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Fact Sheet: The Value of Pre-Employment Medical Screenings

A candidate’s ability to perform the physical demands of a position they have been offered is essential information for hiring decisions. Not knowing this information can leave the employee or a resident injured and lead to costly claims. In accordance with the Equal Employment Opportunity Commission and the Americans with Disabilities Act, as Amended (ADAA), pre-placement screenings must be conducted after the job offer has been made. And as a general but obviously limited statement, the ADAA prohibits employers from discriminating against individuals with disabilities and also requires employers to make reasonable accommodations when it will allow an individual to otherwise perform the essential duties of the job.


Fit for duty medical screenings serve a different purpose than physical examinations. A physical examination looks to identify acute and chronic health issues that may negatively influence an individual’s overall wellness, either short or long term. A fit for duty screening, on the other hand, focuses on an individual’s ability to perform the physical demands of the job he or she is being hired to do. This type of screening is very specific to the job duties and hones in on the physical demands of the job.


Here’s an example of a physical examination: A candidate with a history of diabetes who has occasional diabetic reactions resulting in their short-term (30 minute – 1 hour) incapacity asks the employer to allow him to:

    • Check his glucose level twice per day.
    • Provide a refrigerator where he can store orange juice should his blood sugar fall too low.
    • And, in situations where the employee may be found incapacitated, the employer calls emergency medical services for assistance.

In most cases, the employee’s request for accommodation would be considered reasonable and the individual considered medically qualified for hire.


Now, let’s take this scenario one step further. Let’s say this same candidate was hit by a car sometime in the past and has permanent limitations and activity restrictions:

  • No lifting over 10 pounds.
  • No far-forward reaching.


Let’s say this candidate is applying for a direct patient care role. This role requires the worker to:

  • Turn and reposition patients, requiring the ability to lift up to 50 pounds without assistance.
  • Transfer physically dependent patients from their beds to wheelchairs or assist them with ambulation.
  • Assist the patient with activities of daily living (ADLs), such as: bathing/showering, teeth-brushing, feeding, combing hair and dressing.
  • Assist in the evacuation of patients from the facility in the event of an emergency.


As an employer begins to evaluate how to accommodate these restrictions, considerations include:

  • The primary purpose of this role, which is to deliver ADLs and physically assist patients. This ability is an essential function.
  • The shortage of workers in the industry, which often leaves the facility with less staff than they desire, placing greater demands on current workers.


While the candidate may be able to perform some of the duties of the position, they are unable to perform many of the physical requirements that are essential to a direct caregiver role.

In comparing the two scenarios, the chronic disease, diabetes, does not limit the candidate’s ability to perform the duties of the job, while the second medical condition does. In the second situation, the candidate would not be medically fit for the job.


Note: GuideOne Insurance Loss Control services are for insurance purposes only to assist its staff in the underwriting process. GuideOne Insurance does not warrant or represent that its Loss Control services detect all hazards or potentially harmful conditions, and any remedial or corrective recommendations are not intended as a warranty of compliance with any laws, regulations or standards.


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