Fitness to workGuidance for company and contractor health, HSE and HR professionals

Health2011

The global oil and gas industry association for environmental and social issues

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International Association of Oil & Gas Producers

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OGP Report Number 470

Fitness to workGuidance for company and contractor health, HSE and HR professionals

Photographs reproduced courtesy of the following: front cover (bottom) and page 1: Photos.com; front cover (top) andpages 3, 7, 13, 14 and page 19 (right): Shutterstock.com; pages 6, 10, 11 and 19 (left): Halim Mohamed (Shell).

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ii

FITNESS TO WORK

Contents

Purpose of this guidance 1

Introduction 1

Definition 2

Why fitness to work? 2

Roles and responsibilities 3

Principles of a fitness to work process 4

Designing a fitness to work process 4

The fitness to work risk assessment 5

Key questions arising from the risk assessment 5

Assessing tasks or activities for specificdemands or safety-critical impact 5

Fitness to work as part of an overall risk management process 6

Control options 7

Medical examinations for fitness to work 7

Functional capacity evaluation 10

Trade testing 11

Using different tests together 11

The outcome of fitness to work evaluations 12

The consequences of fitness to workevaluations 12

Legal assessment 13

Implementing a fitness to work programme 15

Appendix 1Test combinations for selected positions 16

Appendix 2Examples of medical screening protocols 17

Appendix 3Examples of functional capacity evaluation protocols 19

Appendix 4Special considerations for selected positions and tasks 20

References 21

Glossary 21

This guide presents a structured process for thesystematic identification, assessment andmanagement of the risks associated with tasks thatplace specific demands (physical or psychological)on employees. It offers processes and tools which, ifadopted, help to reduce the risk of injury or harmto employees, the company and third parties.

Objectives

The key objectives of this report are to:1. Describe the rationale for fitness to workprocesses and systems.

2. Describe a risk assessment process to focusactivity on what needs to be done.

3. Discuss legal constraints on what can andcannot be done in certain jurisdictions.

4. Describe medical control options, e.g. fitness towork examinations.

5. Describe work capacity testing, its strengths andlimitations.

6. Describe special considerations for certaingroups of employees.

1

FITNESS TO WORK

Purpose of this guidance

In the oil and gas industry there are many tasks inwhich the health and capacity of an individualcould have an impact on the safety of a task beingconducted, or could worsen the health condition ofthe individual. Any individual who is unable tocomplete a task safely places themselves and othersat risk. It is not surprising, therefore, that over theyears, many employers have sought to reduce thisrisk through a process of defined interventions,whether medical examinations or otherwise.Currently, no established consensus orstandardized approach exists which is applicableto the global oil and gas industry, and a widevariety of fitness to work practices and proceduresare commonplace. This lack of a standardizedapproach results from many root causes, includingdiffering risk tolerances, multiple interfacesbetween joint venture partners and contractors,legal systems and the objectives of individualprogrammes. Historically, many programmes havehad a clinical focus and depended upon clinicalmedical opinions. Increasingly, and specifically insome jurisdictions, this approach is being

challenged and, in some cases, is illegal. This doesnot mean that fitness to work assessments cannot bemade, but it does mean that a careful assessmentof the risk should be carried out, and that anydecisions taken with regard to an individuals fitnessto work should be objective and fair. This documentdoes not attempt to achieve a standard approachfor the industry with respect to fitness to work. Forreasons that are discussed, the approach adoptedby a company will be shaped and tempered by thesituation pertaining to the workplace, country andcompany. It does, however, offer a structuredapproach, describing the assessment of risk, aswell as control options. It is primarily intended forhealth, HSE and human resources (HR)professionals who are charged with designing andimplementing a fitness to work system. It is not adetailed reference point for clinical decisions in themedical assessment of fitness to work, nor is it anauthoritative text on assessing work capacity. Theseprocesses are described, and examples are given,but more comprehensive texts on these subjectsexist elsewhere.

Introduction

For the purposes of this document, fitness to workrelates to the process of assuring that an individualcan complete a task safely and withoutunacceptable risk to themselves, their employingcompany or a third party.

This definition specifically excludes processesdesigned to monitor the health of a workforceexposed to occupational hazards (usually termedmedical surveillance) and/or any processdesigned to promote the general health and well-being of the workforce (often referred to as healthpromotion or wellness). The rationale for this

distinction is that, where a company adopts afitness to work control, it is considered mandatoryfor the employee to comply with its requirements.Hence, an employee cannot decline a requiredfitness to work test or examination, whereas theycan choose to decline any test or screening madeavailable as part of a health promotionprogramme. Not infrequently, elements of all threetypes of examination (i.e. fitness to work, medicalsurveillance and health promotion) are included atone clinic visit; however, the distinction of eachcomponent is important and has meaning in termsof the outcome of the examination.

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Definition

Work-based tasks place physical and psychologicaldemands on the individual conducting them. Suchdemands may be directly associated with thetaskfor example the physical exertion of carryingloads. Alternatively, a task may not beexceptionally demanding but is conducted in alocation where workers falling ill would present amajor logistical challenge for the company andcarry unnecessary risk for the individual. It istherefore important to understand that being fit fortask and fit for location may not be the samething, and a fitness to work assessment shouldaddress both aspects where relevant. Additionally,working in extreme climates (hot or cold) mayrequire a greater degree of physical fitness thanthat which may be necessary to carry out a similartask in a temperate climate. In all cases, the fitnessto work question is: can this person do theassigned tasks safely and repeatedly withoutforeseeable risk to their health and safety or that oftheir colleagues, third parties and companyassets? An airline pilot is an obvious example,where a medical event resulting in the incapacity ofthe pilot would result in serious consequences forthe aircraft, passengers and crew. Fire and rescueteams encounter extremes of physical exertion in

their work, and may place colleagues and thepublic at risk if they are unable to complete thattask. Offshore work carries additional but differentrisks. Tasks may or may not involve specialrequirements, but living in a remote offshoreenvironment, away from normal services andhealth resources, may be inappropriate for somepeople. Another factor to be considered whencarrying out an assessment of fitness to work is theavailability and quality of medical services. Anindividual who requires regular access tosecondary and tertiary health care may not besuitable for a remote assignment where theprovision of medical care is restricted to simpleprimary care and emergency response.

Some of the tasks for which a fitness to workassessment is appropriate are fairly obvious. Butfor many others it is less so. This can result ineither the application of a process which is notjustified or value adding, or the lack of a processand the persistence of undue risk. Some basicprinciples of design for any fitness to workprogramme are therefore key to ensuring that thedevelopment of such a process is both effectiveand appropriate.

Why fitness to work?

