Employee Medical Resource Book

Transcription

NORFOLK SOUTHERN MEDICAL DEPARTMENT
RESOURCE BOOK FOR EMPLOYEES
Norfolk Southern Medical Department (NSMD) resources listed below provide you with direct
contact information for your assigned NSMD case coordinator and information about the
return-to-work process to help you return-to work as quickly as possible. These resources
also include a medical fax cover sheet that you can use when sending records to the NSMD
as well as exam checklists for physicals.
This resource book is available from your supervisor through Material Management on a zip
drive – Product ID 008351. This book and the resources described below are also available:
•
•
on the ERC – go to the ERC, click on Employee Self-Service, then, click on Medical
Information.
at nscorp.com – click here or go to nscorp.com, click on EMPLOYEES, then click on
Medical.
From these locations, you can view, print or transfer the resource to your computer, iPad or
Smartphone:
 View the resource by simply clicking on the resource name.
 Print the resource by clicking on the resource name to open and view, then click the
print icon, or click “File” and “Print”.
 Each of these resources is a PDF file that can be saved on your computer and/or
stored on your Smartphone or iPad.
1. Contact Information
•
Red Flyer for Employees – this 8 X 10 flyer provides direct contact information for the
NSMD case coordinator assigned to the employee’s case.
•
Medical Department Personnel Phone Directory – provides phone numbers for
NSMD personnel.
2. General Information
•
Resources Summary Chart for Employees – this chart provides the employee with
a quick summary of available NSMD resources, forms and documents, including
where the resources can be accessed.
•
NSMD procedure for handling Local and General Chairmen calls – guidance for
Local and General Chairmen when calling the NSMD on behalf of a member.
NSMD Resource Book for Employees
3. Links – step by step picture guides to help you quickly access medical resources.
•
How to access NSMD forms, documents and other resources – this step by step
picture guide describes how to access NSMD resources on the ERC or outside the NS
network at nscorp.com.
•
How to access the Federal Motor Carrier Safety Administration’s web page – this
step by step picture guide describes how to access the Federal Motor Carrier Safety
Administration’s web page for helpful information about driver fitness-for-duty
requirements, specialty programs (Diabetes and Vision Exemption programs), and
answers to frequently asked questions.
4. Physical Exams Checklists for designated jobs – these checklists describe the
examination components for physical exams that are required by the company or federal
regulation. Exam checklists are available for:
•
•
•
•
•
•
•
Brakeman
CDL – Initial certification for other than Signalman/signal maintainer.
CDL – initial certification for Signalman/Signal Maintainer.
CDL/Non-CDL Driver recertification
Crew Transporter
Non-CDL Driver initial certification
T&E and other specified crafts - recertification
5. Medical Condition and Medication Guidance
•
Medical Condition and Medication Guidance – describes the responsibilities that an
employee has with respect to his/her medical condition and medication to help ensure
his/her safety at work. This guidance also describes additional responsibilities that
safety-related employees, yardmasters, crew haulers and NS police officers have
regarding their medical conditions, medical events, medication and workplace safety.
•
RX Med Form – this form describes NSMD prescription medication guidance by
category for safety-related employees, yardmasters, crew haulers and NS police
officers. This form is a supplement to NSMD Medical Condition and Medication
Guidance.
6. Return-to-Work
•
Return-to-Work Checklist – this checklist describes important steps for an employee
to take when he/she marks off work medically, and also provides helpful information
about the return-to-work process.
•
Return-to-Work Information Sheet – this document provides direct contact
information for the NSMD case coordinator assigned to the employee’s case; provides
general medical documentation requirements for specific conditions; describes general
return-to-work procedures and describes how to send medical records to the NSMD.
NSMD Resource Book for Employees
•
Medical Fax Cover Sheet – interactive fax cover sheet for use by employees when
sending records to the NSMD.
•
Health Questionnaire – for employees with non-medical absences of a year or longer
due to, furlough, military leave, discipline, etc.
7. Educational Material about Medication - educational material about medication is
available to help employees: actively manage the benefits and risks of their medication;
read a drug label; talk with a pharmacist; select the right over-the-counter medication;
understand drug interactions; and drive safely if they are taking medication.
•
•
•
•
•
•
•
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What’s on the Label?
Tips for Talking with a Pharmacist
Be an Active Member of Your Health Care Team
Think it Through: A Guide to Managing the Benefits and Risks of Medicines
Over-the-Counter Medication: What’s Right for You?
Drug Interactions: What You Should Know
Driving When You Are Taking Medications
Opioid Painkillers: What you need to know before you start taking them
8. Vocational Rehabilitation Services (VRS) – this flyer describes VRS services provided
as well as VRS contact information.
9. Drug and Alcohol Rehabilitation Services (DARS)
•
“How Can You Help Someone Who May Be In Drug & Alcohol Trouble?” – this
brochure describes what you can do to help a co-worker who may have a drug or
alcohol problem, and also provides information about the Norfolk Southern DARS
program, a confidential service available to help all NS employees without
jeopardizing employment. This brochure is also available on the DARS website at
www.nscorp.com/DARS.
•
Peer to Peer Program: Railroaders for Recovery – this brochure describes a
program supported by Norfolk Southern and promoted by employee volunteers, that
will assist all NS employees impacted by drugs and alcohol in the workplace through
awareness and education.
These brochures are also available on the DARS website at www.nscorp.com/DARS.
Medical Condition and Medication Guidance Page 1 Medical Condition and Medication Guidance
Medical conditions, medication and dietary supplements may impair your ability to safely perform your
job duties. Some medications and supplements – taken alone or in combination – can cause serious
side effects that may impair your safe job performance. These medications include both prescription
and non-prescription drugs.
This guidance describes what you must do if or when you have a medical condition or are taking
medication or dietary supplements.
You can access this guidance and other helpful resources described below on the ERC [Click on
Employee Self Service, then, on Medical Information.] or, at www.nscorp.com [Click on
EMPLOYEES, then, on Medical]. If you do not have access to a computer, please call the NSMD at
800-552-2306 for help.
1. You have responsibilities to help ensure your safety at work with respect to your medical
conditions and your use of prescription and over-the counter medications, and dietary
supplements. These responsibilities include:
a. Staying off work (do not report to work or remain at work) if your ability to safely perform your
duties is compromised by your medical condition, medication and/or dietary supplement.
b. Knowing and understanding the potential adverse effects of any medication and dietary
supplement you are taking.
i.
Read the medication and dietary supplement labels. Pay particular attention to label
warnings that indicate use may compromise the safe performance of your duties – such
as “may cause drowsiness” or “do not take this medication while driving a vehicle or
operating heavy equipment”.
ii.
Comply with label recommendations if the over-the-counter (OTC) medication or dietary
supplement label indicates that use may compromise the safe performance of your
duties.
iii.
If prescribed a medication, talk to your prescribing health care provider about potential
side effects from the drug (when taken alone or in combination with other medication or
dietary supplement) that may compromise your ability to work safely.
c. Talking to your treating healthcare provider if you question whether your medical condition may
compromise your ability to work safely.
d. Providing to the Norfolk Southern Medical Department (NSMD) medical information requested
to enable a determination of your fitness-for-duty. A fitness-for-duty evaluation determines your
ability to perform safely your essential job functions with respect to your medical condition,
medication and any reasonable accommodation. This includes your disclosure of medical
conditions and medications during periodic medical evaluations required either by the
company or by Federal regulation. A fitness-for-duty determination is based upon an
individualized assessment of your specific situation.
Revision Date: 7/28/15 Medical Condition and Medication Guidance Page 2 e. Complying with any work restriction(s) that your health care provider and/or the NSMD have
imposed on you with respect to your medical condition and/or medication, as well as any
applicable regulatory medical standards.
2. If you are a safety-related employee1, yardmaster, crew hauler or NS police officer, you also
have the responsibility to:
a. Notify your treating healthcare provider(s) about the full extent of your duties.
b. Notify at least one of your healthcare providers of all your prescription and over-the-counter
medication, and dietary supplements to help ensure that your use is consistent with the safe
performance of your duties. c. Notify the NSMD if you have a reportable medical condition or medical event as outlined in
Appendix A. Appendix A also includes a reporting form for your use. Appendix B provides
NSMD contact information.
i.
The list in Appendix A focuses on some medical conditions and events that may
compromise your mental functioning and result in sudden impairment. This list is not allinclusive and serves as a starting point to guide you.
ii.
If you question whether you have been diagnosed with a medical condition or had a
medical event listed in Appendix A, please provide the list to your treating health care
provider, and ask him/her for help.
d. Follow NSMD guidance for prescription medication described in RX Med Form. For answers
to frequently asked questions about NSMD medication guidance, please refer to page 2 of the
form.
3. Educational material about medication is available to help you: actively manage the benefits and
risks of your medication; read a drug label; talk with a pharmacist; select the right over-the-counter
medication for you; understand drug interactions and drive safely if you are taking medication.
1
Safety-related employee - any agreement or non-agreement employee who: is covered under the hours of service laws; inspects,
installs, constructs, repairs, or maintains track, roadbed, bridges and signal and communication systems; inspects, repairs, or maintains
locomotives, passenger cars or freight cars, or other on-track equipment when such equipment is in service that constitutes a train
movement; determines that an on-track roadway maintenance machine or hi-rail vehicle may be used without repair of a non-complying
condition; directly instructs, mentors, inspects, or tests, as a primary duty, any person while that other person is engaged in a safetyrelated task; or is responsible for conducting periodic tests and inspections of safety-related employees.
Revision Date: 7/28/15 Medical Condition and Medication Guidance Page 3 Appendix A: Reportable Medical Conditions and Events
(For safety-related employees, yardmasters, crew haulers and NS police officers.)
Remember, your medical information is confidential. When the NS Medical Department requests your medical
information for a fitness-for-duty determination, you should not reveal your medical information to any NS
employee except Medical Department personnel.
REPORTABLE MEDICAL CONDITIONS AND EVENTS
This list highlights some medical conditions and events that may compromise your mental functioning
and result in sudden, unsafe impairment. If you question whether you have been diagnosed with a medical
condition or had a medical event listed below, please provide this list to your treating health care provider
and ask him/her for help.
This list is not all-inclusive. If you have questions or concerns about your medical condition/event and
safe work performance, talk to your health care provider. Your NS Medical Department case coordinator
(please see Appendix B for contact information) is also available to help you.
A new diagnosis or change in a prior stable, medical condition, and/or a recent (e.g.,
within the prior 6 months) medical event for one of the following:
New diagnosis or change in prior stable, medical condition:

Cardiac (heart) or cardiovascular condition:
Angina (heart-related chest pain or discomfort)
Heart attack
Cardiac arrest (heart suddenly stops beating) requiring cardio-pulmonary resuscitation
(CPR) or use of a defibrillator
Serious Cardiac Arrhythmia (abnormal heart rate or rhythm) requiring medical treatment
Severe Hypertrophic or Dilated Cardiomyopathy (enlarged heart or heart failure)
Severe Aortic Valve Stenosis (heart valve problem)

Neurologic (brain, spinal cord and nerves) condition:
Bleeding inside the skull (intracranial) or bleeding inside the brain (intracerebral)
Stroke or Transient Ischemic Attack
Seizure Disorder, such as Epilepsy, Complex Partial Seizure Disorder or Simple Partial
Seizure Disorder
Recent (e.g., within the prior 6 months) medical event:

Seizure of any kind

Loss of consciousness or fainting (syncope) episode that:
occurred two or more times in the prior six months or
is due to a cardiac (heart), cardiovascular or neurological (brain and nerves) condition

Severe hypoglycemic event (low blood sugar event requiring the assistance of another
person and/or causing confusion, loss of consciousness or seizure)
Revision Date: 7/28/15 Medical Condition and Medication Guidance Page 4 Appendix B: How to notify the NSMD about your reportable medical condition or event
(For safety-related employees, yardmasters, crew haulers and NS police officers).
Remember, your medical information is confidential. When the NSMD requests your medical
information for a fitness-for-duty determination, you should not reveal your medical
information to any NS employee except Medical Department personnel.
1. The best way to notify the NSMD is to contact directly your assigned case coordinator. Please
provide your case coordinator with your full name and employee identification number. Please
describe your reportable medical condition and/or medical event (including the date of your
diagnosis, date your condition changed or date you experienced the medical event).
First letters of
employee’s last name
Your Assigned Case Coordinator
PHONE
FAX
A – Cm
757-629-2438
757-823-5772
Cn – GL
757-629-2440
757-823-5880
Gm – K
757-629-2448
757-668-1368
L–O
757-629-2439
757-823-5994
P – Sg
757-664-5005
757-668-1369
Sh – Z
757-629-2055
757-823-5771
2. You can also use the Medical Condition and Medical Event Reporting Form to notify the
NSMD. In order to expedite the fitness-for-duty review, the NSMD prefers this format, but will
accept the information in other formats.
Please complete and fax the form directly to your assigned case coordinator, or email the form to the
[email protected].
Revision Date: 7/28/15 Medical Condition and Medication Guidance Page 5 Medical Condition and Medical Event
Reporting Form
For safety-related employees, yardmasters, crew haulers or NS police officers – please complete this
form and provide the completed form directly to the Norfolk Southern Medical Department (NSMD).
EMPLOYEE INFORMATION
Name (Print) Last__________________________First_________________________Middle Initial_____
Home Address___________________________City____________________State_____Zip__________
Phone No: Work_________________ Home_______________________ Cell_______________________
Employee ID No.________________ Date of Birth:____/____/______ Job title: _____________________
Employee’s preferred method of contact: (check one) _____Email* _____Phone _____Either email or phone
*If email preferred, employee’s email:
SUPERVISOR INFORMATION
Supervisor's Name____________________________Title___________________Department_____________ Supervisor's Phone No.: Location (City/State): TO: NSMD
SUBJECT: REPORTABLE MEDICAL CONDITION OR MEDICAL EVENT
Please describe your new medical condition (diagnosis), change in your prior stable condition, and/or
your recent (e.g., within the prior 6 months) medical event. Please note the date you were diagnosed,
date your condition changed and/or date you experienced the medical event.
DATE FORM COMPLETED: ______________________________
The best way to send this form is to fax it directly to your NSMD assigned case coordinator. Your case
coordinator’s contact information is located in Appendix B of the Medical Condition and Medication Guidance.
Alternatively, you can email this form to [email protected].
Revision Date: 7/28/15 RED FLYER FOR EMPLOYEES – DIRECT CONTACTS
FOR NS MEDICAL DEPT CASE COORDINATORS
MEDICAL CASES ARE ASSIGNED BY THE FIRST LETTERS OF AN EMPLOYEE’S LAST NAME
IF YOU NEED HELP WITH OR HAVE QUESTIONS ABOUT:
 RETURN-TO-WORK PROCESS
 “REPORTABLE” MEDICAL
CONDITIONS AND EVENTS
 MEDICATION GUIDELINES
 PHYSICAL EXAMINATIONS OR HEALTH
QUESTIONNAIRES
 DISABILITY/SICKNESS BENEFIT FORM
COMPLETION
YOUR CASE COORDINATOR’S DIRECT CONTACT INFORMATION IS:
A-Cm Phone: 757-629-2438
Fax:
757-823-5772
Cn-Gl
Phone: 757-629-2440
Fax:
757-823-5880
Gm-K Phone: 757-629-2448
Fax:
757-668-1368
L-O
Phone: 757-629-2439
Fax:
757-823-5994
P-Sg
Phone: 757-664-5005
Fax:
757-668-1369
Sh-Z Phone: 757-629-2055
Fax:
757-823-5771
FOR VOCATIONAL REHABILITATION QUESTIONS, YOUR CASE COORDINATOR’S
DIRECT CONTACT INFORMATION IS:
A-Z Phone: 757-664-5047
Best way to send records:
Fax or email your records
directly to your case
coordinator (call your case
coordinator for his/her direct
email address).
Alternate ways:
Email to
[email protected], or
Fax to 866-627-0592, or
Mail to NS Medical Department.
NS Medical Department
Phone 800-552-2306
Three Commercial Place
Norfolk, VA 23510-9202
8/3/2015
Fax: 757-823-5981
YOUR MEDICAL RESOURCES
Available on www.nscorp.com website:
Click on EMPLOYEES, then on Medical.
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Medical Condition and Medication Guidance
RX Med Form – medication guidelines by category
Educational resources about medication
Return-to-Work Checklist
Return-to-Work Information Sheet
Medical fax cover sheet
Health Questionnaire (non-medical absence >1 yr)
Med Dept Resource Book for Employees
and more…
Available on ERC: Click on Employee Self Service tab,
then on Medical Information.




All of the above resources, and…
Red Flyer for Employees
Resources Summary Chart for Employees
Physical Exam Checklists (for T&E / CDL driver)
MEDICAL DEPARTMENT PERSONNEL PHONE DIRECTORY
Norfolk Southern Corporation
Medical Services
Norfolk, VA 23510-9202
Toll-free number: 800-552-2306
Director Medical Services
757-629-2443
ADMINISTRATIVE SERVICES
Manager Medical Administration
Medical Secretary
Medical Case Coordinator
Employees w/ last name initial A-Cm
Employees w/ last name initial Cn-Gl
Employees w/ last name initial Gm-K
Employees w/ last name initial L-O
Employees w/ last name initial P-Sg
Employees w/ last name initial Sh-Z
CLINICAL SERVICES
Associate Medical Director
Medical Services Clinician
Employees w/ last name initial A-D
Employees w/ last name initial E-K
Employees w/ last name initial L-Rod
Employees w/ last name initial Roe-Z
Manager Vocational Rehabilitation Services
Vocational Rehabilitation Services Case Coordinator
DRUG AND ALCOHOL TESTING SERVICES
Substance Abuse Testing Manager
Drug and Alcohol Testing Coordinator
757-629-2051
757-823-5331
757-629-2438
757-629-2440
757-629-2448
757-629-2439
757-664-5005
757-629-2055
757-629-2446
757-664-2017
757-823-5332
757-823-5337
757-823-5335
757-823-5303
757-664-5047
757-629-2442
757-823-5333
757-823-5487
757-664-2030
DRUG AND ALCOHOL REHABILITATION SERVICES (DARS)
Manager DARS – Norfolk, VA
757-629-2447
DARS COUNSELORS
Austell, GA
Charlotte, NC
Decatur, IL
Harrisburg, PA
Hartford City, IN
Knoxville, TN
Pittsburgh, PA
Roanoke, VA
770-405-3619
704-378-3701
217-425-2131
717-541-2236
765-348-4561
865-521-1555
412-893-7021
540-524-4406
August 2015
NS Medical Department – Resources Summary Chart for Employees
RESOURCE
(If you do not have access to a computer, please call the
NS Medical Department at 800-552-2306 for help)
Employee Resource Center
(Click on “Employee Self
Service”, then on “Medical
Information”.)
www.nscorp.com
(Click on
“EMPLOYEES”, then,
on “Medical”)
Available
through Material
Management
System
Contact Information
Medical Department Personnel Phone Directory

Red Flyer for Employees (Direct Contacts for Case Coordinators)

Authorized Medical Facility Listing (for company approved exams)

Links (step by step guide)
FMCSA’s Driver Medical Fitness for Duty page

How to Access NS Medical Department Resources

General Information
Medical Dept Resources Summary Chart for Employees

Employee Medical Resource Book


Fax Cover Sheet


Health Questionnaire for non-medical absences of > 1 year


008351
(zip drive)
Forms
002276
Checklists for physical exams
Physical Exam Checklist for Brakeman

Physical Exam Checklist for CDL Initial Cert Other than
Signalman/Signal Maintainer
Physical Exam Checklist for CDL Initial Cert Signalman/Signal
Maintainer

Physical Exam Checklist for CDL and Non-CDL Driver Recert

Physical Exam Checklist for Crew Transporter

Physical Exam Checklist for HAZWOPER/Sentinel Initial Exam

Physical Exam Checklist for HAZWOPER/Sentinel Periodic Exam


August 2015
NS Medical Department – Resources Summary Chart for Employees
RESOURCE
(If you do not have access to a computer, please call the
NS Medical Department at 800-552-2306 for help)
(Click on “Employee Self
Service”, then on “Medical
Information”. Look in the
yellow window)
www.nscorp.com
(Click on
“EMPLOYEES”, then,
on “Medical”)
Available
through Material
Management
System
Checklists for physical exams - continued
Physical Exam Checklist for Police/Forest Personnel

Physical Exam Checklist for T&E and Other Specified Crafts Recert

Medical Condition, Medication and Return-to-Work
Medical Condition and Medication Guidance


