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- AR 523.1 (Exhibit) History and Physical Examination Form
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AR 523.1 (Exhibit) History and Physical Examination Form
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ADMINISTRATIVE RULE 523.1
AR523.1 - Staff Physical Examinations
All potential employees of the School District of Fort Atkinson shall provide evidence of satisfactory health and freedom from tuberculosis and controlled substance usage within two weeks of the initial offer of employment by the School District. The District will contract for such pre-placement examinations with a common health services provider. The cost of such pre-placement examinations shall be incurred by the School District. The following procedures have been developed to implement a section of Board Policy 523.1:
A. It is recognized that the nature of employee examinations will vary. There are two basic pre-placement physical examination options. They are:
Option 1 General Employee
Option 2 General Employee with Lifting Duties, Buildings and Grounds Staff
Food Service Workers
Other physical examination components may be required based upon particular job descriptions, e.g., audiology screening, pulmonary function testing. Most of these additional examination requirements affect custodial/maintenance positions.
B. Before job interviews are conducted, the following supervisors will determine the pre-placement examination requirements based upon the essential job functions of that particular position, and complete a “Pre-Placement Health Physical Checklist” (Appendix A):
1. Director of Instruction: All FEA positions
2. Building Principals/Central Office Supervisors: All FESS positions, AFSCME positions (laundry worker only), long-term substitute teachers.
3. Director of Buildings and Grounds: AFSCME positions (custodial positions only).
4. District Administrator: All administrative positions and non-union positions.
5. Head Cook: AFSCME positions (food service workers only)
C. After the interview team makes an employment selection, the aforementioned supervisor (cited in B above) will give a “Pre-Placement Health Physical Checklist” to the potential employee. The potential employee will be responsible for scheduling and securing a pre-placement staff examination with the health services provider within two weeks of the interview. A “History and Physical Examination Form” (Appendix B) will also be given to the potential employee by the supervisor. The potential employee will need to complete the form and submit it to the health services provider at the time of the pre-placement physical. The authorized “Pre-Placement Health Physical Checklist” will be given to the health services provider by the potential employee at the time of the examination appointment.
In addition to health screening, all potential AFSCME employees will participate in technical skill and other related testing as described in the District document “American Federation of State, County, and Municipal Employees (AFSCME) Job Descriptions and Related Pre-Placement Physical and Skill Requirements on the School District of Fort Atkinson”.
D. Upon completion of the pre-placement physical examination, the health services provider shall contact the referring supervisor and inform him/her of the examination results.
E. The supervisor shall contact the potential employee to inform him/her of the final disposition of the selection process.
F. All staff examination reports compiled by the health services provider will be forwarded to the District’s School Nurse for storage and annual review.
Approved: October 1996