Key point:Fitness for task

and fitness for

environment or

location may not be

the same thing.

For example, an

employee

considered fit to

work on an

offshore platform in

the North Sea may

not be fit to work in

the climatic

extremes and

remoteness of the

West Coast of

Africa or a desert

location in the

Middle East.

The assessment of

fitness must

consider both

aspects for it to be

complete and

meaningful.

3FITNESS TO WORK

Roles and responsibilities

A successful fitness to work programme requiresthat all individuals are aware of their specific rolesand responsibilities. These are summarized below.

Health professionals conduct risk assessments,select controls, and apply medical screening testsand examinations. They are professionallyaccountable for their medical opinions, and forcompliance with the law and ethical standards.

HSE professionals (including industrial hygienists)conduct risk assessments and select controls (e.g.operating procedures, specific test requirementssuch as medical examinations and capacityevaluations, etc.).

Line managers ensure that employees attendnecessary assessments in a timely fashion. They maybe required to assist in risk assessment by confirmingthe exact operational requirements of a task. Theyshould seek the advice of HR and a healthprofessional if they become concerned about anemployees fitness to work.

HR professionals lead any necessary consultationprocesses with the line management, and managecases where employees are found to be unfit forduty. They can provide detailed and country-specific knowledge of employment law.

Legal professionals review proposed practicewithin the context of applicable legislation.

Employees attend for assessments when required todo so and, if they develop any limitation of theircapacity for work between assessments, they shouldreport this to their line manager and seekconfidential advice from a health professional.

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Principles of a fitness to work process

The principles of a fitness to work process may besummarized as follows: The programme should be based on anassessment of the risk.

The programme should aim to match therequirements of a position with the reasonable(and foreseeable) health and capacityrequirements for an employee in that position.

Any tests of functional capacity or medicalexaminations should relate to an assessment offitness for the assignment or tasks.

Tests and examinations should producerepeatable and consistent results.

Tests or examinations should apply equally to allwho are required to do the work. Tests andexaminations required to define control optionsare mandatory, not optional (in contrast withany test or process associated with healthpromotionsee Definition on page 2).

Tests and examinations must be legal in thecountry in which they are applied.

All work capacity tests or medical examinationsmust be safe.

A well-designed fitness to work process willreduce risk and liability, and will determinewhether employees are capable of conductingtheir assigned tasks. At the same time, however, awell-designed process will avoid waste,discrimination, and unnecessary andinappropriate exclusion of individuals from workthat they could carry out safely and productively.

An effective fitness to work process can be achievedby going through a series of linked steps to determinethe activity required for reducing the risk. Often,these steps are not followed, and practice is basedon historical precedents of clinical examinations for

Designing a fitness to work process

Figure 1 Key steps in the design of an effective fitness to work programme

Risk assessment

Monitoreffectiveness

Definecontrol options

Legal validationApply controls

certain positions. Failing to understand the risks,and subsequently failing to design the appropriatecontrols, is poor practice. At best, this will result ina wasteful programme. At worst, it is illegal andmay result in additional liabilities for the company.

5FITNESS TO WORK

The fitness to work risk assessment

Many companies address health risks through asystematic process, such as the health riskassessment. This generally results in a holistic viewof tasks and positions in the organization, and theassociated health and safety hazards. Other riskassessment processes, including safety cases andHAZID (hazard identification) programmes, willresult in a systematic assessment of activities andthe identification of safety-sensitive positions.

Key questions arising from therisk assessment

The risk assessment will give rise to a number ofkey questions. For example: Which tasks are associated with specificphysical or psychological demands?

Which tasks are associated with direct safetyimplications if the operator is incapacitated?

What could go wrong and what are thepotential consequences?

Can the risk be reduced through systemredesign or process-related controls?

What additional factors may add to the riskfor example locations and/or environment?

Could fitness to work tests or examinationsfurther reduce the risk?

Assessing tasks or activities for specificdemands or safety-critical impact

A high-level screening process can be used toidentify the many positions or tasks that do notwarrant detailed assessment; these may then beexcluded from further consideration. For theremaining positions, one way of reducing apotentially large number of detailed assessments isto apply a risk rating methodology, such as a riskassessment matrix (Figure 2). Typically, positionsassociated with a high or medium risk of anadverse event would be further assessed to identifythe need for possible fitness to work controls.

Figure 2: Eachcompany willdecide on its ownlevels ofacceptability.Typically, the focuswill be on tasks orpositions where theincapacity of anindividual mighthave a severity of4 or 5leading todetailed assessmentof those positions.

Never heardof in theindustry

Consequences Increasing likelihood

People Assets Environment ReputationSeverity

0

1

2

3

4

5

A B C D E

Heard of inthe industry

Has happened inthe organization,

or more thanonce per year in

the industry

Has happenedat the location,or more than

once per year inthe organization

Has happenedmore than

once per yearat the location

No injury orhealth effect

Minor injuryor health effect

Major injuryor health effect

Permanent totaldisability or upto 3 fatalities

More than3 fatalitities

Slight injury orhealth effect

Nodamage

Slightdamage

Minordamage

Moderatedamage

Majordamage

Massivedamage

No effect

Slighteffect

Minoreffect

Moderateeffect

Majoreffect

Massiveeffect

No impact

Slightimpact

Minorimpact

Moderateimpact

Majorimpact

Massiveimpact

Figure 2 An example of a risk assessment matrix

Fitness to work as part of an overallrisk management process

The application of safe working practices isessential to limit the potential consequences of anadverse health event. In the absence of suchpractices, a fitness to work control will be of limitedor no value.

Such practices might include: safe systems of work (e.g. tying off at height); procedures for managing illness absence; supervisory surveillance of the workforce andreferral of concerns;

personal accountability for safe working andself-referral of concerns;

incident investigation; substance misuse policy and procedures; and trade testing for the safe execution of tasks.

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Box 1: Common examples of positions withspecific demands or safety critical impact 1

Fire fighters and emergency responders

Commercial divers

Catering personnel

Airline/helicopter pilots

Professional drivers (e.g. heavy goodsvehicles)

Remote location workers (e.g. offshoreworkers)

Users of sealed mask breathing equipment

Expatriates (some locations only)

Colour vision-dependent tasks (e.g. electricians)

Manual tasks with high aerobic energydemands

Workers in climatic extremes (hot or cold)

1 The list provided in Box 1 is not exhaustive. Some companies following a due process may chose to include other workers andtasks (e.g. working at height or working in a confined space). Such a decision will depend on the tolerance of risk, thelocation, practical considerations and the local regulatory requirements.