RX Med Form – medication guidance by category








Educational Medical Resources
Educational resources regarding medication
August 2015
NS Medical Department handling of calls from Local and General Chairmen
General Chairmen have an “open line” to the NS Medical Directors. When calling NS Medical
Department (800-552-2306), the General Chairman should identify himself as a General Chairman
and request to speak with the Medical Director.
NS Medical Department handles the following types of Local Chairmen calls:
What is the employee’s status?
What records have been received and/or what medical information is still needed?
Why there is a “delay” in the employee’s return to work?
Why is a Functional Capacity Evaluation or a Medical Specialty Examination (such as an
evaluation by an Orthopedic doctor) needed? What is the purpose of the requested
evaluation?
When calling the Medical Department on behalf of a member, the Local Chairman should first
contact the member’s assigned case coordinator listed on the Red Flyer for Employees or on page
2 of the Return-to-Work Information Sheet. The Red Flyer can be accessed on the ERC (Click on
“Employee Self Service”, then on “Medical Information” and look in the yellow window). The Returnto-Work Information Sheet can be accessed on the medical information page on the ERC and at
www.nscorp.com (Click on “EMPLOYEES”, then, on “Medical”). If more help is needed, the case
coordinator will refer the call to the assigned clinician handling the case.
NS Medical Department will refer Local and General Chairmen calls to Labor Relations as
appropriate, such as the following:
DARS related case question to include status of return to work or assistance with benefit
continuation.
Initial requests for neutral or third party doctors (must be handled in accordance with CBA).
Local Chairman or General Chairman understands the medical handling/medical decision
(e.g. why the employee was placed on medical hold or why a Functional Capacity Evaluation
is needed even though the treating doctor released the employee…) and is disputing either
the medical handling and/or medical decision (to include a medical disqualification or medical
hold) in a case.
Any questions involving a case with an existing labor claim or questions about filing a new
claim.
NOTE: In responding to a chairman’s call, the NS Medical Department must of course comply with
its legal obligations regarding confidentiality. Basically, that means the Medical Department cannot
provide details about the employee’s medical condition, which the employee has not shared with the
chairman. So, the more information about his condition(s) and his doctors that the employee
voluntarily chooses to share with the chairman, the more specific the Medical Department’s
response to the chairman’s questions can be. For example, if the chairman knows that Conductor
Smith had a heart attack and is under Cardiologist Dr. Johnson’s care, or is recovering from back
surgery and is under the care of Orthopedist Dr. Jones, the Medical Department can advise the
chairman that the NSMD is waiting on a stress test report from Dr. Johnson, and Dr. Johnson’s
cardiology office visit notes dated since June 5th…, or the Medical Department is waiting for
Orthopedist Dr. Jones’s response to a questionnaire faxed on July 16th…
The chairman should also have the employee’s EIN available to enable the Medical Department’s
access to the employee’s medical file. As an additional safe guard, the local chairman will be asked
by the Medical Department to provide his/her own EIN to verify his/her status.
August 1, 2013
Where can you find
NS Medical Department’s forms,
documents and other resources?
 On the “Medical” page on the ERC,
or
 Outside the NS network at:
www.nscorp.com
August 2015
On the “Medical” page on the ERC
Go to
“Employee
Self Service”
1
Then, look
here
2 Click
on “Medical
Information”
Outside the NS Network… just a few clicks
1
Go to
nscorp.com
2
Click on
EMPLOYEES
3 Click on
Medical
Then, look
here
Federal Motor Carrier Safety
Administration (FMCSA)’s
Medical web page
•
•
How to get to this page (step by step picture guide)
Links to helpful resources, like:
•
•
•
National Registry of Certified Medical Examiners
Fitness for Duty Requirements
Medical exemption programs (e.g., Diabetes and
Vision)
April 2015
Go to www.fmcsa.dot.gov
Then, click on
Regulations
Click on Medical
on the
dropdown menu
Here you go!
Physical Exam Checklist
NORFOLK SOUTHERN PHYSICAL EXAMINATION REQUIREMENTS
{NS employee: please take this checklist with you and give it to the NS approved
facility conducting your physical. For exam questions, call 800-552-2306.}
EMPLOYEE PHYSICAL FOR:
 BRAKEMAN – not applicable if certified conductor
The employee should have the Employee Exam Packet forms:


EMPLOYEE-EXAM FORM
MED-AUDIO FORM
The following exam components are required:

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

Medical History
Physical Exam – includes Blood Pressure, Pulse, Height, and Weight
Vision
 Distant – each eye, uncorrected and corrected
 Color – Ishihara or Titmus
 Field of Vision
Audiogram
Company Policy urine drug screen – split collection (this is not a Federal test)
The following exam components are not required:
 Rectum and prostate exam
 Stool test (blood) and digital rectal exam
Medical facility handling of completed exam forms:
1) Within 24 hours, provide the Norfolk Southern Medical Department (NSMD):

EMPLOYEE-EXAM and MED-AUDIO Forms: email [email protected] or fax
# 678-512-5090.

Custody and Control Form: fax # 678-512-5056.
2) Provide to employee: copy of completed Work Status Report (p. 4 of EMPLOYEEEXAM form).
3) Retain originals of the EMPLOYEE-EXAM, MED-AUDIO, and Custody and Control
forms for your file.
Rev. March 2015
{NS Employee: please take this checklist with you and give it to the NS approved facility
conducting your physical. For exam questions, call 800-552-2306.}
 INITIAL CERTIFICATION FOR CDL DRIVER (26,001+ LBS VEHICLE)
FOR OTHER THAN SIGNALMAN/SIGNAL MAINTAINER
The employee should have the CDL Initial Cert Packet forms:




CDL-I FORM
MED-AUDIO FORM
FMCSA Commercial Driver’s Medical Exam Report (Form 649-F)
FMCSA Medical Examiner’s Certificate (Form 651)


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
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Medical History
Vision
 Field of Vision
Audiogram
Urine dipstick for glucose, blood and protein
Federal DOT-FMCSA urine drug screen – initial CDL cert
The following exam components not required:
1) Within 24 hours, fax to the Norfolk Southern Medical Department (NSMD):


CDL- I, MED-AUDIO, 649-F, and 651 forms – fax # 678-512-5090.
Custody and Control form – fax # 678-512-5056.
2) Form 651 (Medical Examiner’s certificate):


Provide original certificate to employee.
Retain a copy of the certificate for your file.
3) Work Status Report (p. 4 of CDL-I form) – provide copy to employee
4) Retain originals of the CDL-I, MED-AUDIO, 649-F, and Custody and Control forms for
your file.
Rev. March 2015
facility conducting your examination. For exam questions, call 800-552-2306.}
 INITIAL CERTIFICATION FOR CDL DRIVER (26,001+ LBS VEHICLE)
FOR SIGNALMAN/SIGNAL MAINTAINER
The new hire should have the CDL Initial Cert Packet forms:




CDL-I FORM
MED-AUDIO FORM






Medical History
Vision
 Field of Vision
Audiogram
Federal DOT-FRA urine drug test – Initial CDL cert for Signalman/Signal
Maintainer


2) Provide to employee:


original 651 form (Medical Examiner’s certificate) – retain a copy for your file.
copy of completed Work Status Report (p. 4 of CDL-I form).
3) Retain originals of the CDL-I, MED-AUDIO, 649-F, and Custody and Control forms for your file.
Rev. March 2015
 RECERTIFICATION FOR CDL DRIVER (26,001+ LBS VEHICLE)
OR NON-CDL DRIVER (10,001 – 26,000 LBS VEHICLE)
The employee should have the CDL Recert Packet forms:
 CDL-R FORM
 MED-AUDIO FORM
 FMCSA Commercial Driver’s Medical Exam Report (Form 649-F)
 FMCSA Medical Examiner’s Certificate (Form 651)
 Medical History
 Physical Exam – includes Blood Pressure, Pulse, Height, and Weight
 Vision
 Field of Vision
 Audiogram
 Urine dipstick for glucose, blood and protein
 Company Policy urine drug screen – split collection (this is not a Federal test)




your file.
Rev. March 2015
 CREW TRANSPORTER / JITNEY DRIVER


EMPLOYEE-EXAM FORM
MED-AUDIO FORM





Medical History
Vision
 Field of Vision
Audiogram

# 678-512-5090.

Rev. March 2015
NS employee: please take this checklist with you and give it to the NS approved
 INITIAL CERTIFICATION FOR NON-CDL DRIVER (10,001 – 26,000
LBS VEHICLE)
The employee should have the CDL Initial Cert Packet forms:




CDL-I FORM
MED-AUDIO FORM






Medical History
Vision
 Field of Vision
Audiogram
Company Policy urine drug test – split collection (this is not a Federal test)




your file.
Rev. March 2015
 RECERTIFICATION FOR TRAIN & ENGINE SERVICE AND
OTHER SPECIFIED CRAFTS




CONDUCTOR
STUDENT ENGINEER
LOCOMOTIVE ENGINEER
HOSTLER
 REMOTE CONTROL
OPERATOR
 LOCOMOTIVE SERVICING
ENGINEER


EMPLOYEE-EXAM FORM
MED-AUDIO FORM





Medical History
Vision
 Field of Vision
Audiogram


# 678-512-5090.
Rev. March 2015
Norfolk Southern Medical Department
Medication Guidance
By Category
RX Med Form
8/2015
Safety-related employees, yardmasters, crew haulers or NS police officers
Please provide this chart to your prescribing health care provider. Ask if your
prescription medication falls within one of the categories described below. If it does, follow
the applicable guidance.
Prescription Medication Category / NSMD Guidance
If you are prescribed a Narcotic for treatment of opioid dependence,
promptly contact NSMD for a fitness-for-duty evaluation.
Examples of narcotics used to treat opioid dependence: Suboxone, Subutex,
(Buprenorphine), Methadone.
If you are prescribed a Narcotic (for other than treatment of opioid
dependence) or a Benzodiazepine, NSMD medication guideline prohibits
use of the medication while at work. Or, for a minimum number of hours
prior to reporting for work. The time period is equivalent to the dosing
interval as written on the prescription label.
If you cannot meet this guideline, promptly contact NSMD for a fitnessfor-duty evaluation.
Narcotics (opioids/opiates) are commonly used to treat acute and chronic pain.
Other uses include cough suppression, and treatment of opioid dependence. Side
effects may include drowsiness, lightheadedness and dizziness.
Examples of narcotics – Generic name (brand name): Codeine (Tylenol #3; many
brand names for cough suppressants), Hydrocodone (Lortab, Norco, Vicodin,
Vicoprofen, many brand names for cough suppressants), Fentanyl Transdermal
System (Duragesic), Hydromorphone (Dilaudid), Meperidine (Demerol), Morphine
(Avinza, Kadian), Oxycodone (OxyContin, Percocet), Oxymorphone (Opana).
Benzodiazepines are commonly used to treat anxiety. Other uses include treatment
of insomnia, panic disorder and seizure disorder. Side effects may include drowsiness,
dizziness and decreased alertness.
Examples of benzodiazepines – Generic name (brand name): Alprazolam (Xanax),
Chlordiazepoxide (Librium), Clonazepam (Klonopin), Diazepam (Valium), Lorazepam
(Ativan).
This form is a supplement to the NSMD Medical Condition and Medication Guidance,
which is available on the medical information page on the ERC, and also at nscorp.com.
If you have any questions or concerns, please contact your NSMD case coordinator or call
NSMD at 800-552-2306. For answers to frequently asked questions, please refer to page 2
of this form.
1
Frequently Asked Questions
About NSMD Medication Guidance
RX Med Form
8/2015
1. Which NS employees are governed by the medication guidance in the RX Med form? This medication
guidance applies to safety-related employees*, yardmasters, crew haulers and NS police officers.
2. I am prescribed a medication in one of the categories listed on RX Med form. I meet the NSMD
medication guideline. Do I need to contact NSMD for a fitness-for-duty evaluation? No. You do not need
to contact NSMD for a fitness-for-duty evaluation, unless you do not meet the medication guidelines and/or
you are prescribed a narcotic for treatment of opioid dependence.
3. I am prescribed a medication in one of the categories listed on RX Med form. I cannot follow the
medication guideline. Will I be removed from work? Each case is evaluated on an individual basis. A
fitness-for-duty assessment will be based on your specific situation. This evaluation typically begins with a
request for you to have your health care provider provide NSMD with more information about your medication,
medical condition and any recommended work restrictions or accommodations.

