Navigating the Maze: When is Return to Duty Testing Required?

When is return to duty testing required? A RTD test is part of the return-to-work process for employees in safety-sensitive industries who have tested positive for drug and/or alcohol use or have violated workplace drug and alcohol policy.

In this blog, we explain the RTD process, who must take the test, and the importance of treatment and follow-up testing.

Understanding the Return-to-Duty Process

Workplace incident leading to when is return to duty testing required

Statistics show that more than 70% of Americans dealing with drug or alcohol addiction are employed. These employees pose significant health and safety risks to their employers, co-workers, and the public. If they violate workplace drug and alcohol policy or work in a safety-sensitive job, they may find themselves removed from duty.

Fortunately, RTD testing gives employees a second chance.

Incidents Leading to RTD Testing

There are three circumstances that can trigger an RTD test in safety-sensitive industries.

  1. Positive drug/alcohol test: U.S. Department of Transportation (DOT) regulation requires that any employee in a safety-sensitive position who tests positive for drug or alcohol on a random drug test or based or a reasonable suspicion test must be removed from duty. The individual must then complete a drug and alcohol treatment program under the supervision of a Substance Abuse Professional (SAP). A negative RTD test result must be recorded before they can return to work.
  2. Violation of a drug or alcohol rule or policy: Violations may include possession of drugs or alcohol at work or transporting drugs or alcohol while operating a commercial vehicle. In these circumstances, the employee must be removed from duty, complete a drug and alcohol treatment program, and undergo an RTD test.
  3. Refusal: If an employee refuses to take a random drug test or reasonable suspicion test, they may be removed from duty. To return to duty, they must complete a drug and alcohol treatment program and undergo an RTD drug test.

Steps in the RTD Process

The RTD process encompasses the following steps:

Step 1: Removal from duty

An employee must be immediately removed from duty following a workplace drug or alcohol violation or positive drug/alcohol test as confirmed by a Medical Review Officer (MRO). The MRO must also report the violation to the Federal Motor Carrier Safety Administration (FMCSA) Drug and Alcohol Clearinghouse.

Step 2: SAP evaluation

If the employee wishes to return to work, they must submit to an evaluation by a Substance Abuse Professional (SAP). The employer must provide the employee with a list of DOT-approved SAPs.

Following the face-to-face assessment of the employee, the SAP will establish a drug and alcohol treatment program.

Step 3: Completion of treatment

Once the treatment is complete, the assigned SAP will review the employee’s progress and determine if they are ready to take an RTD test and return to work upon a negative result. The SAP may also recommend continued counseling as part of any follow-up care.

If the employee fails to complete treatment or requires additional evaluation or treatment, the SAP will not clear them for return to work.

Step 4: Reporting

The SAP will communicate their findings to the employer, providing details on the employee’s progress in treatment and the number of follow-up drug tests required.

Step 5: RTD test

After examining the report, the employer is required to arrange an RTD drug test for the employee. The test should be performed under direct supervision to ensure an untampered result. To pass the RTD test, the employee must exhibit the following results:

  • Alcohol concentration of less than 0.02; and/or
  • Controlled substances with a result indicating a verified negative result for drug use.

Employers must notify the FMCSA Clearinghouse of successful treatment completion and negative test results. Follow-up test results must also be reported to the FMCSA.

Role of the Substance Abuse Professional

Substance Abuse Professional's role in determining when return to duty testing is required

A Substance Abuse Professional or SAP is a medical professional who evaluates employees who have violated a DOT drug and alcohol program regulation.

To become an SAP, the individual must pass the Certified Substance Abuse Program Administrator (C-SAPA) exam. Once certified, an SAP can make recommendations concerning employee treatment, follow-up testing, and aftercare.

Importantly, an SAP doesn’t advocate for the employee or the employer. Their main task is to protect the public. After all, the decisions they make determine whether to place an employee behind the wheel of a truck, in an aircraft cockpit, or at the throttle of a train.

As part of their duties, SAPs must be knowledgeable of DOT procedures for transportation workplace drug and alcohol testing programs (49 CFR Part 40), including substance abuse return to duty processes, employee confidentiality laws, and more.

Finding a Qualified SAP

As part of the RTD process, employers are required to provide employees with a list of SAPs qualified in accordance with DOT Rule 49 CFR Part 40 Section 40.281.

If the employer does not provide a list, employees can search the internet using terms such as “DOT qualified SAP.”

Post-Treatment and Return-to-Work

Employee's return to work after passing the required return to duty testing

Following treatment and return-to-work the employee must submit to a series of follow-up RTD tests as recommended by the SAP.

Types of Drug and Alcohol Tests Post-Treatment

In addition to the initial RTD test, the SAP will establish the number of tests required after treatment and return to work based on regulatory requirements or company policy. DOT law requires a minimum of six unannounced, random tests during the first 12 months following resumption of work.

These tests must be conducted under direct observation. All results must be reported to the FMCSA Clearinghouse.

Common Questions About RTD Testing

What are the steps for RTD?

The RTD process includes:

• Evaluation by a Substance Abuse Professional (SAP)
• Completion of a treatment program
• RTD drug and/or alcohol testing
• Follow-up testing (as required by law or company policy)

What do you need an SAP for?

An SAP or Substance Abuse Professional is a certified medical professional who evaluates employees and recommends substance abuse treatment programs and follow-up RTD testing.  

Employers in DOT-regulated industries are required to refer employees to an SAP following removal from duty due to a drug or alcohol violation. However, SAPs can assist any employer in managing and administering their return-to-work drug programs.

What does returned to duty mean?

An employee is returned to duty after completing treatment for a workplace drug and alcohol policy violation and passing a drug and/or alcohol test. Follow-up random testing may also be required.

Unraveling the Mystery: Why “When is Return to Duty Testing Required” Matters

RTD testing is vital to ensuring a safe and compliant workplace. When is RTD testing required? Employees in safety-sensitive and regulated industries must undergo RTD testing following a positive drug/alcohol test, violation of a workplace drug or alcohol rule or policy, or refusal to submit to a random drug/alcohol test.

At Acuity, we offer a wide range of workplace drug and alcohol testing services, both for regulated and non-regulated industries, including pre-employment, random, reasonable suspicion, DOT drug and alcohol tests, RTD, and follow-up tests.

These services are backed by advanced technology and a widespread provider network to give employers 24/7 access to scheduling, testing status notifications, case management reporting, and more.

Learn more about Acuity’s comprehensive portfolio of Occupational Health Services.

What is a Comprehensive Drug Test? Unraveling the Details

A comprehensive drug test is a screening method designed to detect a variety of substances, including prescription and over-the-counter medications and illegal drugs. A comprehensive drug test can identify hundreds of substances, including those that go undetected during routine testing. These tests play a crucial role in employment screening and are useful for identifying and treating addiction.

In this blog, we look at what comprehensive drug testing entails, the science behind it, how to interpret test results, and more.

Understanding Comprehensive Drug Testing

Negative impact of drug use in a diverse workplace environment

A comprehensive drug test is designed to look for hundreds of prescription and non-prescription medications, as well as illicit drugs and even alcohol. These highly sensitive and specific tests can easily identify substances in blood and urine that other tests fail to detect, making them a powerful tool for workplace and overall health screening.

Why is it Called “Comprehensive”?

Comprehensive drug panels detect many more substances than other targeted drug tests, which may only discover a certain subset of drugs or medications. Thus, these tests are considered “comprehensive” because they screen for a wide range of substances.

Common Drugs Detected

Some of the drugs that comprehensive drug screens detect include:

  • Opiates, amphetamines, and narcotics—all of which can be highly addictive when used regularly and in large quantities.
  • Barbiturates and benzodiazepines, including medications used to treat anxiety, insomnia, etc.
  • Cannabinoids—active ingredients in marijuana.
  • Antidepressants, which can cause significant side effects, including nausea, dizziness, and fatigue.
  • Stimulants, which are often prescribed for ADHD and other disorders but can lead to increased heart rate, high blood pressure, and other serious side effects.

There are many reasons employers may wish to consider implementing comprehensive drug testing for their workforces. Comprehensive drug tests can reveal whether an employee or prospective employee is using substances that could impact their ability to do their jobs effectively, resulting in greater worker productivity. They can also be an effective tool for maintaining a safe and happier working environment for everyone.

Comprehensive drug screening can also help organizations reduce liability and save money. The National Council on Alcohol and Drug Dependence estimates that substance use disorders cost companies $81 billion annually through lost productivity and absenteeism, turnover and recruitment costs, workplace accidents, healthcare expenses, and more. Testing can identify employees who might be engaging in substance abuse and mitigate these costs.

Most importantly, comprehensive drug tests can lead to employees getting the treatment they need to help them become healthier. Thus, comprehensive drug testing does not just improve a company’s bottom line; it can improve employees’ lives.

Types of Comprehensive Drug Tests

Elderly Asian doctor performing a comprehensive drug test using sweat analysis in a lab

There are several types of comprehensive drug tests, each with its own unique processes, benefits, and limitations. Here, we’ll explore the advantages and disadvantages of comprehensive urine and blood tests, as well as a few other lesser-known testing methods.

Urine Drug Screen

A urine drug screen is the most commonly used comprehensive drug test method. They are painless, easy, and cost-effective.

With a urine test, a person simply urinates into a plastic container and provides the sample to a technician or doctor. The person collecting the sample then measures the temperature of the sample to ensure it is suitable for testing. If it is, the sample is sealed in a plastic bag and sent to a laboratory for a urinalysis. Results are usually available within a few days or, in some cases, on the same day.

A physician or medical review officer will evaluate the test results and explain their findings to the test subject. In the case of a positive test, the subject may be asked to re-test to ensure that the results are accurate.

