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Work Ability Screening for Pre-Placement /Post Offer Jobs
We offer a multi-step process based on your job descriptions.
Step One: Identify Essential Job Skills
Working with your management (usually Safety or HR Department), our staff will identify the essential job skills of your work force.
Step Two: Physical Exam
The employee will be given a physical exam by our experienced physicians. A review of systems will be done with emphasis on reviewing history to include previous occupations, sports activities, exposures, etc. as well as their medical history.
Step Three: Work Ability Screening
The employee performs a series of simulated jobs designed to measure the key elements of their routine activities as identified in your Job Task Analysis to include, but not limited to the following:
1. Lifting 2. Bending 3. Pulling 4. Pushing 5. Stooping 6. Twisting 7. Walking on incline 8. Climbing stairs 9. Fine motor skills coordination
The above will be measured against a set of predetermined standards for the identified jobs: for example a Work Ability Screening for a Truck Driver (delivery driver) might include:
1. Demonstrates lift/lifting technique
2. Climbing
3. Repetitive stooping
4. ROM (Range of Motion), Head/Neck, Extremities
Step Four: Validated Testing (if needed)
If the post offer applicant can not meet the screening criteria, then more extensive validated testing by a Physical Therapist would follow.
Note: All hiring and placement decisions are made by the company, not by the medical staff. The above tools are offered to assist in the decision making process. Work Assessment Screening
The company to which you applied is using physical ability tests to ensure that their workers are placed in jobs that they are physically capable of doing. Therefore, you will need to perform a series of tests so they can determine the jobs for which you may qualify. Each test will be explained to you in detail before you take it.
Health Questionnaire related to the Strength, Balance and Step Tests.
A physician must review any “yes” answers before beginning the testing.
Please circle the appropriate answer:
1. Are you presently restricted from lifting or pulling by any physician? YES NO
2. Have you recently had any surgery, which should limit your lifting or pulling? YES NO
3. Are you presently on any medical limitations by your employer or doctor? YES NO
4. Has your doctor ever said you have heart trouble? YES NO
5. Are you having back pain? YES NO
6. Do you have high blood pressure (greater than 140/90)? YES NO
7. Have you recently experienced chest discomfort with exertion or shortness of breath for no apparent reason? YES NO
8. Do you often feel faint or have spells of severe dizziness? YES NO
9. Have you ever has a blood clot? YES NO
If yes, where_____________________________When? ____________________ 10. Do you currently have an infection? YES NO
11. Do you currently have an uncontrolled metabolic disease (diabetes thyrotoxicosis, gout, myxedema, etc.) or serious disorder (mononucleosis, hepatitis, etc.)? YES NO
12. Has your doctor ever told you that you have a bone, joint or musculoskeletal problem, such as arthritis or sciatica, that has been made worse by exercise or are you currently under medical care for any bone, joint or musculoskeletal problem? YES NO
13. Are you currently taking any prescriptions or non-prescription medication? YES NO
If yes, what and when last taken? _____________________________________
14. Do you have asthma? YES NO If yes, are you on daily medication and if so, what and when last taken? ____________________________________________
15. Are you pregnant? YES NO
16. Is there a good physical reason not mentioned here why you should not perform these tests, even if you wanted to? YES NO
I understand the above questions and have answered them truthfully to the best of my knowledge. I feel physically able to perform the strength, balance and step tests.
Climbing Pass Fail
Individual climbs 10 steps up and 10 steps down in a maximum of 2 minutes.
Recommend individual leads with Left foot 5 steps, leads with Right foot 5 steps (not required).
Lift #1 Pass Fail
Individual lifts (20 pounds) from (10 inch) hand-level to (30 inch) hand-level.
Individual turns (90 degrees) while performing this lift.
Individual performs this task (6X) in a maximum of (5 minutes)
Individual performs this lift with Box.
Lift #2 Pass Fail
Individual reaches over (20 inch) partition in order to initiate lift.
Individual lifts (35 pounds) from (6 inch) hand-level to (30 inch) hand-level.
Individual turns 180 degrees while performing each of these lifts.
Individual performs this task (20X) in a maximum of (5 minutes).
Lift #3 Pass Fail
Individual lifts (35 pounds) from (30 inch) hand-level to (6 inch) hand-level.
Individual turns 180 degrees while performing each of these lifts.
Individual reaches over (20 inch) partition in order to complete lift.
Individual performs this task (20X ) in a maximum of (5 minutes).
Lift #4 Pass Fail
Individual initiates lift of (30 pounds) from (30 inch) hand-level position.
Individual turns 90 degrees.
Individual reaches over (20 inch) partition at end of lift.
Individual completes lift by placing weight at (6 inch) hand-level.
Individual performs this lift (15X) in a maximum of (4 minutes).
Above Shoulder Lift #1 Pass Fail
Individual lifts (50 pounds) from (36 inch) hand-level to (60 inch) Hand-level.
Individual performs this task (2X) in a maximum of (5 minutes).
5/10/04 Form # OM 602 (Work Ability Screening company specific)
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