After posting my last blog on Challenging the Validity of a Doctor's Note and providing recommendations for employers, I had many discussions with corporate clients about how they deal with Employees who bring in a note saying "light duties only" or something equally as vague.

The best practise solution came from one of my manufacturing clients who shared with me a simple tool that helps them sort through what to do with the doctor's note that provides no details of what the employee can actually do. When an employee brings in any doctor's note about limitations in ability to work at full capacity, they immediately provide the employee with a Medical Evaluation Report Form, which is a one page form including specifics on Employee abilities/limitations, that they are to bring to their physician to fill out.

Unfortunately the form was not as specific as I would like, if I were the employer who has to accommodate the injured employee. I took a look online to compare this form with other Medical Forms and decided to create a form based on relevant information from a few of these. My revised form makes it easier for the physician to give the employer the qualitative information they require when accommodating the injured worker.

The first part of the form asks the physician to fill in complaint/prognosis information and asks them to check boxes as they apply, regarding specifics about modified duties, how long they will not be fit for regular duties, etc. There are 6 scenarios the doc can choose from. Here are two of those statements that require action:

"This employee is able to return to MODIFIED DUTIES for ____days and then: ____return to regular duties OR ____reassess."

"This employee is not fit to return to any work activity for a period of ____days."

The main chunk of the form deals with specifics regarding employee abilities and includes lifting, positional demands, category of work (sedentary, light, medium, heavy), and manual dexterity including these statements, that require a check if they apply:

___Can lift up to shoulder height ___

___Can lift up to ____lbs from waist to shoulders

___Able to Work extended hours

The last section outlines clear restrictions regarding lifting, position demands and repetitive activities, so there is no room for interpretation and includes statements like: 

___No kneeling ___No bending

___Limited reaching ___Limited pushing

Finally the physician AND employee need to sign the form and return to the employer. As a clinician, this form filled out would give me all the information I would need to effectively put the modified duties or return to work plan in action. It also provides me with great information, should a Functional Capacity Evaluation be required.

If your workplace is using a strong Medical Evaluation Report and you would like to share it with me, I will collect them and make revisions to the form I am working on and then I will post the update revised Medical Report Form as a resource for employers dealing with this issue. It is time we share best practices strategies to ensure the safety of the employees and to guide HR decision making.

Marnie Courage, OT Reg.(MB)

Managing Director

Enabling Access

By now most companies have ergonomics on their radar and have at least added the topic to the WPSH committee meeting agendas. Others have been nudged into paying more attention to ergonomics by government WPSH orders or penalty fees, following injuries and subsequent WCB claims. 

I have assisted companies who pride themselves in having sound ergonomic programs, having Safe Work procedures in place and policies that elicit quick responses to reports of pain, injury, and identified risk factors, as well as investing in administrative and engineering changes to solve the issues. Although off to a great start, they are reactionary in their methods and their injury statistics do not reflect a decreasing trend in injuries, most likely due to a lack of prevention in their focus.

Safe Work policies alone do not prevent musculoskeletal injuries, as they are job specific and not employee specific. Many ergonomic risk factors are individual in nature and warrant an individual ergonomic assessment to best match the environment to the worker. Providing ergonomic assessments for newly hired employees can prevent future injuries and therefore save the employer costs they incur responding to injuries.                       

Leaders in Health and Safety have taken their ergonomic prevention procedures a step further by including an ergonomic education session in the orientation of new hires along with the WHIMS and Safe Work Procedure training, to create a sound prevention program.

We know the risk of MSI is high in the first six months of being on the job, so spending loads of time and energy finding the right person for the job, might prove less than fruitful without ergonomic prevention measures in place. OK, so I'm sure you see the value in this type of prevention method, but how do you get your HR and Health and Safety Reps to get on board and put the plan in action? 

Marnie Courage, O.T.Reg(MB)

Owner/Managing Director

Enabling Access

Developing a Critical Job Inventory (CJI) is an important task in creating an effective Injury Prevention Program at your workplace. The following is a Safe Work guideline to developing your CJI :

1. Develop a system for identifying critical jobs:

Review specific tasks conducted by occupations. If you have a large workplace, start by identifying the departments within your workplace. Identify the different occupations within those departments. List the jobs or tasks within each one of the occupational groups. 

• Review the equipment used at the workplace. Multiple jobs or tasks may be performed with one piece of equipment. Remember to look at set up, calibration, changing blades and equipment operation for examples.

