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Post Offer Employer Medical Screening Tool

Post Offer Employer Medical Screening Tool

It is vital for private employers to understand what sort of medical inquiries may be made during the hiring process. The U.S. Equal Employment Opportunity Commission (EEOC) spells out the difference between lawful and unlawful medical inquiries under the Rehabilitation Act, the Genetic Information Nondiscrimination Act (GINA), Title VII of the Civil Rights Act of 1964, and the Age Discrimination in Employment Act (ADEA). Section 501 of the Rehab Act, which applies to federal employees, adopts the standards of Titles I and V of the American Disabilities Act (ADA). This article will help your company avoid any unnecessary issues with the ADA and other federal anti-discrimination laws.

Medical inquiries and the ADA: Key ADA restrictions on medical inquiries of applicants:

  • There is no exception to the straight-forward rule that disability-related inquiries or medical examinations are prohibited in the pre-offer stage of the application process.
  • If applicants must fill out any medical questionnaires prior to the receipt of a conditional job offer, use of the forms violates the Rehabilitation Act [and the ADA].
  • After a conditional offer is made, an employer may ask disability-related questions and require medical examinations as long as it does so for all entering employees in the same job category.
  • Once employment begins, an employer generally may make disability-related inquiries and require medical examinations only if they are job-related and consistent with business necessity.
  • In the post-offer stage of the application process individual applicants may be asked questions not asked of other applicants if those questions are “medically-related” to medical information previously received.

Offer Withdrawal

Under the ADA Amendments Act, withdrawing an offer based on the information obtained from a post-offer health history inquiry or follow-up medical questions will likely result in a finding that the applicant was regarded as having a disability. Therefore, the employer would be required to establish that the particular impairment renders the individual unqualified to perform the essential functions of the job or, where the employer has excluded the applicant due to safety concerns, that the applicant poses a direct threat because of the impairment.

When the applicant’s impairment substantially limits a major life activity or constitutes a record of a substantially limiting impairment, the employer’s determination of whether the applicant can perform the essential functions of the job must also include consideration of whether a reasonable accommodation would enable performance of the job functions or would reduce any direct threat to an acceptable level.

GINA-Related Considerations

Pursuant to Title II of GINA, employers are prohibited from requesting, requiring, or purchasing genetic information — including family medical history — from applicants or employees, except under very limited circumstances. Therefore, questions about an applicant’s family medical history or genetic information are unlawful under GINA. “There is no exception to the general rule prohibiting employers from requesting genetic information of an applicant in a medical questionnaire.

Title VII, ADEA

Part of the Peace Corps’ application process included post-offer medical questionnaires required only of applicants in certain protected groups — e.g., a “Mammogram Form” required only of women age 50 and over. Thus, it appeared that women and a protected age group were required to undergo medical tests not required of applicants outside of these protected groups. This requirement raised a big red flag under Title VII, which prohibits sex discrimination, and the ADEA, which prohibits discrimination against persons age 40 and over. An application process with these requirements is deemed “facially discriminatory.”

What does all this mean for employers?

The EEOC points to several best practices worth keeping in mind:

  • Do not subject applicants to disability-related inquiries or medical exams prior to a conditional offer of employment.
  • After a conditional offer of employment, make disability-related inquiries and require medical exams only if the same is required of all entering employees in the same job category.
  • After employment commences make sure that any disability-related inquiries or medical exam requirements are job-related and consistent with business necessity.
  • Any post-offer questions not asked of others must be confined to those which are medically related to medical information already provided by the applicant.
  • If an offer is withdrawn based on medical information provided by the applicant, make sure it can be established that either:
    • the particular impairment at issue renders the individual unqualified to perform the essential functions of the job; or
    • the applicant was excluded for safety reasons because he or she poses a direct threat due to the impairment.
  • Do not ask questions about an applicant’s family medical history or genetic information.
  • Do not make medical inquiries of or require medical exams for protected category members, such as women and older applicants, unless the same inquiries and exams are also imposed on applicants outside the protected categories
Oceaneering Safety Director Discusses Effective Communication in Occupational Health

Oceaneering Safety Director Discusses Effective Communication in Occupational Health

Safety Director Joe Lavender describes Oceaneering International’s experience with Taylor Made Diagnostics’ occupational health services. Mr. Lavender highlights the effective communication that they have enjoyed while working with TMD.

Transcript: It’s no secret that the ship repair industry is an aging workforce overall. It’s important that we take care of the folks we have and just give them the best care that that we can
provide for them through Taylor Made.

Oceaneering’s local branch is the Marine Services Division and we primarily do repairs on US Navy submarines and some other ship repair work. Taylor Made Diagnostics is one of the few I’ve ever come across that deals solely with occupational health care therefore they understand our industry. They are familiar with the type of injuries that occur in our industry and how to best treat those.

I remember when when she started with humble beginnings in a rented bank building.

The communication is very good. We don’t have to explain to them each time who we are and worry about insurance issues and all of those types of things. When we bring someone to Taylor Made the doctor or physician’s assistant who provides the care for that person personally calls you after the care has been given and lets you know exactly what was done what you can expect with this person and any follow-up care that’s needed. So that’s huge for us that we can actually talk to the person and get a good understanding of what’s going on. You can’t get that in most places.

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Video: What is Occupational Medicine?

Video: What is Occupational Medicine?

Dr. Michael Picio our Medical Director explains what Occupational Medicine is and how it can benefit your company.

Transcript: Hi, I’m Dr. Michael Picio. I’m the Occupational Medicine Specialist and the Medical Director here at Taylor Made Diagnostics. We’re here to protect the health of your business and we do that by providing you the best occupational medicine care available for 25 years.