If you are unable to meet the applicable medication guideline, you may be restricted by an NSMD clinician
from performing your safety-related duties pending completion of the fitness-for-duty evaluation.

These are guidelines only. It is your responsibility to use good judgment. Do not compromise your safety
at work. Stay off work – Do not report to work or remain at work if you are unsafely impaired by your
medication.
4. What is the dosing interval referred to in the medication guidelines? The dosing interval refers to either
the minimum time that your health care provider prescribed for you to wait between taking doses of the
medication. For example, if your medication is prescribed for use every 4 to 6 hours, the minimum dosing
interval is 4 hours.
5. Does RX Med form list all of the prescription medication that may cause unsafe impairment? No. This
form provides you with NSMD prescription medication guidance for two major medication categories. These
commonly prescribed medications may cause unsafe impairment at work. This list is not all-inclusive. There
are many medication categories and numerous medications not listed that also can cause unsafe impairment.
This list is subject to change and will be updated periodically.
6. Should I change or stop the prescription medication on my own if I cannot follow NSMD medication
guidelines? No. Always follow the prescription directly as written. Never stop the medication on
your own. Never change the dose or frequency of use unless advised to do so by your
prescribing health care provider.
7. Where can I find more guidance about safe use of medication? Talk to your prescribing health care
provider. Ask your pharmacist. Contact NSMD. Educational resources about medication are also available on
the ERC and at nscorp.com.
8. Where can I find my NSMD case coordinator’s direct contact information? It is listed in the NSMD
Medical Condition and Medication Guidance, Red Flyer, and Return-to-Work Information Sheet available
on the ERC and at nscorp.com.
Medical information is available at nscorp.com. Click on EMPLOYEES. Then, click on Medical. It is also available
on the ERC. Go to the ERC, click on Employee Self-Service. Then, click on Medical Information.
*Safety-related employee - any agreement or non-agreement employee who: is covered under the hours of service laws; inspects,
installs, constructs, repairs, or maintains track, roadbed, bridges and signal and communication systems; inspects, repairs, or
maintains locomotives, passenger cars or freight cars, or other on-track equipment when such equipment is in service that
constitutes a train movement; determines that an on-track roadway maintenance machine or hi-rail vehicle may be used without
repair of a non-complying condition; directly instructs, mentors, inspects, or tests, as a primary duty, any person while that other
person is engaged in a safety-related task; or is responsible for conducting periodic tests and inspections of safety-related
employees.
2
NS Medical Department
Medical Absence and
rev. August 1, 2015
 Notify your supervisor of your medical leave of absence.
 Start your benefits. If you are eligible for benefits, submit the Railroad Retirement Board
(RRB) Sickness Benefit forms to the RRB and/or claim forms to your disability insurance
carrier.
 You must file RRB Form SI-1ab, Application for Sickness Benefits, within ten (10) days
from the first day you want to claim benefits. Applications can be obtained from your local
RRB field office (877-772-5772), RRB’s web site at www.rrb.gov, or your labor
organization.
 If you are covered by a supplemental disability or sickness plan, you may have a
Summary Plan Description booklet. It will contain the information you need to file a claim.
Assistance is available through the insurance carrier or your labor organization.
 Please ask both RRB and your insurance carrier for the end date of your coverage. Keep
track of this date throughout your medical absence. Knowing the end date of your
coverage can help prevent lapses of coverage. This is especially important during the
time period after your doctor has cleared you to work and before you have been
medically qualified to work by the NS Medical Department.
 Know where to find helpful medical resources: Medical resources described below are
available on at nscorp.com. Click on EMPLOYEES. Then, click on Medical on the dropdown
menu. These resources are also available on the ERC. Go to the ERC, click on Employee
Self-Service. Then, click on Medical Information. NOTE: If you do not have access to a
computer, please call the NS Medical Department at 800-552-2306 for help.
 Identify your NS Medical Department case coordinator. Your case coordinator can
provide you with helpful information about the return-to-work process, and help you get back
to work as quickly as possible. Your personal case coordinator’s direct phone number is
listed on the Red Flyer for Employees and on the Return-to-Work Information Sheet. Call
your case coordinator for more contact information, and share the best way for him/her to
reach you.
My Case Coordinator is ______________________________________
Case Coordinator’s Phone ____________________________________
Case Coordinator’s Fax ______________________________________
Case Coordinator’s Email _____________________________________
 Know your responsibilities related to your medical condition, medication and safe returnto-work described in the NSMD Medical Condition and Medication Guidance and Returnto-Work Information Sheet. If you are in a designated safety-related job, follow the
guidance for your additional responsibilities regarding your medication and “reportable”
medical conditions and events.
 Be proactive; get started early!
 Call or email your case coordinator as soon as possible after you have marked off for
an extended medical absence. Your case coordinator will let you know what medical
records and information, if any, will be needed by NSMD to determine your ability to
return-to-work.
NSMD Medical Absence and Return-to-Work Checklist
Page 2
rev. August 1, 2015
 You can expedite your return-to-work by faxing or emailing a copy of requested medical
records and information directly to your personal case coordinator as soon as you know
your targeted return-to-work date. In many cases, even earlier!
 There is an easy to use Fax Cover Sheet available to you for faxing medical records to
us.
 Please be sure to provide us with your full name, your employee ID number, and your
correct phone number and email address when sending us your records. You should
contact your case coordinator the same business day to ensure that your records were
received.
 At your doctor’s office:
 Please provide your doctor with a copy of any letter you receive from us requesting
medical records or information.
 You will need to sign a medical records release for the requested records to be sent to
you or directly to us. Please ask each of your doctor’s staff about their medical records
release process and complete all the necessary steps.
 If you choose to have your records released directly to us, please ensure that your doctor
provides only the requested information pertaining to your condition that caused the
absence. If possible, give your doctor’s staff the completed NS Medical Department fax
cover sheet.
 Ask your doctor for your targeted return-to-work date.
 After your doctor has released you to work:
 If you have not been medically cleared by the NS Medical Department, we will complete
your RRB Sickness Benefit forms and insurance claim forms while we determine your
fitness-for-service. Please fax these forms to your case coordinator, who will help with
their completion.
 In order to ensure your continued disability certification, please quickly provide the
required medical documentation to the Medical Department.
 When you are medically qualified to return to work by the NS Medical Department:
 Your case coordinator will personally notify you. Please make sure that your case
coordinator has your correct phone number and email address! You should contact your
supervisor to expedite your return-to-work.
 Finally: Communicate with us throughout your return-to-work process. By working
together, we can make sure you get back to work as quickly as possible!
Page 1 of 7
(rev. August 2015)
The Norfolk Southern Medical Department’s (NSMD) process for returning you to work following
a non-medical absence of one year or longer or a medically-related absence will depend on
your specific situation. NSMD will conduct an individualized assessment of your fitness-for-duty
(your ability to return to work and safely perform your essential job functions with respect to your
medical condition and any reasonable accommodation). Most cases involve the same general
steps1 that are described in this information sheet.
This information sheet also:
 describes resources that are available to help you through the return-to-work process,
 provides direct contact information for your assigned NSMD case coordinator who can
help you quickly return-to-work,
 describes how to send medical records to the NSMD, and
 provides general medical documentation requirements and return to work procedures
and/or requirements for specific conditions.
You can access this Return-to-Work Information Sheet and other helpful resources described
below on the ERC [Click on Employee Self Service, then, on Medical Information.] or, at
www.nscorp.com [Click on EMPLOYEES, then, on Medical]. If you do not have access to a
computer, please call the NSMD at 800-552-2306 for help.
1. Return-to-Work Checklist.
A checklist is available to help you with some steps to take when you mark off for an
extended medical absence, and help you through the return-to-work process.
2. Your Personal Case Coordinator.
You will be assigned a NSMD case coordinator based upon your questions and the first
letters of your last name. Your case coordinator will help you through the return-to-work
process and help you get back to work quickly.
Be proactive and get started early by contacting your personal case coordinator as soon
as possible after you have marked off work for an extended medical absence. Your case
coordinator can help answer questions about what medical records and information, if any,
are needed to determine your ability to return-to-work.
a) For help with questions about:





1
Return-to-work process
Reportable medical conditions and events
Medication guidelines
Physical examinations or health questionnaires
Disability/sickness benefit form completion
This is intended as an overview of the return-to-work process. Because an individualized assessment is always
conducted, the exact return-to-work process may vary on a case-by-case basis. NSMD reserves the right to modify
its policies at any time.
Page 2 of 7
(rev. August 2015)
Here is your case coordinator’s direct contact information:
First letters
of your
last name
Your Personal Case Coordinator
PHONE
FAX
A - Cm
757-629-2438
757-823-5772
Cn - Gl
757-629-2440
757-823-5880
Gm - K
757-629-2448
757-668-1369
L-O
757-629-2439
757-823-5994
P - Sg
757-664-5005
757-668-1369
Sh - Z
757-629-2055
757-823-5771
b) For any questions about VOCATIONAL REHABILITATION SERVICES:
Here is your case coordinator’s direct contact information:
Your Personal
Case Coordinator
PHONE: 757-664-5047
FAX: 757-823-5981
NOTE: You can also find your case coordinator’s direct contact information using the Red Flyer
for Employees.
3. How you can provide requested medical records and information to the NSMD
There are several ways that you can provide the NSMD with requested medical records and
information:
Send the records directly to your personal case coordinator (recommended):

Fax (or email) the records directly to your assigned case coordinator.