Blood Tests and Other Methods

Urine tests are not the only type of comprehensive drug screen. Other methods include:

  • Blood tests. These very precise tests are particularly useful in detecting high levels of alcohol.
  • Hair follicle tests can detect the use of cocaine, amphetamines, opioids, methamphetamines, phencyclidine (PCP), and other drugs. Hair follicle tests can vary based on the characteristics of each person’s hair. Scalp follicles have a detection time of about three months, while body hair can have a detection time of up to a year.
  • Sweat tests use perspiration to determine levels of illegal substances in a person. With sweat testing, an absorbent pad is placed on a person’s skin. It is used to monitor how much of and what kind of substance the person consumes while wearing the pad. Detection windows range from hours to weeks.
  • Oral fluid tests, which test for controlled substances in a donor’s saliva. Oral fluid tests were recently approved by the U.S. Department of Transportation.

The Science Behind Drug Testing

Urine drug screens are usually very accurate, but false positives are possible. In general, immunoassay (IA) urine tests are more prone to false positive results than gas chromatography-mass spectrometry (GC-MS) tests. In fact, GC-MS tests are often used to confirm the results of IA tests. GC-MS tests can also detect more substances, making them the most comprehensive of all urine drug screens.

GC-MS combines gas chromatography and mass spectrometry to identify various substances in a test sample. Gas chromatography separates and analyzes compounds in a mixture; mass spectrometry measures the mass-to-charge ratio of ions. When put together, the two analytical processes can positively identify even very small amounts of substances in a person’s system. This makes the GC-MS test the “gold standard” when it comes to comprehensive drug testing.

However, GC-MS testing is more expensive than an IA test, and the results take longer to retrieve. Therefore, IA tests are more commonly used.

An IA test measures the presence of macromolecules through the use of an antibody or antigen. These antibodies can detect the presence of drugs and other substances. IA testing is usually considered the frontline when it comes to comprehensive drug testing because of its ease, cost-effectiveness, and ability to deliver results quickly.

Interpreting Drug Test Results

Interpreting the results of a comprehensive drug test can sometimes be challenging. According to the Mayo Clinic, people who misuse drugs are adept at finding ways to mask their drug use, via methods such as adulteration, urine substitution, and urine dilution. It’s important that physicians and medical review officers know what to look for, including:

  • The color of a urine sample. A normal urine sample is pale yellow or clear, depending on concentration.
  • A pH less than 3 or greater than 11, which could indicate adulteration or dilution of the sample.

Assuming the sample has not been tampered with, the actual interpretation of test results is straightforward. That’s because drug screen results are reported as either positive or negative. Some tests will state the concentration of the drug or metabolite contained in the sample.

Factors Affecting Test Results

There are many factors that can affect the results of a comprehensive drug screen. Some of the most prominent ones include:

  • Metabolism. High metabolism helps a person’s body process and remove the residue of drugs more quickly. Therefore, a test performed on a person with a high metabolism has a higher chance of returning a false-negative result.
  • Drug half-life. Half-life is the amount of time a drug stays in a person’s system. Half-life is different depending on the drug. Some drugs have a longer half-life than others, which makes them more likely to show up in a drug test (depending on when the test is taken). For example, the half-life of Xanax is four days, whereas the half-life of Fentanyl is one to three days.
  • Frequency of drug use. A substance that is used more frequently is more likely to be discovered on a comprehensive drug test, simply because there is a higher likelihood that the drug may be in the subject’s system at the time of testing.
  • Dosage. The higher a drug’s dosage, the more likely it will be detected during a drug test.

Frequently Asked Questions About “What is a Comprehensive Drug Test”

Essential drug testing tools laid out on an office desk

What does a comprehensive drug test include?

A comprehensive drug test is a test designed to detect hundreds of possible medications and illicit drugs in a person’s system. Comprehensive drug tests look for both prescription and non-prescription medications, illegal substances, and, in some cases, alcohol. They are generally performed through urinalysis, but blood tests, hair follicle tests, and others can also be performed.

What is the most accurate type of drug test?

The most comprehensive urine drug test is a gas chromatography-mass spectrometry (GC-MS) test, which positively identifies even very small amounts of substances in a person’s system. This makes the GC-MS test the “gold standard” when it comes to comprehensive drug testing.

What is a 12-panel comprehensive drug test?

A 12-panel comprehensive drug test is a urine drug test that tests for 12 different metabolites in a person’s system. It can accurately detect substances—including painkillers, opiates, and stimulants—that may be more difficult to detect on smaller panel drug tests.

Conclusion: The Importance of Comprehensive Drug Testing

Comprehensive drug testing is a critical tool for ensuring a safe and productive workplace. With comprehensive drug testing, employers can proactively tell if employees and prospective employees are using substances that could impact their job performances—and their overall well-being. Proactive drug testing can also help organizations avoid the costs and liability associated with drug use in the workplace, which costs companies billions of dollars every year.

Acuity’s comprehensive drug testing services are available 24/7, wherever and whenever they are needed. Featuring Medical Review Officers and Medical Review Officer Assistants with decades of experience, Acuity’s drug testing services are ideal for all industries, whether they require regulated or unregulated testing.

Learn more about how Acuity can help you meet your drug testing needs.

Why is OSHA Necessary? The Definitive Guide to Occupational Safety’s Pillar

Why is OSHA necessary? Put simply, the Occupational Safety and Health Administration (OSHA) saves lives. Since 1970, OSHA programs have reduced work-related fatalities by almost 63% and cut workplace injuries by 40%.

Created under the Occupational Safety and Health Act of 1970, OSHA equips employers and workers with the knowledge and tools they need to ensure a safe and healthy workplace. OSHA sets and enforces employer standards and responsibilities and provides compliance assistance, education, and training to ensure those obligations are met.

This blog explores the role that OSHA plays in employee health and safety as well as resources and tools that can help you achieve OSHA compliance.

OSHA Demystified: The Beacon of Workplace Safety

Lighthouse symbolizing OSHA as a beacon of workplace safety.

According to the U.S. Bureau of Labor Statistics, employers report 2.6 million injury and illness cases and 5,190 work fatalities a year.

OSHA requires you to safeguard your workforce, but your employees also expect you to do so. Recent survey data reveals that 75% of workers are more likely to remain loyal to a company that prioritizes their physical safety.

The Importance of Occupational Safety

OHSA’s occupational safety programs help reduce falls, slips, trips, vehicular and machinery-related incidents, exposure to chemical and hazardous materials, and more.

But OSHA also plays an important part in workplace productivity and cost management. Work-related injuries and illness are a leading cause of absenteeism, lost productivity, emotional and psychological costs, and workers’ compensation claims volume.

Proactive changes that improve workplace safety can result in significant improvements to your organization’s productivity and financial performance. According to OSHA:

  • Companies spend $170 billion each year on costs associated with workplace incidents.
  • Workplace health and safety programs lower injury incidences from anywhere between 9% and 60%.
  • These programs can also reduce injury and illness costs by up to 40%.

The Genesis of OSHA: A Timeline of Transformation

In 1970, a staggering 14,000 U.S. workers were killed on the job – that’s 38 people every day. But these numbers were not new. For decades, thousands of workers lost their lives or faced hardship because of workplace injury and illness.

Finally, in response to pressure from labor unions, employers, and their families, in December 1970, the U.S. government passed the Occupational Safety and Health Act. In April 1971, OSHA opened its doors.

OSHA is a national agency dedicated to the basic proposition: no workers should have to choose between their life and their job.

OSHA has progressed from representing 56 million workers in 1971 to 105 million private sector workers today. These workers look to OSHA for guidance on workplace health and safety and to their employers to share information on workplace hazards and how to protect themselves.

Catalyst Events: The Urgent Calls for Change

Workplace health and safety first came under the spotlight with the Industrial Revolution and societal shifts like the formation of labor unions, civil rights, women’s rights, and the Vietnam War. However, a series of workplace tragedies and associated public outcry were instrumental in shaping OSHA, including:

  • Triangle Shirtwaist Factory Fire: In 1911, 146 people were killed following a fire in a clothing factory in lower Manhattan. The factory lacked a sprinkler system, had all exit doors locked, and possessed only a single fire escape. Employees tragically lost their lives as they tried desperately to escape, succumbing to smoke inhalation, crushing injuries, or falls from windows.
  • Hoover Dam Construction: The 1930s construction project caused the death of 96 workers, although unofficial reports cite dozens more fatalities.
  • Texas City Industrial Disaster: In 1947, a docked freighter containing a cargo of ammonia nitrate caught fire and exploded. The blast leveled 1,000 buildings, including oil storage facilities and hundreds of homes, and killed almost 600 people. The tragedy is considered one of the largest industrial disasters in history.
  • Farmington Mine Disaster: In 1968, an explosion at the Consol No. 9 coal mine in Farmington, West Virginia trapped and killed 78 underground miners. Recovery efforts continued for nearly 10 years but only 59 bodies were recovered.

Read more from the Centers of Disease Control (CDC) about the workplace tragedies that occurred before the passage of OSHA.

The Real-World Impact of OSHA: Stories from the Ground

Diverse workers sharing OSHA success stories in safety.

Since OSHA was established, workplace fatalities, injuries, and illnesses have been cut dramatically. OSHA proudly shares examples of success stories of OSHA-compliant employers.

Voices of Change: Testimonials and Experiences

Here are just a couple of examples of companies that have taken advantage of OSHA’s on-site consultation program and operate exemplary safety and health programs.

Lifecore Biomedical, Inc, Minnesota

Lifecore Biomedical is a fully integrated contract development and manufacturing organization focused on sterile, injectable-grade pharmaceutical drugs and medical device products. The company employs 450 workers worldwide.

Following a routine OSHA inspection in 2003, the company learned about the Minnesota OSHA Workplace Safety Consultation (WSC) Program. WSC works with employers at no cost to help them improve workplace health and safety. Based on WSC’s recommendations, Lifecore implemented several improvements including routine safety audits, fall prevention measures, a safety on-boarding process for new hires, and team-based incident and near-miss investigations.

Results: With OSHA and WSC’s assistance, Lifecore has reduced injury rates by 66% and decreased its days away, restricted, or transferred (DART) rate by 73%. Read more.

Grenzabach Corporation, Georgia

Grenzabach is a German-owned material handling manufacturer with 100 employees at its Newnan, Georgia facility. Prior to 2012, the plant was averaging five recordable injuries per week. Despite a robust commitment to health and safety, additional measures were needed.

