Fitness-For-Duty



Medical Qualification Policy

for

________________________

(Name of Transit System

I. Overview and Policy Statement:

___________________ Transit System is committed to providing a safe working environment and to protect the health and safety of customers, the public, staff, visitors, and transit property. Employees of Indiana transit systems must report for their safety-sensitive job duties “fit for duty,” or for the purposes of this policy, “medically qualified.” This policy establishes a mechanism for identifying and intervening when an employee may pose a threat to him or herself, the safety of others, or property and assesses an employee’s “medical qualification” as it relates to the performance of safety-sensitive job functions.

Safety-sensitive applicants and employees are required, as legally appropriate and as permitted under the Americans with Disabilities Act, to comply with the Medical Qualification program and assessments.

II. Definitions:

Medical Qualification: The physical and cognitive health status that facilitates the performance of essential job functions in a safe and effective manner, protecting the health and safety of oneself, others, and property.

Cognitive Health: The brain-based skills needed to carry out any task from the simplest to the most complex. Cognitive abilities have more to do with the mechanisms of how an individual learns, remembers, problem-solves, and pay attentions rather than with any actual knowledge.

Physical Health: The overall condition of an individual at a given time, the soundness of the body, freedom from disease or abnormality, and the condition of optimal well-being.

Safety- Sensitive Position: A job with duties that include responsibility for the employee's own or other people's safety.

Safety-Sensitive Function[1]: Any of the following duties, when performed by employees of recipients, sub-recipients, operators, or contractors:

(1) Operating a revenue service vehicle, including when not in revenue service;

(2) Operating a nonrevenue service vehicle, when required to be operated by a holder of a Commercial Driver’s License;

(3) Controlling dispatch or movement of a revenue service vehicle;

(4) Maintaining (including repairs, overhaul and rebuilding) a revenue service vehicle or equipment used in revenue service. This section does not apply to the following: an employer who receives funding under 49 U.S.C. 5307 or 5309, is in an area less than 200,000 in population, and contracts out such services; or an employer who receives funding under 49 U.S.C. 5311 and contracts out such services;

(5) Carrying a firearm for security purposes.

Medical Qualification Assessment: A physical examination performed by the ___________________ Transit System’s Medical Determination Officer (MDO), including but not limited to a health history, physical and/or psychological examination, and any medically indicated diagnostic studies, including blood tests.

Medical Qualification Determination: A determination made by the MDO attesting to an employee’s medical qualification in any of the situations described following an extended medical absence or management-required medical qualification assessment. Allowable costs to obtain the certification may be paid by Workers’ Compensation for work-related injuries by the employee’s health insurance, the employee, or the employer depending on the circumstances that led up to the medical qualification assessment and the outcome of the assessment.

Medical Determination Officer (MDO): A medical professional under contract to the ________________ Transit System that performs a variety of medical services including, but not limited to, physical examination services/medical qualification assessments for all safety-sensitive transit positions in accordance with State and Federal requirements and applicable transit system policies including Medical Qualification, RX/OTC and Substance Abuse Policies. As such, the MDO provides a written recommendation for an applicant’s ability to perform the essential duties of a safety-sensitive job.

Reliable Report: Observations by a manager/supervisor to assess an employee’s medical qualification, taking into consideration such factors as direct observation of the employee’s appearance, behavior, and work performance, interactions with other employees, and/or other verifiable reports of the employee’s behavior or condition.

Reportable Accident:

A fatality confirmed within 30 days of the event

•   An injury requiring immediate medical attention away from the scene for one or more person

•   Property damage equal to or exceeding $25,000

•   Collisions involving transit revenue vehicles that require towing away from the scene for a transit roadway vehicle or other non-transit roadway vehicle

•   An evacuation for life safety reasons

Working Hours: All time, from the time an employee begins to work or is required to be in readiness to work (on duty or on call) until the time he/she is relieved from work and all responsibility for performing work. All work activities are included whether these activities occur on or off transit property.

III. Medical Qualification Responsibilities

Transit employees and management share responsibilities for ensuring that individuals are medically qualified to perform and, therefore, ensure the safety of ________________ Transit System’s employees and passengers. Specific responsibilities for each are detailed below.

