What is required for a work physical?

Requirements for a Work Physical Examination

A comprehensive work physical examination should include a medical history, physical examination, and specific functional assessments tailored to the job requirements, with particular focus on cardiovascular health, musculoskeletal function, and respiratory status.

Medical History Components

• Comprehensive medical and occupational history including work and exposure history, smoking history, and respiratory symptoms in relation to work 1
• Personal cardiovascular history including chest pain/discomfort related to exertion, unexplained syncope, excessive dyspnea/fatigue with exercise, and prior cardiac testing 2
• Family history of premature cardiac death, specific genetic cardiac conditions, and disability from heart disease in close relatives 2
• Detailed history of musculoskeletal injuries, particularly to upper extremities, back, and lower extremities that could affect standing tolerance and job performance 3
• Review of conditions that might affect balance, coordination, or dexterity required for job tasks 3

Physical Examination Components

Cardiovascular Assessment

• Blood pressure measurement in sitting position 2
• Heart rate and rhythm assessment, including orthostatic vital signs 2
• Comprehensive cardiovascular examination including heart auscultation with assessment of heart sounds and murmurs 2
• For workers over 45 (men) or 55 (women) years with multiple cardiovascular risk factors, consider exercise stress testing, especially if job requires moderate to heavy physical exertion 3

Respiratory Assessment

• Physical exam of the lungs and chest wall 1
• Baseline spirometry to assess pulmonary function, especially if worker will be required to wear respiratory PPE 3
• Evaluation for conditions that might interfere with proper respirator fit or use 3

Musculoskeletal Assessment

• Spine examination to evaluate for conditions that might limit prolonged standing or affect posture during work tasks 3
• Testing of lower extremity strength and joint stability to ensure standing tolerance 3
• Assessment of upper extremity strength and range of motion, particularly important for jobs requiring repetitive motions 3

Job-Specific Functional Testing

• Job-specific lifting assessment with materials up to the weight required by the position 3
• Evaluation of standing tolerance for prolonged periods if required by the job 3
• Assessment of worker's ability to recognize and respond to potential workplace hazards 3
• Evaluation of worker's understanding of proper body mechanics for lifting tasks 3

PPE Compatibility Assessment

• Evaluation of ability to wear and use required PPE properly, including respiratory protection 3
• Ensuring proper fit of any required respiratory protection, conducting fit testing if appropriate 3
• Documentation of any skin conditions that might be exacerbated by PPE use 3

Laboratory and Diagnostic Testing

• Spirometry testing for workers exposed to respiratory hazards or required to use respirators 1
• Resting 12-lead ECG when indicated based on cardiovascular risk factors 2
• Vision testing to ensure adequate visual acuity for job tasks, especially for detailed work 3
• Selective laboratory testing based on risk factors and job requirements 4

Risk Classification for Physical Exertion

• Classification of workers based on health status to determine appropriate level of physical exertion:
  • Class A: Apparently healthy individuals with no symptoms or known presence of heart disease 1
  • Class B: Individuals with known, stable cardiovascular disease with low risk for complications 1
• For apparently healthy individuals, no restrictions other than basic guidelines for physical activity 1

Common Pitfalls to Avoid

• Inadequate assessment of cardiovascular fitness for workers who may experience physical stress from prolonged standing 3
• Overlooking the importance of standing tolerance assessment for workers who must stand for extended periods 3
• Neglecting to assess compatibility between corrective eyewear and required safety equipment 3
• Failure to obtain informed consent before conducting physical examinations and testing 1
• Not considering the specific physical demands of the job when establishing fitness requirements 5

Documentation Requirements

• Written documentation of all findings and recommendations 4
• Development of a written plan with prioritized goals for addressing any identified health concerns 4
• Documentation of any work restrictions or accommodations needed 1
• Protection of worker confidentiality - providers must not disclose individual workers' personal health information to employers without employee consent 1