Physical Exams: Your Edge for Better Workplace Safety

Michelle Hopkins

Employers confront critical unknowns when seeking to create a productive business and a safe and healthy workplace for employees. For instance, how do you know if the employees you hire can perform all the requirements of the job without risk of injury to themselves or others? Further, with many variables involved in manufacturing or production processes, how can you avoid – or at least reduce – injuries? Finally, when an injury occurs, might an employee’s pre-existing condition be worsened by the incident, or perhaps have been a contributing factor?

As part of an overall occupational health and safety program, physical exams can help you address questions like these as a strategy in reducing health care and workers’ compensation costs. By considering the variety of physical exams available and understanding the purpose of each, you take an important first step toward achieving the healthiest and most productive workforce possible.

5 Types of Physical Exams

There are five types of physical exams commonly associated with the workplace today:

Post-offer, pre-placement physical exams

Human performance evaluations (HPE)

Physical exams for profession-specific safety-sensitive jobs

Medical surveillance or screening exams

Exams to determine if an employee is able to return to work or fit for duty

Several exams fall into more than one of the five classifications. For example, HPEs, safety-sensitive job exams such as DOT exams, and medical surveillance and certification exams can all be regarded as pre-placement physical exams. But to address the relevant issues of each, they are discussed here as individual exam types.

Compliance Requirements

While post-offer, pre-placement physical exams are a valuable aid in providing a healthy and safe work environment, employers must use them only in a way that is compliant with federal and state laws and regulations. For example, employers may require a physical examination only after a contingent offer of employment has been made. Additionally, all candidates for the job are required to have the same physical exam, and all exam results must be kept separate from personnel records and never used in a discriminatory fashion.

Can Drug or Alcohol Tests Be Required?

Employers generally can require job candidates to undergo drug and/or alcohol screening as part of a physical exam. After hiring, the rules for drug and alcohol screening can vary by state, industry, or safety-sensitive nature of the job. Depending on the type of information the employer requires, drug and alcohol screenings can be performed in any of multiple ways:

  • Blood tests measure the level of alcohol or drugs only at the time the blood is drawn. Drugs typically screened for as part of the employment process include cocaine, marijuana, amphetamines and methamphetamines, opiates, nicotine, and alcohol.
  • Breath tests (alcohol only) measure the current level – not past use – of alcohol and indicates degree of impairment or intoxication.
  • Mouth swab or saliva/oral fluids tests (drugs only) show the presence of drugs currently and up to a few hours or as much as two days before the swab is taken.
  • Hair tests (drugs only) show past use for up to 90 days for cocaine, marijuana, opiates, methamphetamines, and phencyclidine (PCP, also known as angel dust, which is a hallucinogenic compound).
  • Urine tests show the presence of alcohol and drug residues, even after the effects have worn off. Drugs screened include cocaine, marijuana, amphetamines and methamphetamines, opiates, nicotine, and alcohol.

In 2019, the Federal Transit Administration’s minimum random drug test rate for covered mass transit (bus and rail) employees is 50 percent, up from the 25 percent rate set in 2007. The rate for random alcohol testing remains at 10 percent.

What Happens in a Work-Related Physical Exam?

There is a lot of similarity between a work-related pre-placement physical exam and a general physical exam. The clinician will check vital signs (i.e., blood pressure, respiration, heart rate), do blood work, and assess general physical status (i.e., height, weight, head, ears, eyes, nose, and throat). But there are some areas where a work-related exam may be more in-depth. These can include vision and hearing screenings; abdominal check for hernias; a musculoskeletal exam of muscle tone, strength, and stability; a neurological exam of reflexes, coordination, and balance; and possibly dynamic lifting, aerobic testing, or other job-specific function assessments. In addition, an employee undergoing a work-related exam may be asked, not only about medical history, but also any past hazardous exposures or impairments in performing job functions.

Sometimes, a little preparation is required to ensure the individual has necessary documentation, such as for the standard DOT exam and the DOT exam for commercial drivers with insulin-treated diabetes. If you have any questions about what you need to bring to a physical exam, you may call a Concentra® location to get that information.

Understanding More About the Major Physical Exams

A pre-placement exam is any exam conducted after a job offer has been made but before the first day of duties – a general physical, drug test, Human performance evaluation, or an exam tailored to a specific job. It frequently includes, but is not limited to, heart, lung, musculoskeletal, neurologic, and vision exams, and lab work.

Human performance evaluations assess an individual’s physical performance in multiple lifting postures and pull/push tests within an allotted time to confirm a good match between a candidate’s physical capacity and the demands of the job.

Profession-specific, safety-sensitive physical exams. DOT regulations require physical exams for employees in safety-sensitive occupations in interstate commerce (commercial truck and bus drivers) and rail, aviation, and pipeline employees. Concentra provides physical exams for these requirements as well as for the military and employees in health care.

Medical surveillance exams help protect employees with exposures to regulated substances and provide early detection of any detrimental health effects due to these exposures. Medical surveillance exams establish a baseline of an employee’s health and monitors for adverse health effects over time. A surveillance physical exam frequently emphasizes the respiratory system and includes X-rays and a pulmonary function test or spirometry, which must be performed by a certified technician who has completed an approved training course of the National Institute of Occupational Safety and Health (NIOSH). There are surveillance exams unique for dozens of substances, including the recently announced respirable crystalline silica and beryllium rules.

Respirator medical evaluations for clearance to wear a respirator and respirator fit tests. When respirable exposures are the concern, there are two types of respirator evaluations that are required by the Respirator Protection Standard 29 CFR 1910 130. First, the respirator medical evaluation determines whether an employee is medically able to wear a respirator under specific work conditions. Following clearance, a respirator fit test is done (either qualitative or quantitative, depending on respirator type and fit factor requirements).

HAZMAT and HAZWOPER exams are designed for employees who interact with hazardous or dangerous materials, or uncontrolled sites. HAZMAT regulations pertain to employees who handle/transport dangerous or hazardous materials. The HAZWOPER standard (an acronym for Hazardous Waste Operations and Emergency Response Standards) is for employees involved in hazardous site clean-up efforts or uncontrolled emergency situations. In both cases, a standard physical exam includes medical and work history with specific emphasis on the systems related to hazardous substances and fitness for duty, including the ability to safely wear personal protective equipment at the worksite.

Return-to-work and fit-for-duty exams. There are times when an employer may need to assess a current employee’s physical or psychological ability to perform a job. This can be following an extended absence, when a job transfer occurs, or when behavioral changes are observed. To address this need, Concentra offers return-to-work exams after an extended absence and fit-for-duty exams in all other instances involving existing employees.

Single-point Destination for Physical Exams You Can Trust

Concentra has 40 years of experience in occupational health and more than 239,000 employer relationships so our track record for all types of physical exams is difficult to match elsewhere. But Concentra has another strategic advantage that our competitors miss. Our clinicians take a standardized, patient-centric approach to health care delivery thanks to careful guidance our Medical Expert Panels (MEPs). Concentra has developed MEPs on patient care, therapy, regulatory testing and examinations, transportation, and pharmacy and therapeutics to ensure services delivered to employers represent the finest in the industry. That starts with physical exams and runs the gamut of all of your occupational health care needs.

Contact a Concentra expert.