A. Employee Responsibilities

Employees of __________ Transit System must:

▪ Be medically qualified to report to work;

▪ Notifying the manager/supervisor when the employee him/herself does not meet the medical qualification requirement;

▪ Notifying the manager/supervisor of any concerns in the workplace which may impact an employee’s medical qualification. (Note: In cases where concerns involve the employee’s manager, the employee should make the notification to the next higher level manager); and

▪ Cooperating with a manager/supervisor’s directive and/or referral for a medical qualification assessment.

B. Manager/Supervisor Responsibilities

Managers/Supervisors of _________________ Transit System are responsible for:

Observing the attendance, performance, and behavior of the employees they supervise;

▪ Interviewing an employee who appears to the manager/supervisor as medically unqualified and, therefore, unfit for duty and referring that employee to the MDO for a medical qualification assessment, when appropriate;

▪ Recording the reasons/observations that triggered a medical qualification assessment referral on a Medical Qualification Referral form;

▪ Following appropriate leave and disciplinary policies, when appropriate; and

▪ Enforcing this policy in a fair and consistent manner, respecting the employee’s privacy and the confidentiality of medical information.

C. Medical Determination Officer (MDO) Responsibilities

The Medical Determination Officer (MDO) is responsible for:

▪ Conducting physical examination services/medical qualification assessments for all safety-sensitive transit applicants and employees, including the request and review of laboratory tests, in accordance with State and Federal requirements and applicable transit system policies including Medical Qualification, Substance Abuse, and Prescription and Over-the-Counter Medications;

▪ Making medical qualification determinations, as applicable and providing written reports of all such assessments and determinations;

▪ Reviewing health history information collected for all safety-sensitive position applicants and all safety-sensitive employees to issue a determination about an individual’s physical qualifications and ability to perform transit-related safety-sensitive functions pursuant to State and Federal requirements and applicable transit system policies including Medical Qualification, Substance Abuse and Prescription and Over-the-Counter (Rx/OTC) Medications; and

▪ Providing a written recommendation on an applicant’s or employee’s ability to perform the essential functions of a job based upon a review of a physical capabilities examination or assessment exercise.

IV. Conducting Medical Qualification Assessments

Medical qualification assessments will be conducted for all safety-sensitive employees or applicants for safety-sensitive positions in the following circumstances:

A. As a requirement of the hiring process.

B. As a requirement of the biannual medical qualification assessment.

C. Upon returning to duty from absences as defined below.

D. Following a triggering event, as defined by this Policy and other applicable ________________________ Transit System policies.

E. In special circumstances, as required.

A. Hiring and Employment Qualifications

Applicants and existing employees must meet the qualifications detailed in the safety-sensitive job description for the applicable position in order to be considered for and/or maintain a safety-sensitive position with ____________________ Transit System.

B. Biannual Medical Qualification Assessments

All safety-sensitive transit employees are expected to continue to meet all of the Medical Qualification requirements established at the time of their hire (see Section A above) and to undergo a biannual medical qualification assessment, and at other times as established by this policy.

C. Return to Active Status

Employees must undergo a medical qualification assessment by the MDO following return to active status in the following situations:

▪ Before returning to work from a non-occupational medical leave of 30 calendar days or longer;

▪ Before returning to work from a serious non-occupational injury or illness requiring hospitalization; and

▪ Before returning to work if employee experienced a medical episode that suggests serious safety risk such as chest pains, loss of consciousness, dizziness, blurry vision, temporary paralysis, extremely elevated blood pressure, suspected heart attack, etc.

The MDO may consult with the treating physician to obtain additional information, as necessary. The system’s MDO will be the ultimate determining factor in an employee’s medical qualification and return to active status. The MDO also determines whether or not the employee can perform essential functions of the job with or without reasonable accommodations. The manager/supervisor provides, and the employee utilizes, reasonable accommodations, if applicable. If none apply and the employee is not approved to return to active status, the manager/supervisor will then inform the employee of his or her options in accordance with the system’s medical leave policy. Accommodations that result in an undue financial burden to the transit system will not be approved.

D. Triggering Events

A triggering event requires that an employee undergo a medical qualification assessment by the MDO. Triggering events include 1. a qualifying accident (see definition below), 2. self-referral, and 3. observations (reliable reports).

1. For purposes of this policy, a qualifying accident is one which meets the National Transit Database definition of a “reportable accident.” Qualifying accidents will be investigated and documented in accordance with the _____________________ Transit System’s Post Accident Investigation Procedures (see Exhibit B).

