Attachment 2- Exam Services.pdf

PHYSICAL EXAMINATIONS‐ To be performed as the baseline for all Exam Services

Qualified Occupational Health Physician or Licensed Health Care Provider*

*If performed by a Licensed Health Care Provider, must be reviewed and signed by a Qualified Occupational Health Physician

See specific exam service

Examination that focuses on the overall medical, mental, and physical health of the individual and the individual's ability to perform the requirements for the job (see employee's specific Position Description) Review of medical and occupational history (do not include family medical history) Blood pressure screening Evaluation of eyes, nose, mouth, ears, thyroid, heart, lungs, abdomen, reflexes, generalized skin condition, circulation, spine, back, and hernias Laboratory work: CBC, PSA & TSH Urinalysis Vision screening Electrocardiogram Audiogram Periodic chest X‐rays

NOTE: Where procedures in any of the below overlap the "Physical Examinations" Exam Service, such only needs to be performed once.

A Qualified Occupational Health Physician or Occupational Health Nurse must review all test results with the employee.

A Medical Clearance Determination form (Attachment 3) must be completed by a Qualified Occupational Health Physician.

Fit for Duty Examination According to "Physical Examinations" Exam Service

As Requested

Screening which focuses on the overall medical, mental, and physical health of the individual and the individual's ability to perform the requirements for the job (see employee's Position Description) Particular Evaluations:

Narcotics/Prescription Medication: Any employee under a physician's treatment and taking prescribed narcotics or any medication that may prevent one being ready, willing and able to safely perform position duties‐ medical clearance/evaluation that duties can be performed

According to "Physical Examinations" Exam Service

Lock Operator/Maintenance Worker Physical According to "Physical Examinations" Exam Service

Biennial

Interview with Qualified Occupational Health Physician or Licensed Health Care Provider focusing on overall medical, mental, and physical health (may be conducted virtually)

According to "Physical Examinations" Exam Service

Dive Physical

A licensed physician who completed a Diving Medical Officer course, hyperbaric fellowship, or a Federal Aviation Administration (FAA) Aeromedical Examiner with diving medicine experience

Initial, Annual

According to ENG Form 6227, Diver Medical Instructions and Authorization.

- For chest x-rays: single view (PA) chest x-ray. A 2-view (PA and Lateral) if something suspicious is found

Document clearance on ENG Form 6227, Diver Medical Instructions and Authorization.

Procedures Other RequirementsExam Service Performed By Frequency

(For Information Only)

H4CTXENC

Highlight

Crane Operator Physical Medical Examiners as defined by the Federal Motor Carrier Safety Administration

Initial, Every 3 Years

Vision‐ depth perception, field of vision, distinguish colors Sufficient strength, endurance, agility, coordination, manual dexterity, and speed of reaction to meet demands of equipment operation No evidence that subject seizures or loss of physical control, physical, emotional, or psychologic limitations that could interfere with operator performance

Clearances must be signed by a Medical Examiners as defined by the Federal Motor Carrier Safety Administration and must state that the operator received a physical examination and meets the medical requirements defined EM 385‐ 1‐1 Section 16.B.04.

Commercial Driver's License (CDL) Physical Medical Examiners as defined by the Federal Motor Carrier Safety Administration

Initial, Every 2 Years According to 49 CFR 391

Clearances must be signed by a Medical Examiners as defined by the Federal Motor Carrier Safety Administration.

Medical examination shall be documented on Medical Examination Report Form, MCSA‐5875.

Issue Medical Examiner's Certificate, MCSA‐5876 according to 49 CFR 391.

Forms available at: fmcsa.dot.gov/medical/driver‐ medical‐requirements/medical‐applications‐and‐ forms

As Requested‐ Exposure identified

Complete physical exam of all systems with emphasis on respiratory system, cardiovascular system, and digestive tract Completion of 29 CFR 1910.1001, Appendix D, Medical Questionnaires, Part 1 Chest roentgenogram (posterior‐anterior 14 x 17 inches or digital- single view (PA) classified by a B-reader per appendix E). Interpretation and classification of chest roentgenogram shall be conducted in accordance with 29 CFR 1910.1001, Appendix E Pulmonary function tests to include forced vital capacity (FVC) and forced expiratory volume at 1 second (FEV(1.0)) Any additional tests deemed appropriate by the examining physician.

