Given the wide variation in approaches to workforce health throughout the Department of Homeland Security (DHS), the committee recognized the need for a set of standard information from each of the component agencies to help inform its work. The question lists presented in this appendix were constructed to help the committee draw comparisons among component agency medical, occupational safety and health, and workers’ compensation programs. These lists were disseminated to staff with responsibility for these functions in each of the components.
QUESTIONS TO ASSESS DHS MEDICAL PROGRAMS
1. Planning, Accountability, and Leadership Commitment
A. Do you have an overarching strategic plan for the health protection and well-being of your employees? If yes, please provide the plan. If this is not possible, what are the main elements and/or goals outlined in the plan?
B. Do you have an action plan that lays out how your organization will work toward those goals, with specific measurable outcomes? What metrics are used to evaluate performance? Who set them? Do you have a scorecard or other tool to track those metrics so that performance can be evaluated?
C. Who in your organization is held accountable for progress toward those goals? How is accountability achieved (e.g., incorporated into a performance plan)?
D. Please name ways by which your organization ensures that managers above the level of line supervision demonstrate a commitment beyond paper promises to the health and well-being of the workforce (e.g., actively participate in communication strategies designed to promote worker health and safety by discussing the importance of such initiatives at workplace events and publicly recognizing and celebrating positive results).
A. Do you have published guidance and standard operating procedures (SOPs) for the health protection and well-being of your employees? If yes, can you provide the policy? Does the policy/guidance cover:
- Medical surveillance/monitoring for exposure to known health hazards
- Infectious disease prevention
- Travel medicine
- Medical readiness/fitness for duty
- Medical quality assurance
- Medical case management and return to work
- Wellness/health promotion
B. How do you ensure compliance with such policies/SOPs?
C. Do you have a policy requiring sites to comply with all relevant health-related laws and regulations (with specification of the applicable laws and regulations for a given site)?
D. Do you have a policy and SOP for addressing medical aspects of crisis management for any potential major hazard (e.g., infectious disease epidemic, natural disaster, terrorist attack)?
A. For which positions in your organization are medical and/or physical fitness standards in place? What process was used to set those standards? How often are they reviewed and updated? What is the process for doing this?
B. Are there any law enforcement or other safety and security sensitive positions in your organization for which standards have not yet been developed or are in the process of being developed? If so, which?
C. For which positions in your organization are there standards for certification/licensure/registry? How is compliance with those standards being tracked?
Save a Life
A. Do you have safe and effective systems for basic life support at all worksites, including automated external defibrillators (AEDs) and emergency medical services (EMS)?
B. Do you have a system to ensure advanced life support (e.g., advanced cardiac life support) is available at a worksite within a set amount of time from when an alert is issued? If so, what is that set amount of time?
C. What processes do you use to prevent occupational infections?
Medical Quality Assurance
A. Does your organization have an active, documented medical quality management (MQM) program? If not, why not (e.g., health services are not provided to employees, lack of funding or personnel to run such a program)?
B. If so, what are the main elements of your MQM program? Please describe briefly how your organization addresses any of the following processes that are a part of your MQM program:
- Ensuring medical providers (contracted or in-house) are appropriately qualified (e.g., licensed, certified, or registered).
- Reporting adverse or sentinel events (unexpected effects of treatment or medical support that result in harm to the patient) and near misses. Are such reports provided to: your organization’s medical program office, the OIG, or OHA within a set amount of time after the event occurs?
- Investigation of adverse or sentinel events and near misses (Who is responsible for this? How are they conducted? Do you do a root cause analysis? What is done with the results?).
- Performance improvement (What metrics are you using and what performance goals or standards do you benchmark against? Do
you have a quality improvement committee that guides and assesses performance improvement activities?)
- Clinical competency assessment for health services providers (How is this done and how frequently?)
Can you provide a copy of documentation describing your MQM program?
C. What, if any, medical quality assurance information (e.g., reports of adverse/sentinel events, status reports on corrective actions after an adverse/sentinel event, performance improvement reports) do you report to the Office of Health Affairs (OHA) (e.g., through the OHA MQM mailbox)? If none, why not? What are the largest barriers to doing so? How long after a sentinel event resulting in a patient death occurs is it reported to OHA?