A fitness to workprogramme mayinclude trade tests,e.g. helicopterunderwater escapetraining (picturedright). An effectivefitness to workprogramme can bedesigned bycombining tradetests with medicalevaluations.

Having considered the possible outcomes and thedegree of control afforded by existing work practices,the following questions should be addressed:

1. Will fitness to work controls further reduce therisk; and

2. Can these controls be reasonably applied (interms of complexity and cost)?

Having gone through this process, most companieswill be left with a shortlist of positions and tasks forwhich they will go on to consider, design and applya fitness to work process. The resulting process islikely to provide a targeted and risk-basedapproach, avoiding unnecessary testing and cost.

7FITNESS TO WORK

Control options

Having identified the positions for which a fitnessto work control is appropriate, it is necessary todefine which control options shall be applied, andhow frequently they will be carried out. While notforgetting the overall management of risk asdescribed earlier, the interventions used in afitness to work process can be divided into threebroad types: medical examinations; functional capacity evaluation; and trade tests.

All three have their place in a well-designed fitnessto work programme, and they may co-exist, withone supplementing either or both of the others.

Medical examinations for fitness to work

The objective of such examinations is to identifyphysical and psychological limitations which maybe incompatible, or cause particular problems, withperforming a specific task or employment in aparticular location. For example, an individual whoexperiences sudden and unpredictable loss ofconsciousness will normally be considered unfit fordriving. An individual with complex chronicmedical conditions may not be considered fit for anassignment at an overseas location where

appropriate medical help is not immediatelyavailable. Whilst such decisions are sometimesclear cut and simple to make, it is often the casethat considerable experience and skill is required tointerpret the issues accurately and appropriately. Thisis essential to avoid the potential legal implications ofdeploying an individual who is not suitable for therequired task, or the potential waste anddiscrimination when unreasonable restrictions preventpeople who are fit from taking up assignments.

Medical examination protocols

Many companies work through a network ofmedical providers when arranging forexaminations to be conducted. It can therefore beuseful to establish medical protocols to guide thecontent of a medical examination, thereby helping

CASE STUDY: Tanker driver in Thailand

Athit is a 32-year-old tanker driver responsible for long haul transportation and delivery of refinedproducts including gasoline and diesel. His job requires him to work for several days at a time on the road,sleeping in his truck overnight when he has completed his permitted driving miles in any given day. Roadtrips can last for up to three weeks when he is away from home. He is also required to climb on top of hisvehicle to dip the contents of tanks and check volumes and additives on some of the older fleet vehicles.This requires considerable agility and a head for heights. As part of safe working practice he is required totie off when more than two metres above ground level.

Athit has a medical every two years to confirm his fitness to drive. This includes a screening test for sleepdisorders and sleep apnoea.

In addition, Athits company offers voluntary counselling and testing for HIV. This is not a fitness to workrequirement but is combined with clinical visits for his driver certification.

to ensure that it is appropriate for the case inquestion (see the Appendices for examples). In theabsence of such protocols, the company will rely onthe service provided by the medical contractor, butin these circumstances, the company should stillspecify which position, task and location theemployee is being assessed for. Failure to providesuch information will increase the chances of aninappropriate decision being made on theindividuals fitness to work.

Practical issues and limitations ofmedical examinations

Failure to plan ahead, and in particular to addressthe following points, can make the fitness to workprocess unnecessarily complicated and expensive: The examination should take place where theemployee can easily and reasonably attend.

The examining health professional must knowwhere the employee is going to work, and whatthe candidate will be required to do once there.

For those going on international assignments,early examination (ideally before other details of

a move have been progressed) is essential tomitigate potential delays later on.

If the company has any specific requests for themedical examiner, these should be clearlystated. Special tests (e.g. exercise stress testing)may be required, and unnecessary trips can beavoided if the examiner is notified in advance.

Where a (potential) employee has a significantmedical history, taking copies of relevant medicalreports (if available) can save time and obviatethe need for collecting supplemental informationfrom family doctors and specialists, etc.

Quality control and the integrity of the medicalexamination process can be an issue in somecountries. In the case of a large contractedworkforce, it can be important to consider theoverall governance of the process, in particularwho will conduct the medical examinations,their suitability and qualifications, etc.

Preparing the employee for livingand working in a new environment

In some cases, the employee (and his/her family)will be preparing for life in a new country andenvironment. Vaccinations and malaria trainingmay be an important requirement, and the medicalexamination is an opportunity for these to beprovided. In addition, it may be appropriate toexplore the employees understanding of their newlocation in terms of access to health-care facilities,education, recreation, etc. Expatriate assignments canfail for social and non-adaptation reasons as oftenas for medical reasons. The medical examination isan opportunity to explore this psychologicalsuitability with the employee and his/her family.

Pre-employment or pre-placementmedical examinations?

A pre-employment medical examination is conductedprior to, and as a precondition to, a job offer. On theother hand, a pre-placement medical examination isconducted prior to being placed in a safety-sensitiveposition, but after a job offer has been made to the

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Box 2: Principles of medical examinations forfitness to work

1. They should be restricted to identification oflimitations which will materially impact thecapacity of the individual to complete therequired tasks or to live in the location ofassignment.

2. They should be conducted by a healthprofessional.

3. Medical confidentiality shall be preserved.Typically, only statements of fit, fit withrestrictions, and unfit shall be madeavailable to management or HR. (Exceptions tothis rule require the consent of the individualunder examination.)

4. Decisions made as a result of medicalexaminations should avoid over-generalizations and interpretation. (It is not thepresence or absence of a condition per se thatis relevant, but the implications of thatcondition on capacity or health-care needs.)

9FITNESS TO WORK

Key point:Medical evaluations

are most useful

when carefully and

specifically applied

to a defined

population with a

specific objective.

General, untargeted

fitness to work

examinations of an

entire workforce is

likely to be wasteful,

generate many false

positive and false

negative results, and

expose the company

to litigation.

candidate. In the case of a new candidate applyingto join a company for the first time, the companymay consider requesting the individual to undergoa pre-employment medical examination. It shouldbe noted that, in many countries, pre-employmentexaminations are prohibited by anti-discriminatorylaws. In these countries, a medical assessment forfitness to work must follow a firm offer of employmentrather than precede it. Any pre-employment or pre-placement examination must relate specifically tothe work required by the position on offer. Non-risk-based pre-employment examinations should beavoidedthey are costly, add no value to healthand safety, and are potentially harmful. Theprinciples of a pre-placement examination are thesame as for any fitness to work assessment. Theobjective is to reasonably, legally and reliably matchthe employee to the requirements of their intendedposition. Some countries have prescriptive legalrequirements for pre-placement examinations and acareful review of the prevailing law is essential.

