Health Evaluation Examinations 
in 
Industry 
Preplacement Examination 
Periodic Examination 
Screening New Applicants 
Division of Industrial Hygiene 
NEW HAMPSHIRE STATE DEPARTMENT OF HEALTH 
Industrial Health Committee 
NEW HAMPSHIRE MEDICAL SOCIETY 
1949 Health Evaluation Examinations 
in 
Industry 
Preplacement Examination 
Periodic Examination 
Screening New Applicants 
Division of Industrial Hygiene 
NEW HAMPSHIRE STATE DEPARTMENT OF HEALTH 
Industrial Health Committee 
NEW HAMPSHIRE MEDICAL SOCIETY 
1949 EVANS PRINTING COMPANY 
CONCORD. N. H. HEALTH EVALUATION EXAMINATIONS IN 
INDUSTRY 
Preplacement Examination 
Periodic Examination 
Screening New Applicants 
With the rapid growth of technological developments in 
industry during the past quarter of a century and the pass- 
age of compensation laws for occupational diseases, the 
maintenance of the health of the working force in industry 
has become constantly of increasing importance. The re- 
sponsibility of the employer has steadily broadened, due 
largely to the facts that the opportunity for the control of 
health conditions lies almost entirely in his hands with the 
full cooperation of all employees and that money losses due 
to sickness and accidents among the workers can be re- 
duced to a minimum through active efforts in health super- 
vision, plant safety, education and plant sanitation. 
According to a survey conducted by the National Asso- 
ciation of Manufacturers: “No plant, however small, can 
afford to be without a health program. The annual net 
profit to the average plant of 500 employees from the opera- 
tion of a health program is $5,611. The yearly loss to a 
company of 500 employees which operates without a health 
program may be seen to be $39,000.” In 1943, a survey by 
the National Association of Manufacturers showed that 
of 1,625 companies who were asked whether they considered 
health programs a paying proposition, all but five answered 
“Yes.” Ninety-three per cent mentioned compensation in- 
surance reduction of 28.86 per cent, 92 per cent had lower 
absenteeism of 29.7 per cent. Eighty-seven per cent had less 
labor turnover of 27.3 per cent. Occupational disease reduc- 
tion 62.8 per cent. Accident frequency reduction 44,9 per 
cent. 
The essential basis for health and accident control in in- 
dustry is the physical examination. Without knowledge of 
the physical condition of the individual, it would be nearly 
impossible to develop the facilities required for conservation 
and betterment of health. Physical examinations should be 4 
considered only as one of the means for the maintenance of 
a sound health program and when used for the purpose for 
which they are rightfully intended, proper placement of 
employees, may become the most important part of the 
medical control program. 
While many organizations have been reluctant to insti- 
tute physical examinations, fearing the antagonism of their 
employees to a compulsory procedure, it is a well known 
fact that physical examinations, well and fairly conducted, 
are a sound means for safeguarding health and direct better- 
ment of the workers themselves. In addition, it is also a well 
known fact that a well conducted medical service in indus- 
try is one of the best means to good relationships between 
the working force and management. 
There are two sorts of physical examinations which in- 
dustry is particularly concerned with: (1) the preliminary 
examination of applicants for employment, and (2) the sub- 
sequent periodic examination of some or all workers at 
regular intervals during service in the organization. 
Preplacement Examination. The preliminary examina- 
tion of applicants for employment, the preplacement exam- 
ination, is designed to accomplish the following: 
1. Determination of those workers who are physically 
and mentally unfit for work and must be rejected. 
2. Acceptance of workers who are physically and men- 
tally capable of performing the work to be done with- 
out limitation. 
3. Classification of workers with physical or mental de- 
fects so that they may be permitted to perform work 
which they are capable of doing, while at the same 
time they are protected from work which would be 
hazardous to them or in which they would constitute 
a menace to fellow workers. 
4. Provides a means for the detection of remedial defects 
and the early discovery of chronic disease and de- 
terioration. 