There is an easy to use Medical Fax Cover Sheet available to you for faxing records
to us.
Other ways you can send records to the NSMD:

Email the records to [email protected]

Fax the records to toll-free fax number 866-627-0592
Page 3 of 7

(rev. August 2015)
Mail the records to:
Norfolk Southern Corporation
Medical Services
Norfolk, VA 23510-9202.
NOTE: When sending us records, please be sure to provide your full name,
including middle initial, employee identification number, and a correct phone
number and email address.
4. Fitness-for-duty Documentation Requirements.
a) Non-Medical Absences (less than one year)
Unless there is a fitness-for-duty issue, no additional information or evaluation is necessary if
you have been out of work for less than one year due to a non-medical absence.
b) Non-Medical Absences (one year or longer)
If you have been out of work due to a non-medical absence (such as furlough, leave of
absence, discipline or military leave) for one year or longer, you must complete a Health
Questionnaire (Form/Item 002276-0) for review and determination of your fitness-for-duty
by the NSMD.

An interactive version of this Health Questionnaire is available on the ERC or at
nscorp.com. You can also obtain this questionnaire from your supervisor.

You should complete the Health Questionnaire for the time period of your recent nonmedical leave of absence, then, forward the completed questionnaire directly to the
NSMD. The preferred method is to fax or email the questionnaire directly to your
personal case coordinator.

The completed questionnaire can also be faxed to toll-free fax # 866-627-0592,
emailed to [email protected] or mailed to Norfolk Southern Corporation,
Medical Services, Three Commercial Place, Norfolk, VA 23510-9202.
When evaluating your fitness-for-duty, the NSMD may also request additional medical
records and information for your medical condition(s) that occurred during the time period of
your non-medical absence. Once these records and information are received and reviewed,
your personal case coordinator will let you know if any additional information is needed to
determine your fitness-for-duty.
Finally, when a determination is made that you are fit-for-duty, your case coordinator will
personally notify you. Please make sure that your case coordinator has your correct phone
number and email address! You should notify your supervisor to expedite your return-towork. The NSMD will also notify your supervisor (or administrative assistant) that you are
medically cleared to return-to-work.
Page 4 of 7
(rev. August 2015)
c) Medical Absences
In general, when you are returning to work from other than a minor medical absence, a work
release from your treating doctor(s) including any recommended work restrictions and/or
accommodations should be furnished to your supervisor and the NSMD.
When evaluating your fitness-for-duty, the NSMD may also request that your treating
doctor(s) provides additional medical records and information regarding your specific
medical condition that caused the absence. Please contact your personal case coordinator
for information about whether any specific medical records and information will need to be
provided. Once these records and information are received and reviewed, your case
coordinator will let you know if any additional medical information is needed to determine
your fitness-for-duty.
Your case coordinator will also personally contact you when you are medically qualified to
return-to-work. Please make sure that your case coordinator has your correct phone number
and email address! You should notify your supervisor to expedite your return-to-work. The
NSMD will also notify your supervisor (or administrative assistant) that you are medically
cleared to return-to-work.
5. Your Medical Condition, Medication and Return-to-Work
Medical conditions, medication and dietary supplements may impair your ability to safely
perform your job duties. Some medications and supplements – taken alone or in combination
– can cause serious side effects that may impair your safe job performance. These
medications include both prescription and non-prescription drugs.
NSMD Medical Condition and Medication Guidance describes your responsibilities to
help ensure your safe return-to-work with respect to your medical conditions and your use of
prescription and over-the counter medications, and dietary supplements.
If you are in a designated safety-related job, Medical Condition and Medication Guidance
also describes your additional responsibilities regarding your medical conditions, medical
events, and medication.
Educational material about medication is available to help you:






actively manage the benefits and risks of your medication;
read a drug label;
talk with a pharmacist;
select the right over-the-counter medication for you;
understand drug interactions; and
drive safely if you are taking medication.
Page 5 of 7
(rev. August 2015)
6. General guidance on medical records and information requested for specific medical
conditions.
The following provides general guidance on medical information and records that may be
requested by the NSMD to assist in determining your fitness-for-duty for the medical
condition(s) that resulted in the medical absence or that occurred during the time period of
your non-medical absence. The records and information requested may vary depending on
your individual case. Please see section 4 of this sheet for more information about the
fitness-for-duty process.
a) Attention Deficit Disorder
 Written statement from your treating doctor that addresses:
o any current symptoms (including inability to remain focused and alert)
o treatment, including prescribed medication and any adverse medication side
effects you may be experiencing
o recommended work restrictions and/or accommodations, and if any, their
anticipated duration
b) Diabetes mellitus
 Office visit notes from your treating doctor (including any treating endocrine specialist)
 Most recent fasting blood sugar level and most recent Hemoglobin A1C level, if
available
 Home blood glucose monitoring log for the past 2 weeks, if available
 Your treating doctor’s (including any treating endocrine specialist’s) recommended
work restrictions and/or accommodations, and if any, their anticipated duration
c) Fracture or broken bone
 Most recent office visit note from your treating doctor:
 Written statement (or office visit note) from your treating doctor that addresses:
o whether your fracture is “clinically healed”
o your treating doctor’s recommended work restrictions and/or accommodations,
and if any, their anticipated duration
d) Heart condition or procedure (such as heart attack, stent placement…)
 Office visit notes from your treating cardiologist (and any other treating specialist)
 The results of the most recent stress test prior to your heart attack, angioplasty,
and/or stent placement, if applicable
 The results of a stress test following your heart attack, angioplasty and/or stent
placement, if applicable
 Operative/procedure report (such as cardiac catheterization, stent placement,
angioplasty, CABG…), if applicable – This report may be obtained from your
surgeon’s office or from the hospital where the surgery was performed. It is not
necessary to provide all of the hospital records.
Page 6 of 7
(rev. August 2015)
 If hospitalized, the “hospital admission summary” and “physician’s discharge
summary”. Please request these documents from the Medical Records Department of
the hospital. It is not necessary to provide all of the hospitalization records.
 Your treating cardiologist’s (and any other treating specialist’s) recommended work
restrictions and/or accommodations, and if any, their anticipated duration
e) Mental health condition (such as Anxiety or Depression)
 Office visit note or written statement from your treating doctor (your treating
psychiatrist and psychologist, if any) that addresses:
o prescribed medication and any adverse medication side effects you may be
experiencing
o current control and stability of your condition
f) Orthopedic, bone or joint condition

Office visit notes from your treating doctor (including any treating orthopedic
doctor)

Operative report, if applicable – This report may be obtained from your surgeon’s
office or from the hospital where the surgery was performed. It is not necessary to
provide all of the hospital records.

Diagnostic test results, such as the most recent X-ray or MRI report - please do
not send X-ray or MRI films!

