5310
01/2007
Health Risk Assessment (HRA) – an evaluation of health risk based on lifestyle, family history and current health status. The Fermilab Medical Department conducts voluntary HRAs on employees who are eligible to receive employment benefits (e.g., group medical insurance).
Occupational Medical Surveillance Group - employees participating in regularly-scheduled mandatory medical monitoring to assure their fitness to engage in a specific work activity (e.g., respirator usage) or to identify changes in their health status associated with exposure to a specific hazard (e.g., lead).
Work Activities Analysis Form (WAAF) - an online questionnaire used to communicate worker job functions and potential exposures to Medical Department personnel. This application includes a checklist that allows supervisors to identify the nature and frequency of potential workplace exposures. A WAAF must be completed prior to each Health Risk Assessment (HRA). In addition, Medical Department personnel will request a review and update of an employee’s WAAF any time they are placed on work restrictions.
Senior Safety Officers (SSOs) designate employees within their division/section who participate in occupational medical surveillance programs.
1. Applicability – Fermilab’s occupational medicine program is primarily limited to Fermilab employees (full-time, part-time and on-call). Medical surveillance may be provided to others doing work on site as a matter of expedience (cost, convenience or assurance). This is most often encountered as a pre-requisite for participating in Oxygen Deficiency Hazards operations (see chapter 5064 in this manual).
2. Fitness Reviews - The purpose of medical fitness reviews is to ensure that workers do not have medical conditions that may be aggravated by their job duties or that may adversely affect the health or safety of others. Critical factors in the review process are worker health status, job duties, and work environment. At Fermilab, these factors are used to focus the content of medical reviews in order to optimize benefits while minimizing the use of resources.
a. Employment Status Reviews
Hire – Laboratory Services Section notifies the Medical Department whenever a job offer has been extended and also provides a copy of the associated job requisition. Medical Department staff review the requisition to determine whether potential job risks are such that the candidate must successfully complete a medical exam prior to being hired. This is referred to as a “post-offer” exam. Such jobs typically involve significant physical demands and/or participation in an occupational medicine surveillance group. If this is the case, successful completion of this exam is a prerequisite for employment and is scheduled to occur as soon as possible. If not, the medical exam may be delayed, though it must be completed before the end of the probationary period. This is referred to as a “delayed post-offer” exam.
Termination - Laboratory Services Section notifies the Medical Department whenever an employee is about to terminate employment. Medical Department staff review the employee’s medical chart to see whether there are occupational health issues that warrant a final interaction. A history of work injuries or participation in an occupational medicine surveillance group would typically indicate that a final visit will be required.
b. Return to work reviews
>3 days of sick leave – If an employee accumulates more than three consecutive days of sick leave, their health status must be reviewed by Medical Department staff prior to their return to work. The assessment will determine the employee’s level of fitness in one of three categories:
· Fit to perform all regularly-performed duties
· Specific work limitations are imposed
· Not well enough to perform any duties
In the case of limitations or total disability, the employee’s supervisor will be formally notified.
The Medical Department will also verify for the Payroll Department whether documentation has been received that substantiates the occurrence of an illness. Appropriate certification includes a written statement from a physician that clearly states the following:
· Diagnosis
· Prognosis
· Date of visit
· A medical confirmation that the employee was unable to work due to illness
· The period of absence covered by the illness
· The physician’s signature
This information is considered to be individually-identifiable medical information and is handled in accordance with Chapter 5330 of this Manual. Failure to provide written certification may result in the denial of sick leave, a subsequent loss of pay and disciplinary action.
Occupational Injury/Illness – Before an employee may return to work following a period of absence due to an occupational injury/illness, they must first be evaluated by the Medical Department. As with extended sick leave, the assessment will determine the employee’s level of fitness in one of three categories:
· Fit to perform all regularly-performed duties
· Specific work limitations are imposed
· Not well enough to perform any duties
In all cases subsequent to an occupational injury/illness, the employee’s supervisor will be formally notified regarding the results of the evaluation.
c. Health status change reviews
Long-term/Chronic conditions – Some employees develop potentially work-impacting health conditions without being in a work category that otherwise requires a review of fitness by the Medical Department. Examples include non-occupational problems of the back, joints, balance or consciousness, as well as the use of function-impairing medications.
Employees who develop such conditions are encouraged to report them to a medical professional in the Medical Department. This may be done by phone, e-mail, in person, etc. If an external health care professional has imposed specific work-related limitations or work impacts are already ongoing or imminent, employees are required to provide a status report to the Medical Department. In many cases, limitation of work activities may be necessary.
