OPTIMA HEALTH MEDICAL FITNESS ASSESSMENT FOR TRAIN DRIVERS / TRAIN DRIVER MANAGERS PROCEDURE P-CG-036 Issue 2 19/12/13 Reviewed Feb 2015 Definition: Train Driving - refers to the control of trains or traction units from a driving cab by a train driver. Competent Person refers to a person who is required to travel with a train driver, due to defective on-train equipment, who is passed as being qualified and has the required knowledge and skills to carry out a particular rule, regulation, instruction or procedure. PLEASE NOTE: Train Driver Managers all have Train Driver medicals because they all drive trains and have to keep a competency in train driving as per the rail industry requirements. As Managers they will be involved in the supervision /training and assessing of safety critical working / driving. Objective: To assess the medical fitness for Train Driving / Train Driver Managers in accordance with their duties based on: - Railway Group Standard GO/RT3451 Train Movement Staff Suitability and Fitness Requirements - GO/RC3561 Recommendations for Train Movement Staff Suitability and Fitness Requirements - GO/GN3655 Guidance on Medical Fitness for Railway Safety Critical Workers Note: GE/RT 8070 will also apply for new entrants. Types of Train Driver / Train Driver Manager Medicals New Entrant / Pre-employment Examination Periodic Examination Examination after Sickness/ Absence / Incapacity / Accident NOTE: Please refer to the Group Operating Standards GO/RT3451, GO/RC3561, GO/GN3655 before conducting Train Driver / Train Driver Manager medical assessments 1
New Entrant and Periodic Medical Fitness Assessment for Train Drivers / Train Driver Managers GO/RT3451, GO/RC3561, GO/GN3655 Allocated Appointment Time: 45 minutes 15 minutes OH Physician NOTE: for all New Entrant Medicals a Drug and Alcohol screen is required. Therefore additional time (e.g. 30 minutes) will be required within the overall medical for this procedure. NOTE: for Periodic Medicals Northern Rail do not require a Drug and Alcohol screen. However other train companies may require a Drug and Alcohol screen for periodic medicals. Stationery Required: F-CG-074 Safety Critical Medical Form (Optima) F-CG-075 Railway Industry Medical Report Form (Optima) F-CG-043 Employee Consent Form (Optima) Medical Records (Periodic only) NOTE: Train Drivers employed by Infrastructure Companies may hold additional competency specific Level 1 fitness relating to specific Track Safety requirements whilst on the Infrastructure. Hence if they hold additional PTS Network Rail competencies they will need to be additionally certificated with an on line electronic Sentinel NR/1018/1 certificate as well as a Train Driver certificate (i.e.f-cg-075 Medical Industry Report Form). Therefore in circumstances where a Train Driver has additional Network Rail Competencies you will be required to complete an on-line NR1018/1 Network Rail Competence Specific Medical Certificate IN ADDITION to a F-CG-075 Medical Industry Report Form. For those Train Drivers employed by a Train Operating Company (e.g Northern Rail) only F-CG-075 Medical Industry Report Form will be required to be completed. If D & A required: Donor Information Sheet (Synergy Health) Step by Step Checklist (Synergy Health) Current Medication Questions (Synergy Health) Chain of Custody Form (Synergy Health) F-CG-115 Donor Information Sheet - Alcohol Breathalyser Testing (Optima) F-QM-050 Drug and Alcohol Results Log Book (Optima) blue A4 Ring Binder In circumstances where a Train Driver has additional Network Rail Competencies you will be required to complete an on line electronic NR1018/2 Network Rail Drug and Alcohol Medical Certificate IN ADDITION to F-CG-122 Drug and Alcohol Results Report form For those employed by a Train Operating Company (e.g Northern Rail) only a F-CG-122 Drug and Alcohol Results Report Form will be required. 2
General Procedure for Train Driver / Train Driver Manager Medicals GO/RT3451, GO/RC3561, GO/GN3655 Action Undertaken by Check client details and confirm client photographic identification. Obtain informed consent. (Note: For those Train Drivers who hold additional Network Rail competencies you will also need to carry out a Network Rail based Competence Specific (PTS) Medical and D & A see P-CG-032 Medical Fitness for PTS Testing and P-CG-034 Drug and Alcohol Testing) Safety Critical Medical Form F-CG-074 to be completed by client and. If Drug and Alcohol Test required then Donor Information Sheet should be given to client for information (see separate procedure on how to complete Drug & Alcohol Testing). If verifiable photo ID is not provided: 1) Request photographic identification electronically from the employer and print two copies of this one for the medical file and one to be enclosed with the documentation sent to the employer; 2) If on site, seek endorsement of ID by the Site Representative record the Site Representatives ID including their photograph. / Admin IF THERE IS NO