Pre-Placement Health Assessment

PURPOSE:

To ensure that employees hired are not placed in jobs that would pose undue risk of infection or injury to them, other personnel, patients, or visitors. To screen for potential health problems which would limit the employee’s ability to perform job functions as outlined in the job description.

POLICY:

Pre-Placement health screenings, as determined by job description requirements, will be completed after hire prior to beginning job duties at no cost to the employee.

PROCEDURE:

Refer to accompanying graph of job categories

1. All newly hired employees will complete a health history form outlining their personal medical history and immunization status.

2. If required by the job description, the employee will have blood drawn by the lab.

3. Pre-placement screening will be performed by the Physical Therapy Department, based on job requirements outline by job description.

4. A basic physical assessment and review of the above findings will be done by the employee health RN (DON or NM). If indicated, a physical exam by MD/PA will be scheduled.

5. If lab findings and job description require them, immunizations will be offered as indicated.

6. Follow up blood draws for titers to document immunity will be drawn at the designated interval.

DOCUMENTATION:

Records will be maintained in the employee’s personnel health file and be subject to safeguards of confidentiality as outlined in the HIPAA laws.

Chadron Community Hospital & Health Services Employee Health Procedure

	History Form	Blood Draw	PT Eval	RN Assess	Physical	Annual Physical	TB Test	Hep B Offer	MMR Offer	Varicella Offer
Job Category I	Required	Hep B Rubella Varicella	Yes	Yes	If Indicated	Not Required	Required Annually	Yes	Counsel	Counsel
Job Category II	Required	None	Yes	Yes	If Indicated	Not Required	Required Annually	If Exposed	No	No
Job Category III	Required	None	Yes	Yes	If Indicated	Not Required	Required Annually	No	No	No

DRUG FREE WORK PLACE

It is the policy of Chadron Community Hospital and Health Services to maintain a work place that is free from the effects of drug, narcotics, and alcohol abuse.
    The drug testing program outlines in this policy has been instituted in accordance with the NEBRASKA DRUG FREE WORK PLACE ACT OF 1988 and CHADRON COMMUNITY HOSPITAL AND HEALTH SERVICES' Anti-Drug Plan. Chadron Community Hospital and Health Services has reviewed the legal, operational, social, medical, and ethical aspects of instituting this program.
    The manufacture, distribution, possession, use, sale, transfer, purchase, and transport of illegal drugs will be considered a violation of the Hospital's Anti-Drug Plan and shall be grounds for termination. This program will allow all employees to enjoy a safe, productive and healthy work environment.
    Employees with drug abuse problems are urged to seek assistance prior to problems affecting on-the-job performance.

DEFINITIONS

	Employee: Any person employed by the Hospital
	Accident: Defined as any on-the-job related accident which causes injury to an employee who is subject to worker's compensation; any accident which causes damage to property of the Hospital or others, or injuries to non-employees; and any OSHA reportable injury.

TESTING APPLICATIONS

Pre-Placement All job applicants who are being considered for employment must read the Anti-Drug Plan, sign the consent form, and submit to pre-placement drug testing.
Accident Testing All employees at the Hospital will be subject to accident drug testing in accordance with the accident definition.
Reasonable Cause The Hospital will test any employee when reasonable cause exists that the employee is impaired due to drug or alcohol use.
Refusal To Be Tested Testing shall be considered a condition of continued employment at the Hospital. Refusal to be tested will be viewed as noncompliance with the Hospital policy and cause for disciplinary action up to and including termination.
Return to Duty Testing After completion of a drug or alcohol treatment program or after refusal to be tested, the Hospital will require a Return to Duty drug test.