With cause evaluations

A with cause evaluation is one where an off-schedule review of fitness to work is carried out.An essential element of any fitness to workprogramme is the capacity to review and repeat anassessment of an employees fitness to work

between regularly scheduled evaluations. Examplesof circumstances when a with cause evaluationmay be appropriate include: on return to work after illness, or aftercommencing new medication;

after referral by a supervisor following observedbehaviour in the workplace, e.g. failing tocomplete a task appropriately;

on self-referral by an employee with concernsover fitness to work; and

following an incident or accident in theworkplace where it is considered that fitness towork may have been a factor.

Limitations of medical examinations

In a well-designed process, a medical examinationwill reduce the likelihood of a mismatch betweenan employees capability, their health and theassigned position. However, such examinationsoffer an assessment at a moment in time and havelimited predictive value for the future developmentof medical or capability problems. The employertherefore needs a system which allows for thesubsequent review of the fitness of any individualreturning to work after an illness, and which alsoprovides guidance for the assessment of anemployees fitness should there be concerns duringemployment. Ideally, such provisions will be

CASE STUDY: A pregnant job applicant in Malaysia

A 23-year-old female candidate applied for an office-based job in a large multinational company inMalaysia. She was found to be suitable for the job, and was given a conditional offer, subject to theoutcome of a medical assessment for fitness to work. The medical assessment found her fit, but also foundher to be in early pregnancy. After discussions between, the line, HR and health managers, the candidatewas rejected. This decision was based on the fact that a long maternity leave will negatively impact thedepartments output. In addition, a non-pregnant candidate was available, albeit less qualified.

Although there were no disability discrimination laws in Malaysia, the dissatisfied candidate pursued alawsuit against the company on the basis of discrimination.

Subsequent investigation into this incident revealed that there was no legal requirement for the pre-employment medical examination. In addition, the company could not demonstrate how the medicalexamination performed could have protected her from the health and safety risks of office work.

As a result of this incident, the company reviewed their fitness to work protocols, and proceeded to adopta risk-based, non-discriminatory fitness to work process.

specified in the overall fitness to work process,which should include a mandatory review of fitnessto work after an illness of a specified duration(typically weeks not days). It should also specify theright of a supervisor to refer an employee for areview if they have reasonable grounds to considerthat an employee is unfit or unable to completehis/her assigned work. Where appropriate, theseadditional steps should be agreed with staffrepresentative groups and unions.

Functional capacity evaluation

A principal category of fitness to work control is thefunctional capacity test. These tests evaluate anindividuals capacity to carry out a work-relatedtask, by simulating the functional demands (e.g.strength, endurance, range of movement) of thattask. A well-designed functional capacity test is auseful means of evaluating fitness for duty. However,the design and execution of such an assessment isnot a straightforward process, and considerablecare and expertise is required when formulatingsuch a test to ensure that it provides a truepredictive value for the position in question. As withmedical examinations, it is essential that a functionalcapacity evaluation matches the requirements of the

The photographsbelow showexamples offunctional capacityevaluation.The step test (left) isa simple method ofmeasuring anindividuals level offitness and theirability to recoverafter strenuousexercise.Neuropsychiatrictesting (right), usingthe NeurobehaviouralCore Test Battery(NCTB) developed bythe World HealthOrganization,consists of a series oftests designed tomeasure anindividuals cognitiveperformance.

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Box 3: Advantages and disadvantages offunctional capacity evaluations

Advantages

Good reliability and predictive value if well-designed.

Compatible with disability legislation.

Well accepted by employees and theirrepresentative groups.

Disadvantages

Require careful and skilled design.

Can be expensive and time consuming.

Used on their own, will not address riskposed by medical conditions (e.g. risk ofsudden loss of consciousness).

position. Failure to do this can result in unnecessarycost and the potential for legal disputes.

Examples of functional capacity evaluations include:1. Laboratory testing of physical strength and

aerobic fitness: Following an assessment oftask requirements, it is possible to produce testsof strength and aerobic fitness which have apredictive value for the position in question, butwhich do not require the candidate to carry outthe actual tasks required for the position. Theseassessments are carried out in a controlledenvironment. An example is the step test,used for evaluating the aerobic fitness ofrescue team members.

2. Specialist testing of functional or mentalcapacity: Such tests are not normally applied toall candidates for a position but may apply wherethere is a specific need to assess an individualfollowing an injury or illness. Examples includeneuropsychiatric testing and evaluation after ahead injury.

There are a number of advantages anddisadvantages of functional capacity evaluations(see Box 3).

11

FITNESS TO WORK

Key point:Combining medical

examinations with

functional capacity

and trade tests is a

common and useful

option for more

demanding positions

such as fire and

rescue work. To

demonstrate their

fitness to work, these

workers will typically

be required to

undergo periodic

medical

examinations,

complete a bench

step test to

demonstrate a

minimum level of

aerobic fitness, and

finally complete a

trade test involving

simulated fire/

rescue tasks.

Above: employees take part in a fire simulation exercise,usually carried out as part of the mandatory training forfire team personnel.

Trade testing

Trade testing requires an individual to demonstratehis/her capacity to complete a required task incontrolled circumstances. Trade tests are typicallyconducted after any necessary medical screeningprocessso as to reduce the risk of harm resultingfrom the trade test. For example, fire team workerswill typically complete a medical examination toestablish their fitness for fire team duty, beforebeing asked to demonstrate their capacity forrescue work using the appropriate functionalcapacity evaluation and fire ground trade tests.

Common examples include:1. Helicopter underwater escape test: This is a testof an employees physical and psychologicalability for self-rescue in a simulated helicopterditching. The activities tested include the abilityto exit the submerged helicopter, and to swim toa life raft, climb into the life raft and use ascramble net. The test is usually done as part ofthe mandatory training for offshore work,known as helicopter underwater escapetraining or HUET.

Above: a helicopter underwater escape test simulates anescape following a helicopter ditching, and is usuallycarried out as part of the mandatory training foroffshore work.

2. Fire ground simulation test: This requires anemployee to demonstrate his/her capacity toconduct work in a fire team, wearing breathingapparatus and performing simulated emergencyresponse tasks including fire fighting, ladderclimbing, fire hose deployment and stretchercarries. This is usually done as a part of themandatory training for fire team personnel,known as fire ground simulation training.