To help identify workplace hazards, the company reached out to Georgia’s OSHA On-Site Consultation Program and Tech Safety, Health, and Environmental Services (SHES) program.

Following an on-site assessment visit, Grenzabach mitigated all health and safety issues. It also pursued OSHA’s Safety and Health Achievement Recognition Program (SHARP) certification. Small businesses that achieve SHARP status receive a deferral from OSHA or the State Plan programmed inspections for the period that the SHARP designation is valid.

Results: Since making these changes, the number of recordable incidents at the plant has decreased by 85%. In 2020, the company completed an entire calendar year with zero recordable injuries. Read more.

OSHA’s Multidimensional Approach to Safety

From proactive training to rigorous compliance checks, OSHA offers a great deal of information and assistance to employers to help them comply with their health and safety responsibilities.

The Power of Prevention: OSHA’s Proactive Initiatives

OSHA’s forward-thinking programs help employers preemptively address potential hazards. Tools and resources offered by OSHA include:

OSHA and Healthcare: A Critical Intersection

Healthcare professionals upholding OSHA safety protocols.

According to OSHA, more workers in the healthcare industry are injured than in any other. In 2020, the sector reported a 40% increase in injury and illness cases.

Healthcare workers face many safety and health hazards including airborne and bloodborne pathogens, chemical and drug exposures, waste exposures, ergonomic risks such as repetitive and heavy lifting tasks, workplace violence, and more.

In addition to being dangerous, these injuries come at a high cost to employers. Nationwide workers’ compensation losses result in a total annual expense of $2 billion for hospitals.

For these reasons, OSHA has developed specialized standards for healthcare that include safety and health management systems, safe patient handling, and workplace violence.

Because of the high-risk nature of this sector, OSHA offers a range of tools and resources to help hospitals and healthcare employers align with OSHA standards. Check out OSHA’s Worker Safety in Hospitals website for information including:

  • Tools for assessing and advancing a culture of safety.
  • A “How Safe is Your Hospital?” questionnaire and safe patient handling assessment.
  • Facts about who is most at risk and what hospitals can do to address the problem.
  • How health management systems work, save money, and improve quality of care.
  • A roadmap for preventing workplace violence.
  • And more

Acuity International & OSHA: Pioneering a Safer Tomorrow

Acuity International is committed to championing OSHA standards. Whatever industry you’re in, we can deliver tailored, one-stop occupational health services – whenever and wherever those services are needed.

Our innovative and diverse occupational health services include pre-placement, medical, return-to-work, fit-for-duty, and wellness exams, as well as drug and alcohol testing, respirator fit testing, injury prevention services, COVID testing, vaccinations, and more – delivered via mobile and onsite options.

These cost-effective solutions are backed by robust, centralized health analytics for ease of case management, including real-time exam tracking and reporting, data management and transmission, physician medical review services, and more.

FAQs: Unraveling the Essentials of OSHA

Why is OSHA necessary?

In 1970, approximately 14,000 workers were killed on the job – about 38 every day. Today, thanks to OSHA’s standards, enforcement actions, compliance assistance, and other programs, thousands of lives have been saved and countless injuries and illnesses prevented.

OSHA also supports workplace productivity and cost management. OSHA’s workplace safety programs lower injury incidences from anywhere between 9% and 60% and workplace safety programs can reduce injury and illness costs by up to 40%.

Why is OSHA important to employees?

According to OSHA, each year more than 3.2 million workers suffer a serious job-related injury or illness.

OSHA cites numerous examples of real stories where workers were killed or injured at work due to a failure by employers to comply with OSHA standards – and how these cases could have been prevented.

OSHA safety and health standards assure safe and healthful conditions for workers. To date, OSHA and its state partners have reduced work-related fatalities by almost 63%.

What are the pros and cons of OSHA?

OSHA provides vital guidance, standards, and assistance for health and safety in the workplace. However, OSHA compliance can be challenging. Health and safety standards vary by industry and even employers who passionately advocate for a safe and healthy workplace often struggle to identify gaps in their OSHA program.

OSHA penalties for non-compliance can also be strict. A serious violation can result in a $15,625 fine. Failure to abate is $15,625 per day beyond the abatement date, and willful or repeated violations is $156,259 per violation. States with their own OSHA programs must also adopt maximum penalty levels that are at least as effective as the federal government’s OSHA.

The Undeniable Necessity of OSHA: Reflecting on Why OSHA is Necessary for the Future of Occupational Safety

Futuristic workplace exemplifying the necessity of OSHA's influence.

OSHA is a necessity to aid in the prevention of workplace fatalities, injury, and illnesses. But an OSHA-compliant workplace is also sound business. OSHA programs reduce costs related to injury and illness. Prioritizing occupational safety also gives you a recruiting edge, decreases absenteeism, increases productivity, and enhances employee satisfaction.

OSHA has overseen dramatic improvements in workplace safety over the last five decades, and in a post-COVID pandemic workplace, OSHA’s role is more important than ever.

Learn how Acuity’s occupational health services can help you maintain a healthy, safe, and productive workforce and stay OSHA compliant.

What is Cost Engineering: Beyond Budgets to Building Success

Design and construction projects are dynamic. Costs can change rapidly, and project design can deviate at any moment, impacting planning, schedules, and budgets. Many companies have adopted cost engineering strategies to minimize risk and uncertainty throughout the construction process and ensure optimum costing and coordination of projects and programs.

In this blog, we explore what cost engineering is, why it’s important, tools and techniques that cost engineers use, and tips for starting a career in cost engineering.

Origins and History of Cost Engineering

Cost engineering originated as a project management practice in the 1950s in reaction to the increased complexity of building, construction, and infrastructure projects.

It was formally recognized in 1956 with the establishment of the Association for the Advancement of Cost Engineering (AACE International), which represents practitioners and drives thought leadership in the field.

In 2006, AACE published a Total Cost Management (TCM) Framework. The framework established a proven methodology for managing costs throughout the lifecycle of any construction project. It is a structured, annotated process map that explains each practice area of the cost engineering field in the context of its relationship to other practice areas including allied professions.

Fundamentals of Cost Engineering

Engineer analyzing a bar chart, showcasing the fundamentals of what is cost engineering.

Cost engineering involves the application of engineering principles and business acumen to enhance decision-making and reduce risks across the lifecycle of a construction project. Specifically, cost engineering helps builders and contractors understand the scope of a project and associated costs and avoid cost overruns.

Cost engineering services can benefit any sector that deals with complex projects and cost pressures, including government agencies (civilian and defense) and industries including automotive, commercial builders, civil engineering, oil and gas, chemical, manufacturing, healthcare, and more.

The Core Concepts

Cost engineering is an interdisciplinary practice that intersects the fields of project management, engineering, and business management. Think of it as an adjunct to the traditionally technical side of engineering, emphasizing the interplay between different facets of an engineered project, such as expenses, timelines, and resources.

Cost engineering encompasses a wide range of cost-related aspects of engineering and program management including cost estimating, cost analysis, cost assessment, schedule analysis, planning, and risk assessment.

Without the benefit of cost engineering, project owners and contractors may lack clarity in project planning and execution, which can jeopardize project timelines and budgets and make it difficult to respond to variables such as unexpected delays, price increases, or change orders.

Cost Engineering Techniques

Cost engineers use software and other industry tools and resources to collect, analyze, and share cost data.

Tools aside, choosing the appropriate cost engineering technique is critical. Techniques and methodologies can vary depending on several factors, including:

  • The scope and complexity of the project
  • Project phase and maturity
  • Industry and project type
  • Stakeholder requirements

Importantly, cost engineering incorporates lessons learned from previous project experience and data-driven insights to provide an early understanding of design and construction decisions and risks. With these insights, mitigative actions can be recommended to ensure successful project outcomes. For this reason, choosing a cost estimation method also depends on the skills and experience of the cost engineer.

Skills and Qualities of a Successful Cost Engineer

To be successful, a cost engineer must have strong analytical abilities, industry-specific knowledge, experience with cost estimating systems, and excellent communication skills. An understanding of professional engineering principles is also desired and many cost engineers have significant prior engineering experience.

Importance of Cost Engineering in Construction

alancing costs in construction, highlighting the importance of understanding what is cost engineering.

Why is cost engineering important in construction? Consider the following:

Benefits in Construction Projects

Design and construction projects are dynamic. Expenses can fluctuate rapidly, and project designs can veer off course at any point, affecting project planning, timelines, budgets, and profitability. Cost engineering can help owners/builders prepare for risks and uncertainties using engineering techniques, practices, and skillsets to predict project progress and identify deviations from plans.

While projects can be cost-engineered at any stage, the earlier in the planning and design stages the better. This is where cost engineering creates the most value – making the best use of the available budget and resources.

But it shouldn’t end there. Construction project owners can keep their projects on track and within budget by applying cost engineering principles and methodologies across the entire project lifecycle.

Real-World Examples

Effective cost engineering can make the difference between the success or failure of a construction project. Organizations that embrace the benefits of cost engineering can meet mission objectives and complete projects on time, on budget, and to specifications.

Consider the U.S. Army Corps of Engineers (USACE). Acuity’s cost engineers have helped USACE navigate some of the most complex civil works projects and realize value-driven outcomes. For example, Acuity was part of a team that helped the government save millions off the original contractor’s proposed price for the New Orleans West Closure Complex – a floodgate project intended to reduce storm surge risk and ensure flood resiliency.

This project was part of an extensive portfolio of work that Acuity has performed to help USACE control the scope, cost, schedule, risk, and quality of civil works projects. In addition to providing estimating and scheduling support for hurricane protection systems along the Gulf of Mexico, Acuity has conducted a cost schedule risk analysis for shoreline protection in New York and provided project control support for emergency dam repairs in Iraq.

Economic forces, supply chain challenges, sustainability goals, and competitive pressures have ramped up the need for owners and operators to identify risks and deliver savings early and often in the design/build process.

There’s no denying its value, but as business needs change so must the practice of cost engineering. Cost engineers must work faster and with greater agility and accuracy – no matter a project’s scale or complexity.

