan
Screen for diseases of aging, hypertension, glaucoma, cancers
Identify any chronic conditions that will need follow up
Identify any disabilities

27. Post retirement
Identify chronic work related diseases for follow up- e.g silicosis
Institute plan for follow up
Identify non work related conditions requiring follow up
Plan for general medical care

28. Return to work examinations
After sickness
After accident
After pregnancy and maternity leave
Involves
medical assessment
functional capacity assessment
Psychological assessment

29. Return to work When? How soon after injury, recovery from illness etc
Early return to work after injury or illness is of benefit to both employee and employer and can be facilitated by adequate rehabilitation and management of incapacity.

30. Return to work Other factors influencing early return to work
the type of injury or disease
its severity and
the severity of the incapacity.
The attitude of the worker to his job and his psychosocial perception of the work place

31. Return to work Poor work return outcomes Poor job satisfaction
older age
lower educational status
being female
Organizational factors
low or inadequate support from colleagues
high physical workload
high psychological job demands .

32. Return to work Need for psychological assessment
Group and individual counseling and therapy
Return to work plan
Will address all potential obstacles preventing the employee from returning to work
health, work and personal factors

33. Many thanks for your attention!