Physical therapy discharge summary, if applicable

Your treating doctor’s (including any treating orthopedic doctor’s) recommended
work restrictions and/or accommodations, and if any, their anticipated duration
g) Pregnancy, childbirth, or its complications
If you are returning to work to a physically demanding job from pregnancy, childbirth,
miscarriage, or complication of pregnancy, a work release from your personal doctor
noting any recommended work restrictions and/or accommodations should be provided.
h) Seizure or convulsion (single episode) with no prior diagnosis of Seizure Disorder
 Office visit notes from your treating doctor (including treating neurologist, if any).
 Recent office visit note or written statement from your treating doctor addressing:
o likely cause of seizure
o date of last known seizure
o risk of experiencing a recurrent seizure within the next 6 months to one year
Page 7 of 7
(rev. August 2015)
 Diagnostic test results, including EEG report
 Lab results (e.g., medication levels)
i) Seizure Disorder (such as Epilepsy, Complex Partial Seizure Disorder…)
 Office visit notes from your treating neurologist.
 Office visit note or written statement from your treating neurologist addressing:
o date of last known seizure
o treatment, including prescribed medication and any adverse medication side
effects you may be experiencing
o risk of experiencing a recurrent seizure within the next 6 months to one year.
 Diagnostic test results, including EEG report
 Lab results (e.g., medication levels)
j) Sleep Apnea
 Office visit notes from your treating doctor (including any treating sleep specialist)
 Sleep study report of the initial sleep study that established the diagnosis of sleep
apnea, and any subsequent sleep study such as CPAP titration
 A downloaded CPAP log for the past 2 weeks. Compliance guidelines are defined as
CPAP use for at least 4 hours per day on at least 70% of days, for at least the prior 2
weeks.
 Your treating doctor’s (including any treating sleep specialist’s) recommended work
restrictions and/or accommodations, and if any, their anticipated duration
k) Surgery - simple surgical procedures and other specified surgeries:
Examples:
 Ear, nose and throat surgery (such as sinus surgery)
 Stomach and digestive system (such as appendectomy, gallbladder surgery and
laparoscopic procedures)
 Urinary and reproductive systems (such as hernia repair not involving mesh or
extensive reconstruction, hysterectomy and C-section)
 Skin biopsies and removal of minor skin lesions
 Other similar surgical procedures or surgery
 Your treating surgeon’s work release noting type of surgery, date of surgery and any
necessary work restrictions and/or accommodations.
Ask your personal case coordinator if this guidance applies to your surgical procedure
or surgery, and whether any additional medical information and records are needed to
enable a determination of your fitness-for-duty.
FAX COVER SHEET
DATE:
_______________________________
FAX TO:
ATTN:
______________________________
Fax Number:
______________________________
Phone Number:
______________________________
Email:
______________________________
FROM:
Name:
________________________________________
Phone Number:
________________________________________
Fax Number:
________________________________________
______ Pages (including cover sheet)
SUBJECT: (Please check all applicable)
OFF-DUTY ILLNESS OR OFF-DUTY INJURY
WORK RELATED ILLNESS OR ON-DUTY INJURY (INCIDENT DATE:____________)
MEDICAL RECORDS
OTHER:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
_______________________________________________________________________
RE:
Employee Name:
________________________________________
Employee ID #:
________________________________________
Job Title:
________________________________________
Phone Number:
________________________________________
Email:
________________________________________
Employee’s preferred method of contact: (please check one)
______Email
______Phone
______Either email or phone
NORFOLK SOUTHERN CORPORATION / MEDICAL SERVICES
NORFOLK SOUTHERN RAILWAY COMPANY
THREE COMMERCIAL PLACE, NORFOLK, VA 23510-9202
Telephone (800) 552-2306
Form/Item 002276-0
(10/2012)
Page 1 of 2
HEALTH QUESTIONNAIRE FOR EMPLOYEES RETURNING TO WORK FROM
NON-MEDICAL ABSENCES OF ONE YEAR OR LONGER
(e.g., Furlough, Military leave, Discipline, Leave of Absence)
To the employee: please complete this health questionnaire for the time period during your recent non-medical
leave of absence. Please forward the completed questionnaire directly to the Norfolk Southern Medical
Department (see bottom page 2). Upon receipt and review of your questionnaire responses, the Norfolk Southern
Medical Director will evaluate your medical qualification to return to work. When a determination is made that
you are medically qualified, the Norfolk Southern Medical Department will notify your supervisor to allow you to
promptly return to work.
A. EMPLOYEE INFORMATION:
Name (Print) Last____________________________First_________________________Middle Initial______
Home Address______________________________ City___________________State_____Zip___________
Business Phone No.____________
Home Phone No. __________________Date of Birth_________
Employee ID No._______________________ Present Occupation__________________________________
Email address:
B. SUPERVISOR INFORMATION:
Supervisor's Name____________________________Title___________________Department____________
Supervisor's Phone No.:
Location (City/State)
C. For every item in the chart below, please respond to the following question (by checking “Yes” or “No” or
write “Don’t Know”). For the time period of your recent non-medical absence, have you had or do you now
have any of the following?
ITEM
YES
NO
#
1
Head / Brain injury or disorder (e.g., stroke,
concussion…)
17
2
Numbness, weakness or paralysis
18
3
Epilepsy, seizure or “fits”
Loss of consciousness, fainting spell, vertigo
or dizziness
Loss of or impaired memory, alertness or
concentration
Migraines / headaches requiring prescription
medication
High blood pressure
Heart disease or heart rhythm problem, heart
attack, chest pain/angina, heart
surgery/procedure (e.g, stents, cath., …)
Diabetes, Thyroid/Addison’s disease or
Cushing’s syndrome
19
4
5
6
7
8
9
10
11
12
13
14
15
16
Asthma or other lung problem (e.g., short of
breath, cough...)
Tuberculosis or other infectious disease
Stomach/digestive problems; liver or kidney
disease
Anemia or other blood disorder
Cancer or Tumor
Hospitalization or Surgical procedure
Broken bones (cracked/fractured)
20
21
22
23
ITEM
Neck or back injury/pain/condition
Shoulder, arm, elbow, wrist or hand
injury/pain/condition
Hip, leg, knee, ankle or foot injury/pain/ condition
Missing or impaired arm, hand, finger, leg, foot or
toe
Swollen and/or painful joints (e.g., arthritis,
gout…)
Skin rash or condition (e.g., eczema, psoriasis,
etc…)
Allergies (e.g., dust, coal tar, bees, etc…)
24
Sleep disorder or problem (e.g., sleep apnea,
insomnia, narcolepsy, etc…)
25
Eye disorder / impaired vision
(excludes corrective lenses)
26
Ear disorder or impaired balance or hearing
(excludes hearing aids)
27
Mental health/ psychiatric diagnosis, treatment or
medication use for (e.g., depression, anxiety,
attention deficit disorder, post-traumatic stress
disorder, drug or alcohol dependence/abuse, (etc.)
28
Other medical conditions, illnesses or injuries
YES
NO
Form/Item 002276-0 (10/2012)
Page 2 of 2
Employee Name (Print):Last_______________________________ First __________________ MI____
Employee ID No.: ________________________________________
PLEASE EXPLAIN ANY “YES” ANSWERS NOTED IN THE CHART ABOVE:
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
PLEASE LIST ALL MEDICATIONS (INCLUDING PRESCRIBED / NON-PRESCRIBED MEDICATION(S)
AND SUPPLEMENTS) TAKEN IN THE LAST 30 DAYS: _______________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
PLEASE ANSWER THE FOLLOWING QUESTIONS:
(1) Have you used tobacco (including smokeless)? _____Yes _____No. If “Yes”, how much over what time period
(e.g., # packs smoked per day, week…, & # years smoked) and when last used? ______________________________.
(2) Have you consumed alcohol? _____Yes _____No. If “Yes”, (a) describe when last used _____________ and
(b) describe approximate amount/frequency of alcohol use: ________________(specify: # of drinks) per
__________________________(e.g., day, week, weekend…)
(3) Do you use or have you used illicit drugs? _____Yes _____No.
If “Yes”, describe drug(s), frequency of use and
when last used: __________________________________________________________________________________
(4) If the purpose of your leave was military leave, have you been discharged from military service for medical reasons?
_____Yes _____No If yes, specify date of denial, removal or discharge, and medical reason: ________________
______________________________________________________________________________________________
(5) Have you filed a claim or lawsuit because of an illness/injury (including a worker’s compensation claim)?
_____Yes _____ No If yes, specify date, illness/injury ________________________________________________
(6) Are you now drawing or have you applied for disability benefits (including Social Security, VA, Longshore and/or
RRB)? _____Yes _____ No. If yes, specify disability(ies)_______________________________________________
RELEASE, VERIFICATION AND DISCLOSURE STATEMENT: PLEASE READ THE FOLLOWING
STATEMENT CAREFULLY AND SIGN BELOW.
I certify that the answers given herein are true and complete to the best of my knowledge. I authorize whatever
investigation is deemed necessary to confirm statements contained in my responses to this questionnaire. If it is
determined, through investigation or otherwise at any time, that any answers are untrue or misleading, or material
information is omitted, I understand my employment may be terminated.
Signature of Employee: ___________________________________
Date signed:____________________
Please forward the completed questionnaire directly to the Norfolk Southern Medical Department:
Preferred method
Other methods
FAX TO # 678-512-5090
Fax (toll-free) to: # 1-866-627-0592
Mail to: Norfolk Southern Corporation, Three Commercial Place, Norfolk, VA
23510-9202
Email to: [email protected]
What’s on the Label
All nonprescription, over-the-counter (OTC) medicine labels
have detailed usage and warning information so consumers can
properly choose and use the products.
Below is an example of what the new OTC medicine label looks like.
Active Ingredient
Therapeutic substance
in product; amount of
active ingredient per
unit
Purpose
Product action or category (such as an antihistamine, antacid, or
cough suppressant)
Drug Facts
Active ingred
ient (in each
Chlorpheniramin
Uses
e maleate 4 mg
Symptoms or diseases
the product will treat
or prevent
WArnings
M
AN
VICES •
SER
US
HEALTH &
HU
When not to use the
product; conditions
that may require advice
from a doctor before
taking the product;
possible interactions or
side effects; when to
stop taking the product
and when to contact a
doctor; if you are
pregnant or breastfeeding,
seek guidance from a
health care professional;
keep product out of
children’s reach
tablet)
........................
Purpose
........................
........................
temporarily rel
....Antihistamin
ieves these sym
allergies: ■ sne
e
ptoms due to
ezing
hay fever or oth
■ runny nose
er upper respir
■ itchy, water
atory
Warnings
y eyes
■ itchy throa
t
Ask a doctor
before use if
you have
■ glaucoma
■ a breathing
■ trouble uri
problem such
nating due to
an enlarged pro as emphysema or chron
Ask a doctor
ic bronchitis
state gland
or pharmacist
before use if
When using
you are taking
this product
tranquilizers or
■ you may
sedatives
get drowsy
■ avo
■ alcohol, sed
atives, and tra id alcoholic drinks
■ be carefu
l when driving nquilizers may increase dro
a mo
ws
■ excitability
may occur, esp tor vehicle or operating ma iness
ecially in childr
chinery
If pregnant or
en
breast-feeding
Keep out of rea
, ask a health
Control Cente ch of children. In case of professional before use.
r right away.
overdose, get
medical help
or contact a Po
ison
Dire
Uses
Directions
Specific age categories, how much to
take, how to take, and
how often and how
long to take
ctions
adults and chi
ldren 12 years
children 6 yea
rs to under 12
and over
years
children unde
r 6 years
Other inform
ation
■
take 1 tablet eve
not more than ry 4 to 6 hours;
6 tablets in 24
hours
take 1/2 tablet
every 4 to 6 ho
not more than
urs;
3 tablets in 24
ho
urs
ask a doctor
store at 20-25O
C (68-77O F)
■ protect fro
m excessive mo
isture
D&C yellow no.
gelatinized sta
10, lactose, ma
rch
gnesium steara
te, microcrystall
ine
Inactive ingr
cellulose, pre
edients
Inactive Ingredients
Substances such as colors or
flavors
Other
information