Using different tests together

Not infrequently, functional capacity and trade testsmay be used to supplement a medical evaluation.For example, a fire team worker is likely toundergo a medical evaluation first, to eliminatecandidates with a medical profile that renders themunsuitable for fire ground training. The candidatewould then be required to demonstrate his/hercapacity to complete the required tasks bycompleting a functional capacity assessment throughan aerobic fitness test and a strength test. Finally,the candidate would be required to undertake afire ground simulated fire fighting task, sometimescalled a trade test. Careful test combinationimproves the overall predictive value of testing andreduces the false negative and false positive rates.

In the event of an individual being assessed asunfit, it is the responsibility of the employingcompany to seek alternative employment for theindividual, if possible and where appropriate.However, it is important to recognize thatalternative employment may not always bepossible, especially if the restriction relates towork in a particular geographical location.

Temporary or partial restrictions can be thecause of confusion and difficulty. The adviceprovided in a statement of fitness to workshould be clear and unambiguous; phrases suchas fit for light work should be specificallyavoided, as they are meaningless in a practicaland legal sense. The advice should state whattasks the individual can and cannot do, and forhow long the restriction applies. Whether theserestrictions can be accommodated by theemployer is for the line management and/orHR team to resolve. Transitional duties are aparticularly useful means of rehabilitating anemployee back to work after a period of illnessor injury.

A fitness to work evaluation should result in a clearstatement to the employing company on the statusof the employee. Typically, an employee may beregarded as: fit for the assigned work/tasks and location; unfit for the assigned work/tasks and location; or fit with restrictions, i.e. the employee may be fitfor certain tasks but not for others. Such arecommendation should be time bound and is atmanagement discretion.

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The outcome of fitness to work evaluations

The consequences of fitness to work evaluations

An assessment of unfit for a position can haveserious implications for the employee, from losing aposition they hold, to not getting one they areotherwise qualified for. It is imperative, therefore,that the assessment process is fair, consistent andbased on objective assessments of health and workcapacity. In some circumstances and jurisdictions,employers will be asked to prove that the processof selection in a particular case is objective andwithin the law of that country.

To ensure the fair treatment of employees, manycompanies adopt some or all of the followingmeasures as good practice, with the specific goal

of reducing the personal impact of an assessmentof unfit for work:

1. Accommodation: It is good practice to considerwhich of an individuals tasks might be assignedto others, thus permitting the individual tocontinue in the same position. The practicalityof accommodating an individual in this waywill, of course, depend on the task; forexample, a fireman who cannot climb a ladderor use a hose is severely restricted, whereas anemployee who occasionally has to work atheight but cannot do so because of vertigocould be assigned to floor duty only.

Left: a fitness to workcertificate shouldprovide a clear andunambiguousstatement of theindividuals suitabilityfor the task.

13

FITNESS TO WORK

Legal assessment

Accommodation can also take the form ofphysical modifications to the workplace, oradjustments to the work schedule. In manycountries such accommodation processes are alegal requirement.

2. Transfer to alternative work: The incapacity ofan individual to fulfil the needs of a particularposition does not of course mean that theindividual will automatically be consideredunfit for other positions with differentdemands. Although it may not always bepossible, the employer should actively considerthe options to transfer the individual to a moreappropriate position if one is available. In somecountries, a transfer to alternative work is alegal requirement.

3. Termination: The decision to terminate, not offeror modify employment for any individual is amatter for the line management and/or theHR team. This should only be pursued after acareful consideration of the alternatives (i.e.accommodation and transfer to alternativework). A panel review of the medical assessment(commonly known as a Medical Board review)is good practice in the termination process. Itensures that the medical recommendations areaccurate, and that alternative diagnoses oroutcomes have been sufficiently explored.

4. Appeals: Some companies have an establishedappeals process which permits the decisionsmade regarding fitness to work to be reviewed.It is entirely a matter for the company to decideon the value of this process. It is good practiceand is well-received by unions and staffrepresentative groups where appropriate.

In designing a programme of fitness to work, thecompany must also consider the consequences ofan individuals failure or refusal to attend a fitnessto work examination. In most, if not all cases, suchabsence or refusal will render the individual unfitfor that work, because their capacity to do it safelycannot be demonstrated.

The law is a major consideration when specifyingthe components of a fitness to work programme. Itdetermines: actions required for legal compliance (e.g.licensing examinations for drivers of heavygoods or commercial vehicles); and

actions prohibited by a countrys legislation, andany extension such legislation may have toinclude citizens of that country workingelsewhere. (This can be of significance toexpatriated employees).

A logical approach is to start with identifying anyfitness to work tests that are required by law.Requirements will vary significantly from onecountry to another. For example, some countriesrequire an annual medical examination for allthose at work. The exact purpose and content mayor may not be defined. In other countries specificwork groups only will require medical review on aperiodic basis, e.g. the U.S. Department ofTransportation specifies requirements for workers incertain groups according to the nature of their

An assessment whichdetermines anindividual to be unfitfor a position maynot necessarily leadto termination ofemployment;candidates may beconsidered foralternative, lessdemanding positions.

work. Generally, the what is required stipulationsare well-specified and easily understood.

It can be more challenging to address and defineactions, examinations and decisions that areprohibited under country legislation. Often,legislation is aimed specifically at protecting therights of employees with disabilities and ensuringthat medical grounds are not used to exclude themfrom work they could do. A detailed review of suchlegislation is beyond the scope and intent of thispublication. Companies are strongly advised toensure that a competent authority is engaged toreview the companys fitness to work process andensure that it complies with local legal requirements.

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Key point:The law regarding

fitness to work and

employment practice

varies by country,

each having many

unique and often

non-intuitive

requirements. The

applying law may

be the law of the

employer and

employment

contract, or the

country of the work

or both may apply.

Companies

implementing a

fitness to work

programme are

strongly advised to

seek a legal opinion

on their proposals.

Some countries require an annual medical examinationfor all those at work, whilst other countries may onlyrequire the periodic review of specific work groups.

CASE STUDY: Offshore worker in West Africa

Andy is a 46-year-old production technician who works on offshore production platforms off the West Coastof Africa. He works a 28-day roster before returning to the UK for shore leave between trips. He has been inthis position for three years. His work requires that he lives and works offshore. His daily tasks includeoperating the process units from a control room and making routine inspection visits to the plant to checkpressure gauges and valves. The work involves some manual valve operating and climbing platform stairgantries over several deck levels. The platforms are two hours flying time by fixed-wing aircraft from theairport on shore. The climate is tropical with high temperatures of 35C. He is a member of the platformemergency response team, which involves wearing self-contained breathing apparatus and performing firefighting and casualty rescue as necessary. The team conducts regular emergency drills on board the platform.

