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Fitness for Duty Policy - Employees, Covered Individuals

I. Purpose of Policy

In an effort to provide a safe, healthy, and secure environment for all Dartmouth-Hitchcock (D-H) employees, patients, and visitors, this policy establishes every employee’s obligation to report to work fit for duty, and D-H’s right to take reasonable measures to ensure every employee is fit for duty.

II. Policy Scope

This policy applies to the following persons (throughout this policy referred to as “employee” or “employees”) at all D-H locations unless a person is covered by a separate written agreement:

Employees Covered Individuals
X Physicians/Fellows/Residents X Volunteers
X Associate Providers X Travelers
X Non-Provider Staff X Students
X Temporary Staff X Externs
X Per Diem/PRN Staff Vendors
X Geisel (credentialed/privileged) X Geisel (non-credentialed/non-privileged)
X Dartmouth College (credentialed/privileged) X Dartmouth College (non-cred/non-priv)

Nothing in this policy provides any contractual rights regarding job applicant hiring or employee assessment, nor does anything in this policy alter or modify the employment-at-will relationship between D-H and its employees, unless a person is covered by a separate written agreement.

III. Definitions

Consent: An employee’s written consent for D-H to conduct a fitness for duty evaluation.


Drug and/or Alcohol Testing: Any and all testing for drugs and/or alcohol by D-H’s Occupational Medicine Department.


Employee Assistance: D-H’s Employee Assistance Program.


Fitness (or Fit) For Duty: An employee’s ability to perform safely all essential job functions of his/her position from the time the employee reports to work and throughout the entirety of the employee’s scheduled work shift, as determined by D-H in its sole discretion.


Fitness For Duty Evaluation: An assessment conducted by Occupational Medicine, Employee Assistance, and/or HR to evaluate an employee’s fitness for duty. Such evaluation may include, but is not limited to, medical exams, drug and/or alcohol testing, interviews with the employee and others, internal D-H record reviews and audits, public record reviews, consultations with the employee’s provider(s), and psychological assessments. D-H reserves sole discretion to determine the method and means of evaluation.


House Supervisor: D-H’s administrator in charge during after-hours (after 5:00pm and before 8:00am) and during non-business days (weekends and holidays).


Human Resources (HR): D-H’s Employee Relations Department, Community Group Practices Human Resources Department, or other local D-H Human Resources office.


Occupational Medicine: D-H’s Occupational and Environmental Medicine Department or designee in Lebanon, Nashua, or other D-H locations.


Reasonable Concern: Information and/or observations that call into question, in D-H’s sole discretion, an employee’s fitness for duty. Such information and/or observations may include, but are not limited to:

  1. A supervisor’s, co-worker’s, and/or HR’s observations of the employee’s appearance, behavior, speech, body odors, or failure and/or inability to perform job functions safely or completely;
  2. An employee’s possession of alcohol or suspected illicit drugs or drug paraphernalia on D-H property;
  3. An employee’s diversion or suspected diversion of any drugs;
  4. An employee’s handling or apparent handling of drugs or drug paperwork (whether hardcopy or electronic) that departs from D-H or departmental policy or procedure, whether written or unwritten;
  5. An employee’s failure to comply with any applicable licensing board’s requirements, regardless of whether the licensing board has taken or threatened to take action against the employee;
  6. An employee’s arrest, charge, or conviction for a drug and/or alcohol-related offense;
  7. An employee’s identification as a substance abuser through public reporting and/or by state and/or federal authorities;
  8. An employee’s identification by a healthcare provider as being at-risk of committing imminent harm to himself/herself and/or a patient;
  9. Reports of or an employee’s self-disclosure (e.g., telling a supervisor, co-worker, and/or HR, or via e-mail, Facebook, Twitter, or other social media) regarding alcohol and/or drug diversion, consumption, use, impairment, or possession; or,
  10. An employee’s violation of D-H policy, including, but not limited to, D-H’s Substance Abuse and Drug-Free Workplace Policy.

IV. Policy Statement

In compliance with the federal Drug-Free Workplace Act of 1988 and the New Hampshire Drug-Free Workplace for Licensed Health Care Facilities and Providers Act (NH RSA 151:41), D-H has a longstanding commitment to provide a safe, quality-oriented, and productive work environment consistent with the standards of the communities in which we operate. Alcohol and drug diversion, use, and abuse pose a threat to the health and safety of D-H patients, employees, and the public. For these reasons, D-H is committed to the elimination of drug and/or alcohol diversion, use, and abuse in and affecting the workplace and educating employees about the importance of a drug-free workplace. D-H retains sole discretion to interpret and administer all aspects of this policy.

To meet this commitment, every employee must be fit for duty. Being fit for duty is an essential job function of every employee.