Promising innovations and trends include simulation and AI capabilities, as well as greater collaboration and alignment among stakeholders. For example, the use of cloud-based tools for cost estimation, construction scheduling, and cost management can empower cost engineers to generate more precise forecasts and improve cross-functional collaboration. These tools also enable automated workflows for immediate insights into potential schedule and cost deviations, allowing cost engineers to closely monitor the project’s financial status through dashboard views of project data.

Role of a Cost Engineer

Cost engineer with tools, emphasizing the role in what is cost engineering.

Let’s look at the role of a cost engineer and the skills and qualities required to be successful in this profession.

Responsibilities and Duties

It is the cost engineer’s responsibility to coordinate, direct and lead estimating efforts to ensure optimum costing and coordination of projects and programs in line with customer

expectations and manufacturing requirements.

To do this a cost engineer will perform several duties, including but not limited to:

  • Define cost estimate scope: Define the project scope, time period, phases to be estimated, communication channels, and establish any boundaries for estimates or project requirements.
  • Define assumptions or constraints: Identify any schedule or budget constraints, and how those will be resolved.
  • Develop cost element structure: Identify everything defined in the scope to be costed.
  • Collect and monitor data: Collect and monitor data, manage risks, identify a (if necessary) contingency plan, control changes and communication, measure and report on progress.
  • Develop cost estimating relationships: Use cost data to develop formulas/equations entered into the cost model.
  • Document approach: Provide documentation for each cost element, indicating sources of data, assumptions used and any other methodology or analysis.
  • Customer review: Ensure that all expected costs have been properly presented to the customer for review/approval/acceptance of the estimate.
  • Finalize cost estimate: Finalize the cost estimate. Maintain all files and data related to a project.

How to Become a Cost Engineering Professional (H2)

Interested in cost engineering as a career? Let’s look at what’s required and the opportunities afforded by this profession.

Education and Training

Cost engineers usually possess a degree in either civil engineering or business management. To advance into this position, most individuals have accrued four to six years of experience in a related field, often serving as project engineers, project managers, or engineers. Strong analytical abilities and effective communication skills are essential prerequisites for this role.

To help you chart a career path, consider obtaining a certification in cost engineering, through AACE International’s professional certification program. AACE International also offers a variety of continuing education courses on various cost engineering topics.

Career Path and Opportunities

Cost engineers are in demand. The projected job growth rate is 3% by 2028 with salaries increasing 8% in the last five years. The average salary of a cost engineer is $87, 901 (source).

Given the importance of job experience, look for chances to participate in construction ventures that prioritize cost engineering. Explore opportunities in major urban centers like Atlanta, Dallas, Denver, Houston, and Philadelphia, as well as burgeoning metropolitan areas such as Raleigh and Northern Virginia. Consider high-growth construction sectors where cost engineering is likely to be in demand, including hotels, healthcare and education facilities, critical infrastructure, and smart city construction.

Bringing It All Together: The Blueprint of Cost Engineering

Converging elements representing the blueprint of what is cost engineering in construction.

Managing costs and mitigating risk throughout the project lifecycle is key to any successful construction project.

With accurate cost engineering services, project owners ensure their projects stay on schedule and on budget – even in the face of unpredictable economic headwinds and supply/demand challenges.

A career in cost engineering is a promising one. With high earning potential and experience gained across an exciting range of projects, you can develop and apply a wide range of skills. You can also learn about cutting-edge technology, project management best practices, standards, regulations, and other skills that can increase your value and advance your career.

Understanding the PMDD Saliva Test: Insights and Implications

The time of the month has arrived, you’re feeling emotional and irritable, you’re sleepless, and your skin is breaking out. These are all typical symptoms of pre-menstrual syndrome (PMS). But if you have premenstrual dysphoric disorder (PMDD), your symptoms could be much worse.

PMDD is a life-altering condition that puts women at risk of suicide and requires an accurate diagnosis. There are many ways to diagnose PMDD, including the use of a PMDD saliva test (although the test alone is not conclusive).

Let’s look at what PMDD is, its impact on women’s lives, how doctors test for PMDD, and potential treatment options.

Unraveling PMDD: Beyond the Symptoms

Distressed woman experiencing severe PMDD symptoms

PMDD is a severe form of PMS. Like PMS, it causes both emotional and physical symptoms a week or two before your period.

However, PMDD is far more debilitating. Sufferers report depression, severe anxiety, lack of energy, hopelessness, anger, sleep problems, muscle and joint pain, weight gain, and more. More than a temporary nuisance, these symptoms can lead to significant distress and functional impairment. People suffering from PMDD can develop suicidal thoughts and act impulsively, such as leaving relationships or quitting jobs.

According to the National Institute of Health (NIH), PMDD affects 5% to 8% of women.

The causes of PMDD are not well understood. PMDD is associated with the menstrual cycle but is not classified as a hormonal imbalance. Instead, NIH researchers have identified PMDD as a hyper-sensitive response in the brain to the regular hormonal fluctuations that occur during the monthly menstrual cycle.

PMDD is also worsened by factors such as genetics, smoking, prior trauma, and stress. Research is ongoing into the causes of PMDD, but researchers believe that a combination of these factors typically triggers PMDD.

Saliva Tests: The New Frontier in Hormonal Diagnosis

Professional collecting a saliva sample for hormonal diagnosis

Because of PMDD’s life-impacting nature, it’s important to obtain the right diagnosis. Saliva tests are the gold standard for tracking a woman’s hormone levels, but they cannot diagnose PMDD.

That’s not to say PMDD saliva tests are without value. When combined with other diagnostics, a PMDD saliva test can be used to rule out underlying disorders, such as hormone imbalances or endocrinological conditions, and can provide helpful insights to guide treatment decisions.

How Saliva Tests Work

Saliva tests measure the level of hormones circulating in a woman’s body and are more accurate than blood tests at detecting excess or deficient hormones.

PMDD saliva tests are non-invasive. You simply spit into a test tube or swab your mouth and the sample is sent to a laboratory for analysis. For an accurate diagnosis, saliva samples should be collected at multiple intervals to measure changes in hormone levels over time.

Benefits Over Traditional Testing Methods

Saliva tests are generally considered more useful than blood tests for detecting hormonal imbalances. This is because saliva contains many hormones, such as estrogen and cortisol.

PMDD saliva testing is also convenient and cost effective. Patients can easily collect multiple samples at various moments of the day or month without incurring the cost, inconvenience, and invasiveness of blood testing.

Myths and Realities: PMDD and Saliva Tests

Managing PMDD requires an accurate diagnosis. But due to a lack of information about PMDD, many medical providers overlook the importance of a PMDD saliva test. Instead, women are often advised to track their symptoms a week or two before their period for a span of at least two menstrual cycles.

For a doctor to confirm PMDD, a woman must experience at least five very specific symptoms, such as acute depression, difficulty concentrating, feeling overwhelmed, irritability, and a change in appetite. It may be possible for your doctor to rule out PMDD if these symptoms do not interfere with your everyday life or occur outside the two weeks before your period.

It’s very important to get a PMDD diagnosis right because treatments are quite different to PMS or other mood disorders. If you think you’re experiencing symptoms, talk to your doctor about the value of adding a PMDD saliva test to your diagnostic process.

PMDD in the Workplace

Because women experience nine to twelve periods a year, the impacts of PMDD are long-term and far reaching. A person with PMDD may struggle to concentrate, maintain interpersonal relationships, multitask, and even perform basic workplace tasks without feeling exhausted, angry, or overwhelmed.

Awareness of PMDD and proper treatment are key to helping sufferers manage their conditions.

Natural Remedies: Are They Effective?

Woman embracing a balanced diet, regular exercise, and relaxation as natural remedies for PMDD

There are a variety of treatments for PMDD, the most effective being lifestyle changes such as eating a well-balanced diet, regular exercise, and rest and relaxation. Mood-stabilizing medications like antidepressants can also help.

Talk to your doctor about the right combination of methods. Connect with peer groups; for example, the International Association of Premenstrual Disorders (IAPMD) offers several options including video support groups, crisis referral, email support, a forum, and Facebook groups. Sharing experiences and remedies is important when dealing with this very serious yet often misunderstood and under-diagnosed condition.

FAQs About PMDD Saliva Test

How do doctors test for PMDD?

PMDD cannot be diagnosed with a single test. Testing for PMDD involves tracking symptoms over two or more menstrual cycles. However, a PMDD saliva test can help rule out underlying disorders such as a hormonal imbalance or endocrinological condition.

Can you test for hormonal imbalance with a saliva test?

Yes, a saliva test is an accurate and convenient way to diagnose hormonal imbalances.

What are the red flags for PMDD?

hen diagnosing PMDD, a medical provider will check for the presence of at least five emotional and physical symptoms. These include:

• Mood or emotional changes
• Irritability or anger
• Depression, hopelessness, worthlessness
• Anxiety
• Decreased interest in everyday activities
• Difficulty concentrating or brain fog
• Changes in appetite or food disorders such as binge eating.
• Feeling overwhelmed
• Suicidal thoughts or self-harm
• Tiredness or low energy
• Joint or muscle pain
• Breast tenderness
• Bloating or weight gain

A PMDD diagnosis is typically only confirmed if these symptoms are present a week or two before a woman’s period and for a span of at least two menstrual cycles.

How can I get help for PMDD?

Talk to your doctor or connect with peer groups.
The International Association of Premenstrual Disorders (IAPMD) offers peer support in several ways including video support groups, crisis referral, email support, a forum, and Facebook groups.

PMDD Saliva Test: Decoding the Future of Diagnosis

PMDD is a very serious condition that affects 5% of women. Unfortunately, medical providers lack understanding of PMDD and confuse it with PMS, so sufferers are rarely offered diagnostic or treatment options.

For these reasons, it’s important that women advocate for themselves. If a doctor can’t help you get a diagnosis, find another.

Advancements in testing, including PMDD saliva testing, can help improve current approaches to diagnostics.

If you’re suffering and believe PMDD is the cause, talk to your doctor about tracking your symptoms and available diagnostics.

PMDD is a diagnosis that impacts the workplace. Learn more about how Acuity’s Occupational Health Services, including our Absence Case Management Services, can help your organization manage short- and long-term leave related to PMDD.