• Review the statistics you have on file, accident/injury records, first aid books, etc. These will guide you to jobs or tasks that you may have overlooked. What were the injured workers doing when they were hurt? Did you capture this jon or task in the inventory?

Review new jobs or infrequently performed jobs. When a new job is introduced into your workplace, make sure you evaluate it and add it to your critical job inventory. It is important that this process does not stop. It is also important that jobs or tasks that are infrequently done are included and are high on the priority list to develop safe work procedures. These jobs must include a clear procedure so that when workers are to perform then, they are familiar with the safe way to do it.

2. Evaluate your critical jobs. Examine the degree of risk. Factors that you will take into account include:

• Severity-what would the extent of the worker's injuries be if they were hurt while performing this job? Would the injuries be permanent? Would the injuries cause any time off?

• Probability-what is the likelihood of the worker being injured when doing the job? Would it be probable in time? Remotely possible?

• Frequency-how often is the job performed? How many workers would be exposed to the hazards associated with the job?

3. Create a CJI. Your CJI must include the job description and priority so that you can develop Job Hazard Analysis and Safe Work Procedures for the most critical tasks. You then have a plan of action for the remainder of the jobs on your CJI. Things to include on your CJI:

• The date the inventory was done (this should be removed at a minimum every three years along with your program)
• The department the job is conducted in and the manager or supervisor responsible for the area

• The occupation that conducts the job

• The critical rating or priority rating that you have assigned to the job after your evaluation or risk assessment.

Knowing the jobs is the most valuable action you can take towards reducing costs associated with injuries in the workplace. You will need good job descriptions for each job, which are easily compiled with an occupational therapist conducting a Job Demands Analysis (JDA) on jobs listed on your CJI, with prioritization given to those jobs with the highest risk ratings. The JDA will outline and measure all of the physical and cognitive demands of the job, making it easy to draft good job descriptions and help you better match employees to the jobs, at the time of hire.

Please let me know if this post has been helpful.  I would like to hear your comments. 

Marnie Courage

Owner|Managing Director

Enabling Access

marnie@enablingaccess.ca

As an occupational therapist, conducting office ergonomic assessments, I have come across many employees who are unable to position themselves ergonomically, because their body shape prevents them from assuming the positons, we are recommending.

In ergonomics, we typically set up people at their workstation so their elbows are at their sides bent at 90 degrees to access the keyboard and mouse, which are positioned in midline, either on the desk surface or on a keyboard tray. This positioning allows the employee to relax their shoulders and have their forearms supported on the arm rests of their chair while they type and mouse, while preventing reaching.

For employees who are "full-figured", and carry their weight in their stomachs and chest, keeping their elbows at their sides while typing and mousing becomes an impossible task. Instead, these folks have to reach around their larger chests or middles to access the keyboard and mouse which are certain to be positioned farther away from them, then their thinner coworkers, placing them at greater risk of musculoskeletal injury. 

Here's why:

• Reaching forward activates the muscles of the upper back and shoulders. These muscles work hard to sustain the forward reaching and eventually fatigue, resulting in discomfort and pain. By about 2 pm, these folks are wishing they had a personal assistant who is also a massage therapist. 

• To get their hands in typing position in midline, they have to assume ulnar deviation at the wrist (awkward posture) which creates stress on the wrists, discomfort and pain along the outside boarder of the hands and sensitive underside of the wrists. 

• With time, repetitive strain can develop in the wrists and without rest, change in position or treatment, the employee may become disabled and unable to work.

Solutions:

• Purchase a split keyboard to allow the wrists to access the keyboard in a neutral position, preventing the ulnar deviation. There are many brands of these available.
• Separate the two keyboard panels so they are positioned in line with the arm rests of the chair, away from midline to allow the forearms to be positioned on the armrests while typing, if possible.

• Position the split keyboard close to the front edge of the desk to prevent reaching forward.

• It is important for the employee to take Movement Breaks, Stretch throughout the day, as well as drink lots of water.

Just so you know, skinny folks also have other ergonomic challenges, so do tall folks, and so do short folks...so who's left? The point here is that we want to get people working as comfortable as possible, with the least amount of stress to the body. Guidelines for ergonomic positioning are just that, guidelines. Ergonomics is about fitting the environment to the individual, and if this helps to reduce someone's pain, then we all are headed down the right path! What's your ergo issue? 

Marnie Courage, OT Reg (MB)

Managing Director

Enabling Access