On appointment, he had a medical examination designed to determine his fitness to work in a remotelocation, as required by his employing company. This revealed that he was overweight with a BMI of 31,and had controlled high blood pressure (he takes medication, in this case a beta blocker). He was given thenecessary vaccinations for West Africa and routinely takes malaria prophylaxis as he transits a malarialendemic area en route to the platform. (This journey involves an overnight stay.) At the medical examination,he was found fit to work in this role but encouraged to lose weight.

He proceeded to complete his helicopter underwater escape training and fire ground trade test successfully.Because of his satisfactory medical examinations and his passing of these two tests, Andy is considered fitto work for this position. He requires a repeat medical examination every two years prior to repeating hisfire ground training.

One year ago, Andy developed a hernia and required surgery to correct this. The operation was successful, andafter shore leave and a short period of absence he was cleared by an examining physician for return to workon a normal basis. (His company requires a medical clearance following absences of more than two weeks.)

Two months later, Andy changed his blood pressure medication on the advice of his doctor. He contactedthe company occupational physician because he knew he was required to do so to check whether thiswould affect his fitness to work and/or his prescription for malaria medication. No issues were anticipatedin this respect, but it was agreed that he would begin his medication at the start of his 28-day home leaveso that, if there were any problems, he would be close to his doctor for advice. The medication switch wasuneventful and he reported for duty for his next offshore rotation on the expected day.

15

FITNESS TO WORK

Implementing a fitness to work programme

Key point:Interfaces between

joint venture

partners and

contractors can be

the weak point in a

fitness to work

programme.

Necessary fitness to

work requirements

should be agreed

between the relevant

parties early in the

contracting process

to ensure that those

conducting at-risk

activities are

properly assessed in

a timely fashion and

certified fit to work

by a competent

authority.

Implementing a fitness to work programmerequires the coordinated input of a number ofdifferent stakeholders. Successful implementationwill require strong and visible leadership fromsenior management.

There are a number of steps which should befollowed to ensure the successful implementation ofa fitness to work programme:

1. Conduct a risk assessment: Decide which workgroups require a fitness to work control. Thisshould involve HSE professionals who have adetailed understanding of risk assessment andthe operational requirements of the task to becompleted.

2. Identify which medical examinations,functional capacity evaluations and/or tradetests are to be used for each work group:Ensure all tests are valid for their intended use.Specialist help will be required fromoccupational physicians, ergonomists, safetyprofessionals, etc.

3. Conduct a legal review to confirm that theintended approach is permissible within thecontext of the local legislative framework.

4. Consult with unions/staff councils asnecessary. It will be necessary to addressspecifically the consequences of being unfit forduty and refusal to attend an assessment.

5. Agree to a detailed timeline for implementation.

6. Obtain competent resources to deliver tests,paying particular attention to the competenceof those engaged for this purpose. Specificchallenges arise when a network of differenthealth providers is engaged to provide aservice at different locations. All will requirespecific guidance on what is required withrespect to medical examinations and tests,investigations and non-medical evaluations.

7. Develop implementation plan with linemanagement and HR teams, specificallyaddressing notification procedures.

8. Conduct medical assessments for fitness towork on the population identified by the riskassessment (item 1 above). Notify linemanagement and HR teams of the outcome.Set a recall date for periodic review.

9. Review compliance and processit isparticularly important to monitor compliance. Ifa risk assessment identifies a particular test orexamination as necessary but it is not carriedout, the net result may be increased liability.

10. Run periodic quality checks on tests conductedto ensure ongoing validity.

For most contractors, the required fitness to workassessments are often conducted by anotherorganization. In this case, the parent companyshould specify the requirements for fitness for dutywhich the contractor must fulfil. Contract HSEclauses can be an effective means of capturing andenforcing this requirement. This is particularlyimportant for joint venture partners and for theircontractors. Agreement early on in the contractingand procurement process can specify who isresponsible for what in respect of the contractedworkforce.

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Appendix 1:Test combinations for selected positions

Task/position

Medicalquestionnaire

Medicalexamination

Aerobicfitness test

Strengthtest

HUETtraining

Fire groundtraining

Psychologicalprofile

Colourvision test

Office worker

Operations technician

Fire team/rescue

Commercial driver

Pilot

Commercial diver

Remote location

Offshore

Users of breathingapparatus sets

Expatriates

High intensity manual handling

Conflict zone

Aircraft refuellingelectricians

optional

+

+

+

+

+

+

+

+

+

+

+

+

optional

+

+

+

+

+

+

+

optional

+

+

+

+

optional

+

+

+

+

+

optional

+

The examples given below are indicative only, andthe actual tests chosen will depend on the riskassessment and company context as described inthe main text.

Tests may be combined based on the location andtask (e.g. an offshore worker exposed to highintensity manual handling).

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FITNESS TO WORK

Appendix 2:Examples of medical screening protocols

Position Medical assessment Content Purpose Comment

Office workers

Operations technicians

Fire team or rescue workers

Professional drivers

Remote locationworkers

Offshore workers

Users of breathingapparatus

Short questionnairecompleted byemployee andreturned to healthprofessional

Questionnaire with orwithout examinationsconducted by a healthprofessional

Questionnaire plus amedical examinationand additionalphysiological test thatmay be relevant,including aerobiccapacity, strengthtesting and pulmonaryfunction tests

Questionnaire plus (inmost jurisdictions) amedical examination

Questionnaire plus amedical examination

Questionnaire plus amedical examination

Questionnaire plus alimited medicalexamination

Short simple questionsdesigned to identify potentialissues with, e.g. workstationuse, work patterns includingshifts, etc.

Assess for mobilityrestrictions, increased risk ofloss of consciousness fromany underlying medicalcondition, baseline hearingand vision testing

Assess for mobility, strength,underlying risk forcardiovascular disease,diabetes, epilepsy or similarwhich may impactconsciousness level andexercise tolerance

Assess vision hearing,locomotor health,cardiovascular health andrisk of any other debilitatingcondition including diabetesand epilepsy

Assess for any medicalcondition which may requireprompt medical attentionwhich is not readily availableat a remote location

Assess for any medicalcondition which may requireprompt medical attentionwhich is not readily availableat an offshore location

Assess for any medicalcondition which may beexacerbated by use of sealedbreathing apparatus

Basic screeningquestionnaire designedto establish basic healthon entry to position, andany accommodation thatmay be necessary

Site safety, especially iflone worker on plant

Assess medical suitabilityfor high-intensityphysical work, e.g.climbing ladders inprotective gear andbreathing apparatus

Safe operation of aheavy goods vehicle,commercial passengervehicle or high mileageprivate vehicle (in somecases)

Minimize, so far asreasonably practicable,the need forunforeseeable medicalemergencies requiringurgent transfer

Minimize, so far asreasonably practicable,the need forunforeseeable medicalemergencies requiringurgent transfer