Basically, this examination requires the evaluation of the 
worker in relation to his work requirements and consequent- 5 
ly should be sufficiently detailed to permit the examining 
physician to formulate a reasonable opinion based on the 
worker’s medical history and the findings of the examina- 
tion. The nature of the work determines the extent of the 
examination, although the examination basically should be 
thorough and complete. Special diagnostic tests and exam- 
inations should be conducted on individuals where the work 
requires exposures to toxic materials. 
Workers accepted for employment are further evaluated 
by the physician’s examination and those found to have 
some defect or deformity must be afforded protection. Sys- 
tems to facilitate the use of these physically substandard 
workers should be developed with the employment or per- 
sonnel department. The physician should classify the em- 
ployee’s ability to work and this classification then is trans- 
mitted to lay supervisory personnel to be used tor proper 
placement of the worker. Specific findings and diagnoses 
should never be revealed. 
Classification should be meaningful, since general terms 
are relatively useless. The following classification system 
has been used successfully: 
Group 1. Fit for all work 
Group 2. Fit for work under periodic medical review 
Class 1. With limited physical exertion 
Class 2. In non-hazardous work 
Class 3. With orthopedic defect 
Class 4. With defective vision 
Class 5. With defective hearing 
Class 6. With neuromental handicaps (emo- 
tional instability, nervousness, etc.) 
Class 7. Albuminuria, sugar, cardiovascular 
Class 8. Alcohol 
Group 3. Unfit for work at time of examination 
In order to obtain the maximum value from the physical 
examination of an employee, it should be conducted in a 
manner that not only enables management to fit a workman 6 
into a suitable job but also reveals information necessary 
for guidance in the maintenance of the health of the indi- 
vidual so that he may continue in his job effectively. 
The examination should be given before the employee is 
actually hired and it should be conducted in private by the 
physician. Examination of women should not be carried out 
without the presence of a nurse or female attendant. The 
preliminary part of the examination, such as taking medical 
and surgical histories; recording weight, height, tempera- 
ture; performing eye and ear tests, blood pressures, etc., 
may be made by a nurse or trained layman in order to save 
the doctor’s time. 
Record Forms for Preplacement Examinations. The pre- 
placement examination form should be simple in arrange- 
ment, but containing in full detail the questions which must 
be answered with ample room for check marks or answers. 
It should be made up in such detail as not to be dependent 
upon the examiner’s memory but without superfluous ques- 
tions which are usually not truthfully or properly answered 
by the examinee. Thus, every question which is put to the 
applicant should appear in the form, although questions in 
regard to the history of venereal and mental diseases as well 
as conditions not generally known or understood may well 
be omitted, since they are seldom answered accurately. The 
record form should be made of durable material; cards are 
usually more conveniently handled than sheets of paper. 
An example of a physical examination form used in in- 
dustry is shown in Figure 1. Supplementary forms often 
used in connection with the physical examinations are: (1) 
a printed slip with a request for a physical examination 
which may be sent with the applicant to the plant physician 
from the employment department, and (2) a printed card 
or portion of the examination record itself, perforated so 
that it can be torn off, on which the doctor can indicate his 
classification of the applicant when returning him to the 
employment department. 
The results of the preplacement examination should be 
regarded as strictly confidential and the full record of the 
examination should never leave the dispensary office; there- 
fore, the card which is to be filed for review by the employ- 7 
ment, personnel, or other departments usually classifies the 
worker according to his ability to work. 
Periodic Examinations of Selected Employees. A peri- 
odic examination following the entrance examination is a 
logical procedure, particularly in respect to many workers 
who are employed in spite of minor impairments and such 
defects which may subsequently develop and cause trouble 
if not watched. In this group, disease or defects may be 
progressive and of a type not yielding readily to treatment 
or easily correctible. Newly developing acute communicable 
disease may be detected and the patient referred to his 
family physician. Chronic diseases which become disabling 
if allowed to advance may be to some extent controlled and 
careful supervision of those employed in specially hazardous 
occupations may be assured through the use of periodic 
examinations. 
One of the most important functions of the periodic phys- 
ical examination in industry is the early detection of in- 
dustrial diseases and intoxications. Where workers are 
exposed to toxic materials such as fine silica dust, lead, 
benzol, mercury and its compounds, and other highly toxic 
substances, special diagnostic tests should be used to ensure 
that the worker is not absorbing harmful concentrations 
of these materials. 