	Result Reporting: Results of drug testing will be reported to the Hospital's Director of Personnel, his/her Designee, or the Medical Review Officer as necessary.
	Action of Test Results: All positive drug results obtained by EMIT screening will be confirmed by Has Chromatography Mass Spectrometry. The Hospital's Medical Review Officer will evaluate all confirmed positive results to determine if there is any explanation for the positive result other than substance abuse. The employee may request a personal review and submit medical information for review as requested by the Medical Review Officer. A confidential physician/patient relationship will be maintained. A positive test result may result in termination. If, after evaluation, it is determined that the employee requires treatment before returning to work, the Hospital will require successful completion of the treatment program at the employee's expense as a requirement for his or her returning to work. After successful completion of a treatment program, the employee will be subject to all the regular provisions of the Anti-Drug Plan as well as periodic unannounced testing. If an employee is found to be positive after returning from a treatment program, the employee may be terminated. SMOKING Smoking is prohibited in all areas of the facility with the exception of designated areas on the outside grounds. The Administrator is responsible for implementing and monitoring smoking regulations and Department Directors are expected to enforce such regulation. The smoking policy applies to employee during working time and to patients and visitors while on the Hospital's premise. Employees are expected to exercise common courtesy and to respect the needs and sensitivities of co-workers with regards to the smoking policy. Complaints about smoking issues should be resolved at the lowest level possible, but may be processed through the Hospital's grievance procedure. TIPS, GIFTS, AND DONATIONS An employee is not permitted to either solicit or accept tips, gifts, or donations of any kind without permission from the administrator. EMPLOYMENT OF RELATIVES Chadron Community Hospital and Health Services permits the employment of qualified relatives of employees as long as such employment does not, in the opinion of the hospital, create actual or perceived conflicts of interest. Individuals who are related by blood or marriage are permitted to work at Chadron Community Hospital and Health Services. They will not be employed in the same department without specific approval from the hospital administrator. For the purpose of this policy "relative" is defined as: spouse, child, parents, sibling, grandparents, grandchild, aunt uncle, first cousin, or corresponding in-law or "Step" relation. RESIGNATION Employees who find it necessary to terminate their employment with the hospital are asked to give at least fourteen (14) days written notice to their department head, using the Change of Status form, in order to remain in good standing. Failure to give such notice will prejudice the employee from reemployment at Chadron Community Hospital and Health Services and cause the employee to receive only those benefits which are vested in the employee's name. Supervisors and department heads are asked to give at least thirty (30) days written notice of termination. All terminating employees will have an opportunity for an exit interview and exit evaluation. RETIREMENT The normal retirement date for all employees of Chadron Community Hospital and Health Services is the first of the month following the month of which his/her seventieth (70th) birthday occurs. An employee desiring to retire at an earlier age may do so by submitting a request, in writing, to their Department Head. At the time of retirement, all accrued benefits of vacation time shall be paid to the employee. REEMPLOYMENT If any employee terminates with an acceptable job performance/in good standing, he/she will be eligible for reemployment. Application for reemployment should be made with the personnel director. Any former employee who satisfied at least one (1) anniversary of employment and is reemployed must satisfy a ninty (90) day training period to be eligible to receive fringe benefits. However, accrual of benefits shall begin the first day of employment. OUTSIDE EMPLOYMENT Chadron Community Hospital and Health Services has no objection to an employee holding another job as long as it is not in conflict with the performance standards of the employees job at the facility. The employee should think seriously about the effects that such extra work may have on the limits of their endurance and their overall personal health. Should another job interfere with your work, performance standards, etc., the employee will be given the opportunity to resign from Chadron Community Hospital and Health services or quit the other job. As a courtesy to your supervisor, you should inform them that you have a second job. KEYS Keys will be issued for the purpose of providing security of records, etc. within the hospital. A check out system in the Director of Plant Operations office will be used for all keys and a signed receipt shall be filed for each key issued. Loss of issued keys may result in the employee paying replacement cost of the key and a lock. Duplication of any facility key shall not be permitted without written permission of the director of plant operations. Upon termination of employment all keys will be returned prior to the issue of the employees final check. EMPLOYEE CLASSIFICATION To classify all employees for the administration of benefits in an equitable way. Full-Time Employees Full-time employees are those regularly scheduled to work not less than seventy-two (72) hours per two week pay period and who meet the scheduled requirements for full-time employment in their department. Part-Time Employees Part-time employees are those regularly scheduled to work less than seventy-two (72) hours per two week pay period and who meet the scheduled requirements for part-time employment in their department. Casual Employees Casual employees are not regularly scheduled, but may be called to fill specific scheduling deficiencies as they occur and are not eligible for benefits. Regular Employees Regular employees are employees who have been appointed to a regular position and who have successfully completed the probationary period designated at the time of employment. Benefits will not be reduced for any employee who because of low census had hours cut. PRESS RELEASES FROM THE HOSPITAL To ensure the confidentiality of patient and hospital information. Any press releases or any information concerning patients or the hospital, to be used by the news media, shall be distributed by and through the Administrator or his designate. The only exception to this rule shall include: new births, admissions, and dismissals if the patient gives written permission for release. GRIEVANCE PROCEDURE Sometimes in the relationship of worker to worker, or worker to employer, misunderstandings develop. Often these are the results of a misunderstanding or a lack of sufficient information; but before a grievance can be settled, it must be expressed. Any non-supervisory or nonexempt employee who has a grievance, (that is questions about interpretation or application of hospital policy) may use the following procedures. The presentation of such grievance must be made within five (5) days of its occurrence. First Step: Your department director. In order to minimize the possibility of misunderstanding, employees are required to talk over their problems or grievances with their immediate supervisor within five (5) days of the occurrence of the problem creating the grievance. Your department director will investigate, evaluate, and provide a solution or explanation within five (5) work days. Second Step: If you are not satisfied with the recommendations provided by your supervisor, you will have an additional five (5) work days to request an appointment for a personal interview with the administrator who will discuss the problem with you and investigate all aspects of it thoroughly. The administrator will provide a written decision within five (5) work days of the appointment. Third Step: Your personnel director. If you have not received a satisfactory answer of settlement from your administrator within five (5) work days, you will be allowed five (5) work days to refer your problem in writing with a copy sent to your department head, to the personnel director. The personnel director will ask that within five (5) days each party submit a list of three (3) employees acceptable to them as members of a Grievance Panel. The personnel director will meet with both parties to guide them in the agreed selection of four (4) of the six (6) to serve as hearing officer. The personnel director will arrange for a place and time for the hearing within five (5) days. A formal hearing will be conducted with each side having an opportunity to explain his/her position. Fourth Step: After all facts have been presented, the Grievance Panel will meet privately to arrive at a solution to the grievance within the hospitals' policies. The decision will be explained to both parties by the administrator. All parties concerned will receive written copies of the final decision. The decision of the Grievance Panel will be final. MANDATORY IN-SERVICE The following are mandatory for all staff on a yearly schedule:
	Infection Control
	Body mechanics
	Fire and Safety
	Confidentiality
	Bloodborne pathogens, TB
	Sexual Harassment

