Occupational Health Service Policy

Block 3: Occupational Health Management - Section 5 or possibly 4: Medical Fitness Assessment

OHM5 or 4.1: Medical Ajudication

Concepts in medical adjudication - job fitness (disability and incapacity seem to be addressed elsewhere??)

“Unfit”

The term medically “unfit” refers to the failure to meet the specific inherent requirements of an occupation due to the presence of a medical condition that is an exclusion for the relevant occupation, or due to a lack in the capacity (physical or mental) to perform the work, to the required standard.

Note that a person may be “unfit”, but not “disabled”! THIS IS A GOOD EXAMPLE OF INHERENT REQUIREMENTS OF THE JOB BUT WE HAVE TO CLEAR UP THE LINK BETWEEN THE INHERENT REQUIREMENTS OF THE JOB AND THE INHERENT CAPACITY/CONDITION OF THE EMPLOYEE I am also a little unclear on your differentiation here, Jonny...

An example of this is a small and lightly built person who applies for a job that entails heavy manual labour.

Absolute exclusions

The degree to which a person is unsuitable to work in a particular occupation varies according to circumstances. For example, a job applicant who fails to meet a minimum statutory requirement, or for whom the risks of the occupation are unavoidable and life-threatening, the degree of unsuitability would be regarded as a non-negotiable. The medical conditions that lead to the failure to meet these requirements would be regarded as “absolute exclusions”.

An example of an “absolute exclusion” would be the presence of blindness, in a company driver of a vehicle carrying hazardous substances, on the national roads.

Relative exclusions

It is logical to conclude that there are always many medical conditions that are only exclusions when they are present with other factors. On their own, they may pose an acceptable degree of risk, with or without certain “restrictions”. These restrictions could be on the working conditions, or that the employee’s health condition remains satisfactory. These medical conditions are known as “relative exclusions”.

An example of a “relative exclusion” would be as follows. The occupation entails potential exposure to lung irritants, such as chlorine or ammonia. Lung protection is reliant upon adequate ventilation or by means of PPE (respirators, etc). Mild asthma could be regarded as a relative exclusion, with the proviso (“restriction”) that:

lung function be monitored regularly, and that there be no significant decline of measured function (health condition)
the employee is not exposed to levels of lung irritants that exceed the statutory limits (working condition)

THIS WOULD BE ASSISTED BY A 2X2 TABLE SHOWING I DON'T HAVE THIS QUITE RIGHT

	High job performance inherent requirements	Low job performance inherent requirements
Abnormality present or does not meet fitness standard	Absolute exclusion	Relative exclusion: health condition restriction
No abnormalities and meets fitness standard	Relative exclusion: working condition restriction	No exclusion or restriction

Well, I must say, I see what you are getting at - have highlighted the key points. But whilst this has finesse, I am not sure that it holds. Usually, both health conditions and working conditions apply simultaneously (as per the bullet points above) . The relevance of this concept is that the medical professional needs to bear in mind that both the conditions should be monitored (and maintained) for the fitness certification to remain valid.

Hence there are 5 possible adjudication outcomes, regarding "Job Fitness":

Can do the job.
Can do the job with lower efficiency.
Can do the job, but is a danger to himself.
Can do the job, but is a danger to others.
Cannot do the job.