Employee Medical Monitoring Program
Examination Protocols
Comprehensive Medical Examination
Identifiers
Name, birth date, gender, job title, department, etc.
Personal medical history
- Medications
- Allergies
- Illness, injuries, hospitalizations, surgeries
- Smoking, alcohol, drug histories
- Medical conditions-specifically lung disease, heart disease, liver disease, skin conditions, neurological condition
Family medical history
specifically cancers and lung, heart, liver, kidneys or neurological diseases
General Appearance and Physical Development and Posture
Height and weight are recorded.
Head-Eyes
Titimus vision testing including near, far, color vision and depth, lateral phoria, esophoric, exphoric and vertical phoria (right and left hemisphere) and peripheral vision. Also noting ptosis, discharge, visual fields, ocular muscle imbalance, presence of corneal scarring, exophthalomos or srabismus uncorrected by corrective lenses. If the applicant wears contact lenses, it will be noted whether they have good tolerance and has adapted to their use. All vision testing is done without corrective lenses and then with the corrective lenses. This is done in order to determine a baseline vision as well as effectiveness of corrective lenses. Note that certain positions do not allow the use of contact lenses.
Ears
Audiometric tests shall be pure tone, air conduction, hearing threshold examinations with test frequencies including as a minimum, 500,1000, 2000, 3000, 4000 and 6000 Hz. Tests at each frequency shall be taken separately for each ear. Audiometric screening should meet specifications of, and be maintained and used in accordance with ANSI, S 3.6-1969. Audiometry testing room should meet the requirements for maximum allowable octave-band sound pressure levels for audiometric test rooms. In addition, audiometric calibration should be checked acoustically on an annual basis according to Title 8 California Code of Regulations, Section 5097 Appendix D. Ear examination also includes noting any evidence of mastoid or middle ear disease, discharge symptoms of aural vertigo or Meniere’s Syndrome.
Throat
Examination includes detection of any deformities of the throat, larynx, masses or nodes which may interfere with normal breathing and eating.
Heart
Auscultation by stethoscope for heart sounds, presence of murmurs, clicks, rubs, additional heart sounds and dysrhythmias. PMI will be ascertained and full cardiac history is obtained for symptoms such as dyspnea, palpitations, syncope. Blood pressure determinations are also made.
Pulmonary
Examination of lungs and thoracic area. Breath sounds are examined specifically noting any signs of chronic obstructive pulmonary disease, congestive heart failure and history of lung disease like asthma or bronchitis.
Gastrointestinal System
Complete history, and current signs and symptoms will be noted. Noting will be made specifically for presence of hernia, scars, weakness or injuries, location, size and character of any abdominal masses. Bowl sounds will also be noted. A rectal examination with stool guaiac will be obtained on all male employees over 50 years of age.
Genitourinary
Examination for presence of infection or other abnormal findings including urinalysis (noting uncontrolled diabetes, presence of albumin).
Neurological
Examination includes pupil reflexes for light and accommodation, sensory, vibratory and positional movements.
Extremities
Close examination of all extremities for color, warmth, presence of peripheral pulses and skin tugor. Any deformities, paralysis or varicose veins and leg muscle weakness will be documented.
Spine
History of pain, injuries, and physical examination for deformities will be performed.
Additional Tests as Required
Resting 12-lead Electrocardiogram
Electrocardiograms will be read by a Board Certified Cardiologist.
Treadmill EKG or MASTER STEP TEST
Pulmonary Function Testing
To include (at the discretion of the examining physician):
- FVC- Forced Vital Capacity
- FEV 1.0-Forced Expired Volume in one second
- FEV 3.0-Forced Expired Volume in three seconds
- FEF 25-75 - Forced Expiratory flow
- RV - Residual Volume
Results of pulmonary function testing are calibrated in prediction-equations. Degree of respiratory impairment is assessed. Some obstructive diseases that may be associated with abnormal findings include: chronic bronchitis, asthma and emphysema. Restrictive diseases like pleural thickening, pulmonary fibrosis and congestive heart failure are associated with other abnormalities found in pulmonary function testing. All pulmonary function testing equipment must be approved by the American Thoracic Society and the operators must be certified by NIOSH (National Institute for Occupational Safety and Health).
Audiometric Testing
Audiometric tests shall be pure tone, air conduction, hearing threshold examinations with test frequencies including as a minimum, 500,1000, 2000, 3000, 4000 and 6000 Hz. Tests at each frequency shall be taken separately for each ear. Audiometric screening should meet specifications of, and be maintained and used in accordance with ANSI, S 3.6-1969. Audiometry testing room should meet the requirements for maximum allowable octave-band sound pressure levels for audiometric test rooms. In addition, audiometric calibration should be checked acoustically on an annual basis according to Title 8 California Code of Regulations, Section 5097 Appendix D. Ear examination also includes noting any evidence of mastoid or middle ear disease, discharge symptoms of aural vertigo or Meniere’s Syndrome.
Complete Blood Count (RBC, Hgb, HCT, WBC, differential)
Blood Chemistry Panel, Requiring the following tests
- Glucose
- Sodium
- Potassium
- Chloride
- Creatinine
- BUN
- Phosphate
- Uric acid
- Cholesterol
- Total protein
- Calcium
- Globulin
- Triglycerides
- Albumin
- Total Bilirubin
- Alkaline Phosphatase
- G-Glutamyl Transpep
- Transaminase (AST ALT)
- LDH
- Sickle Cell Index
All laboratory testing is performed by a CLIA approved and licensed clinical laboratory.
Chest X-Rays
Posterior / anterior view x-rays. Radiologist interpretation should be done by a Board Certified Radiologist. For employees with potential asbestos exposure, Certified “B” readers will interpret x-rays.
Urinalysis (with Microscopy) to test for:
- Specific Gravity pH
- Acetone Protein
- Albumin Glucose
Biological Monitoring for Lead
- Blood lead level
- Hemoglobin and hematocrit, red cell indices and peripheral smear morphology
- Zinc protoporphyrin (ZPP)
- Blood Urea nitrogen and creatinine
Red blood cell and Plasma Cholinesterase Tests
Stool Specimen
Submitted for culture and examination for OVA and parasites.