Periodic Health Examinations of the Entire Personnel. 
Some plants are so equipped as to extend to all employees 
periodic physical examinations regardless of their occupa- 
tion in the plant. Such programs for the conservation of 
manpower produce significant benefits for both the employer 
and workers. The early detection of tuberculosis and dia- 
betes, and the lengthening of the period of working life, 
particularly of highly skilled workers, are examples of bene- 
fits derived from such programs. One of the main purposes 
of the program is to conserve important personnel such as 
management and supervisory personnel who constitute a 
group that industry cannot operate successfully without. 
The task of guiding industry in these complicated times sub- 
jects executives to continuous nervous and emotional stim- 
uli which frequently effect functional alterations with 8 
accompanying disturbing symptoms. The invaluable assis- 
tance which a physician may render not only to the execu- 
tives but also to all personnel in the organization is an asset 
which industry has recognized as one of its most important 
resources. 
Medical Records. Medical records have great import not 
only from the standpoint of the plant physician and nurse 
but also to management. While the keeping of accurate, de- 
tailed records is an irksome task, the recording of informa- 
tion is an essential function in every phase of industry today. 
The keeping of adequate medical records pays dividends, 
especially in the event of litigation. These records should be 
so organized that management can readily determine (1) 
the overall problems of sickness among employees; (2) fre- 
quency and severity of occupational and non-occupational 
illnesses and injuries of the entire plant and of each depart- 
ment; (3) the relation of sick absenteeism to the type of 
work an employee does. 
Accuracy is of the greatest importance in keeping of 
records. All information should be recorded at the time of 
the incident. It is always wise to write the employee’s version 
of his illness or accident in a statement which indicates the 
source of the information. It should be kept in pen and ink, 
never with a pencil. Once a record is made it should not be 
altered nor should any erasures be made. 
Two basic records necessary in any industrial health ser- 
vice are an individual record for each worker receiving 
service (Figure 1) and a daily log or tally sheet. These two 
forms may be elaborated depending upon the interests of 
management and the attitude of personnel. Most record 
systems contain the following forms: Individual records; 
Folder or jacket of preplacement physical examination; 
Periodic physical examination; Individual service record; 
Referral forms; Return to work permit; Physician’s report 
to plant management; Administrative record; Daily log or 
tally sheet; Weekly, monthly and annual reports; Special 
graphs; Absentee reports. These forms are seldom all found 
in one plant. The forms to be adopted by any given plant 
will have to be modified to meet the needs of that particular 
plant. 9 
The files of individual records should always be kept 
locked in the medical department and any information in 
them should be considered absolutely confidential except as 
it relates to injuries or disabilities due to employment. Upon 
termination of employment, the file folders should be sealed 
and placed in the inactive file. 
A periodic review of these records will enable the indus- 
trial physician to detect accident proneness, the early signs 
and symptoms of disease, and perhaps a tendency to mal- 
ingering. The physician’s interpretation of the data in the 
employee’s folder will serve as a basis for recommendations 
to the personnel department and other interested depart- 
ments in the plant. 
Screening of New Applicants for Employment. While it is 
much more desirable for all new employees to have physical 
examinations by a physician prior to assignment to any 
work in the plant, there are instances where it is not econ- 
omically practical for management to pay the cost for a 
physician’s services. In lieu of the preemployment physical 
examination for all new applicants, certain screening tech- 
niques can be used by the industrial nurse which will aid in 
the evaluation of the health status of the applicant and in 
the advisability of having a complete medical examination 
by a physician. By these techniques a certain amount of 
basic information can be obtained and through the nurse’s 
medical training she is able to assist in the proper placement 
of the applicant in a type of work that he is physically and 
mentally able to perform. Through this system, management 
is able to reduce the costs required for medical examinations 
of the entire working force and at the same time can achieve 
a certain degree of efficiency in proper placement of new 
workers. It should be understood that these screening tech- 
niques are at best to be considered only as a poor substitute 
for the medical examination and should be replaced as soon 
as practical by plant management with medical examina- 
tions by physicians. 
