Assessing fitness to work:

Work (Workplace hazards) Health (disease management) and Health (Pre-existing medical
conditions)  Work
- Safety of himself, co-workers, to general public
Performance
(1) Job
(2) Diseases
(3) Hazards

History:
Exact nature of work: Work environment, Work process, Work tools
Work requirements
Need to operate heavy machinery
Need to climb high/remain in position for long hours
Shift work
Exposure to hazards – pollutants/noise
Clarify other commorbids/disabilities

E.g. IHD – presumed stable, but need to clarify anginal symptoms, risk of reinfarction.
DM – glycemic control, complications, treatment regime (OHGA)
HTN – treatment regime and complications
SOB – etiology ?resp/cardiac/angina-equivalent sx. Possible exposure

PE:
Vitals, VA and colour perception (DM/HTN). Hearing. Neuromusclular sx – ROM, Power.
AMT – Cognitive function for older patients. Full PE – abdo/resp/cardio.

Investigation

Certify fit/unfit/fit with job modifications/fit for redeployment for other areas
- Unfit for this particular job
- State duration and basis
- Explain reasons for certifying unfit
o Protect interests of patient/ensure safety of the others
Complete certificate of suspension

Assessing fitness to drive:

SMA second edition – medical guidelines on fitness to drive
UK guidelines

Return to work

To ensure that worker is fit to resume work

To assist those who are not fit to work assimilate to another workforce if possible
Principles:
(1) Effect on the worker: Long term effect of the disease, nature of job, recurrence of
disease/aggravate the disease
(2) Effect on colleagues: cause damage or ill health to other co-workers
(3) Effect on public: infection control etc.
Stakeholders: (1) Worker – return to work at the right time and ASAP can assist recovery.
Undue delay can aggravate sense of uselessness and isolation + issues with job security (2)
Worker’s doctor (3) Employer (4) Occ health practitioner

Outcomes:
(1) Fit
(2) Fit with restriction
(3) Return to work on trial basis
(4) Redeploy to another job
(5) Unfit

- Physical requirement of the work (Use MET to decide)

- Physical work accommodation – work environment/work station
- Organisational work accommodation – flexible working hours/frequent breaks/job sharing

Specialised examination – assessed by PT/OT

AMA guidelines to evaluation of permanent impairment

If not fit:
- Refer to structured rehab programme
- Collaborate with employers
- Recommend for medical retirement if options are exhausted

Referral to RTW services indications:

(1) Work man compensation cases
(2) Intention to return to work