D. For contracted health services or those supplied through interagency agreement (e.g., with Federal Occupational Health), how do you assure contractor/provider compliance with DHS policy and contract requirements (i.e., medical providers meet professional criteria and certification/licensure requirements, clinical competency of service providers is regularly assessed, adverse/sentinel events and near miss occurrences are reported)? Is the vendor required to supply a quality assurance report? How frequently? Who is responsible for reviewing such reports? Are requirements set forth in the DHS MQM instruction incorporated into contracts/interagency agreements for health services?
A. How do you determine which jobs have a demonstrated need for medical qualification (e.g., How do you determine which jobs to do job task analyses for)? Who performs these? How are the job task analyses used to develop medical standards?
B. Do you have a documented medical qualification process for each job requiring qualification (e.g., law enforcement, buggy/forklift operator, respirator users, firefighters, emergency response personnel, confined space workers)? What is this process (e.g., submission of medical history forms, medical examination [in-house or contracted], evaluation by medical review officer or board [in-house or contracted])? Is it applied only prior to employment or also periodically? If the latter, how frequently?
C. Do you have documentation that all employees in those roles are medically qualified? How is medical qualification status tracked for those that must meet medical standards?
D. Do you have a documented policy requiring those who must meet medical standards to notify the appropriate personnel regarding a change in their health status (e.g., new diagnosis) or the addition of any new drugs to their regimen? Who would need to be notified of such changes? What is the process for someone updating their health status records?
E. What process is used to adjudicate fitness-for-duty cases for current employees?
F. What, if any, process does your organization use to determine if someone is medically qualified for deployment (deployment considered as temporary transfer of an employee during an operation to a site where working conditions may be more hazardous or medical services less accessible than at that employee’s usual workplace, like overseas or to a disaster site)?
Medical Surveillance/Monitoring: (Skip if all medical surveillance is handled by your component’s safety office)
A. How do you ensure/track that all employees exposed to known health hazards are monitored regularly? Is medical surveillance conducted in-house or contracted out? If the latter, to whom? How are results collected from the vendor?
B. Besides those exposures requiring monitoring per OSHA, what other exposures (e.g., tuberculosis) do you monitor? What process was used to determine the need for such monitoring?
C. Is medical surveillance data aggregated and used to identify population-level health risks?
D. Does your organization have an ergonomics program? Who has responsibility for this program? Do you perform symptom surveys? Do you have a mechanism for early reporting and prompt medical attention? How do you address identified ergonomics problems?
Employee Health and Wellness: (If handled by another office in your component, please provide contact information for the best person to address these questions)
A. Does your component have an employee Health and Wellness program? Is it an in-house program or contracted? What are the key elements of that program designed to address and improve employee health? Does it include
- Employee assistance programs or other counseling services?
- Work time for physical fitness, access to a fitness center, and/or onsite fitness classes/programs?
- Health screening/health risk assessment for personal medical issues (e.g., blood pressure, body mass index (BMI), cholesterol, smoking, alcohol intake and other behavioral health risks)?
- Voluntary vaccination program (e.g., flu)?
B. Was an appropriately certified/credentialed physician or other medical personnel involved in the design of the program? What are their qualifications?
C. Do you track utilization of these services? How is utilization data used?
D. If your program includes a health risk assessment (HRA) or voluntary vaccination program, what IT system do you use (if any) to track HRA results or vaccination status for employees?
E. What metrics are used to track employee health and wellness in your component? How do you evaluate the effectiveness of health and wellness interventions? Are there documented goals for the program? If so, what are they?
F. How does your organization incentivize or encourage a healthy lifestyle?
G. Does your component conduct and document a health needs analysis that involves medical and HR personnel in order to identify and address the top health issues in your workforce? If so, which of the following health data sources are utilized for this needs analysis: employee assistance data, wellness program participation data, documented behavioral health and lifestyle risks, available workers’ compensation and safety data, sick leave utilization data? Based on this analysis, are recommendations made to your organization’s leadership on next steps (e.g., future programs) to address the health needs of your organization’s workforce?