Reproduction - If a woman knows or suspects that she is pregnant, and has concerns about radiation exposure, she should refer to Article 951 in Fermilab’s Radiological Control Manual. Concerns about potential reproductive impacts from other occupational exposures can be addressed via an appointment with a medical professional in the Medical Department.
Occupational injury/illness – Following recovery from an occupational injury or illness, an employee may have residual limitations. This is accommodated to the extent possible.
d. Work activity change reviews
Permanent transfers – When a posted position is filled via internal transfer, Laboratory Services Section sends a notice to the Medical Department identifying the individual who filled the position. The supervisor for the newly-filled position then updates the WAAF of the employee. The Site Occupational Medicine Director (SOMD) reviews the WAAF in light of the information contained in the employee’s medical chart. In most cases, there is no need for additional follow up. Occasionally, the employee will be asked to talk or meet with the SOMD. Activity modifications are sometimes required.
Temporary transfers – Employees are occasionally given temporary assignments in other organizations or locations, and may perform work that differs from their usual jobs. A particular example of this is accelerator shutdowns where workers are often reassigned in large numbers. Supervisors and division/section ES&H personnel are encouraged to provide information regarding the details of temporary transfers to medical professionals in the Medical Department. Review of medical fitness and modification of activities are handled in a fashion similar to that used for permanent transfers (see above).
e. Impairment reviews
Employees may be observed behaving in a way that brings into question their ability to safely and/or effectively carry out the responsibilities of their assignment. If the behavior appears to be related to a health condition, medication or substance abuse, the Medical Department is available to assess the fitness of the employee to continue working.
3. Surveillance programs
a. Selection criteria - Senior Safety Officers (SSOs) designate employees who are participating in occupational medical surveillance programs. They are responsible for communicating the addition and removal of individuals to the Medical Department.
b. Required medical monitoring – The content and frequency of monitoring varies with surveillance group. However, the organs/systems most likely to be adversely affected are the subjects of review. There is typically a baseline exam prior to participation, periodic exams during participation, and a final exam upon termination of employment.
c. List of surveillance programs
i. ODH
ii. Hearing conservation
iii. Respiratory protection
iv. Laser
v. Lead
vi. Firefighter
vii. CDL
viii. Grit blasting
ix. Beryllium
x. Asbestos
xi. Pesticides
xii. Hazardous waste
4. Occupational injury/illness management
a. Emergencies – The onsite phone number to obtain help in any emergency is 3131. The call should be placed from a safe location. Be prepared to clearly identify the location and stay on the line until the operator no longer needs your assistance. In medical emergencies, expect that an ambulance will respond to the scene.
b. Transportation – Since most injuries/illnesses are minor in nature, transport of the patient is normally a simple matter.
c. Notification - Notification and investigation processes are described in chapter 3020 of this manual.
d. Evaluation – The SOMD is responsible for evaluating the nature and extent of occupational injuries/illnesses. This is accomplished through direct examination or through the efforts of other medical/health professionals.
e. Treatment – Minor procedures to repair damaged tissues, minimize discomfort, speed recovery or prevent future medical conditions may be administered onsite under the direction of the SOMD. These can include some kinds of inoculation, bandaging, bracing, splinting, wound cleaning/flushing, foreign object removal, use of cold packs, suturing or medications. Procedures to treat (potentially) serious conditions, as well as those requiring specialized skills or equipment are dealt with by referral to offsite providers.
f. Workers’ compensation – Fermilab manages its workers’ compensation program in accordance with the Illinois Workers’ Compensation Act (820 ILCS 305). Although we have an insurance company to administer our claims (Employers Insurance Company of Wausau), we are actually self-insured. That is, all costs are paid out of Fermilab’s overhead budget.
You should report all injuries/illnesses to the Medical Department that could potentially be work-related. If a case is (potentially) compensable, you will be given instructions on how to proceed.
5. Consultation – The Medical Department staff is available to advise workers on health issues that affect job performance. Here are examples of the kinds of consultation that are available:
a. Managers – Excessive employee sick leave use. Workers with medical conditions or chemical substance problems that may affect job performance or safety.
b. Workers – Concerns about (potential) workplace hazards or exposures. (Potential) impact(s) of work on pre-existing medical conditions.
c. ES&H – Management of occupational injury/illness cases. Adding/Removing workers from medical surveillance groups.
d. Personnel – Issues related to FMLA, EAP, ADA and LTD.
e. Payroll – Sick leave and workers’ compensation leave usage.