Fitness for Duty Exams—A Powerful Tool to Offer Employers

Fitness for Duty Exams

—A Powerful Tool to Offer Employers

By David J. Fletcher, MD

SafeWorks Illinois

The Fitness for Duty  (FFD) exam is often an under-utilized service many occupational health programs do not educate their clients enough on the benefits of an exam of this caliber. FFD exams are medical evaluations used to determine if an employee can perform the essential functions of a job, without risking injury to themselves or other co-workers. FFD exams are also used as a“Return to Work Evaluation” after employees have been off work, due to a nonwork or work-related condition or illness.

When to Do a Fitness for Duty Evaluation

  • When an employee is off work for more than five days
  • During a job transfer to determine whether they can meet the essential job functions of the new position
  • If an employee has a physical or mental medical condition, which could affect job performance
  • Reasonable cause situations with indicators of impaired job performance

Often after an illness or injury, a personal physician will release their patient back to work because the patient requests to return to work, even when their illness or injury has not completely resolved and poses a risk in the workplace. The ill or injured employee will want to return to work for economic reasons. The Premature release to work may be inappropriate because the treating physician will not know the physical demands of the job and the workplace environment. Suddenly, a non-work-related issue is turned into a work-related problem. An FFD exam protects the employer from such risk.

The FFD Exam Process

The occupational health professional who conducts an FFD exam must have thorough knowledge of the job to properly determine an employee’s ability to meet the physical demands of the job. The FFD exam process has many steps:

1. Outline the ground rules to the patient on the confidentiality of information shared with the employer.

2. Review pertinent medical records.

3. Conduct a thorough physical examination.

4. Evaluate the diagnosis to determine if it is a correct assessment of the employee’s physical or mental condition.

5. Collect information regarding the job requirements and compare it to the individual’s physical ability to protect them from worsening their condition.

6. Access the State’s PrescriptionMonitoring Program (PMP)system (if applicable) to determine if any employee is taking a controlled substance.

7. Consider drug and alcohol screening, if appropriate.

8. Conduct additional testing, such as functional capacity evaluation(FCE) or neuropsychological (NP)testing if the situation dictates. Unless the employee signs a written release that authorizes the release of the comprehensive FFD report, the only written communication an occupational health provider can release is whether the employee is fit for duty, conditionally fit for duty, or not fit for duty.

FFD Exams for Trucking Companies

FFD examinations for trucking companies are a service line that OHS programs should aggressively market. Many trucking companies are not educated about the requirements of 49

C.F.R §391.45c mandates fitness-for-duty evaluations on drivers who develop medical issues in between their periodic medical certification exams. A recent court case in Kentucky

That resulted in a fatality illustrating this widespread ignorance about continuously monitoring commercial drivers’ health. The defendant trucking company argued their driver was medically qualified on the day of the fatal accident despite the driver’s deteriorating vision because he had a current medical certificate. The defendant trucking

company maintained 49 C.F.R §391.41establishes a driver need only be ‘physically qualified to operate a commercial motor vehicle at the time of a medical examination. Thereafter, it was the apparent position of the defendant trucking company that the driver’s physical well-being was not material until the expiration date displayed on the medical certificate. The court ruled this position defies the spirit and letter of the FMCS Regulations.49 C.F.R §391.45 that imposes a continued

obligation upon commercial motor vehicle drivers to seek medical examination and certification:

“The following persons must be medically examined and certified as physically qualified to operate a commercial motor vehicle:

(a) Any person who has not been medically examined and certified as physically qualified to operate a commercial motor vehicle;

(b)(1) Any driver who has not been medically examined and certified as qualified to operate a commercial motor vehicle during the preceding 24 months.

(c) Any driver whose ability to perform his/her normal duties has been impaired by a physical or mental injury or disease; AND

(d) Beginning June 22, 2018, a person found by a medical examiner not to be physically qualified to operate a commercial motor vehicle.

49 C.F.R §391.45. The use of the word ‘and’ makes it clear the 24-month period in which a medical examiner’s certificate is typically valid does not defeat or limit a driver’s continuing obligation to be physically qualified to operate a commercial motor vehicle and the ongoing responsibility of the trucking company to only place medically qualified drivers on the road.

In this case, the trucking company failed to send this driver for an FFD exam when he had missed work and did not investigate the reasons behind his absence. If the trucking company had conducted a 391.45c FFD exam, they would have uncovered an eye problem that rendered the driver unfit to drive.


FFD exams are an important, complex service line for OHS programs that provide tremendous value for employers. In Addition to a physical exam, an FFD exam requires a detailed review of medical records. Depending on the situation, conferring with a treating physician, functional capacity testing, cardiovascular stress testing, drug and alcohol testing, job site analysis, and other specialized testing can be utilized to make an accurate assessment. The pricing for the services varies on the complexity of the issue the evaluating provider is asked to access, and it may require several visits or additional testing to complete. Since most OF exams are for non-work-related issues, the examiner must pay attention to HIPAA-protected health information and obtain a written release from the patient before releasing any confidential medical information to the company.

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