H. Is information from medical qualification processes used to track the health status of employees who must meet medical standards? For example, if someone is hired with controlled diabetes, is the status of his/her diabetes checked during future medical screenings? Is that information used to tailor individual health promotion interventions? Are these data aggregated to get a sense of the health risks in your component’s workforce (e.g., risk from diabetes)? If so, are these data used to drive population level interventions?
I. Is your organization’s employee health and wellness program coordinated in any way with occupational medicine and/or occupational safety and health programs? If so, how?
5. Metrics and Performance (output, outcome and quality measures and systems in place for tracking, analysis, and communication)
A. What performance measures do you rely upon to determine whether your employees are adequately protected from workplace health hazards?
B. What metrics do you rely upon to determine whether your employees are medically fit to perform their jobs?
C. What performance reports/scorecards containing summaries of tracked metrics are prepared? Who receives the results? How often?
D. Are metric summaries analyzed to determine future training or program needs?
6. Organizational Structure and Integration with Operations
A. What organizational steps have been taken to ensure that safety, workers’ compensation/return to work, wellness, and medical programs are fully coordinated within your component and responsibilities clearly delineated?
B. Does your office participate in committees/councils or working groups with representatives from medical, wellness/health promotion, workers compensation, and/or OSH programs? Who leads this group? How often does it meet? How is it working to ensure coordination among these different activities?
C. Do you feel that the current placement of workforce health protection functions across your component’s organizational structure interferes with coordination and integration of such functions? If so, what are the major barriers to coordination and integration?
D. Who provides medical oversight for your component agency? To whom do they report? How/when do medical program staff interface with safety and workers’ compensation personnel?
E. Do you use an integrated health risk assessment process (i.e., team-based approach utilizing medical, safety, human resources, and operations personnel) to survey worksites and identify the major health risks to the workforce at that site? If so, are these surveys conducted periodically?
7. Resources (budgets, technologies, facilities, and personnel levels/expertise to support safety and health objectives)
A. Please describe staffing levels and skill sets within your component’s medical programs office. Do any medical program personnel
in your organization have expertise in health or medical informatics? If so, how many? Do you have a chief medical information officer? What are the most pressing personnel needs?
B. What medical/health services personnel are available at your agency field sites?
C. Does your component have an electronic health information system to track employee health information (medical qualification/fitness-for-duty status, health risk data)? If not, how is this information tracked (e.g., spreadsheets, database)?
D. What other investments has your organization made in health information and communications technology? Does your component have the necessary health information technology (software and hardware) to ensure situational awareness and support continuous improvement? If not, what is needed?
E. How is the budget for your component’s medical program set? Who makes this decision? What was your component’s most recent budget for medical programs?
OCCUPATIONAL SAFETY AND HEALTH QUESTIONS
1. Strategic Planning and Management Commitment
A. Does your organization have any document (e.g., strategic plan) that lays out specific goals/objectives related to the safety and health of your workforce?
B. If so, what are the goals or elements of the plan? Or, can you provide us with a copy?
C. Who in your organization is held accountable for progress toward those goals (or if none are defined within your organization, toward the President’s Protecting Our Workers and Ensuring Reemployment [POWER] goals)? How is accountability achieved (e.g., incorporated into a performance plan)? What metrics are used to evaluate performance of those held accountable?
D. How is the Designated Safety and Health Official engaged in ensuring the safety and health of the workforce as required by your organization’s occupational safety and health (OSH) policy (ensuring adequate budget and personnel for program implementation, establishing goals, priorities and strategies for reducing injuries and illnesses, evaluating your OSH program)?
E. Please name ways by which your organization ensures that managers above the level of line supervision demonstrate a commitment beyond paper promises to the implementation of your occupational
safety and health program (e.g., Do managers have safety as part of their performance plan? Do they serve on safety committees/councils?).
2. Standards and Policies
A. Does your organization have a handbook or manual specifying requirements, policies, standards, and procedures set by your occupational safety and health program? If so, can you provide us with a copy of it?
B. If not (or in addition to), do you have policies and standard operating procedures that detail the way you comply with the safety and health requirements set by your component or DHS? If so, can you provide copies of these?