According to "Physical Examinations" Exam Service

Every 5 Years

Complete physical exam of all systems with emphasis on respiratory system, cardiovascular system, and digestive tract Completion of 29 CFR 1910.1001, Appendix D, Medical Questionnaires Chest roentgenogram (posterior‐anterior 14 x 17 inches or digital- single view (PA) classified by a B-reader per appendix E). Interpretation and classification of chest roentgenogram shall be conducted in accordance with 29 CFR 1910.1001, Appendix E. Frequency based on age and years since exposure:

0‐10 years since exposure: every 5 years; 10+ years since exposure: 15‐35 years old‐ every 5 years, 35‐45 years old‐ every 2 years, >45 years old‐ every year Pulmonary function tests to include forced vital capacity (FVC) and forced expiratory volume at 1 second (FEV(1.0)) Any additional tests deemed appropriate by the examining physician.

According to "Physical Examinations" Exam Service

Asbestos Exposure Examination According to "Physical Examinations" Exam Service

Initial

Annual

As Requested‐ Significant threshold shift or employee changes positions

Initial According to 29 CFR 1910.134 and its appendices to include completion of Appendix C, OSHA Respirator Medical Evaluation Questionnaire

As Requested‐ Employee reports medical signs or symptoms associated with respirator use or a change occurs in workplace conditions

According to 29 CFR 1910.134.

Initial

According to 29 CFR 1910.1030 to include education on the Hepatitis B vaccination.

Offer Hepatitis B and C titer. If employee declines Hepatitis B vaccination, complete 29 CFR 1910.1030, Appendix A, Hepatitis B Vaccine Declination

As Requested‐ Post‐Exposure According to 29 CFR 1910.1030 to include written opinion for Hepatitis B vaccination and post‐exposure prophylaxis

Lead Exposure Examination According to "Physical Examinations" Exam Service

As Requested‐ Exposure identified

Complete blood count with morphology of red blood cells, Blood Urea Nitrogen (BUN), and creatinine Total blood lead and zinc protoporphyrin (ZPP) Microscopic urinalysis Physical exam with emphasis on central and peripheral nervous systems, the cardiovascular system, and the abdomen

According to "Physical Examinations" Exam Service

Bloodborne Pathogens According to "Physical Examinations" Exam Service

According to "Physical Examinations" Exam Service

Noise Exposure Examination

Audiometric tests shall be performed by a licensed or certified audiologist, otolaryngologist, or other physician, or by a technician who is certified by the Council of Accreditation in Occupational Hearing Conservation, or who has satisfactorily demonstrated competence in administering audiometric examinations, obtaining valid audiograms, and properly using, maintaining, and checking calibration and proper functioning of the audiometers being used. A technician who operates microprocessor audiometers does not need to be certified. A technician who performs audiometric tests must be overseen by an audiologist, otolaryngologist, or physician.

According to 29 CFR 1910.95 and its appendices. According to "Physical Examinations" Exam Service

Respirator User Examination According to "Physical Examinations" Exam Service

According to "Physical Examinations" Exam Service

Chromium VI Exposure Examination According to "Physical Examinations" Exam Service

As Requested‐ Exposure identified

Emphasis on previous exposure to chromium (VI), respiratory system dysfunction, asthma, dermatitis, skin ulceration, or nasal septum perforation; and smoking Medical examination of the skin and respiratory tract

According to "Physical Examinations" Exam Service

Chemical Exposure Examination According to "Physical Examinations" Exam Service As Requested‐ Exposure identified Based on chemical exposure According to "Physical Examinations" Exam

Service

Arbovirus Exposure Examination According to "Physical Examinations" Exam Service As Requested‐ Post‐Exposure

Diagnostic testing and treatment according to standard medical practice based on exposure

According to "Physical Examinations" Exam Service

Most likely ticks/Lyme’s disease, but possibly West Nile, Zika, Yellow Fever, Japanese Encephalitis, Dengue and also Rocky Mountain Spotted Fever