Exams that survive an audit

49 CFR 391.41 and 391.43

A federal fitness-for-duty exam for commercial drivers, performed only by an examiner listed on the FMCSA National Registry. It is not a general health check, and passing it says nothing about your cholesterol.

• Driver's licence, glasses or contacts, and hearing aids if worn
• A complete list of medications with doses and the prescribing clinician
• Vision at least 20/40 in each eye with correction, plus 70 degrees of horizontal field
• Hearing: forced whisper at five feet, or an audiometric alternative
• Blood pressure below 140/90 for a full two-year certificate
• Urinalysis for protein, blood, sugar and specific gravity
• CPAP compliance download if you are treated for obstructive sleep apnoea

What you get back: MCSA-5875 examination report retained, MCSA-5876 medical examiner's certificate issued to you the same visit.

49 CFR Part 40 for DOT collections

DOT collections follow the federal custody and control form and the federal five-drug panel. Non-DOT collections follow your company policy, which can be broader.

• Photo identification, always
• DOT 5-panel: marijuana metabolites, cocaine, amphetamines, opioids and phencyclidine
• Non-DOT 10-panel adds barbiturates, benzodiazepines, methadone, methaqualone and propoxyphene
• Split specimen collection with temperature check within four minutes
• Evidential breath alcohol testing with a confirmation test after 15 minutes when the screen reads 0.02 or above
• Chain of custody signed by the collector and the donor

What you get back: Results released only to your designated employer representative or medical review officer, never to a supervisor who telephones.

OSHA 1910.134 Appendix C

Before an employee wears a respirator they must be medically cleared, because the equipment itself adds cardiac and respiratory load. Clearance is required before fit testing, not after.

• The Appendix C medical questionnaire, completed confidentially by the employee
• Spirometry where the questionnaire or job class indicates it
• Blood pressure and a focused cardiopulmonary examination
• Details of the respirator type, work rate, temperature and hours of expected use
• Qualitative fit testing with saccharin or Bitrex, or quantitative fit testing by particle count

What you get back: A written clearance stating whether the employee is cleared, cleared with restriction, or not cleared. The employer receives the conclusion, not the medical detail.

OSHA 1910.95 hearing conservation

Anyone exposed at or above an eight-hour time-weighted average of 85 decibels needs a baseline audiogram within six months, then an annual test.

• At least 14 hours away from workplace noise before the baseline test
• Otoscopic examination to exclude wax occlusion before testing
• Pure-tone air conduction thresholds at 500, 1000, 2000, 3000, 4000 and 6000 Hz
• Comparison against the baseline with age correction applied
• Standard threshold shift defined as an average change of 10 dB or more at 2000, 3000 and 4000 Hz in either ear

What you get back: Annual comparison report, employee notification within 21 days of any confirmed standard threshold shift, and a retest offer.

Oklahoma workers' compensation reporting

An injured employee is seen the same day, treated, imaged if needed, and sent back with restrictions written in language a supervisor can act on.

• Company authorisation form, or an email from a listed authorised sender
• What happened, when, and what the employee was doing at the time
• Post-accident drug screen if your policy requires it, collected in the same visit
• Mechanism detail for crush, chemical, electrical or eye injuries

What you get back: Treatment notes, work status report and first report of injury the same business day.

29 CFR 1904.7

The line between first aid and a recordable case is drawn by the treatment given, not by how bad the injury looked. We document which side of it we landed on, and why.

• First aid includes non-prescription medication at non-prescription strength, wound cleaning, bandages, hot or cold therapy and non-rigid support
• Recordable treatment includes sutures, staples, prescription medication, a rigid splint used for immobilisation, or removal of a foreign body from the eye with anything other than irrigation
• Any loss of consciousness, restricted work, job transfer or days away is recordable regardless of treatment

What you get back: A written clinical opinion with reasoning. The recording decision stays with the employer.

Employer policy and treating clinician judgement

Restrictions have to be specific enough to schedule. We write weights, hours, and the movements to avoid, with a review date rather than an open end.

• Maximum lift, push and pull in pounds, and how often
• Standing, walking and sitting tolerance in hours
• Specific prohibited movements: overhead reach, ladder work, kneeling, driving
• A named review date, usually 7 or 14 days

What you get back: A one-page work status report the employee carries out with them, plus a copy to your listed contact.

Written service agreement

One named coordinator, an authorised-sender list, protocols by job class and a signed rate sheet so invoices never surprise anyone.

• Authorised senders who may request services and receive results
• Protocols per job class: which exams, which panel, which forms
• Billing contact and purchase order handling
• Preferred clinic and after-hours escalation path

What you get back: A written service agreement, a rate sheet, and same business day reporting.