C. Which of the following does your manual/SOPs address: identification and control of safety hazards; identification and control of health (e.g., infectious disease) hazards; mishap reporting, job safety/hazard analysis; medical surveillance?
D. For which of these areas does your organization have specific mandatory requirements/standards: periodic job safety analysis; exposure limits for identified health hazards; professional credentials and certification? Has your organization developed and received approval for any standards besides those set by OSHA? If so, please give examples. If not included in the agency manual/handbook, can you provide copies of any relevant standards?
E. Who was responsible for developing and approving each of these standards/requirements? By what process were they developed?
F. How often is your program audited for compliance with policies/standards dictated in your OSH handbook/manual internally? Externally (by DHS HQ)? How is the evaluation scored (e.g., use of worksheet with a rating system)? Who receives the results?
G. Can you provide a copy of a recent audit (including any self-assessments that were provided during the evaluation) along with an explanation of actions taken to address any deficiencies that were identified?
H. Who is responsible for ensuring that the standards in use by component organizations are consistent throughout DHS?
3. Hazard Identification and Control Programs
A. What jobs in your organization have job safety/hazard and ergonomic analyses on file? Who conducts these and who approves them? How are they used?
B. Does your organization have an ergonomics program? Who has responsibility for this program? Do you perform symptom surveys? Do you have a mechanism for early reporting and prompt medical attention? How do you address identified ergonomics problems?
C. How often are site safety inspections performed internally? Externally? Who participates in these? Do Collateral Duty Safety Officers or Safety Specialists (in-house or contracted?) conduct OSHA-required annual site inspections?
D. Who receives the results of site safety inspections?
E. What processes are in place to notify the site OSH office that a workplace injury/illness has occurred? Is there a 24-hour hotline available for reporting an injury or illness? How is the HQ OSH office notified about injuries/illnesses?
F. When safety or health hazards have been identified and reported (during inspections or by employees), who is responsible for determining whether there is a hazard that requires correction? Who is responsible for addressing identified hazards? How are the responsible persons held accountable?
G. Does your organization maintain a list of identified hazards with workplans, assigned responsibilities and timelines for their correction?
H. When does a report of workplace injury or illness trigger a job safety and health assessment? How soon after a workplace injury or illness report is filed is a job safety and health assessment performed?
I. How do you ensure/track that all employees exposed to known health risks (OSHA required or other site-specific exposures as identified by OSH) are monitored regularly? Is medical surveillance conducted in-house or contracted out? If the latter, to whom? How are results collected from the vendor?
J. Besides those exposures requiring monitoring per OSHA, what other exposures (e.g., tuberculosis) do you monitor? What process was used to determine the need for such monitoring?
K. Is medical surveillance data aggregated and used to identify population-level health risks?
4. Employee Involvement
A. Do you provide employees with a chance to participate in your occupational safety and health programs? If so, by what methods (e.g., membership on joint employer/employee safety committee, participation in safety inspections)?
5. Education and Training
A. Do you provide training on safety and health to all employees? How many hours of occupational safety and health training are required each year for employees, supervisors, and managers?
B. Do you have a training program for CDSOs? Was it developed in-house or contracted out? How many hours of training do you require CDSOs to take annually?
C. How is the effectiveness of occupational safety and health training assessed?
6. Metrics and Evaluation
A. Besides TCR and LTCR, what lagging indicators of safety and health performance do you document and track on a regular basis?
B. What leading indicators of safety and health performance (measures of injury/illness prevention) do you document and track on a regular basis? Does your organization conduct a safety climate survey? If so, which do you use (can you provide a copy)? Who fills this out?
C. How are performance metrics collected/tracked (input and storage of data)? When safety and health services are provided by contract, how is the data collected from the vendor and integrated with data collected in-house?
D. How are summary reports generated from the tracked injury and illness data? Do these reports include both OSHA-recordable injury/illness data and injury/illness data from workers’ comp claims? How often are reports generated?
E. Who is responsible for evaluating these reports? Who receives such reports? How often are such reports shared with field office management? Component management? DHS HQ Safety Office?