2. Employees have a responsibility to request a medical qualification assessment any time they believe their performance of safety-sensitive job functions may be compromised, either from a medical condition, as a result of taking Prescription or Over-the-Counter Medications (Rx/OTC), or any other condition or event that has the potential to impact the safe performance of their job duties.

3. “Observations” (reliable reports) addresses issues including, but not limited to, an employee’s manual dexterity, coordination, alertness, speech, vision acuity, concentration, response to criticism, interactions with co-workers and supervisors, suicidal or threatening statements, change in personal hygiene, presence of condition likely to lead to foodborne disease transmission, memory and/or odor of alcohol, marijuana, or other substance of concern. Observations must be made by a manager/supervisor, or if by another employee, verified by a manager/supervisor.

In cases of triggering events, the following steps must be followed:

▪ The manager/supervisor immediately assesses the risk and, if applicable, removes the employee from safety-sensitive duty;

▪ The employee is sent to the MDO for a medical qualification assessment; and

▪ In the event of a qualifying accident, the employee will be immediately subject to a medical qualification assessment and FTA substance abuse testing, including an expanded opiates panel under the transit system’s own authority, as identified in the _________________ Transit System’s substance abuse policy and/or Rx/OTC medication policy.

Special Circumstances

The _________________________ Transit System reserves the right to request a medical qualification assessment as a result of special circumstances, to be determined on a case-by-case basis.

V. Documenting Risk Assessments

In the cases of qualifying accidents, the employee is immediately referred to the MDO for a medical qualification assessment. In other triggering events, Managers/Supervisors must assess the risk and document each individual triggering event.

▪ No risk: Keep notes of the event.

▪ Minor risk: Remove the employee from safety-sensitive duty, and encourage the employee to seek medical treatment or use the Employee Assistance Program. Document the event.

▪ Significant risk:

o Remove the employee from safety-sensitive duty, refer to the MDO for immediate medical qualification assessment, and, as applicable, place the employee on paid leave of absence (sick leave or paid administrative leave, in accordance with the system’s leave policies;

o Arrange for the employee’s safe transportation home or to a medical facility, as the situation warrants;

o Refer the employee for medical qualification assessment or to the Employee Assistance Program; and

o Implement discipline, in accordance with the system’s discipline policies.

o Contact local law enforcement, as appropriate.

VI. Medical Qualification Referrals

Medical qualification referrals are either self-referrals by the employee or referrals made by the manager/supervisor.

▪ Employees voluntarily seeking assistance (i.e., self-referral) for physical or cognitive impairments (including impairments resulting from use of a controlled substance, drug and alcohol abuse/addictions, side effects resulting from legally prescribed or purchased Rx/OTC medications in accordance with the ______________________ Transit System’s established Rx/OTC Medication Policy), mental, and/or emotional problems before their work performance or attendance is adversely impacted will be eligible for leave in accordance with the system’s established policies. Self-referral, does not exempt an employee from disciplinary action for work performance or safety infractions, if such action is warranted.

▪ In instances where management makes a mandatory medical qualification assessment referral, employees must cooperate with the assessment. Failure to cooperate will result in immediate medical disqualification and discipline in accordance with the ________________________ Transit System’s discipline policy.

▪ Employees cooperating in a medical qualification assessment and determined to have successfully complied with recommendations for medical, psychological, and/or chemical dependence treatment may be returned to the job with an appropriate Medical Qualification determination provided appropriate discipline, if warranted, has taken place.

▪ Employees posing a significant safety risk may be medically disqualified from performing safety-sensitive duties and, as such, their safety-sensitive employment status may be medically disqualified indefinitely.

VII. Appeals Procedure

In instances where an employee believes the medical determination rendered has incorrectly disqualified him or her from performing safety-sensitive duties, an appeals procedure has been established as follows.

Overview:

The Medical Qualification Program has integrated procedures to ensure a thorough review of the employee’s health status, increasing the accuracy of the Medical Qualification Determination.

______________ transit system has established this Medical Qualification Determination Appeals Procedure to ensure an objective review of the facts related to a disputed medical qualification determination of a safety-sensitive transit employee.

As established in the _________________ transit system’s adopted Medical Qualification Policy, applicants and employees must be able to perform essential safety-sensitive position functions. The following actions will be taken during the initial Medical Qualification Assessment to ensure the objective review of facts:

▪ All medical qualification assessments will be reviewed by the Medical Determination Officer (MDO).