Mastering Construction Budgeting: A Comprehensive Guide

Construction budgeting is a crucial component of any construction project. A construction budget is a cost estimate that outlines the anticipated costs and expenses associated with a project – however large or small.

A construction budget helps builders and owners stay on track financially, supports client relationships, and guide decision making from project inception through closeout.

In this blog, we explore the opportunities and challenges presented by construction budgeting and go into detail about how to develop a construction budget (plus pitfalls to avoid).

Understanding the Basics of Construction Budgeting

Building in progress next to a pie chart displaying construction budget segments.

Here’s a high-level overview of the basics of construction budgeting and why it’s important.

What is Construction Budgeting?

Construction budgeting is critical to the planning process of any project. Budgeting helps owners and builders understand the scope of the project and associated costs and avoid cost overruns.

Although the terms “construction budget” and “construction project budget” are used interchangeably, they are different:

  • A construction budget is an estimate of the overall costs incurred during the physical construction of a building or infrastructure asset. A construction budget includes the cost of lumber, steel, concrete, HVAC, wiring, windows, etc.
  • A construction project budget encompasses every cost essential for the realization of the project, including financing, permits, legal expenses, site planning, fixtures, furnishings, and more.

Why is Construction Budgeting Important?

A construction budget is important for several reasons. It can help control costs, highlight project risks, assist in decision making, facilitate communication with project stakeholders, and ensure profitability.

Without a well-planned budget, project owners and contractors may lack clarity regarding project timelines, risk overhead costs, and cost overruns, and struggle to plan for variables (such as unexpected delays, price increases, or change orders).

Key Components of a Construction Budget

A tri-sectioned illustration showing direct costs, indirect costs, and contingency funds in construction budgeting.

A construction budget is composed of two types of costs: direct and indirect. While these form the foundation of a budget, cost estimators must also set aside contingency funds for unexpected events.

Direct Costs to Construction

Direct construction costs are budget items that are tied directly to a specific project. Examples include labor, materials, equipment, subcontractors, and more. Each has a direct impact on the profitability of a project.

Indirect Costs to Consider

Indirect costs include expenses that aren’t unique to a specific project. Examples include administrative expenses, insurance, utilities, rent, etc. Indirect costs have a greater impact on a construction company’s bottom line than direct costs.

Contingency Funds

Contingency funds are budget categories designated for variable or unexpected costs, such as overtime labor expenses or unexpected increases in construction material prices during the course of a project. Construction owners and contractors should allocate reserves specifically for these unforeseen expenditures.

Types of Budgets in Construction

Comparative icons of annual budget fluctuations and detailed construction planning tools.

Construction budgets can be categorized into two main types: annual budgets and project budgets.

Two Main Types of Budgets

  1. Annual budget: Every construction company should have an annual budget. This encompasses anticipated earnings, cash flow, project costs, payroll, and other business expenses.
  2. Project budget: A project budget is created for each specific job. It is an estimate of project costs, including labor, materials, equipment, and other project expenses.

Creating a Robust Construction Budget

Creating a construction budget is a massive undertaking. Even the most experienced cost estimators can struggle to account for the variables and unexpected costs that arise on a project. Follow these steps to create a construction budget:

Steps to Create a Construction Budget

  1. Project research: Start by researching and analyzing the project goals and requirements. Assess site conditions, zoning and permit requirements, and any project documentation. This will aid in evaluating the feasibility of the project.

To ensure ease and accuracy, use a historical construction budget template as your guide. See where certain costs went over budget and account for them in your rough draft.

  1. Project scope: Meet with the project’s architects and engineers to understand and determine the scope and design options for the project. Create a list of materials needed. Reach out to subcontractors and suppliers to determine the feasibility of the timeline.
  1. Pre-construction and documentation: Meet with all stakeholders (contractors, architects, etc.) to discuss the project and review the budget in detail, flag any issues, and develop mitigation strategies. This phase is critical to reducing risk, such as cost overruns, from the start of the project and ensuring the budget and timeline remain on track. Document your discussions (both internal and external).

In addition, gather and securely store all project documentation, including permits, contracts, deliverables, and so on.

  1. Construction and project closeout: Revisit your budget often during the construction phase. Monitor building and associated costs to ensure alignment with projected costs and schedules. Identify any problems and develop workarounds as needed. Maintain a change order log so that any deviations from the budget or schedule are tracked. You should also track deliverables and any materials used so that you can pay your contractors on time. Templates, such as a project closeout checklist of time and materials, can help you manage these steps.

Role of a Construction Project Manager

Project management is critical to ensuring that any construction project – regardless of size – is executed successfully, on time, on budget, and to the highest quality standards.

A construction project manager is responsible for leading each phase of the construction process. They develop the project plan, assist with budget planning, coordinate resources, and collaborate with stakeholders and team members to achieve the desired outcomes.

Budget Follow-Up and Monitoring

Construction project managers also oversee budget follow-up. This position involves monitoring project budgets and project finances, making adjustments to accommodate risks, and ensuring the project stays on schedule.

Modern Tools & Software for Construction Budgeting

Engineer's desk with devices displaying budgeting software, construction schedules, and budget alerts.

The accuracy of your construction budget can make the difference between completing the project within the designated timeframe and budget or causing your company to lose money. Greater accuracy can be achieved using digital tools and software for construction budgeting.

Digital Solutions for Accurate Budgeting

With modern digital tools, you can centralize and access all the information you need to make critical decisions. Useful tools for construction budget management include:

  • Construction scheduling tools: These tools include built-in templates for accurate scheduling. Automated workflows can alert teams to changes in schedules and potential cost overruns in real time. Furthermore, many construction scheduling tools include dashboard views that keep all stakeholders informed, from planning to project closure.
  • Construction estimation and cost management software: This software integrates contract management, payment management, and change management into a single platform. Using cost management software, project managers and cost estimators can develop accurate estimates and forecasts, keep track of any project’s financial health, and ensure teams have easy access to accurate project information throughout the lifecycle.
  • Construction reporting: Construction reporting software can help with managing multiple construction projects. Dashboard views provide a single viewpoint into cost and financial data and can be customized as needed.

Challenges and Solutions in Construction Budgeting

Split puzzle with challenges and solutions in construction budgeting such as declining charts and collaboration symbols.

Construction budgeting is important, yet it is not without its challenges. Budgeting mistakes are surprisingly prevalent, and unforeseen occurrences like scope expansion can lead to cost overruns if not adequately addressed during the planning phase.

Common Hurdles in Budgeting

Consider the following case studies:

  • Oregon Capitol construction quietly edges $90 million over budget: In August 2023, Oregon lawmakers quietly approved a $90 million cost overrun for a Capitol renovation project, increasing spend on the project by 25%, without notifying the public. The measures will see taxpayers pay approximately $465 million for a $375 million job. Project managers blame inflation (to the tune of $27 million) and growth in project scope for the cost overrun.
  • Elementary school construction project costs reduced, but still over budget: The East Lycoming School Board in Pennsylvania recently received a revised construction cost estimate of $37 million for the redesign of Joseph P. Ashkar Elementary School in Hughesville, PA. This amount exceeded the initial estimate and surpassed the available budget allocated by the district.

Architects are now looking into cost-saving measures, including removing the district gym from the project scope and using less costly building materials. The project will be put out to rebid before the deadline for the use of a $25 million bond issue before the project expires. Dr. Mark Stamm, superintendent, noted “The clock is ticking.”

How to Avoid Construction Budgeting Pitfalls

There are always risks in construction budgeting, but pitfalls can be avoided by adhering to the following guidelines:

  • Define budgets and schedules early: Inaccurate estimates can be avoided by defining budgets and schedules early in the project phase, without rushing the process.
  • Foster proper client communication: Maintain strong relationships with clients by documenting the scope of work and maintaining close communication and transparency throughout the project to mitigate potential issues.
  • Plan for contingencies: Plan for unexpected events such as scope creep and change orders to improve estimates and minimize cost overruns.
  • Learn from past challenges: Analyze projects that faced challenges due to poor budgeting and apply lessons learned.

You don’t have to tackle this alone. Consider seeking guidance from an expert skilled in precise cost estimation to help you navigate budgeting challenges more effectively. Additionally, utilizing construction software can enhance budget accuracy, improve forecasting, facilitate project collaboration, and streamline issue resolution.

FAQs on Construction Budgeting

What are the two types of budgets in construction?

The two types of budgets are annual budgets and project budgets.

1- Annual budget: This encompasses anticipated earnings, cash flow, project costs, payroll, and other business expenses.
2- Project budget: A budget created for each specific job. It is an estimate of project costs, including labor, materials, equipment, and other project expenses.

What is the difference between a construction budget and a project budget?

The terms “construction budget” and “construction project budget” are often used interchangeably, but they are not the same.

• A construction budget is an estimate of the overall costs incurred during the physical construction of a building or infrastructure asset. This includes the cost of lumber, steel, concrete, HVAC, wiring, windows, etc.
• A construction project budget encompasses every cost essential for the realization of the project, including financing, permits, legal expenses, site planning, fixtures, furnishings, and more.

What are the four components of building a construction budget?

The four main elements of a construction budget are:

1. Direct or hard costs
2. Indirect or soft costs
3. Fixed costs
4. Variable costs

Laying the Foundation: The Power of Effective Construction Budgeting

Active construction site foundation above, and a detailed hand-written budget below.

A construction budget should be at the center of any construction project – from the research phase through project closeout. Getting it right leads to positive outcomes for construction firms, owners, and the taxpaying public.

Acuity can help you achieve your cost goals for construction projects, make informed decisions, and minimize risks. Our comprehensive cost engineering services, advanced technology, cost engineers help project owners manage complex, dynamic, and budget-constrained construction projects.

Contact us to learn how our cost engineering services can help you optimize construction project budgets and reduce risks.

Unraveling the Cost of Pre-Employment Physicals: Everything You Need to Know

Pre-employment physical exams are a critical part of the hiring process. Contingent upon an applicant’s ability to pass the exam, pre-employment physicals help ensure that job applicants are physically capable of performing required job tasks.