F. Can you provide examples of when corrective action was taken on the basis of such reports?
G. Are you able to electronically query your injury and illness data to get information regarding a particular kind of injury or illness,
about injuries and illnesses at specific locations, or for specific types of employees? Have any such reports been used to set in motion a hazard analysis? If so, can you give one or more examples?
H. Has OSHA conducted a workplace inspection in any of your organization’s workplaces in the past year? Can you provide copies of a recent OSHA inspection report? How did your organization respond to this report?
A. Please describe staffing levels and skill sets within your HQ Safety and Health Office. Does your organization have a Safety and Occupational Health Specialist (GS-0018 series) on staff? Industrial Hygienist (GS-0690 series)? Health physicist? Exercise physiologist?
B. Please describe staffing levels and skill sets for safety activities at your field sites. How many CDSOs does your organization have for the purpose of identifying safety and health hazards at the local workplace sites?
C. Do you feel your organization is adequately staffed and funded for each of the following program elements: worksite inspections, employee training, job safety analysis, periodic medical surveillance? What are the most pressing personnel or resource needs?
D. What IT system is used for (1) filing/tracking workers’ compensation claims; (2) tracking and analyzing safety data; (3) tracking and analyzing medical surveillance data? Are these systems linked in any way?
E. Do you feel your organization has the necessary information technology in place to support all program needs? If not, what are the most pressing IT needs?
8. Coordination and Integration
A. How is your safety and health program (hazard identification and mitigation, medical surveillance, job safety analysis) coordinated with other employee health protection programs (e.g., medical programs like fitness for duty, wellness, workers’ compensation case management, return to work)? For example do you have committees, councils, workgroups, or common reporting chains to ensure coordination? How do IT systems support this coordination?
B. When these working groups cannot reach consensus on important issues, how are final decisions made?
C. Do you feel that the current placement of workforce health protection functions across your component’s organizational structure interferes with coordination and integration of such functions? If so, what are the major barriers to coordination and integration?
QUESTIONS FOR WORKERS’ COMPENSATION PROGRAM STAFF
1. Workers’ Comp (WC) Claims Management
A. Does your office handle assignment of light duty and return to work in addition to WC claims management? If not, who in your organization oversees these functions?
B. Do you have SOPs or a manual with procedures for handling workers’ comp claims? If so, can you provide us with a copy?
C. Do you feel your organization is adequately staffed and funded for WC claims management? What are your most pressing personnel or resource needs?
D. Are WC claims filed electronically in your organization? If so, using what system? Are claims tracked in the same system? If not, how are they tracked?
E. Does the filing of a WC claim result in automatic notification to the OSH office that there has been a workplace injury or illness? If not, how does that office become aware that an injury or illness has occurred?
F. Do you assign WC costs to the local site level?
G. Does your organization review chargeback reports for accuracy? If so, how often (e.g., annually, quarterly)?
2. Case Management and Return to Work (RTW)
A. Do you have SOPs or a manual with procedures for getting injured employees back to work? If so, can you provide us with a copy?
B. When a WC claim is filed, is someone assigned to communicate with the employee and the employee’s physician to begin plans for return to work? Does this depend on the nature of the injury or illness? If so, how? How soon after a workplace injury or illness report is filed is contact initiated?
C. Does your organization have a nurse case management program for this purpose? If so, are nurse case managers employees of your organization or contracted staff? If the latter, which vendor do you use?
D. Does anybody have responsibility for contacting an employee who has been out for more than a few days with a workplace injury or illness but who has not submitted a WC claim? If so, who is that and how soon after the injury occurs is contact made?
E. What IT system is used to track work status (at work or off work)/medical status and progress (i.e., when the employee is expected to return to work and whether working a modified or regular job) of an injured worker over time?
F. Who determines if a modified job is available for someone who has not fully recovered? At what point does a person on WC for an extended time lose his or her job?
G. Who is responsible for ensuring a returning employee meets any applicable medical standards? What happens if the Department of Labor clears an employee for return to work but the employee doesn’t meet the medical standards for the position?
H. Does your RTW process include modified work, restricted hours, task rotation, and/or functional rehabilitation?