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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