How much does a pre-employment physical cost? The cost of a physical exam for work depends on the employer’s required exam type and specialty. Using national pricing as a guideline, exam costs could range between $100 and $700.

In this blog, we explore why pre-employment physicals are important, what they screen for, and the financial costs involved.

What is a Pre-Employment Physical

Doctor examining job applicant in a medical room with job application forms in the foreground.

A pre-employment physical exam is often required by employers before an offer is extended to a job applicant. These exams help ensure that a candidate has the physical ability to perform a job safely and without risk of injury.

Components of a Pre-Employment Physical?

The components of a pre-employment physical are dictated by the industry, position, and, in some cases, government regulations.

What Does a Pre-Employment Physical Consist of?

Pre-employment physical exams include a variety of tests and evaluations:

  • Weight
  • Blood pressure
  • Temperature
  • Heart rate/pulse
  • Respiratory health
  • Cardiovascular health
  • Reflexes
  • Range of motion
  • Hearing
  • Vision

In addition, a pre-employment physical may include an assessment of:

  • Physical ability (including the ability to perform certain functions required for the position, such as lifting or aerobic activity)
  • The candidate’s medical history
  • Laboratory tests
  • Psychological and cognitive screening
  • Strength, stamina, and physical endurance
  • Drug and alcohol screening (if the position requires the operation of heavy equipment, machinery, or a commercial motor vehicle (CMV) — and any substance abuse could put the employee, other workers, and the public at risk)

What’s Included in a Full Physical Exam?

The specific tests performed during a full physical exam vary based on the position an applicant has received a conditional job offer for, the employer’s industry, and the functions the individual must perform.

For example, the U.S. Department of Transportation (DOT) requires that all applicants in safety-sensitive positions undergo a DOT physical. A DOT physical exam is used to screen CMV drivers to determine if they are healthy enough to perform their roles. DOT medical exams are mandated by the Federal Motor Carrier Safety Administration (FMCSA) and help keep the nation’s roads safe. A driver must participate in a physical to maintain a valid commercial driver’s license (CDL). The exam is valid for 24 months.

Other industries that require a pre-employment physical include construction, manufacturing, law enforcement, firefighters, healthcare, and more. These physical exams focus on the candidate’s strength, stamina, and drug and alcohol use and are essentially a medical clearance for work.

What’s the difference between a pre-employment physical and a regular physical? A pre-employment physical is designed to assess a candidate’s ability to perform specific job functions and record baseline health. While a typical annual physical is performed by an individual’s primary care physician and is more in-depth and comprehensive.

Understanding the Cost of Pre-Employment Physicals

Calculato and dollars on a table, representing the cost of pre-employment physicals.

How much does a pre-employment physical examination cost?

Factors Influencing the Cost of Pre-Employment Physicals

The cost of a pre-employment physical exam depends on several factors including the type of position the employee is being hired for and the complexity of tests involved.

Physical Exam Cost Without Insurance

The typical cost for a pre-employment physical examination is dependent on the employer’s compliance or regulatory requirements and is priced anywhere between $100 and $700. These costs vary depending on the medical examiner, state, and the employer’s screening requirements.

Who Foots the Bill

Employer and job applicant sitting across a table with a bill for a pre-employment physical exam.

Both employers and future hires understandably have questions about who pays for pre-employment physicals and how that rate varies. Let’s address some of these questions.

Who Pays for Pre-Employment Physical Exams?

The cost of a pre-employment physical exam is typically the responsibility of a prospective employer – not the individual being evaluated. In fact, in most cases, insurance companies will not cover the cost of a pre-employment physical for employers or potential employees.

There are benefits to employers in covering these costs. For instance, physical exams help employers gain valuable insight into the health of their workforce and save money by reducing workplace accidents and absences. They also help ensure compliance with occupational health and safety regulations.

Pre-employment physicals are especially important in detecting chronic conditions that can impede an individual’s ability to perform work-related tasks. They also provide a medical baseline that is used to track an employee’s health or injuries over time.

Physicals also provide recruitment and retention advantages. By offering health and wellness screening, organizations demonstrate how much they value their employees.

Low-Cost Work Physicals and How to Find Them

To keep costs low, employers should look for a network of pre-employment physical providers who have screening sites near them. Alternatively, on-site examination options can bring the process nearer to, or scheduled at the workplace, increasing convenience for job applicants and reducing screening cost and time.

In the rare event that an employer does not cover the cost of a pre-employment physical, job applicants who are expected to undergo a physical exam for work should consult their insurance provider to see if any portion of the exam is covered. Alternatively, occupational health services providers or outpatient medical facilities offer affordable pre-employment physical exams. A search for “urgent care physical exam” or “free physical exam near me” will suggest options.

Special Cases in Pre-Employment Physicals

A lineup of workers from different industries being examined by medical professionals.

In addition to DOT-regulated industries, other sectors, such as healthcare, have special requirements for pre-employment physicals.

Physical Exam for Healthcare Workers

Because of the high-risk nature of their occupation, healthcare workers are subject to unique requirements and tests as a condition of employment.

Many nurses and providers are required to lift and move patients and must have the stamina to perform these tasks – and be free of health conditions that could be exacerbated by heavy lifting, such as cardiovascular disease, high blood pressure, vertigo, or a recent surgery or injury.

Healthcare workers must also undergo screening to ensure they are free of communicable diseases, such as air-borne and blood-borne pathogens (Hepatitis A, B, and C and HIV).

Potential Roadblocks: Reasons for Failing a Pre-Employment Physical

There are various reasons why job candidates might not pass a pre-employment physical. For instance, if they don’t meet the requirements for strength or stamina and cannot perform their job without modifications, they might be disqualified from roles like firefighting or operating heavy equipment.

Can high blood pressure cause you to fail a pre-employment physical? The answer depends on the industry and role an individual is applying to. DOT regulations state that candidates with blood pressure that is too high or uncontrolled cannot be cleared for employment. However, other industries may pass a candidate or require them to undergo a treatment plan to lower their blood pressure and retake the exam at a later date.

If a job candidate fails a pre-placement physical exam an employer is legally permitted to withdraw the contingent or conditional job offer. However, the exam results may not be used to discriminate against the candidate/employee. Their medical records and history become confidential and are protected as Protected Health Information (PHI) and Personal Identifying Information (PII).

Other reasons why a job applicant may fail a pre-employment physical include:

  • A failed drug or alcohol test
  • Inability to stand or sit for a protracted period of time
  • A vision impairment that can’t be corrected to 20/40 in each eye
  • A chronic condition such as insulin-treated diabetes mellitus (ITDM) or heart disease
  • Certain mental health conditions, including dementia, PTSD, ADHD, bipolar mood disorder, and more

Note: The U.S. Equal Employment Opportunity Commission and Americans with Disabilities Act (ADA) prohibit employers from failing a candidate based on any disability.

FAQs on Pre-Employment Physical Costs and Procedures

What is a pre-employment physical?

A pre-employment physical exam is often required by employers before an offer is extended to a job applicant. These exams help ensure that a candidate has the physical ability to perform a job safely and without risk of injury.

Who pays for a pre-employment physical?

The cost of a pre-employment physical exam is typically the responsibility of a prospective employer.

What does a complete physical include?

Pre-employment physical exams include a variety of tests and evaluations:

• Weight
• Blood pressure
• Temperature
• Heart rate/pulse
• Respiratory health
• Cardiovascular health
• Reflexes
• Range of motion
• Hearing
• Vision

In addition, a pre-employment physical may include an assessment of:

• Physical ability (including the ability to perform certain functions required for the position, such as lifting or aerobic activity)
• The candidate’s medical history
Laboratory tests
• Psychological and cognitive screening
• Strength, stamina, and physical endurance
• Drug and alcohol screening

What reasons would you fail a pre-employment physical?

Job applicants may fail a pre-employment physical for several reasons, including:

• A failed strength or stamina test
• High blood pressure
• A failed drug or alcohol test
• Inability to stand or sit for a protracted period of time
• A vision impairment that can’t be corrected to 20/40 in each eye
• A chronic condition such as insulin-treated diabetes mellitus (ITDM) or heart disease
• Certain mental health conditions, including dementia, PTSD, ADHD, bipolar mood disorder, and more

What happens if a job applicant fails a pre-employment physical exam?

If a job candidate fails a pre-employment physical exam an employer is legally permitted to withdraw the contingent or conditional job offer. However, the exam results may not be used to discriminate against the candidate/employee. Their medical records and history become confidential and are protected as Protected Health Information (PHI) and Personal Identifying Information (PII).

However, exceptions can be made. For example, if a medical examiner finds that a candidate for a firefighter position cannot perform their essential job tasks due to a specific condition, the physician can recommend restricting that individual from performing tasks that cannot be safely performed given their medical condition.

What types of drugs can be detected in a pre-employment physical exam?

A five-panel drug test is a common pre-employment drug screening exam for job candidates. The test is used to determine the presence of cocaine, marijuana, amphetamines, opioids, and phencyclidine (PCP). Workplace drug testing may also check for alcohol.

Understanding Performance Evaluations

Job candidate lifting a box during a performance evaluation with charts and graphs in the background.

Like physical exams, human performance evaluations (HPEs) are a form of pre-employment screening.

What is a Human Performance Evaluation?

A human performance evaluation is a pre-employment screening measure that compares a job applicant’s physical abilities to those required for a position. The exam assesses whether the individual can complete tasks safely and without risk of injury.

Types of Performance Evaluation

What are the two types of performance evaluations?

Employers can use two types of evaluations to assess a potential hire’s physical readiness for a position: a human performance evaluation or a pre-employment physical.

These screening methods are frequently mistaken for being identical. Nevertheless, there exist significant distinctions:

  • A pre-employment physical is performed by a licensed medical examiner or practitioner in a medical setting and focuses on assessing a candidate’s overall health.
  • A HPE focuses more on the tasks the candidate must perform daily. The evaluation is often completed by a licensed occupational therapist.