In the conduct of these screening tests, a nurse should 
work under the supervision of a physician and until the 10 
nurse becomes completely familiar with the techniques, the 
physician should personally supervise her evaluations and 
classification of applicants. 
Medical History. The taking of the medical history of 
an applicant often reveals important information in the 
evaluation of the applicant’s physical and mental status. 
The nurse should converse with the applicant in a cordial 
manner and maintain a friendly atmosphere at all times. 
Items to be included in the medical history are: Name 
(Maiden name in case of female applicants); Present ad- 
dress; Age; Marital status; Nationality; History of the 
following diseases in applicant or applicant’s family: Tuber- 
culosis, Diabetes, Heart trouble, Fainting spells, Arthritis, 
Hypertension and Allergies. 
The surgical history should be taken as stated by the ap- 
plicant and should include kind of operations and broken 
bones, with dates of operations or accidents. 
A history should be taken of his military service, particu- 
larly in respect to any diseases that he may have suffered 
and particularly the theatre in which he has seen active 
duty. Data should be obtained on the duration of military 
service, reasons for his discharge, whether on points or for 
medical reasons; if the latter, the reason should be recorded. 
If the applicant was 4-F the reason for this classification 
should be stated. Definite questions should be asked regard- 
ing malaria, tropical diseases, wounds or injuries and trench 
foot. The date of the last physical examination should be 
recorded as well as the place where it was taken and any out- 
standing pathology that was found. 
Physical Examination. Upon completion of the medical 
and surgical history, the following tests should be conducted. 
1. Height and weight by medical scales. 
2. Eye-screening tests should be done, using a wall chart. 
If instruments are available for eye examinations, they 
should be used and the results recorded on the physical 
examination form. 
3. Hearing should be tested by the watch method. 11 
4. Teeth should be inspected using a throat stick, and 
condition or loss of teeth recorded. 
5. Throat should be inspected using a throat stick, and 
any general abnormalities recorded. 
6. Inspection of arms and hands: applicant stands facing 
the examiner with arms stretched out and fingers 
spread apart. Notation should be made of any defects 
or tremors, abnormal biting of nails, dry skin, eczema 
or rashes. 
Request the applicant to flex forearms acutely until 
fingers touch the shoulders; raise elbows anteriorly 
as far as possible; follow by bending over and touch- 
ing the ground, resume erect position, squat on heels 
and rise to original position; abduct first one leg and 
then the other; rotate the head side to side. 
These motions can be gone through rapidly and 
every important joint in the body will have been 
tested. If any defect in a joint is observed, such nota- 
tion should be made on the examination form. 
7. Legs, Any abnormality of the feet which is observed, 
such as flat feet, should be recorded. Varicose veins 
should be noted. 
8. Skin. Observation should be made of skin about the 
face and neck, hands, for the presence of acne and any 
other abnormal condition. 
9. Blood Pressure. Systolic and diastolic blood pressure 
should be taken and recorded. 
10. Urine specimen should be obtained and tests made for 
sugar and albumin. 
11. Under “Remarks” of the examination form, notation 
should be made of any unusual appearance, deformity 
or mentality. 
Upon completion of the above items, the nurse evaluates 
the applicant’s health status and classifies him according to 
two groups: 
A. Fit for all work. 12 
B. Fit for work with periodic examination of special de- 
fects which may be classified generally as follows: 
1) With limited physical exertion 
2) In non-hazardous work 
3) With orthopedic defect 
4) With defective vision 
5) With defective hearing 
6) With neuromental handicaps (emotional in- 
stability, nervousness, etc.) 
7) Albuminuria, Sugar, Cardiovascular 
8) Alcohol 
Applicants are not considered unfit for work except upon 
medical examination by a physician. 
Figure 1 can be used by the nurse in performing the tech- 
niques for screening new applicants for work by complet- 
ing the items marked by an asterisk. 
As soon as the applicant has been classified by the nurse, 
the classification is sent to the employment or personnel 
office for their use in proper placement of the applicant. 