CONFIRMATION OF ID THEN DO NOT PROCEED If the client fails to attend, inform the Employer by telephone and arrange an alternative date. Admin SUMMARY OF REQUIREMENTS OF EXAMINATION BEFORE APPOINTMENT AS A TRAIN DRIVER & AFTER APPONTMENT MINIMUM CONTENT OF EXAMINATION BEFORE APPOINTMENT TO TRAIN DRIVER ROLE General Medical Examination Examinations of Sensory Function (vision, hearing, colour perception) Blood or urine tests, testing for diabetes mellitus ECG at rest Tests for psychotropic substances (including illicit drugs or psychotropic meds and abuse of alcohol Attention & concentration, memory, perception, reasoning Communication Reaction time, hand coordination Occupational psychological examinations - when established occupational psychological deficiencies particularly in operational aptitudes or any relevant personality factor MINIMUM CONTENT OF EXAMINATION AFTER APPOINTMENT TO TRAIN DRIVER ROLE General Medical Examination Examinations of Sensory Function (vision, hearing, colour perception) Blood or urine tests, testing for diabetes mellitus & other conditions as indicated by the clinical examination ECG at rest for those over 40 years Tests for drugs where clinically indicated personality factor 3
Explain medical procedure to the client Physically check the client s mobility, balance and coordination (e.g. ask them to walk in a straight line, stand on their tip toes; touch their toes, stand on one foot and then the other, kneel on the right / left knee, full range of neck movement, clap hands above head). Undertake the following tests: Height Weight BMI Visual Acuity - Snellen Near and Distance Vision (using 6 metre Snellen Chart at a distance of 6 metres) (Note: ensure the chart is well illuminated) aided or unaided distance visual acuity: 1.0; minimum of 0.5 for the worse eye where contact lenses are used, test should be repeated using persons corrective spectacles that would normally be carried by the person on duty. Contact lenses & glasses are authorised when periodically checked by a specialist. If spectacles or contacts worn then uncorrected visual acuity shall be at least 3/60 in each eye. For Train Drivers maximum corrective lenses: hypermetropia +5 / myopia -8 Near & intermediate vision sufficient, whether aided or unaided. Field of vision must be full. No evidence of pathological eye condition likely to cause visual impairment. There should be no progressive eye diseases present Lens implants, keratotomies & keratectomies are allowed only on condition that they are checked yearly or at appropriate intervals set by a recognised doctor. Train Drivers / Managers undertaking driving duties require binocular near vision of at least N8, with spectacles or contact lenses if worn. Where individual has undergone or considering laser eye surgery, take note of Appendix A GO/GN3655 & possibly consider more frequent fitness examination on advice of 4
Ishihara colour vision (MUST BE NORMAL) Measured Ishihara 24 plates - Red and green colour vision shall be tested. Record information on F-CG-002 Ishihara Test form. Persons with defective colour vision are NOT permitted to drive trains, travel as a competent person with a train driver, be involved in train dispatch or shunting Vision is recorded as normal or abnormal Conduct test under natural diffuse daylight (not direct sunlight) or fluorescent lighting. The test plate can be held or place on a table at arms length approx 66 cm from the eye. The plates should not be touched by the candidate. The examiner does not have to have normal colour vision if you using F-CG-002. If 17 or more of the first 21 plates are read normally colour vision is regarded as normal. If responses are abnormal, the test shall be repeated in accordance with designers instructions. Use of coloured spectacles or contacts as a means of passing the colour test or to perform tasks requiring normal colour vision is NOT permitted. UV filter lenses ARE permitted Sensitivity to contrasts must be good. There should be recognition of colour signals: the test must be based on recognition of single colours and not on relative differences There should be an ability to withstand dazzle Further guidance on testing colour vision can be found in Appendix B Of GO/GN3655 5
