Number: VI.5. 
Date Issued: July 25, 1991
Date Revised:


To identify policies and procedures related to medical examinations directed by management to determine "fitness for duty".


Also see Pre-employment Medical Examinations and DMV Medical Examinations in this same Section.


Government code Section 12940
Vocational Rehabilitation Act of 1973 - Sections 501, 503 and 504
Americans with Disabilities Act of 1990
Civil Service Rules, Section IV - Standards and Qualifications for Employment
Civil Service Rules, Section XI, Leaves of Absence, including part D. Involuntary Leave of Absence Without Pay for Medical Reasons at Direction of Appointing Authority
Section 168.1 Personnel Regulations - Leave of absence without pay


  1. Determining a need for medical examination:

    1. Occasionally a situation occurs where a department believes it is necessary to direct an employee to undergo a medical examination at departmental expense to either :

      1. determine whether an employee with a known medical problem can safely perform his/her duties without endangering his/ her safety or the safety of others; or

      2. determine whether or not an employee with a documented performance problem has a physical problem which is interfering with the performance of his/her duties.

    2. Examples of appropriate and inappropriate reasons for medical examinations

      1. Appropriate:

        1. An example of where referral for an employee for a medical examination would be appropriate is:

          A long term employee with a history of continued satisfactory performance and whose duties include recording court actions in case files has a recent, documented history of frequent omissions and errors in recording the judge's actions. The recording of court actions is an essential job function in the employee's job. The employee has been counseled regarding this problem. The department suspects the employee may have a hearing loss. The employee does not acknowledge that there may be a medical problem (i.e. hearing loss).

        2. An example of where directing an employee to go for an medical examination would be appropriate is:

          A detention officer working in the jail appears to have a hearing problem. One day the employee is monitoring the audio alarm system for the jail, but fails to hear an alarm activated by another officer, placing the other officer at risk. As the employee has a documented problem which jeopardizes the safety of others, ordering the employee to a medical examination may be appropriate.*

          * Should the situation arise where it appears that an employee cannot safely perform his/her duties, the employee should be removed from those duties immediately. The department may wish to temporarily assign the employee other duties which appear to entail less risk. However, if the department does not have other duties for the employee to perform, or if not SURE that the employee can perform the other duties safely, the employee can be and should be sent home. The department should attempt to get the employee to concur with this. If the employee does not concur, the department should review Civil Service Rule XI.D. regarding involuntary leave of absence without pay for medical reasons at direction of appointing authority. Contact Employee Relations for assistance.

      2. Inappropriate:

        1. Examples of where directing or referring an employee for a medical examination would be inappropriate are:

          1. A department suspects that an employee may be using drugs, but cannot identify any way in which such usage has manifested itself in terms of work performance. The nature of the work the employee performs is such that it is highly unlikely that, if the employee was under the influence, such usage would endanger the employee or others. In this case, the employee will need counseling on the County's policy on Drug Free Workplace. Employee Relations should be contacted for assistance with this problem.

          2. An employee's work performance is satisfactory, however, the employee has a high number of unscheduled absences. While the employee's absences are of concern to the department, and may be the result of a health problem, referral to a medical examination paid for by the department is inappropriate. The department needs to counsel the employee concerning the absences, and may suggest to the employee that s/he seek medical help if there is a medical basis for the absences.

  2. When a department believes a situation exists where referral of an employee for a medical examination might be appropriate, they should contact Employee Relations. Employee Relations staff will work with the department and other resources (e.g. County Occupational Health physician, Risk Management staff) to determine whether the situation would warrant such a referral, what type of specialist and which specialist to use, and work with the department to identify essential job functions of the employee's position/job class when necessary.

  3. If a department believes an employee has a medical condition which may be interfering with his/her work performance or preventing the employee from returning to work, the department should first encourage the employee to seek medical advice.

  4. Payment for employee medical examinations can only be made for management directed examinations which have the PRIOR, written approval of the Personnel Director.

  5. Departments may be authorized under this policy to have a medical examination of an employee. This never applies to treatment. If the medical examination indicates the employee has a condition which requires treatment, it is the responsibility of the employee to obtain and pay for such treatment (which may be reimbursable under employee insurances).

  6. Such medical examinations are not for work related illnesses or injuries, as these are covered by Workers' Compensation, and the County's Workers' Compensation administrator should have medical records on which to base a determination. However, there may be instances when a workers' compensation claim has been rejected, and an examination is needed to protect the department (i.e., to obtain a medical report which indicates the employee can perform his/her duties safely).

  7. When referral of an employee for a medical examination is approved, the department shall:

    1. notify the employee of the required referral in writing, including the time, date and location of the office of the specialist;

    2. inform (and confirm in writing) the medical specialist of the problem(s), how to bill the department, and to whom the report is to be sent (normally, the County's Occupational Health physician).

  8. If an employee indicates s/he has a medical problem, it is incumbent upon the employee to obtain a medical examination and any medical treatment that is necessary. Departments will not be authorized to pay for such examinations.

  9. If department management believes that employees in a class in that department need a "baseline" medical exam or tests because of work exposures, they need to discuss this with the Deputy Director of Personnel Services, who will confer with the Occupational Health physician regarding the need, the type of examination or test which might be used, and with the CAO analyst regarding the financing such examinations. Such "baseline" and continuing examinations are separate from those described in this policy and are defined in the Pre-employment Medical Examination policy Section VI.5.


  1. If a department believes a situation exists where a department paid medical examination may be appropriate, the department contacts the Employee Relations Manager in Personnel. The department should be prepared to identify:

    1. the specific problems in work performance or safety;

    2. the essential duties of the position;

    3. what documentation exists of the problem;

    4. when the employee was counseled about the problem.

  2. The Personnel Department will work with the operating department and others to gather information, clarify issues, and coordinate any referral. Questions which will be addressed include:

    1. Will an examination provide the necessary information?

    2. What are the essential duties of the job?

    3. Are there alternatives which could or should be tried?

    4. What type of examination is necessary?

    5. Which practitioners might be used for the examination?

  3. If the Personnel Department believes that a medical examination is warranted, a memo will be sent to the operating department confirming authorization for the examination.

  4. The appointment will normally be scheduled by the operating department (exceptions will be identified by the Personnel Department). The practitioner will need to know:

    1. What the problem appears to be and how it manifests itself.

    2. What the essential duties of the position are.

    3. Who in the department is to receive the bill.

    4. Who in the department is to receive the report of the examination (the Occupational Health physician in HSA will need to review the medical examination results, but most physicians will want to send a report along with the bill to the operating department.)

  5. The operating department notifies the employee of the appointment for the medical examination in writing. The notice should identify whether it is a referral or that the employee has been directed to have the examination, and when and where the appointment is.

  6. Upon receipt of the medical report, the operating department, Personnel, and the Occupational Health physician will consult and decide how to proceed.

  7. The operating department prepares a blue claim for payment of the bill for the examination from the appropriate departmental account, and attaches the bill for services and the memo from the Personnel Director authorizing the examination.