General information

A fundamental clinical service of our occupational health program is the pre-placement evaluation, formerly known as the "pre-employment" examination. The word pre-placement is used to emphasize that the medical assessment is merely one component of the employment process, and should not be used as the final determining factor of whether the person is hired.

According to the Americans with Disabilities Act (ADA), "A covered entity may require a medical examination after an offer of employment has been made to the job applicant and prior to the commencement of employment duties of such applicant." The results of the evaluation may be a condition of the job offer, provided:

1. All entering employees are similarly evaluated, irrespective of disability.
2. All findings resulting from the medical history and evaluation are treated as a confidential medical record and maintained on separate forms in medical health record files.
3. Supervisors / managers may be informed of certain necessary work restrictions, necessary accommodations, including those suggested by entering employees.

In summary, the pre-placement evaluation is an effort to determine if the applicant has the capacities to accomplish the specific duties of the job in keeping with the physical, environmental, and psychological demands of the position. All exams or inquiries concerning a disability must be "shown to be job-related and consistent with business necessity."

Rationale for pre-placement evaluations

In the past, the exam performed at the time of hire had been used judiciously by employers. While some employers used this as a tool for intelligent and beneficial matching of the applicant to the job, others were known to use it as a device to disqualify persons deemed "undesirable." Now, the pre-placement exam serves as a vehicle to introduce the new employee to an occupational health program. The completion of the exam may be necessary to ensure that a medical condition doesn't preclude safe job performance, and to identify reasonable accommodation.

Benefits of pre-placement evaluations

Some of the benefits of pre-placement evaluations include:

• Appropriate pairing of the applicant to the occupational requirements of the job.
• Discovery of health condition(s) that may place the safety or health of the applicant or others at risk.
• A basis for determining needs in the area of reasonable accommodation (for example, sensory aids, special work stations, additional devices, relocation of a workstation, and/or special parking).
• The introduction of a healthcare system that emphasizes wellness and a preventive care belief which, if followed, can help to stop a premature onset of chronic disease or complications of a previously existing disabling disorder.
• A baseline of health status so future measurements can determine whether any workplace exposures have proven detrimental to the employee's health.
• Knowledge of family health problems so counsel (EAP/Employee Assistance Program) can be provided, which can help reduce periods of employee absence, stress, or decreased productivity.
• A basis for relationship with the employee's supervisors regarding potential emergency situations (for example, insulin-dependent diabetes, convulsive disorders).
• Compliance with state or local statutory requirements for certain job categories, such as primary education and health care.
• Measurement of psychological status so proper referral to counseling sources can avert future job-related stress.

It is imperataive that the professional conducting the pre-placement examination be provided with a description of the job being offered so he or she has adequate and appropriate knowledge of the work demands.

Purposes of pre-placement evaluations

• To determine if the applicant has a health condition that may be aggravated by the workplace.
• To determine if the applicant has a health condition that may place the safety or health of others at risk.

The primary objective of the pre-placement evaluation is to ensure that employees are medically qualified to perform the essential functions of the job.

The second objective is to determine whether the applicant has a medical condition that may place the health and safety of others at risk. This is critically important with certain jobs, such as operating machinery or driving. The Interstate Commerce Commission for example, stipulates that people with unstable epilepsy or insulin-dependent diabetes are not permitted to drive interstate trucks. The rationale is that if these conditions are not properly controlled, they could place others at risk for a trucking or transportation-related incident. Circumstances may allow persons with these medical conditions to perform other job duties.

The physical examination form may vary from person to person. However, the basic components will apply to all:

• Applicant demographics (name, social security number, sex, date of birth)
• Physical examination (blood pressure, pulse, respiration, temperature, height, weight)
• Review of systems (head/neck, heart/lungs, gastrointestinal, genitourinary, skin and soft tissue, musculoskeletal, neurological)
• Ancillary tests (depending on job description, employer requirements, patient age)
• Vision screening
• Auditory screening

The examining physician can also document whether he or she finds the applicant able to perform his/her job duties.

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• Physicals
• Medical surveillance exams
• Independent medical examination

Common OSHA regulations and required exams

General information

Rationale for pre-placement evaluations

Benefits of pre-placement evaluations

Purposes of pre-placement evaluations