▪ The MDO will request and review laboratory tests, in accordance with Indiana Code 20-9.1-3-1 and applicable transit system policies including but not limited to Medical Qualification, Substance Abuse, and Prescription and Over-the-Counter Medications.

▪ The MDO will review health history information for all safety-sensitive applicants and employees.

▪ The MDO will consult with treating physicians to obtain additional information, as necessary.

▪ The MDO will provide a written report of all Medical Qualification assessments and determinations to the _______________ transit system.

______________ transit system will take the following actions in the event a safety-sensitive employee is determined to be medically unqualified:

▪ Notify the applicant or employee of his or her Medical Qualification status.

▪ Evaluate and determine if the system has an alternate position available to provide the employee with a reasonable accommodation.

▪ Inform the employee of his or her options in accordance with the system’s medical leave policy.

▪ Enforce the medical determination in accordance with the system’s established policy.

Safety-sensitive employees have the right to appeal a medical determination. Safety-sensitive employees appealing a medical determination must complete the following:

• Submit a written notice of appeal and request for review of the medical determination to _______________(System CEO) not more than 30 days after the medical determination is rendered.

• Submit documentation to support the request for appeal with the written notice of appeal.

_____________ transit system will acknowledge the appeal request and/or the request for direct observation evaluation in writing to the safety-sensitive employee no later than five (5) days from receipt of the request and will forward this request to the MDO for review and determination.

The MDO will review the appeal request and any supporting documentation. During this review, the MDO may request additional medical testing and/or clarification or further explanation of supporting documentation.

The MDO will render a written decision within 30 days of receipt of the review request or in cases where additional testing or information is requested, 30 days from the receipt of requested information, to the transit system. The transit system will notify the employee of the MDO’s appeal decision in writing within five (5) days of receipt of the information from the MDO.

Safety-sensitive employees have the right to prove functional capability to effectively perform all safety-sensitive job functions associated with their position. Safety-sensitive employees requesting to demonstrate their performance of safety-sensitive job functions bear the burden of proof and must:

• Submit a written request for a job function capability evaluation to __________ (System CEO) no later than 30 days after the medical determination was rendered.

_____________Transit System will acknowledge the functionality capability request in writing to the safety-sensitive employee no later than five (5) days from receipt of the request. A functionality capability evaluation of the employee’s qualification to perform safety-sensitive duties will be performed within ten (10) days from the receipt of the written request. The evaluation will be performed in a controlled environment by a team determined by the MDO and consisting of: a Physical Therapist, a Medical Practitioner, and an INDOT Passenger Assistance Trainer. The cost of the evaluation will be borne by ___________________________.

The MDO will render a written decision to the transit system within thirty (30) days of receipt of the functionality capability evaluation report or in cases where additional testing or information is requested, thirty (30) days from the receipt of the requested information. The transit system will notify the employee of the MDO’s decision within five (5) days from the receipt of the MDO’s decision.

The MDO’s decision is final.

There are some conditions or factors that may be revealed during the physical exam that could prevent a driver from obtaining the required medical qualification. Those conditions include:

➢ Sleep apnea

➢ Loss of limb or limb impairment

➢ Diabetes

➢ Cardiovascular condition

➢ Hypertension

➢ Respiratory dysfunction

➢ Rheumatic, arthritic, orthopedic, muscular, neuromuscular, or vascular disease

The waiver processes and disqualification criteria for individuals diagnosed with these conditions should follow the DOT standard for Commercial Driver License (CDL) holders and a process that mirrors the DOT standard should be used for Public Passenger Chauffeur operators. The Bureau of Motor Vehicle (BMV) form 54750 Request for Driving Ability Review form for those PPC operators may be completed by the MDO and submitted to the BMV.

For CDL operators, the Federal or State Bureau of Motor Vehicles waiver process must be utilized as prescribed in 49 CFR Part 391.

This Medical Qualification Policy is effective as of (insert date policy effective date).

Supplemental Policies:

I. Prescription and Over-the-Counter (Rx/OTC) Medication Policy

Exhibits

A-Prescription and Over-the-Counter Medication Information Form

B-Post Accident Investigation Procedures and Forms

D-Safety-Sensitive Job Descriptions

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[1] USSDOT Federal Motor Carrier Regulations, §382.107

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