BP - blood pressure shall be measured in all medical examinations and recorded as follows: PASS for any blood pressure of 140 / 90 and below. PASS plus ADVICE blood pressure between 140 / 90 and 160 / 95. Give advice on lifestyle issues. Medical certificate shall be issued with the normal validity period and without any restriction due to blood pressure. PASS plus ACTION - blood pressure between 160 / 95 and 180 /100. Ask the examinee to visit their GP for advice and treatment. Issue the medical certificate with a limited validity of 6 months, after which a further medical examination shall be required. FAIL Blood pressure greater than 180 / 100. ECG All new entrants [and Periodics from the age of 40] Hearing: Train Drivers / Train Driver Managers and those travelling as a competent person with a Train Driver must have sufficient hearing to enable them to hold a telephone conversation and to be able to hear warning sounds, alert tones and radio messages. The hearing assessment should take into account the individuals normal working environment, including ambient noise levels in and outside the cab and the communications equipment available. The following should be used as guidelines to assess the persons audiometric test results: - the hearing deficiency should not be higher than 40dB at 0.5 and 1kHz; - the hearing deficiency should not be higher than 45dB at 2kHz for the ear with the worst air conduction of sound. More stringent hearing values may be decided as necessary to control any potential risks identified during assessment of required physical and sensory functions, particularly where duties require the individual to be on or near the line. Where a Train Drivers hearing deficiency is higher than those recommended guidance levels specified above, OH should refer to the Train Company s Internal Standards on the action to be taken with the employee having failed the audio level. For example it may be appropriate to suggest the Train Company contact a qualified audiologist to determine if a hearing aid will rectify the problem satisfactorily. In special cases, subject to medical opinion, Train Drivers /Managers or those travelling as a competent person with a Train Driver, may be allowed to wear hearing aids to meet the hearing levels recommended.(refer to GO/GN3655 for further guidance). Urine Test (haemacombstix) Pregnancy in event of poor tolerance or a pathological condition, pregnancy must be considered a reason for temporary exclusion of drivers. Legal provisions protecting pregnant drivers must be applied. Drug & Alcohol Test (new entrants only or if specified by the employer / sponsor) Fill in details on F-CG-075 Railway Industry Medical Report Form 6
For Train Drivers / Managers the date of subsequent examinations should occur at the following frequencies: a) prior to employment b) Every 3 years for staff aged up to 55 years c) Annually for staff aged between 56 years plus Frequency increases if the health of the staff member so requires. Medical examination carried out when reason to doubt that a holder of train driving licence or train driving certificate fulfils medical requirements in para 1 of the Schedule. Medical fitness must be checked regularly & after any occupational accident or period of absence following accident involving persons. Additional medical fitness test, (particularly after a period of 30 days sick leave). Fitness must be checked if employer withdraws driver due to safety. IF DRUG & ALCOHOL TEST REQUIRED, PLEASE REFER TO SEPERATE DRUG AND ALCOHOL PROCEDURE P-CG-034 ON HOW TO CARRY OUT DRUG & ALCOHOL SCREENING 7
Refer to OH Physician Undertake full medical examination Analyse all screening results undertaken by the Discuss results with client Complete F-CG-075 Railway Industry Medical Report Form and return the form to Admin. If a client is found: Fit with restrictions; OR Unfit. the employer will be informed by telephone and then formally in writing. If Client is found: Unfit Admin / i.e. if an individual does not meet the medical fitness standards defined in GO/RT3451 and GO/RC3561 for visual acuity, colour vision, hearing or general health then the individual has FAILED the Train Driver / Manager medical assessment and this should be recorded on the white F-CG-075 Medical Report Form. If the assesses the individual and they meet the medical fitness standards defined in the GO/RT 3451 & GO/RC 3561 standard but feels that additional control measures are required, he can issue a Medical Report form with an earlier expiry date than that suggested under the age related medical frequencies. As the certificate will only be valid for a shorter time frame this will require the individual to take responsibility to return for a medical assessment sooner. The Medical Report Form can be restricted using the following: can be issued for a restricted duration, e.g. where close monitoring of a condition is required to identify deterioration in a condition that could compromise the individual s safety. The recommendation that the individual should not work alone can be recorded using the phrase must be accompanied at all times. This information must be documented on the F-CG-075 Railway Industry Medical Report Form stating the duration of the restriction or whether the client is required to be accompanied at all times until the restriction is removed. The reason for the restriction or accompaniment must also be detailed (e.g. to ensure prescription check with Optician; to ensure appointment is made with GP for advice and treatment for BP). Completed F-CG-075 Railway Industry Medical Form should be photocopied and placed on the clients file. The originals should then be posted to the employer. Medical Record Filed Admin 8