How to store the
product properly and
required information
about certain
ingredients (such
as the amount of
calcium, potassium,
or sodium the product
contains)
The Drug Facts labeling requirements do not apply to
dietary supplements, which are regulated as food products,
and are labeled with a Supplement Facts panel.
A
N
T
OF
For more information visit: www.fda.gov/cder or call 1-888-INFO-FDA
U.S. Department of Health and Human Services
Food and Drug Administration
DEPAR
TM
E
After you have the medicine, and
before you leave the pharmacy
• Look to be sure you have the right
medicine. If you’ve bought the medicine
before, make sure this medicine has the same
shape, color, size, markings, and packaging.
Anything different? Ask your pharmacist. If
it seems different when you use it, tell your
pharmacist, doctor, or other healthcare
professional.
• Be sure you know the right dose for the
medicine and you know how to use it.
Any questions? Ask your pharmacist.
• Make sure there is a measuring spoon,
cup, or syringe for liquid medicine. If the
medicine doesn’t come with a special
measuring tool, ask your pharmacist about
one. (Spoons used for eating and cooking
may give the wrong dose. Don’t use them.)
• Be sure you have any information the
pharmacist can give you about the
medicine. Read it and save it.
• Get the pharmacy phone number, so you
can call back.
Go to
STOP
Stop and remember that all
medicines have risks
LEARN
Learn how to use your
medicine to increase
the benefits
GO
Go inside this brochure
for the U.S. Food & Drug
Administration’s
www.fda.gov/usemedicinesafely
to learn about
• choosing the medicine that’s best for you
• buying medicine from sources you can trust
• using medicine to increase its safety and
effectiveness
www.fda.gov • 1-888-INFO-FDA
Publication No. (FDA) CDER 09-1930
Tips for Talking with
Your Pharmacist
to learn how to use
medicines safely
Use these tips for talking with
your pharmacist.
Your pharmacist can help you learn
how to use your prescription and
nonprescription (over-the-counter)
medicines safely and to increase
the benefits and decrease the risks.
You can also use these tips when
talking with your other healthcare
professionals.
Tell your pharmacist
Tell your pharmacist...
• everything you use. Keep a record and give it
to your pharmacist. Make sure you put all the
prescription and nonprescription medicines,
vitamins, herbals, and other supplements
you use. Your pharmacist will use this to keep
his/her records up-to-date and help you use
medicine safely.
• if you’ve had any allergic reactions or
problems with medicines, medicines with
dietary supplements, medicines with food,
or medicines with other treatments.
• anything that could affect your use of
medicine, such as, if you have trouble
swallowing, reading labels, remembering
to use medicine, or paying for medicine.
• before you start using something new. Your
pharmacist can help you avoid medicines,
supplements, foods, and other things that
don’t mix well with your medicines.
• if you are pregnant, might become pregnant,
or if you are breast feeding.
Ask your pharmacist
• What are the brand and generic (non-brand)
names?
• What is the active ingredient?
Can I use a generic?
• What is this for, and how is it going to
help me?
• How and when should I use it?
How much do I use?
• How long should I use it?
Can I stop using it, or use less if I feel better?
• What should I do if I miss a dose or use
too much?
• Will this take the place of anything else I
am using?
• When will the medicine start working?
How should I expect to feel?
• Are there any special directions for using this?
• Should I avoid any other medicines, dietary
supplements, drinks, foods, activities, or
other things?
• Is there anything I should watch for, like
allergic reactions or side effects?
What do I do if I get any?
• Will I need any tests to check the medicine’s
effects (blood tests, x-rays, other)?
When will I need those?
• How and where should I keep this medicine?
• Is there a medication guide or other patient
information for this medicine?
• Where and how can I get more written
information?
More important tips on the back
2ActiveMemberBrochure
3/4/03
10:36 AM
Page 1
QUESTION GUIDE
Use this guide to gather the information you need
to know from your health care team.
that the benefits outweigh
the known risks that are
outlined on the drug’s label.
Physicians, physician
assistants, nurses,
pharmacists and YOU make
up your health care team.
To reduce the risks related
to using medicines and to
get the maximum benefit,
you need to play an active
role on the team.
• Should I avoid any other medicines, (prescription or over-the-counter), dietary supplements,
drinks, foods or activities while using this drug?
• When should I notice a difference or improvement? When should I report back to the team?
Will I need to have any testing to monitor this
drug’s effects?
• Can this medicine be used safely with all my
other medications and therapies? Could there
be interactions?
• What are the possible side effects? What do I do
if a side effect occurs?
• What other medicines or therapies could be used
to treat this condition? How do the risks and
benefits compare?
Be An Active Member
of Your Health Care Team
• How and where do I store this medicine?
• Where and how can I get written information
about this medicine? What other sources of
information can I use to make my decision?
For more information, visit our web site at
www.fda.gov/cder or call 1-888-INFO-FDA.
HU
approval of a drug means
M
AN
SERV I CE S • U
SA
HE A L TH &
Drug Administration (FDA)
OF
risks. The U.S. Food and
• How and when will I use it, what amount will I
use, and for how long? What do I do if I miss a
dose?
T
safe. All medicines have
N
such thing as completely
• What is the medicine for and what effect should I
expect? Does this drug replace any other medicine I have been using?
TM
E
medicine, there is no
DE P AR
When it comes to using
• What are the brand and generic names of the
medicine? Can I use a generic form?
(FDA) 01-3236
2ActiveMemberBrochure
3/4/03
10:36 AM
Page 2
You may also want to bring along a friend or
relative to help you understand and remember
the answers.
Speak up
The more information your health care
team members know about you, the better
they can develop a plan of care tailored to
you. ALL of the members of your team
need to know:
• your medical history
• any allergies and sensitivities you have
• the medications you take routinely
and occasionally — prescription
and over-the-counter
• any dietary supplements you use,
including vitamins and herbals
• other therapies you use
• anything that may affect your
ability to use the medication
Use the Question Guide on the back of this
brochure to help you gather the information
you need from your health care team. If you
don’t understand an answer, ask again.
Learn the Facts
Before you purchase a
prescription or over-thecounter medicine, learn and
understand as much about
it as you can, including:
• generic and brand names
• active ingredients
• proper uses—
(indications/contraindications)
• instructions
• warnings and precautions
Ask Questions
Your health care team
members help you make
the best-informed
choices, but you have
to ask the right
questions. When
you meet with a
team member,
have your
questions written
down and take notes.
• interactions—with food, dietary
supplements, other medicines
• side effects/adverse reactions
• expiration dates
Drug information designed for the consumer
is available from a variety of sources—your
pharmacy, the manufacturer, the library,
the bookstore and the internet. If there is
something you don’t understand, ask your
health care team.
Balance the
Benefits and Risks—
Make Your Decision
After you have exchanged all the information,
weigh all your options. At this point you must
decide if the benefits you hope to achieve from
the medicine outweigh its known risks. The
final choice is yours.
Follow Directions
When you are ready to use the medicine,
maximize the benefits and minimize the risks
by following the instructions printed on the
drug label:
• Read the label every time you fill your
prescription — before you leave the
pharmacy. Be sure you have the right
medicine and understand how to use it.
• Read the label every time you are about
to use the medicine —to be sure it’s the
right medicine, for the right patient,
in the right amount, in the right way,
at the right time.
• Take the recommended dose exactly as
prescribed — no matter how tempted you
are to use more to feel better faster.
• Finish all the medicine as directed —
even if you start to feel better before
all your medicine is completed.
Report Back
to the Team
Pay attention to how you
feel and notify your health
care team of any problems.
If you have doubts
that the medicine
is working
effectively, don’t
stop taking it
without checking
with the team.
Some medications
take longer to
show a benefit, and some need
to be withdrawn gradually to
decrease undesirable effects.
If you experience a side effect,
let your health care team know
immediately. An adjustment in
the dosage or a change in
medication may be needed.
Go to www.fda.gov/cder
or call 1 (888) INFO-FDA for
more information about how
to be an active member of your
health care team and additional
drug information.
Distributed as a public service by the
U.S. DEPARTMENT OF HEALTH AND
HUMAN SERVICES
and the
Consumer Healthcare Products Association
CONTENTS
Advice for Americans About
Self-Care. . . . . 1
OTC Know-How: It’s on the Label . . . . . 4
Drug Interactions: A Word to
the Wise . . . . . 6
Time for a Medicine Cabinet
Checkup . . . . . 8
Pregnancy and Breast-Feeding . . . . . 9
Kids Aren’t Just Small Adults . . . 10
Protect Yourself Against Tampering . . .12
CHPA
FOUNDED 1881
CONSUMER HEALTHCARE PRODUCTS ASSOCIATION
R
Advancing Quality Healthcare Through
Over-the-Counter Medicines and Nutritional Supplements
JP-12/03-150M
FDA03-3224
ADVICE FOR AMERICANS
ABOUT SELF-CARE
Access + Knowledge = Power
A merican medicine cabinets contain a growing
choice of nonprescription, over-the-counter
(OTC) medicines to
treat an expanding
range of ailments.
OTC medicines often
do more than relieve
aches, pains and
itches. Some can
prevent diseases
like tooth decay,
cure diseases like athlete’s
foot and, with a doctor’s guidance, help manage recurring conditions
like vaginal yeast infections, migraines
and minor pain in arthritis.
The U.S. Food and Drug Administration (FDA) determines whether
medicines are prescription or nonprescription. The term prescription (Rx)
refers to medicines that are safe and
1
effective when used under a doctor’s
care. Nonprescription or OTC drugs are
medicines FDA decides are safe and
effective for use without a doctor’s
prescription.
FDA also has the authority to
decide when a prescription drug is safe
enough to be sold directly to consumers
over the counter. This regulatory process allowing Americans to take a more
active role in their health care is known
as Rx-to-OTC switch. As a result of this
process, more than 700 products sold
over the counter today use ingredients
or dosage strengths available only by
prescription 30 years ago.
Increased access to
OTC medicines is especially important for our
maturing population. Two
out of three older Americans
rate their health as excellent
to good, but four out of five
report at least one chronic
condition.
Fact is, today’s OTC
medicines offer greater
opportunity to treat more of the aches
and illnesses most likely to appear in
2
our later years. As we live longer, work
longer and take a more active role in
our own health care, the need grows to
become better informed about self-care.
The best way to become better
informed—for young and old alike—is to
read and understand the information on
OTC labels. Next to the medicine itself,
label comprehension is the most important part of self-care with OTC
medicines.
With new opportunities in selfmedication come new responsibilities
and an increased need for knowledge.
FDA and the Consumer Healthcare
Products Association (CHPA) have
prepared the following information to
help Americans take advantage of selfcare options.
3
OTC KNOW-HOW:
IT’S ON THE LABEL
You wouldn’t ignore
your doctor’s instructions for using a
prescription drug, so
don’t ignore the label
when taking an OTC
medicine. Here’s what to
look for:
PRODUCT NAME
“ACTIVE INGREDIENTS”—
therapeutic substances in
medicine
“PURPOSE”—product category
(such as antihistamine, antacid
or cough suppressant)
“USES”—symptoms or diseases
the product will treat or prevent
“WARNINGS”—when not to use
the product, when to stop taking
it, when to see a doctor and
possible side effects
“DIRECTIONS”—how much to
take, how to take it, and how
long to take it
“OTHER INFORMATION”—such
as storage information
“INACTIVE INGREDIENTS”—
substances such as binders,
colors or flavorings
4