The nurse always should refer to a physician applicants 
whom she believes to be unfit for work and also those appli- 
cants who have defects or conditions which should receive 
medical attention prior to or during employment. The physi- 
cal examination form with the screening data can be given 
to the examining physician for his use in the medical exam- 
ination. However, all forms with findings and classifications 
should be returned and kept in the dispensary files at the 
plant. With proper instruction and supervision the nurse can 
become very efficient in these techniques and her work will 
be a great asset to management in the reduction of absences 
from work due to sickness and injury, compensation costs, 
and in the provision of continuous protection of the health 
of the employees. Figure 1, 
♦Name 
♦Address 
♦Department 
♦Operation 
♦Age *S.M.W.D 
♦Nationality 
♦Male 
♦Female 
♦Medical History; TB. 
Diabetes Heart Hypertension 
Fainting Spells 
Arthritis 
Allergies 
♦Surgical History: 
♦War Record: U.S. 
E.T.O. 
Pac. Duration 
Disch. Points 
Medical 
♦4F Malaria 
Tropical Diseases 
Wounds or Injuries 
Trench foot 
♦Date of Last Physical Examination 
♦Place 
♦Pathology 
♦DATE 
RE-EXAMINATIONS 
♦Height: Ft. 
In. — ♦Weight Lbs. 
1 1 
♦PHYSICALLY 
♦General Appearance 
♦Alcohol 
1 1 
First Class Defective 
♦Eyes 
Corrected 
1 1 
Average Unfit 
Vision—Far: Rt. 
Lt. Rt 
Lt. 
1 1 
Near: Rt. 
Lt. Rt 
Lt. 
1 1 
♦MENTALLY 
♦Ears 
Hearing 
Rt. Lt. 
1 1 
Alert Average Dull 
♦Nose 
Throat 
1 1 
♦Teeth: Good Med. 
Poor Artificial 
1 1 
♦SUMMARY AND 
♦Neck (General Appearance) 
1 1 
♦Arms and Hands 
1 1 
RECOMMENDATIONS 
♦Back (deformities) 
♦Skin 
1 1 
Heart 
♦Pulse 
1 1 
A. Fit for all work 
Lungs 
1 1 
Hernia Ing. 
Fern. Umb. 
1 1 
B. Fit for work under periodic 
medical review: 
1. With limited physical exertion 
2. In non-hazardous work 
3. With orthopedic defect 
4. With defective vision 
5. With defective hearing 
6. With neuromental handicap 
7. Albuminuria Sugar 
♦Legs ♦V.V. 
♦Feet 
1 1 
Abdomen 
1 1 
♦Blood Pressure 
Sys. 
Dias. 
1 1 
♦Catamenia 
♦Dysmen. 
1 1 
♦Children 
♦Misc. 
1 1 
♦Reflexes ♦K.J. 
♦Tremor 
1 1 
Rectal 
Hemorrhoids Fistula 
1 1 
G.U. 
1 1 
1 1 
♦Laboratory Data 
8. Alcohol 
♦Urine: ♦Sp. Gr. 
Reac. 
♦Alb. ♦Sug. 
1 1 
Acetone 
Diacetic 
Bile 
1 1 
C. Classification with physician 
♦RATING: 
Blood 
Hgb 
Hinton 
1 1 
X-ray 
1 1 
Nurse 
Doctor 
PHYSICAL EXAMINATION 
Screening by Nurse 
•Items to be accomplished by the nurse in screening new applicants 
REMARKS: 14 
Figure 2. 
MEDICAL RECORD 
Name 
Date 
Date 
Reported 
Discharged 
Treatment and Remarks 
1 1 
1 1 
1 1 
1 1 
1 1 
1 1 
1 1 
1 i 
1 1 
1 1 
1 1 
1 1 
i 1 
1 1 
1 1 
1 1 
1 1 
1 1 
1 1 
1 1 
1 1 
1 1 
1 1 
1 1 
1 1 
1 1 
1 1 
1 1 
1 1 
1 1 
1 1 
1 1 
1 1 
1 1 
1 1 
1 1 
1 1 
1 1 
1 1 
1 I 
1 1 
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1 i — 
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1 j