I’ve been a family medicine physician and I’ve done that on active duty in the Navy. You go out to sea you’re already in an industrial medicine environment. A ship is nothing more than a big floating factory. You’re already managing programs like hearing conservation and heat stress and radiology and ready radiation health. So these skills which I was already trained in now I’ve been doing every day. I wanted to formalize that to be an actual occupational medicine specialist.

I’ll summarize what occupational medicine is in just a quick fundamental phrase. It’s the specialty of preventive medicine and the diagnosis, treatment and management of workplace related injuries, disabilities and illnesses.

Objectively, studies have even shown in journals and publications that patients do get better faster and they recover much more quickly if they stay engaged in work. And that’s better for the company line because the bottom line is that they’ll make money. They’ll keep that patient engaged there’ll be more productive if they keep the patient at work.

It’s a different intellectual challenge that you bring to this job. The intellectual challenge of investigating whenever patients have illnesses that aren’t quite clear cut when they come in from work and the intellectual challenge of figuring out how to diagnose it, treat it, manage it and get the patient back to work.

If you come to Taylor Made Diagnostics not only are you going to experience the best occupational medicine available and the delivery of that but we’re going to be serving your company as if you’re the only company we have. We’re going to make sure that your patients are going to get the best care possible as if they’re the only patients we have today.

Fit Testing and Facial Hair

Fit Testing and Facial Hair

While beards and mustaches are very fashionable, they do present a challenge to workers who are required to use a respirator and receive proper fit testing in accordance with OSHA standard as referenced in 1910.134(g)(1) Face piece Seal Protection.  Facial hair can put workers at increased risk because a beard or mustache, if not trimmed properly, can compromise the performance of tight-fitting respirators.  Anything that comes between the face and the respirator’s seal, or gets into the respirator’s valves, can allow contaminated air to leak into the respirator face piece, reducing your worker’s protection.

Higher than expected exposures to a contaminate may occur if users have poor face seals with the respirator, resulting in excess leakage.  No attempt should be made to fit a respirator on an employee who has facial hair which comes between the sealing periphery of the face piece and the face, or if facial hair interferes with normal functioning of the exhalation valve of the respirator.  Employees should be monitored throughout the fit testing process to determine if they can keep a seal during respirator use.

Respirator Usage Written Program

OSHA mandates that all employers requiring respirator usage have a written program. That program should include defining facial hair policies if tight-fitting respirator masks are used. Often, this is enforced only at the time of hire or at annual fit-testing; yet, it is equally important to monitor and remind employees of the policy and its purpose throughout the year. A mustache grown for a social cause is not necessarily a point of concern – as long as it is trimmed and maintained to the point that it does not violate the seal area of the respirator and the length does not interfere with exhalation valves, which prevent inward leakage of hazards during inhalation.

Understand OSHA Guidelines

Whether you are fit testing internally, or using an outside vendor, ensure your written program includes a facial hair policy and that your fit testers clearly understand OSHA guidelines for fit testing.  The OSHA Respiratory Protection Standard addresses the issue of respirator use and facial hair; clearly stating tight-fitting respirators are not permitted to be worn by employees who have facial hair that comes between the sealing surface of the face piece and the face, or that interferes with valve function. Be sure your workers are aware and understand the purpose of the regulation, as it will eliminate delays in the fit testing process, and ensure your workers are fully protected while wearing the respirator at all times.

Audiogram Validity

Audiogram Validity

OSHA mandates that employers are required to provide annual audiometric testing for employees exposed to 85 decibels or greater in an 8 hour time weighted average.  If you provide hearing protection to control your employees’ noise exposure you must provide annual audiometric testing.

According to the Centers for Disease Control and Prevention, the most common workplace injury is hearing loss. In fact, according to the Centers for Disease Control and Prevention, it is the most common work-related injury, with approximately 22 million workers exposed annually to hazardous levels of occupational noise. Workers in the mining sector, followed by those in construction and manufacturing, are most likely to suffer from hearing impairment. According to the Department of Labor, an estimated $242 million is spent on worker’s compensation annually for hearing loss disability.

OSHA mandates that employers are required to provide annual audiometric testing for employees exposed to 85 decibels or greater in an 8 hour time weighted average.  If you provide hearing protection to control your employees’ noise exposure you must provide annual audiometric testing.

Maximize Audiogram Accuracy

To maximize the accuracy and to ensure valid audiometric testing:

  • Employee should not be exposed to workplace noise for 14 hours prior to testing.
  • For workers who have audiometric testing conducted during their work shift, hearing protection may be used to meet the “no noise” requirement.
  • Employees should also avoid high volume, non-occupational noise levels 14 hours prior to testing.  These activities include: grass cutting, loud television or radio, motorcycle riding, use of firearms or other activities that generate noise in excess of 85 dB.
  • Employees with a build-up of earwax or a history of wax impaction should clean their ears prior to presenting for the hearing test.

Importance of Employee Awareness & Training

Employers should enforce and remind their employees the day before and the day of their scheduled audiometric test to take necessary precautionary measures ensuring they limit their noise exposure.  By doing so the audiogram will be more valid and repeat testing may become unnecessary.  Employee training is very important. Workers who understand the reasons for the hearing conservation program – and the need to protect their hearing – will be more motivated to wear their hearing protection.

When audiometric testing is required for employees, it is recommended that employers ensure the audiometric service provider complies with the relevant requirements of AS/NZS 1269.4:2005 – Occupational noise management – Auditory assessment and CFR 1910.95.  Employers need to ensure testing is accurate and carried out by an appropriately certified audiometric technician.