The following are mandatory for all persons in direct patient care:

CPR - all nursing and non-nursing personnel (lab, x-ray, RT, PT, Home Health)

DISCRIMINATION

To ensure all job applicants, patients, medical staff, and employees will not be discriminated against.
Chadron Community Hospital and Health Services will not discriminate against employees, job applicants, patients, or medical staff on the basis of race, creed, national origin, color, religion, political affiliation, sex, marital status, age, mental or physical disability or citizenship.
All applicants, eighteen (18) years of age or over, seeking employment will be given the opportunity to complete and application for employment. If no vacancy exists for which the applicant is qualified, the application will be retained on file for a minimum period of six months.

REDUCTION IN FORCE

Policy Statement(s)

a decision to cut back the employee force is a difficult on e and would only be made after Chadron Community Hospital and Health Services had exhausted all possible solutions to correct an adverse economic situation. If it becomes necessary to implement a cutback in the employee force, the following factors will be followed in determining which employees will be affected:

Job classification within a department.
Length of continuous service.
Ability and fitness to perform the required work. An employee's ability and fitness to perform the required work shall be defined as having the basic qualifications defined in the job description and current performance evaluation results.

Regular employees within the same job classifications will be treated equally, with those of less seniority permanently separated from Chadron Community Hospital and Health Services, providing those with higher seniority are qualified and willing to work the hours and shifts available. Employees permanently separated from the hospital will be eligible for appropriate termination benefits.
Employees affected by staff reduction will be, however, placed on a priority rehire list and may continue to utilize the hospital's job posting system to apply for vacant positions in the hospital for which they qualify by experience, education and/or training. A qualified former employee or a priority rehire list will be given first consideration over equally qualified applicants. Priority rehire consideration will be effective for one year.
Staff reduction may require that employees who are not affected be reassigned to different shifts/units/schedules in order to assist Chadron Community Hospital and health Services in meeting its mission. When this is necessary the facts above will be used to make any reassignments as equitable as possible.

STAFF REDUCTION-EXCEPTION REVIEW

During the process of staff reduction, it may occur that certain employees who are affected by a staff reduction are providing key/critical services. When the loss of such an employee will have significant cost impact, or seriously impair Chadron Community Hospital and Health Services' ability to complete its mission, an exception to the staff reduction process may be in order. Extreme caution is necessary to assure that any exceptions made are done so only when there is clear, documented evidence of a critical need. The Administrative Staff will evaluate all exception requests according to the following guidelines:

Experience, education, and/or training which qualify affected employees to perform duties of job description necessary to meet goals, and no other employee can perform or be trained to perform in a reasonable period of time.
Past expenditure of substantial amount of money for employee training in unique area.
Ability of affected employee to perform duties that can be obtained by Chadron Community Hospital and Health services only through expenditure of monies substantially higher than cost when provided by employee (Example-required to subcontract work to outside at premium rates).
Ability of affected employee to perform task or tasks that administration deems critical to the long term well-being of the institution.
Work by affected employees in key/critical areas when past recruitment for that position has been severely restricted.
Qualifications to perform duties shall be determined by an analysis of the employee's past education, experience, training and performance against the minimum standards listed and required by the job description. In addition, an employee shall be required to demonstrate performance on the job at a satisfactory level upon completion of the orientation period.
PAYROLL DEDUCTIONS