Minimize risk to user

Not legal in somecountries for a low-risk environment/position

Examination isoptional andusefulness willdepend on nature ofsite, location andtasks conducted

Often combined witha fire ground tradetest

Heavily regulatedareamost countrieshave detailed andspecific legislation

The degree ofisolation at thelocation drives therisk, and thereforethe acceptability, ofdifferent medicalconditions

Sector specificguidelines (e.g. Oiland Gas UKguidelines) apply inthe North Sea

Regulated in manycountries (e.g. OSHAfit-testing in USA)

continued

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Appendix 2:Examples of medical screening protocols (continued)

Position Medical assessment Content Purpose Comment

Expatriates

Conflict zone

Colour vision-dependent tasks

Questionnaire with orwithout examinationsconducted by a healthprofessional

Questionnaire plus amedical examination

Colour vision testing

Assess for a medicalcondition for which treatmentis not readily available indestination

Assess for any medicalcondition which may requireprompt medical attentionwhich is not readily availablein a location with particularsecurity issues that limitaccess to health care

Screening test (e.g. Ishiharatest) followed by detailedassessment (e.g. at cityuniversity), as necessary

Minimize risk of failedexpatriation for healthreasons

Minimize, so far asreasonably practicable,the need forunforeseeable medicalemergencies requiringurgent transfer

Assure colour visionwhere necessary forsafe task completion

Not necessary forcountries withdeveloped medicalinfrastructure

Some form ofpsychologicalassessment (formalor informal) may berelevant

Can be combinedwith a trade test

19

FITNESS TO WORK

Appendix 3: Examples of functional capacity evaluation protocols

As described in the main text to this document,fitness for duty may be established by a medicalscreening process. However, the medical screeningprocess is limited in its ability to predict theindividuals capability for conducting a given task.A more robust test is a well-designed work capacitytest. Such a test is established by measuring thephysical demands of the tasks in question and thendesigning a screening test which has a highpredictive value of fitness for the task.

Examples include: Aerobic fitness requirements for operations

technician work activity: this can be establishedby measuring the aerobic demands of theposition or activity which simulates the demandsof the position. From this it can be predicted thatan individual with an aerobic capacity (i.e.VO2 max) below a given threshold is unlikely tobe able complete the tasks required of theposition. This can easily be measured using asimple step test in a controlled environment.

Strength requirements for operations technicianwork activity: through technical study, it ispossible to identify the strength requirements thatan operator will need to meet in order tocomplete repetitive strength-dependent tasksduring a shift (e.g. lifting weights and turningvalves). Strength can be measured in acontrolled environment and, following carefulstudy, a predictive value can be identified as aminimum requirement. Employees who do notmeet this minimum standard will have difficultysustaining the necessary level of activity in thecourse of a full shift.

A simple step test can be used tomeasure an individuals aerobic capacity,and hence the persons physical ability tocomplete the tasks required of theposition in question.

The grip test shownhere is an exampleof a functionalcapacity evaluationdesigned to assessthe individualsability to completerepetitive strength-dependent tasksinvolving the hands.

Caution when using functionalcapacity evaluations

Considerable skill and expertise is required todesign an appropriate work capacity test whichhas a true predictive value for the demands of theposition in question. Hence, only principles, andnot quantitative values, are given in this guide.

Anyone considering such tests should ensure thatthey are carefully designed and have an establishedpredictive value for the work in question. The resultsof the tests also need to be interpreted by acompetent individual, not least because some resultswill fall into the borderline category which shouldnot be taken as automatically indicative of failureor unfitness for the task.

The migrant workforce

Major construction projects will often use largenumbers of workers from emerging nations. Inassessing their fitness to work, there are a numberof aspects to consider: Visa requirements will often dictate the contentof the medical examination (e.g. screening fortuberculosis, hepatitis B and HIV in somecountries).

Primary vaccinations, typical of the developedworld, may not be complete, and primarycourses and/or booster vaccinations may berequired.

The presence of a chronic disease may have animpact on an individuals suitability for anassignment if timely access to a specialist(secondary) health-care facility cannot befacilitated at the location.

Some employees may have had limited accessto regular health care. The percentage with asignificant pathological condition that couldhave consequences for their fitness to work may,therefore, be higher than in other populations.

Medical screening examinations conducted inthe country of departure may not be a reliableindicator of fitness to work. Care should betaken in the selection of a medical provider, andthe authenticity of any medical certificates issuedshould be verifiable.

The executive

Many companies offer their senior executivesspecial medical screening programmes, therationale being that this group are of high value tothe company. In accordance with the definition offitness to work as used in his document, this groupdo not require a fitness to work assessment. Anyexamination and support offered is typically anemployment benefit rather than a contractualrequirement (this varies). The composition of suchexaminations should adhere to the principles of

good screening as recommended by the relevantprofessional health associations. No test is perfect,and conducting more tests may result in falsepositive diagnoses, unnecessary furtherinvestigations, and anxiety. The value of additionaltests therefore needs to be balanced against theactual or perceived value of any existing medicalscreening programme.

Drugs and alcohol abuse

An essential element of any fitness to workprogramme is a robust drug and alcoholprogramme. A detailed discussion of substancemisuse is beyond the scope of this document. For further information on this subject seeOGP-IPIECA, 2010.

The expatriate family

Expatriates (those employed outside their normalcountry of residence) can face many challenges intheir new country, including health, educational,dietary, cultural and socioeconomic challengesbeyond their previous experience. In addition toan assessment of the employee, it is also importantto assess the employees family for fitness to residein the new destination. The presence of a chronicmedical condition in a family member may beincompatible with relocating to a developingcountry where access to a secondary or tertiaryspecialist cannot be guaranteed.

Psychological and social factors are also commonin failed expatriations. Families may not have a fullappreciation of the challenges imposed by aparticular location, or the impact of separationfrom an extended family. Many companies offersupport in this area. A pre-departure medicalexamination offers a good opportunity to raisethese issues and highlight the available support.

IPIECA OGP

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Appendix 4: Special considerations for selectedpositions and tasks

21

FITNESS TO WORK

References

Oil & Gas UK (2008). Medical Aspects of Fitness forOffshore Work: Guidance for Examining Physicians.Issue 6, March 2008. ISBN 1903003374.

Palmer, K.T., Cox, R.A.F. and Brown, I. (2007).Fitness for Work: The Medical Aspects. 4th edition.Oxford University Press, 2007. ISBN:9780199215652

Milligan, G.S., House, J.R., Long, G.M. and Tipton,M.J. (2010). A recommended fitness standard forthe oil and gas industry. Energy Institute Report.First Edition, October 2010.

