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Fitness for duty evaluation form

Fitness for duty form 2025

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The document is a 'Fitness for Duty Certification' form from the University of Texas Health Science Center at San Antonio, designed to assess an employee's physical capabilities and working conditions. It includes sections for supervisors to detail job requirements and for attending physicians to certify the employee's fitness to perform their duties, with options for full-time, part-time, or intermittent work and any necessary restrictions.

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Click ‘Get Form’ to open the fitness for duty certification in the editor.
Begin by filling in the employee's name, date of birth, job title, and department at the top of the form.
In Section I, assess the physical activities required for the job. Use the provided scale to indicate how often each activity is performed during a typical workday.
Proceed to Section II to evaluate repetitive hand/wrist activities. Again, mark the frequency of each activity as per your assessment.
In Section III, answer questions regarding working conditions. Provide descriptions where necessary to clarify any potential hazards.
Section IV requires you to describe physical skills and abilities such as vision and hearing acuity.
Complete Section V by indicating whether specific skills and abilities are required for the job role.
Use Section VI for any additional comments that may help clarify job requirements.
Finally, ensure both employee acknowledgment and supervisor signatures are completed in Sections VII and VIII before submitting.

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How do you assess fitness for duty?

By comparing their knowledge of the working environment and the specific demands of the occupation with their medical assessment of an individuals current mental, physical and medical capacity, they can identify any conditions that could make a person unfit for duty.

How to assess fitness for duty?

What Does a Fit-for-Duty Exam Consist of? A review of the employees medical history. A physical exam. An assessment of the employees mental and emotional state. A job analysis. A review of any relevant medical records or test results.

Why is it important to be fit for duty?

Employees who are not physically fit for their jobs are more likely to get injured, leading to costly compensation claims and downtime. Fit for Duty tests help prevent injuries by ensuring employees can handle the job demands without risking their health.

How do you assess fitness?

What Does a Fit-for-Duty Test Involve? Audiometric Testing. This test checks if your employees hearing is adequate to perform their job safely, especially in noisy environments. Vision Testing. Functional Testing. Respirator Medical Evaluation and Pulmonary Function Testing.

What are some ways to know if you are fit-for-duty?

Fitness for Duty. Medical evaluations under this Program are required in order for the Agency to determine if covered employees are physically and medically capable of performing the essential duties of the position efficiently and without posing a hazard to themselves or others.

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What is fit for duty?

What does fitness for duty mean? An employee is fit for duty when they are able to perform their essential job functions, with or without a reasonable accommodation, in a manner that does not pose a direct threat.