Only deductions required by law or authorized in writing by employees will be withheld from pay.
Required by law:

	Federal Social Security Tax (the hospital matches the employee's payment with both payments credited to the employee's account with the Social Security Administration).
	Federal Income Tax
	State Income Tax
	Garnishment of wages by court or IRS May be authorized by employee:

Meals
Hospital bills
Health, Dental, and Supplemental insurance
T.S.A. or other investment plan
Cafeteria Plan
Uniforms

Questions about these deductions should be directed to the personnel office. Assignment of pay by an employee to a creditor other than Chadron Community Hospital and Health Services for the payment of debts is not permitted.

GARNISHMENT

Employees are urged to handle their personal financial affairs in such a manner as to avoid any garnishment of salary. Garnishments are embarrassing to the individual, cause unnecessary work for the hospital and affect the credit standing of the employee in the community. Should an employee's salary be garnished by the Courts for any reason, the garnishment will be handled in accordance with the current payroll laws governing garnishments.

PERMISSION TO LEAVE DURING WORKING HOURS

If it is necessary for you to leave your department or the hospital premises during working hours, permission should be obtained from your department head. If you leave without proper authorization, it will be considered an unexcused absence.

AMERICANS WITH DISABILITIES ACT

What the ADA Covers. The ADA prohibits discrimination against any qualified individual with a disability because of that individuals' disability. This covers job application procedures, hiring, promotion, transfers, discharge, layoffs, training, compensation, and fringe benefits.
The ADA does not preempt other federal, state, or local laws providing equal or greater protection to the disabled.

SERIOUS DISEASE/ILLNESS

It is the policy of Chadron Community Hospital and Health Services that employees with infectious, long-term, life-threatening, or other serious diseases may work as long as they are physically and mentally able to perform the duties of their job without undue risk to their own health or that of other employees or patients.

	Serious diseases for the purposes of this policy include, but are not limited to; cancer, heart disease, multiple sclerosis, hepatitis, tuberculosis, human immunodeficiency virus (HIV), and acquired immune deficiency syndrome (AIDS).
	Chadron Community Hospital and Health Services will support, where feasible and practical, educational programs to enhance employee awareness and understanding of serious diseases.
	Employees afflicted with a serious disease are to be treated no differently than any other employee. However, if the serious disease affects their ability to perform assigned duties; such employees are to be treated like other employees who have disabilities that limit their job performance.
	Employees who are diagnosed as having a serious disease and who want an accommodation should inform the Personnel Department of their condition as soon as possible. Department Director and the Personnel Department will respond with compassion and understanding. In addition, they should review the policy on such issues as employee assistance, leaves and disability, infection control, requesting and granting accommodations, Chadron Community Hospital and Health services' continuing expectation regarding the employee's performance and attendance and available benefits.
	Employees who have a serious disease and who want an accommodation should provide the personnel Department with any pertinent medical records needed to make decisions regarding job assignments, ability to continue working, or ability to return to work. Chadron Community Hospital and Health Services may also require a doctor's certification of an employee's ability to perform job duties safely. Additionally, the employee may be requested to submit to a medical examination if it is believed the employee is a health or safety threat to himself/herself or others.
	An attempt will be made to maintain the confidentiality of the diagnosis and medical records of employees with serious diseases, unless otherwise required by law. Information relating to an employee's serious disease will not be disclosed to other employees unless the information is, in the opinion of Chadron Community Hospital and Health Services, necessary to protect the health or safety or the employee, co-workers, or others.
	Chadron Community Hospital and Health Services will comply with applicable occupational safety regulations concerning employees exposed to blood or other potentially infectious materials. Universal precautions, engineering and work practice controls, and personal protective equipment will be utilized to limit the spread of diseases in the work place.
	Employees concerned about being infected with a serious disease by a co-worker, patient or other person should convey this concern to their Department Director or the Personnel Department. Employees who refuse to work with or perform services for a person known or suspected to have a serious disease, without first discussing their concern with their Department Director; will be subject to discipline, up to and including termination.

Full-Time Employees

Part-Time Employees

Casual Employees

Regular Employees

PRESS RELEASES FROM THE HOSPITAL

GRIEVANCE PROCEDURE

First Step:

Second Step:

Third Step:

Fourth Step:

Policy Statement(s)

STAFF REDUCTION-EXCEPTION REVIEW

PERMISSION TO LEAVE DURING WORKING HOURS

AMERICANS WITH DISABILITIES ACT

SERIOUS DISEASE/ILLNESS