Key Components of a Performance Evaluation

What are the three components of a performance evaluation? A human performance evaluation includes:

  • A review of the candidate’s medical and occupational history
  • A medical examination
  • Evaluation of functional tasks such as heavy lifting, pushing, pulling, and carrying

Human performance evaluations must be performed in compliance with ADA guidelines and can only test for medical or physical issues that would prevent a potential hire from safely performing their duties. They must also be given to every candidate offered a job and cannot be limited to specific individuals.

A see-saw in a park-like setting with a doctor and employer in balance, symbolizing the cost and necessity of pre-employment physicals.

Regardless of cost, pre-employment physicals are an important part of maintaining occupational health and workplace safety. A physical exam for work also helps job applicants ensure they are the right fit for a role and not at risk of injury.

More importantly, a pre-employment physical exam helps employers make informed, objective decisions about hiring based on an applicant’s physical and behavioral health and monitor employee health over time.

If you have questions or are looking to start or optimize your pre-employment physical program, contact us to learn more about how Acuity can help. We combine our pre-employment physical exam services with advanced technology and a widespread provider network to give organizations 24/7 access to scheduling, exam status notifications, case management reporting, and more.

Learn more about Acuity Medical Exam Services.

What is Case Management in Community Services? A Deep Dive into its Transformative Power

Case management is growing in importance as a function of community services. But what is case management in community services?

Case management is a collaborative effort whereby case managers help their clients navigate the social service system. Clients may be provided with information and resources and connected with community services. Case managers also advocate for their clients and teach them how to advocate for themselves.

In this blog, we explore the importance of case management in community services, why it’s so vital to social work, the role of case managers, success stories, and more.

Defining Case Management in the Context of Community Services

During times of need or crisis, social work case management services help connect impacted individuals and families to resources and services that improve their lives and well-being. Social work case management services include counseling, medical care, crisis intervention, and advocacy.

The Core Principles of Case Management

A young woman case manager discussing with an elderly man, highlighting the personalized approach of case management in social work.

Community case management programs are designed to help health and human services, social services agencies, and other entities help people overcome challenges. Case management programs provide holistic care by combining medical, clinical, and community services.

Case management services are overseen by a case manager. These trained professionals assist and advocate for individuals and families in adherence to best practices and standards for case management and care, including those established by the National Association of Social Workers (NASW), the Council on Social Work Education (CSWE), social welfare departments, community outreach programs, mental health services, and more.

In addition to ensuring clinical care, case managers work with other professionals to assess each case, understand the client’s situation, and determine a plan of care. A case manager will also assist with behavioral health and wellness, childcare, referrals to legal support and social services, crisis intervention, and more.

Case managers are essential, high-value individuals. As impacted people await a longer-term solution, case managers act as an intermediary on their behalf, helping minimize trauma, protecting their health, safety, and wellbeing, and ensuring they have access to needed resources and support.

Distinction: Community Case Management vs. General Case Management

Community case management and general case management are terms that are often used interchangeably. While case managers in both scenarios work to improve the well-being of their clients, there are key differences between these functions.

Community case management is the discipline of coordinating the many collaborative efforts involved in helping rehabilitate a client and ensure they have access to appropriate medical, social, and community care. Case managers exhibit skills such as empathy, active listening, and tolerance. The role requires exceptional people skills, communication abilities, planning, and an in-depth understanding of the appropriate services available to each client. At the same time, case managers in community services understand relevant state and federal laws, ethics, accreditation and regulatory standards, health insurance requirements, and evidence-based care/practice guidelines.

Case managers also handle all client administration, tracking, and reporting – easing the burden on busy social workers.

General case management, on the other hand, is typically more limited in scope. A case manager in this domain may connect those in need to resources and services and guide them as they navigate the social system. They may work in hospitals, social service agencies, or community health centers.

The Synergy Between Case Management and Social Work

Three women in a case management meeting, with one taking notes, emphasizing collaboration in social work.

Case management is an important tool in social work. Social work agencies use case management to ensure clients receive services efficiently and in a coordinated manner. Case management in social work has been shown to improve client outcomes and ensure those in need achieve their goals and make positive changes in their lives.

The Role of Case Management in Social Work

Seamless coordination and communication between professionals is essential to case management.

Community case managers are skilled at building relationships with other team members and community providers. As they do so, they remove barriers to care and vital resources, such as housing, benefits assistance, financial and legal resources, child support, life skills acquisition, and more. They also educate and encourage clients to advocate for themselves as they navigate the social services system.

Another benefit of case management in a social work setting is that it reduces the cost associated with health and social care. By connecting clients with resources and services, case management reduces hospital stays, improves medication compliance, minimizes emergency room visits, shortens stays in temporary housing, and returns people to work more quickly.

Case Management in Healthcare: A Look at Community-Based Nursing

Case management is a holistic care approach that involves service integration, multidisciplinary teams, and individualized care plans. As such, there is no one-size-fits-all approach. The healthcare sector uses clinical case management to help address a patient’s medical needs and ensure the best medical care is administered – from intervention through resolution.

However, nurse case management is offered outside the confines of a healthcare facility or institutional setting. In-home care following hospital discharge is an example of a place where case management is often necessary. In addition, adults with disabilities, illnesses, or injuries who are looking to return to work may benefit from nurse case management.

Let’s take a closer look at the functions and role of case management in healthcare.

The Pillars: Main Functions of Case Management

Case management is a highly specialized practice. While there is no singular definition of case management, the profession adheres to the following guiding principles and best practices.

  • Case management is designed to improve a client’s health, welfare, wellness, and autonomy. Case management achieves this through advocacy, collaboration, needs assessment, service planning, facilitation of service, monitoring, and evaluation.
  • Case management is holistic, meaning it addresses end-to-end client needs, including physical and mental health, financial, legal, spiritual, and other health and human services.
  • Case managers are responsible for advocating for client support systems, education, care, and quality outcomes in a supportive, timely, and empathetic manner. Their first duty is to their clients. They use person-centered, strengths-based methods to develop plans of care to meet the needs of their clients.
  • Case managers are committed to maintaining their clients’ privacy, confidentiality, health, and safety. They adhere to standards and accreditations such as those established by NCMN, CSWE, and more. Case managers must also comply with laws such as the Health Insurance Portability and Accountability Act (HIPAA).
  • Case managers ensure timely and accurate data entry, maintenance, and reporting. They also actively participate in meetings and client reviews with internal and partner agencies.

Exploring the 4 Types of Case Management

Community case management has four distinct delivery models. A case manager or organization can choose to use any case management model in their practice:

  1. Brokerage case management: This model focuses on client needs assessment, referral to appropriate community services and resources, and overseeing ongoing support. Case managers who use this model inform clients of their options and how to access them.
  2. Strengths-based case management: As the name suggests, this model identifies a client’s strengths and abilities and works to build on these positive characteristics to ensure independence and positive outcomes.
  3. Clinical case management: This model prioritizes a client’s clinical medical needs and emphasizes coordination of care with medical professionals, such as physicians, psychologists, and counselors.
  4. Intensive case management: Best suited for clients with complex needs, such as severe mental illness, this model delivers extensive, quality services in an expedited timeframe.

The choice of case management model depends on the context and client needs and goals. For example, a child with drug abuse issues may be better served by clinical case management or intensive case management.

Case Management in Practice: Real-World Scenarios

A focused man handing over a folder during a case management meeting, symbolizing the exchange of crucial information.

Case management services are essential to helping organizations, including governments, social service agencies, and employers navigate and manage complex clinical and social work cases.

Success Stories: How Effective Case Management Changes Lives

Case managers change lives every day. They don’t just resolve point issues or problems; they actively work to transform the lives of people and families in need. For example, below are four case studies that highlight how case management has been successfully integrated into community services across the United States:

Case Study: Federal Agency Provides At-risk Young Immigrants Access to Community Services

A federal agency under the Department of Homeland Security needed to establish a case management program that provided appropriate monitoring services for non-dangerous, low-flight-risk young adults. The purpose of this framework was to promote and maintain access to community services during the immigration process. This young adult population often lacks important knowledge, information, and awareness of the community services available to them, especially when there is no verification or confirmation of their safety. The program, which combined community, social work, and remote and patient care management, was designed to reduce friction with the immigration process and provide and/or facilitate referrals and access to services in the community.

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Case Study: Phoenix Reaches Unhoused Citizens and Those Experiencing Mental Health Issues

A community assistance program in Phoenix, AZ, is helping address the community needs of citizens in crisis, including veterans with suicidal ideation, unhoused citizens, and those experiencing mental health problems.

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Case Study: Washtenaw County, MI, Community Manager Works to Break the Cycle of Poverty and Homelessness

Clients put their trust in a local Washtenaw County community case manager to guide and provide important resources to clients such as homeless people, those with addiction issues, and people on felony probation. “A big challenge [with my clients] is not having a social security card or birth certificate. So, we help them go through that process—helping them get whatever ID they need, including their driver’s license. I help my clients find the resources they need. It helps them do the things that get them to a better place, like apply for housing or get a job.”

Read more.

Case Study: Case Managers Improve Outcomes for Maricopa County’s Senior and Adult Services Division (SASD)

SASD serves a unique and vulnerable population of seniors (age 60+ years) and adults with disabilities (age 18-59 years) in Maricopa County, AZ. To help clients remain in their homes for as long as possible, SASD case managers provide comprehensive and holistic case management services addressing all areas of a client’s life. Clients are found in homes with minimally acceptable living conditions or in room-for-rent options and are at high risk of homelessness. Finding themselves isolated, the senior population is also increasingly vulnerable to mental health issues.

Since its inception, SASD’s team of community case managers have managed even the most time-intensive and complex client needs, including:

  • Providing secure, stable, permanent, and affordable housing for SASD clients facing homelessness.
  • Pursuing housing options for special needs populations.
  • Facilitating home environment improvement, including complicated biohazard cleanings, averting client evictions, and improving quality of life.

Read more

Answering Your Questions: FAQs on Case Management (H2)

  • What is community case management?

    Community case management programs are designed to help governments, social services agencies, and other entities connect clients to resources and services that improve their lives and well-being.

  • What does a community case manager do?

    Case managers help clients navigate the social services system, access medical and behavioral care, access financial and legal resources, prevent homelessness, and ensure positive outcomes.

  • What is the difference between case management and social work?