IPIECA-OGP (2010). Substance misuse: A guidefor managers and supervisors in the oil and gasindustry. OGP report number 445.

Glossary

Accommodation: the process by which reasonablechanges may be made to the workplace or worktask, such that an employee may safely conduct thetask or the work be reasonably assigned to anotheremployee.

Fire ground simulation training: training providedto fire teams, to prepare them for fire fighting andrescue tasks (e.g. fire fighting, ladder climbing, firehose deployment and stretcher carries) in acontrolled or simulated fire environment (e.g.wearing breathing apparatus and fire-fighting gearin a smoke-filled and confined space).

Fitness to work: an employees physical andpsychological condition affecting his/her ability tocarry out specific work without significant risk tothe employee, the business or third parties. Fitnessto work is just one category within a range ofoccupational health controls (e.g. elimination ofhazards, substitution of less harmful substances,engineering controls, administrative procedures,use of personal protective equipment, etc.) whichmay be required for the safe execution of a task.

Functional capacity evaluation: an evaluation ofan individuals capacity to carry out a work-relatedtask, by simulating the functional demands (e.g.strength, endurance, aerobic capacity, range ofmovement, etc.) required of a particular task. Theevaluation is usually carried out by a healthprofessional. Unlike a Trade test, functional

capacity evaluations do not simulate the actualtasks of the job (e.g. firefighting).

Hazard: see Health hazard.

HAZID (hazard identification study): a tool forhazard analysis, used early in a project as soon asprocess flow diagrams are available.

Health hazard: the potential to cause harm tohealth. Health hazards may be biological,chemical, physical, ergonomic or psychological innature. Health hazards are also known as agentshazardous to health and hazardous agents.These terms are interchangeable.

Health professional: a doctor, nurse orparamedical professional who has specific trainingin obtaining and interpreting medical data andinformation.

Health promotion: the process of enabling peopleto increase control over their health and itsdeterminants, and thereby improve their health.

Health risk assessment: the identification of healthhazards in the workplace and subsequentevaluation of risk to health. This assessment takesinto account existing or proposed control measures.Where appropriate, the need for further measuresto control exposure is identified.

Health risk: the likelihood that a health hazard willcause harm in the actual circumstance of exposure.Health risk = Hazard x Exposure.

Helicopter underwater escape training (HUET):training provided to offshore oil and gas industrystaff and military personnel who are regularlytransported to and from facilities by helicoptersover water. As the name implies, the purpose is toprepare them for emergency exit in the case of acrash landing over water.

HR: human resources.

HSE: health, safety and environment.

HUET: see Helicopter underwater escape training.

Medical assessment: the process by which medicalinformation is solicited through a questionnaireand/or examination as part of the decision makingprocess in a fitness to work assessment.

Medical evaluation: see Medical assessment.

Medical surveillance: the assessment of anemployees health in relation to identified possibleoccupational risks, using medical or biologicalmethods to identify any significant abnormalitiesattributed to potential exposure to specificsubstances or agents, at as early a stage aspossible. The fundamental purpose of medicalsurveillance is to detect and eliminate theunderlying causes such as specific hazards orexposures. For the purposes of this document,medical surveillance is distinct and separate fromfitness to work assessments.

Non-medical evaluation: evaluations which are notmedical in nature but which are integral parts ofthe fitness to work decision-making process.Examples include strength and agility tests,substance abuse tests and trade tests.

Pre-employment medical examination: a medicalassessment conducted prior to, and as a pre-condition to, a job offer.

Pre-placement medical examination: a medicalassessment conducted prior to being placed in asafety-sensitive position, but after a job offer hasbeen made to the job candidate.

Risk assessment matrix: a tool that standardizesqualitative risk assessment and facilitates thecategorization of risk from threats to health, safety,environment and reputation. The axes of the matrixare consequences and likelihood.

Risk assessment: see Health risk assessment.

Risk: the product of the chance that a specifiedundesired event will occur and the severity of theconsequence of the event. See also Health risk.

Risk-based approach: a method for designing afitness to work process based on objective healthrisk assessment.

Safety case: a structured argument, supported by abody of evidence, which provides a compelling,comprehensible and valid case that a system is safefor a given application in a given environment.

Safety-sensitive position: positions in which theincorrect action of the incumbent or a failure to actcan be a significant factor in events causing orleading to unsafe acts, environmental damage ormaterial losses.

Trade test: an evaluation of an individuals ability tocarry out a particular work-related task, by simulatingthe actual task to be carried out (e.g. fire fighting,helicopter underwater escape, driving, climbing, etc.)in a controlled environment. The test is usually carriedout by the work supervisor or a training instructor.Unlike a Functional capacity evaluation, trade testssimulate actual tasks and thus tend to be a betterpredictor than a functional capacity evaluation.

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22

Unfit: a decision made, as a result of medical andnon-medical evaluation, that an employee has afunctional limitation such that they are not able tocomplete the designated task safely. In thesecircumstances the process of accommodation ortransfer to alternative work is applied to facilitatethe retention of the employee in the workplace.

With-cause evaluation: an off-schedule review offitness to work carried out at any time betweenregularly scheduled evaluations, and triggered by asignificant change in the employees health.

23

FITNESS TO WORK

OGP/IPIECA 2011 All rights reserved.

OGP represents the upstream oil and gas industry before international organizations including theInternational Maritime Organization, the United Nations Environment Programme (UNEP) RegionalSeas Conventions and other groups under the UN umbrella. At the regional level, OGP is the industryrepresentative to the European Commission and Parliament and the OSPAR Commission for the NorthEast Atlantic. Equally important is OGPs role in promulgating best practices, particularly in the areasof health, safety, the environment and social responsibility.

London office 5th Floor, 209215 Blackfriars Road, London SE1 8NL, United KingdomTelephone: +44 (0)20 7633 0272 Facsimile: +44 (0)20 7633 2350E-mail: reception@ogp.org.uk Internet: www.ogp.org.uk

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IPIECA is the global oil and gas industry association for environmental and social issues. It develops,shares and promotes good practices and knowledge to help the industry improve its environmental andsocial performance, and is the industrys principal channel of communication with the United Nations.Through its member-led working groups and executive leadership, IPIECA brings together the collectiveexpertise of oil and gas companies and associations. Its unique position within the industry enables itsmembers to respond effectively to key environmental and social issues.

5th Floor, 209215 Blackfriars Road, London SE1 8NL, United KingdomTelephone: +44 (0)20 7633 2388 Facsimile: +44 (0)20 7633 2389E-mail: info@ipieca.org Internet: www.ipieca.org