D-H will treat notifications and actions taken under this policy as confidential to the fullest extent possible consistent with D-H policy and applicable law.

Every employee must notify his/her supervisor, HR, or Occupational Medicine if he/she is not fit for duty and/or is in violation of D-H’s Substance Abuse and Drug-Free Workplace Policy. When an employee voluntarily self-reports a fitness for duty issue prior to D-H beginning an investigation into the employee’s fitness for duty, D-H will take into consideration the fact that the employee voluntarily self-reported when D-H determines whether any disciplinary action is merited.

Every employee must immediately notify his/her supervisor, HR, or Occupational Medicine of any arrest, charge, or conviction for a drug and/or alcohol-related offense.

Any employee who has reasonable concern regarding a co-worker’s fitness for duty must report that concern to the employee’s supervisor, the co-worker’s supervisor, or HR (or the House Supervisor during after-hours). D-H will maintain the confidentiality of the reporting employee’s identity to the fullest extent possible consistent with D-H policy and applicable law.

When D-H has reasonable concern about an employee’s fitness for duty, D-H will investigate the matter and may require the employee to consent to a fitness for duty evaluation as a condition of continued employment. Any employee who refuses to consent to a request for a fitness for duty evaluation or who does not timely and fully cooperate with a fitness for duty evaluation may be subject to discipline, including, but not limited to, immediate termination of employment.

Occupational Medicine and/or Employee Assistance shall conduct each fitness for duty evaluation. During the period of time that D-H is evaluating an employee’s fitness for duty, including, but not limited to, waiting for and evaluating test results, D-H may place the employee on paid or unpaid administrative leave.

When D-H determines an employee is fit for duty (following a reasonable concern about the employee’s fitness for duty), D-H may return that employee to work subject to any applicable restrictions and/or disciplinary action, up to and including termination of employment.

When D-H determines that an employee’s lack of fitness for duty was caused by work conditions (e.g., fumes within a work area), D-H shall take reasonable measures to correct those work conditions and shall follow D-H procedures for return to work, including compliance with D-H’s Workers’ Compensation and Workability policies.

Except as noted below, when D-H determines that an employee is not fit for duty, D-H may provide the employee with a reasonable opportunity to receive treatment, at the employee’s own cost, in order that the employee may return to work fit for duty. In this circumstance, D-H will place an employee who is not fit for duty on unpaid leave until the employee has satisfied the conditions to return to work or is terminated from employment. To the extent that this leave is covered by the federal Family Medical Leave Act (FMLA), the leave shall run concurrent with an employee’s FMLA entitlement.

The opportunity to take a leave of absence to seek treatment will not be available to an employee who engaged in conduct that violated other expectations of performance and for which D-H determines the appropriate employment action is immediate termination.

As referenced above, when D-H determines that an employee is not fit for duty, and will be provided an opportunity to receive treatment to permit him or her to return to work, Occupational Medicine and HR shall oversee and direct the employee regarding the conditions the employee must fulfill for the employee to be eligible to return to work. Prior to D-H allowing the employee to return to work, Occupational Medicine and HR shall determine if the employee is fit for duty; such determination may require follow-up evaluation by Occupational Medicine and/or Employee Assistance, including, but not limited to, additional drug and/or alcohol testing, and the employee’s execution of a return-to-work agreement that sets forth conditions the employee must fulfill to return to work and to remain eligible to work. An employee who represents that he/she is ready to return to work and then fails to satisfy any part of Occupational Medicine’s follow-up evaluation may be subject to immediate termination of employment. An employee who refuses to engage in this follow-up evaluation process, requests more than a reasonable amount of time to complete treatment, as determined by D-H, refuses to execute the return to work agreement, or breaches any of the conditions of the return to work agreement may be subject to immediate termination of employment.

While D-H will make reasonable efforts to reinstate an employee to his/her position following the employee’s satisfactory completion of return-to-work requirements, unless otherwise required by law, D-H reserves the right to terminate the employee’s employment at any time and post the employee’s position. In such circumstance, at the time the employee is able to return to work, the employee may apply for any position for which he or she is qualified.

Nothing in this policy restricts D-H’s right to take disciplinary action against an employee, including, but not limited to, an employee who has returned to work following execution of a return to work agreement, based on the employee’s violation of any D-H policy, including but not limited to this policy and the Substance Abuse and Drug-Free Workplace Policy, related to or arising out of the incident or circumstance for which the employee was found not fit for duty.

Upon the completion of a fitness for duty investigation, D-H will report the resolution of the investigation to all applicable authorities, including, but not limited to, applicable licensing boards, consistent with D-H policy and applicable law.

Questions about this policy may be directed to Employee Relations at (603) 653-1570.


D-H Policy ID: 511

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