    Social workers and case managers often have overlapping responsibilities. However, while social workers provide direct services to individuals and families, case managers act as planners and coordinators who develop care plans and connect clients to services and community resources while serving as advocates. Case managers also handle all client administration, tracking, and reporting – easing the burden on busy social workers.

  • What types of laws and regulations must community case managers comply with?

    Community case managers must deliver services in accordance with the following laws and regulations:

    • Reno vs. Flores
    • Trafficking Victims Protection Reauthorization Act (TVPRA)
    • Prison Rape Elimination Act (PREA)
    • HIPAA
    • PII/PHI laws
    • OSHA
    • Americans with Disabilities Act (ADA)
    • Do No Harm Act
    • Conflict of interest laws

    And in compliance with guidelines issued by:

    • CDC
    • American Medical Association
    • American Nursing Association

    In addition, community case managers may be trained and/or accredited by the National Case Management Network (NCMN), the Council on Social Work (CSWE), and others.

The Future of Case Management in Community Services

Community case management is a complex field that is growing quickly. To keep pace, case managers must find efficiencies, cost savings, and more time wherever they can.

Technological Advancements and Case Management

A key challenge for community case managers is navigating the organizational and administrative aspects of their work. Social workers are needed more than ever – yet most spend more than 50% of their time doing paperwork-intensive case management tasks. Fortunately, technological advancements can streamline case management tasks, such as tracking and reporting cases, and free up case managers to spend time doing what they do best – improving the lives of their clients.

With community case management software, case managers can securely track clients, manage communication and outreach, centralize case records and documents (including client notes, plans, and treatment plans), generate custom reports, and stay on top of appointments and follow-up tasks.

Challenges and Opportunities Ahead

Case management in community services is a challenging profession. Case managers handle complex, sensitive, and upsetting issues. Stress, burnout, and turnover are common.

But case management also presents opportunities. Case managers work with diverse populations, each with unique needs and expectations. Making a positive difference in clients’ lives and driving social change for at-risk populations can be rewarding in many ways.

Indeed, the value of case managers who advocate tirelessly for their clients is becoming more and more important. The COVID-19 pandemic, economic issues, social isolation, substance use, and other crises, make now the time to invest in this important field of social work and community service.

When combined with innovative technology, case management services relieve case managers and their employers of the burden of managing complex cases – freeing them to provide much-needed services to individuals, youth, and families.

Social Work Case Management Services – Partner with Acuity International

Effective social work requires effective case management. Our agile, interdisciplinary, and responsive social work case management services can help streamline complex social work cases, ensure compliance, and improve outcomes.

Contact us to learn how our social work case management services can help you coordinate all case management activities and make a transformative lifelong impact to the lives of individuals and families in need.

Meet Our Comprehensive Case Management Services Today!

Can You Have a CDL with Mental Illness: Navigating the Intersection of Mental Health and Commercial Driving

Operating a commercial vehicle is a demanding and risky occupation. To ensure the safety of drivers and the public, the U.S. Department of Transportation (DOT) requires that drivers are mentally fit-for-duty. But can you have a CDL with mental illness?

Certain mental health conditions can result in the denial of a CDL, including depression, attention deficit hyperactivity disorder (ADHD), dementia, bipolar mood disorder, schizophrenia, and more. But exceptions and accommodations can be made.

In this blog, we explore the concerns about mental illness and operating a commercial vehicle (CMV), how the severity and nature of the illness can impact eligibility for a CDL, and tips for obtaining a CDL with mental illness.

Understanding CDL

Driving a truck or other CMV requires knowledge, experience, skills, and physical and mental fitness. To obtain a CDL, an applicant must pass a state-administered knowledge and skills test and undergo a DOT medical examination. The examination is performed before a CDL is issued and every two years thereafter.

The medical exam follows guidelines for physical and mental fitness issued by the Federal Motor Carrier Safety Administration (FMCSA) and is performed by a DOT-certified medical examiner.

Once certified as medically fit, a driver must submit the medical examiner’s certificate to their state DMV stating they are medically certified to operate a CMV.

The Intersection of Mental Illness and CDL

Mental illness is of particular concern to regulatory bodies and the transportation industry due to the characteristics that mentally ill drivers may exhibit, such as aggression, hostility, impulsiveness, disregard for laws, and more – all significant risk factors for accidents.

Role of Mental Health in Safe Driving

The relationship between mental health and (un)safe driving has been well documented. A 2021 study by the National Institutes for Health (NIH) showed that mental disorders of depression, hysteria, social mental deviation, paranoia, schizophrenia, and hypomania in individuals with a history of driving accidents led to meaningful differences from individuals without a history of driving accidents. According to the study:

  • Human behavioral factors are the main reasons for 60% of driving accidents and are effective factors in 95% of them.
  • Depression and anxiety in truck drivers increase the chance of a driving accident by 3.6 times.
  • The drivers’ personality characteristics, stress levels, and human behavioral factors determine a driver’s accident history or the lack of it.

Unfortunately, mental illness also increases the risk of drug and alcohol abuse:

For these reasons, the DOT and FMCSA impose strict medical examination requirements before a driver is certified mentally fit to operate a CMV and obtain a CDL.

The FMCSA Regulations Regarding Mental Health

FMCSA regulations have evolved over time to include a range of mental health conditions of clinical significance that may disqualify a driver from obtaining a CDL.

Per FMCSA, there are three categories of risk associated with psychological disorders:

  1. The mental disorder, including symptoms and/or disturbances in performance that are an integral part of the disorder and may pose hazards for driving.
  2. Residual symptoms occurring after time-limited reversible episodes or initial presentation of the full syndrome that can interfere with safe CMV driving.
  3. Psychopharmacology, as many psychotropic medications can compromise performance to the degree that CMV driving would be hazardous.

Can You Have a CDL with Mental Illness

Prescription bottle with pills, emphasizing the question: Can you have a CDL with mental illness while on medication?

Can you have a CDL with mental illness? The answer depends on the severity and nature of the mental illness.

Case-by-Case Analysis

Any presentation of risk factors for mental illness based solely on diagnosis by a medical examiner will not result in automatic exclusion from CMV driving and obtaining a CDL. Before medically disqualifying a driver, FMCSA guidelines require all medical examiners to assess the seriousness of the diagnosis on a case-by-case basis. Careful consideration is also given to any disqualifying medications, side effects, and interactions of medications.

Mitigating Circumstances and Accommodations

A medical examiner may make accommodations for individuals who want to hold a CDL. For example, a driver with ADHD or depression may still be eligible for a CDL based on a medical examiner’s assessment of that person’s treatment plan, how effective it has been, and if the medication has any side effects. An assessment of that person’s ability to safely operate a CMV may also be made.

Similarly, a medical examiner may make accommodations for an individual who takes DOT-disqualifying medications, such as anti-depressants or anti-psychotics, if a letter is obtained from their physician stating that the condition is managed, or if any medication would not impair safe driving.

Steps for Obtaining a CDL with Mental Illness

Therapy session for a male truck driver discussing CDL requirements and mental health with a psychologist.

Mental illness is not always a disqualifier for obtaining a CDL. With the right support and guidance, drivers can take steps to manage their illness, pass a DOT medical examination, and obtain a CDL.

Meeting with Healthcare Providers

If a person has a mental health illness or suspects they might have one, it’s important to consult with a healthcare provider to obtain proper diagnosis, treatment, and long-term care.

Being transparent can ensure the best outcome. Individuals should be clear about their desire to obtain a CDL and have an open and honest conversation about their options with a healthcare provider.

Medical Examination and Certificate

Before obtaining a CDL, an individual must be certified by a DOT-certified medical examiner and obtain a medical certificate for CDL. During the exam, the medical examiner will evaluate a person’s physical and mental fitness, abilities, medical history, strength and stamina, functional limitations, and drug and alcohol use. The exam will also include a drug and alcohol test.

Results are shared with the FMCSA regardless of whether the individual passes or fails.

If the individual passes the medical exam, they are issued a Medical Examiner’s Certificate (MEC). The exam is valid for up to 24 months. Medical examiners are required to keep a MEC on file for three years.

To prepare for the exam, drivers should provide current documentation detailing their medical history and prescription drug use. To aid the process, it’s also recommended to bring records of recent office visits and a signed letter from a physician stating that the individual can perform tasks (including driving safely) despite mental illness.

Follow-Ups and Management of Illness

Follow-ups with a healthcare provider, the right medication, therapy, and other management strategies are essential to ensuring safe driving and maintaining CDL eligibility. DOT medical exams are repeated every two years, so consistency is important.

The Stigma Surrounding Mental Illness and CDL

Female truck driver introspectively looking out the window, pondering about CDL and mental health.

Mental health challenges in the trucking industry are on the rise. But for men, who dominate the profession, the notion of experiencing mental illness can be particularly terrifying. Over six million men suffer from depression per year, but male depression often goes underdiagnosed. And when mental health symptoms do occur, they are often masked by unhealthy and unsafe coping behaviors such as alcohol and drug use.

Ignoring mental illness is dangerous and could lead to denial of a CDL or worse. What can CMV drivers do if they are struggling?

There are no awards for suffering. Like any other medical condition, drivers should seek the help of a professional. Employer-sponsored wellness programs, primary care doctors, and therapists can all help get drivers to understand what they are dealing with, and why, and develop a treatment plan.

Maintaining contact with loved ones, eating a healthy diet, and exercising moderately can also help.

But to truly combat the stigma of mental illness, employers must acknowledge the challenges of being a truck driver and commit to providing confidential access to workplace wellness programs, mental health resources, and counseling.

Steering Forward: Embracing Mental Health in the Commercial Driving Industry

Mental health can be a disqualifying condition for obtaining a CDL. However, exceptions and accommodations may be made.

Furthermore, through awareness and access to mental health resources, drivers and the trucking industry can help support the mental and occupational health needs of drivers – and ensure safe, accident-free highways.

If you are looking to optimize your occupational health screening programs, connect vulnerable workers to resources and services, and ensure compliance with regulations and guidelines, contact us to learn more about how Acuity can help.

Learn more about Acuity Occupational Health Services and Case Management Services.