SCCJA_Physical_Exam_[2021].pdf

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PHYSICAL EXAMINATION

Date of Examination: ________________________________________________________________________

Name of Applicant: _________________________________________________________________________

Vital signs Weight: ______________ Height: ______________ BMI: ______________

Blood pressure: ________/________ Heart rate: ____________

Vision Visual acuity, distant, without correction: LT _________ RT _________ Both _______ Visual acuity, distant, with correction: LT _________ RT _________ Both _______ Visual acuity, near, without correction: LT _________ RT _________ Both _______ Visual acuity, near, with correction: LT _________ RT _________ Both _______ Peripheral vision: LT _________ RT _________ Both _______ Color vision (type of test and score): ________________________________________________

Eyes Unremarkable Abnormal Findings Pupils Conjunctivae Eyelids Extraocular motions

Ears, nose, mouth, and throat Unremarkable Abnormal Findings Oropharynx Teeth Ear canals Tympanic membranes Nose Deformity of face Deformity of skull

Neck Unremarkable Abnormal Findings Trachea (midline) Jugular vein distention Cervical lymphadenopathy Carotid bruit Mass thyroid

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Abdomen Unremarkable Abnormal Findings Hernia Mass Scars Tenderness Rigidity Bowel sounds Enlarged liver Enlarged spleen

Upper extremities Unremarkable Abnormal Findings Deformity Range of motion Tenderness Atrophy Amputation

Lower extremities Unremarkable Abnormal Findings Deformity Range of motion Tenderness Atrophy Amputation

Cardiorespiratory Unremarkable Abnormal Findings Heart auscultation Lung auscultation Pedal pulses Leg / foot edema

Spine Unremarkable Abnormal Findings Scars Deformity Curvature Tenderness Straight leg raise Walk on toes and on heels Range of motion of cervical spine

Range of motion of lumbar spine

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Neurological Unremarkable Abnormal Findings Posture Gait Mental status (alertness, orientation, memory)

Speech Finger to nose Cranial nerves Deep tendon reflexes Light touch sensation Strength (biceps, triceps, knees, ankles)

Tandem walk Romberg Tremors

Skin Unremarkable Abnormal Findings Rash Lesions

Psychiatric Unremarkable Abnormal Findings Mood and affect Judgment Impulse control

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TO THE PHYSICIAN:

All information MUST be completed. Please type or print legibly and return to the Law Enforcement Applicant and/or the Employing Law Enforcement Agency. Attach Additional sheets/documentation as necessary.

It is the primary consideration of the South Carolina Criminal Justice Academy to safeguard the health and well-being of all candidates participating in our training. Therefore, all candidates for training at the South Carolina Criminal Justice Academy should be free of any medical, mental, psychological, or other conditions which may interfere with his/her ability to safely participate in and successfully perform law enforcement activities. Below is a listing of program curriculum and proficiency performance areas for Physician review and consideration in conjunction with the Physician’s knowledge regarding the candidate’s past and current medical condition. The program curriculum and proficiency performance areas include, but are not limited to:

Complete formation runs of various distances up to 3.0 miles in length in a 45-minute time period, without stopping (Class 1 Law Enforcement Officer)

Participate in 90-minute-long physical training sessions designed to increase strength and endurance

(Class 1 Law Enforcement Officer/Class II Detention Officer)

Tolerate exposure to extreme heat/cold/humidity/inclement weather as well as exposure to lead during firearms training (Class 1 Law Enforcement Officer)

Climb, crawl, wrestle, jump, lift and drag heavy weights (Class 1 Law Enforcement Officer/Class II

Detention Officer)

Visually distinguish targets on a firing range at distances of up to 75 yards (Class 1 Law Enforcement

Officer)

Safely operate a motor vehicle at various speeds, including very high speeds, and under varying conditions, including police lights and sirens activated (Class 1 Law Enforcement Officer)

Tolerate loud noises (sudden and sustained) to include sirens, weapons firing, and other percussions weights (Class 1 Law Enforcement Officer/Class II Detention Officer)

Safely handle various types of weapons, including, but not limited to firearms, Tasers, OC spray (Pepper

Spray), Impact Weapons (Asp, Baton, etc...) weights (Class 1 Law Enforcement Officer/Class II

Detention Officer) This includes being able to independently hold and fire a firearm with either hand

(fire one handed) and lying in prone position for part of firearms training (Class 1 Law Enforcement

Officer)

Tolerate the psychological stresses of law enforcement work, including working swing shifts, observing and assisting with traumatic incidents (deciding to discharge weapon in protection of self or others;

responding to serious crimes in progress; responding to child abuse cases; death and dismemberment scenes; and other acts of extreme malice, etc.), work long hours without the possibility of relief

(emergency situations, etc), and high stress incidents (active shooter incidents, etc.) (Class 1 Law

Enforcement Officer/Class II Detention Officer)

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Participate in physically rigorous defensive tactics training including, but not limited to: (Class 1 Law

1) joint manipulation

2) handcuffing (hands extended behind back)

3) take down techniques (prone position flat on stomach)

4) kicks and strikes utilizing padded bags for protection

5) bending at the waist

6) kneel on knees (together and individually) unsupported

7) ground defense technique requiring 1 student to sit on the abdomen of another (suspect) student

Complete a physical agility assessment course, including, but not limited to: running up and down stairs, jumping through an open window, and dragging a 170lbs dead weight dummy (Class 1 Law Enforcement

Officer)

Physical activity and engagements in scenario-based training sessions (Class 1 Law Enforcement

Officer/Class II Detention Officer)

Tolerate exposure to various gas/chemical elements (Pepper Spray, OC Spray, Tear Gas, etc…) (Class 1

Law Enforcement Officer/Class II Detention Officer)

Sit in a desk chair for up to ten (10) hours at a time (Class 1 Law Enforcement Officer/Class II

Detention Officer)

Sustain this level of functioning for 12-14 hours per day for at least 5 days per week (Class 1 Law

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PHYSICIAN REPORT

Name of Applicant: _____________________________________________ DOB: ______________________

Employing Law Enforcement Agency: __________________________________________________________

I certify that I reviewed the medical history, physical examination and diagnostic testing and all other documents included in the medical file for the individual named above.

It is my opinion that this individual, from a medical perspective:

_______ can perform the essential job training functions with no limitations.

_______ cannot perform all essential job training functions due to limitation (see notes below).

_______ cannot make determination at this time, pending receipt of further information (see below).

Notes: ____________________________________________________________________________________

Signature of Medical Provider Date

Name of Medical Provider (please print) Phone Number

Address

City State Zip