A review of assessment of fitness for work and adjustments for health and safety at worksites overseas

OBJECTIVE: In this research, we reviewed studies about assessment of fitness for work and adjustments for health and safety at worksites overseas. METHODS: We systematically searched PubMed (1980-2010) using keywords related to fitness for work. The collected studies are discussed with respect to the country, timing of medical examinations, health problems of workers, occupations, categories of health level in workers, criteria for assessment of fitness for work, and the decision-making process related to accommodations at work. RESULTS: Seventy articles were identified that met the inclusion criteria. They focused on two key points related to assessing fitness for work: 1) safety and risk to workers themselves, to other workers and the public, and 2) ability to perform in potentially dangerous situations, such as those encountered by the military and firemen. Employers were required to provide reasonable accommodations for disabled or sick workers. The following steps were taken to make accommodation decisions: 1) analysis of job requirements; 2) worker analysis, including evaluation of work limitations or risks related to disabilities or illness; 3) choice of necessary adjustments at work, based on reasonable accommodations decided during talks between the disabled or sick workers and employers, including feasibility, effectiveness, and costs of such adjustments; 4) judgment of fitness for work based on steps 1 to 3, and opinions of specialists in various fields. CONCLUSION: In this investigation, we could not find any clear criteria for judgments about fitness for work or numerical criteria for adjustments at worksites after medical examinations of employees. However, we confirmed the following. Assessing fitness for work should be based on a comparison of workers' health with the risks and demands of the job. In addition, doctors should have the ability to offer opinions on adjustments at worksites. The employer's obligation to provide reasonable accommodations is attracting more attention in Japan. To make adjustments for health and safety at worksites for all workers, the procedures and important issues must be determined as well as criteria of judgments or numerical criteria. Moreover, doctors should provide opinions about adjustments at worksites. Therefore, they need more training in assessing fitness for work.