You can help yourself read the
label too. Always use enough light. It
usually takes three times more light to
read the same line at age 60 than at age
30. If necessary, use your glasses or
contact lenses when reading labels.
Always remember to look for the
statement describing the tamper-evident
feature(s) before you buy the product and
when you use it.
When it comes to medicines, more
does not necessarily mean better. You
should never misuse OTC medicines by
taking them longer or in higher doses
than the label recommends. Symptoms
that persist are a clear signal it’s time to
see a doctor.
Be sure to read the label each time
you purchase a product. Just because
two or more products are from the same
brand family doesn’t mean they are
meant to treat the same conditions or
contain the same ingredients.
Remember, if you read the label
and still have questions, talk to a
doctor, nurse or pharmacist.
5
DRUG INTERACTIONS:
A WORD TO THE WISE
Although mild and relatively uncommon, interactions involving OTC drugs
can produce unwanted results or make
medicines less effective. It’s especially
important to know about drug interactions if you’re taking Rx and OTC drugs
at the same time.
Some drugs can also interact with
foods and beverages, as well as with
health conditions such as diabetes,
kidney disease and high blood
pressure.
Here are few drug interaction
cautions for some common OTC
ingredients:
Avoid alcohol if you are taking
antihistamines, cough-cold
products with the ingredient
dextromethorphan or drugs that
treat sleeplessness.
Do not use drugs that treat
sleeplessness if you are taking
prescription sedatives or
tranquilizers.
6
Check with your doctor before
taking products containing
aspirin if you’re taking a prescription blood thinner or if you
have diabetes or gout.
Do not use laxatives when you
have stomach pain, nausea or
vomiting.
Unless directed by a doctor, do
not use a nasal decongestant if
you are taking a prescription
drug for high blood pressure or
depression, or if you have heart
or thyroid disease, diabetes or
prostate problems.
This is not a complete list. Read the
label! Drug labels change as new information becomes available. That’s why
it’s important to read the label each time
you take medicine.
7
TIME FOR A MEDICINE
CABINET CHECKUP
Be sure to look through your
medicine supply at least once
a year.
Always store medicines in a
cool, dry place or as stated
on the label.
Throw away any medicines
that are past the expiration
date.
To make sure no one takes
the wrong medicine, keep all
medicines in their original
containers.
8
PREGNANCY AND
BREAST-FEEDING
Drugs can pass
from a pregnant
woman to her
unborn baby.
A safe amount
of medicine
for the
mother
may be
too much
for the
unborn
baby. If
you’re pregnant, always talk with your
doctor before taking any drugs, Rx
or OTC.
Although most drugs pass into
breast milk in concentrations too low to
have any unwanted effects on the baby,
breast-feeding mothers still need to be
careful. Always ask your doctor or
pharmacist before taking any medicine
while breast-feeding. A doctor or pharmacist can tell you how to adjust the
timing and dosing of most medicines so
the baby is exposed to the lowest
amount possible, or whether the drugs
should be avoided altogether.
9
KIDS AREN’T JUST
SMALL ADULTS
O
TC drugs rarely come in one-size-fitsall. Here are some tips about giving OTC
medicines to children:
Children aren’t just small adults,
so don’t estimate the dose.
Read the label. Follow all
directions.
Follow any age limits on the label.
Some OTC products come in
different strengths. Be aware!
Know the difference between
TBSP. (tablespoon) and TSP.
(teaspoon). They are very different
doses.
Be careful about converting dose
instructions. If the label says two
teaspoons, it’s best to use a
measuring spoon or a dosing cup
marked in teaspoons, not a
common kitchen spoon.
Don’t play doctor. Do not double
the dose just because your child
seems sicker than last time.
Before you give your child two
medicines at the same time, talk
to your doctor or pharmacist.
Never let children take medicine
by themselves.
10
Never call medicine candy to get
your kids to take it. If they come
across the medicine on their
own, they’re likely to remember
that you called it candy.
CHILD-RESISTANT PACKAGING
Child-resistant closures are designed for repeated use to make it difficult for children to open. Remember, if
you don’t re-lock the closure after each
use, the child-resistant device can’t do its
job—keeping children out!
It’s best to store all medicines and
dietary supplements where children can
neither see nor reach them. Containers of
pills should not be left on the kitchen
counter as a reminder. Purses and
briefcases are among the worst places to
hide medicines from curious kids. And
since children are natural mimics, it’s a
good idea not to take medicine in front of
them. They may be tempted to “play
house” with your medicine later on.
If you find some packages
too difficult to open—and
don’t have young children
living with you or visiting—
you should know the law
allows one package size
for each OTC medicine
to be sold without
child-resistant
features. If you
don’t see it on the
store shelf, ask.
11
PROTECT YOURSELF
AGAINST TAMPERING
Makers of OTC medicines
seal most products in
tamper-evident
packaging (TEP) to
help protect against
criminal tampering.
TEP works by providing visible evidence if
the package has been
disturbed. But OTC
packaging cannot be
100 percent tamperproof. Here’s how to
help protect yourself:
Be alert to the tamper-evident
features on the package before you
open it. These features are described
on the label.
Inspect the outer packaging before
you buy it. When you get home,
inspect the medicine inside.
Don’t buy an OTC product if the
packaging is damaged.
Don’t use any medicine that looks
discolored or different in any way.
If anything looks suspicious, be
suspicious. Contact the store
where you bought the product.
Take it back!
Never take medicines in the dark.
12
For free bulk quantities,
visit
M
AN
SER
V I CES •
US
A
N
T
OF
HE ALTH & H
U
www.chpa-info.org
D E P AR
TM
E
U.S. DEPARTMENT OF HEALTH AND
HUMAN SERVICES
CHPA
FOUNDED 1881
CONSUMER HEALTHCARE PRODUCTS ASSOCIATION
The Consumer Healthcare Products Association (CHPA)
is a national organization representing companies dedicated to providing consumers with safe and effective overthe-counter (OTC) medicines and nutritional supplements
and the information to use them properly.
DRUG
INTERACTIONS:
WHAT YOU
SHOULD KNOW
Council on Family Health
Drug Interactions
T
here are more opportunities today than ever
before to learn about your health and to take
better care of yourself. It is also more
important than ever to know about the medicines
you take. If you take several different medicines,
see more than one doctor or have certain health
conditions, you and your doctors need to be aware
of all the medicines you take to avoid potential
problems, such as drug interactions.
Drug interactions may make your drug less effective, cause unexpected side effects or increase the
action of a particular drug. Some drug interactions
can even be harmful to you. Reading the label every
time you use a nonprescription or prescription drug
and taking the time to learn about drug interactions
may be critical to your health. You can reduce the
risk of potentially harmful drug interactions and side
effects with a little bit of knowledge and common sense.
Drug interactions fall into three broad categories:
■
Drug-drug interactions occur when two
or more drugs react with each other. This drugdrug interaction may cause you to experience an
unexpected side effect. For example, mixing a
drug you take to help you sleep (a sedative) and
a drug you take for allergies (an antihistamine)
can slow your reactions and make driving a car
or operating machinery dangerous.
■
Drug-food/beverage interactions
result from drugs reacting with foods or
beverages. For example, mixing alcohol with
some drugs may cause you to feel tired or
slow your reactions.
■
Drug-condition interactions may occur
when an existing medical condition makes
certain drugs potentially harmful. For example,
if you have high blood pressure you could
experience an unwanted reaction if you take
a nasal decongestant.
Drug
Interactions
and Overthe-Counter
Medicines
O
ver-the-counter
(OTC) drug
labels contain
information about ingredients, uses, warnings
and directions that is
important to read and
understand. The label
also includes important
information about possible drug interactions. Further, drug labels may change as
new information becomes known. That’s why it’s especially
important to read the label every time you use a drug.
The “Active Ingredients” and “Purpose” sections list:
the name and amount of each active ingredient
the purpose of each active ingredient
■
■
The “Uses” section of the label:
■ tells you what the drug is used for
■ helps you find the best drug for your specific symptoms
The “Warnings” section of the label provides important
drug interaction and precaution information such as:
■ when to talk to a doctor or pharmacist before use
■ the medical conditions that may make the drug less
effective or not safe
■ under what circumstances the drug should not be used
■ when to stop taking the drug
The “Directions” section of the label tells you:
■ the length of time and the amount of the product
that you may safely use
■ any special instructions on how to use the product
The “Other Information” section of the label tells you:
■ required information about certain ingredients,
such as sodium content, for people with dietary
restrictions or allergies
The “Inactive Ingredients” section of the label tells you:
■ the name of each inactive ingredient (such as
colorings, binders, etc.)
The “Questions?” or “Questions or Comments?”
section of the label (if included):
■ provides telephone numbers of a source to answer
questions about the product
Learning
More About
Drug
Interactions
T
alk to your doctor or
pharmacist about the
drugs you take. When
your doctor prescribes a
new drug, discuss all OTC
and prescription drugs,
dietary supplements, vitamins, botanicals, minerals
and herbals you take, as
well as the foods you eat.
Ask your pharmacist for the
package insert for each prescription drug you take.
The package insert provides more information about
potential drug interactions.
Before taking a drug, ask your doctor or pharmacist
the following questions:
■ Can I take it with other drugs?
■ Should I avoid certain foods, beverages or other
products?
■ What are possible drug interaction signs I should
know about?
■ How will the drug work in my body?
■ Is there more information available about the
drug or my condition (on the Internet or in health
and medical literature)?
Know how to take drugs safely and responsibly.
Remember, the drug label will tell you:
■ what the drug is used for
■ how to take the drug
■ how to reduce the risk of drug interactions and
unwanted side effects
If you still have questions after reading the drug
product label, ask your doctor or pharmacist for
more information.
R
emember that different OTC drugs may
contain the same active ingredient. If you
are taking more than one OTC drug, pay
attention to the active ingredients used in the
products to avoid taking too much of a particular
ingredient. Under certain circumstances — such as
if you are pregnant or breast-feeding — you should
talk to your doctor before you take any medicine.
Also, make sure to know what ingredients are
contained in the medicines you take to avoid
possible allergic reactions.
The following are examples of drug interaction warnings that you may see on certain OTC drug products.
These examples do not include all of the warnings
for the listed types of products and should not take
the place of reading the actual product label.
Category
Drug Interaction Information
Acid
Reducers
For products containing
cimetidine, ask a doctor or
pharmacist before use if
you are:
■ taking theophylline (oral asthma
drug), warfarin (blood thinning
drug) or phenytoin (seizure drug)
H2 Receptor
Antagonists
(drugs that
prevent or
relieve heartburn associated with acid
indigestion
and sour
stomach)
Antacids
(drugs for
relief of acid
indigestion,
heartburn
and/or sour
stomach)
Ask a doctor or pharmacist
before use if you are:
■ allergic to milk or milk products
if the product contains more than
5 grams lactose in a maximum
daily dose
■ taking a prescription drug
Ask a doctor before use if
you have:
■ kidney disease
Category
Antiemetics
■ taking sedatives or tranquilizers
(drugs for
prevention or
treatment of
nausea, vomiting
or dizziness
associated with
motion sickness)
you have:
■ a breathing problem, such
as emphysema or chronic
bronchitis
■ glaucoma
■ difficulty in urination due to
an enlarged prostate gland
When using this product:
alcoholic beverages
■ avoid
Antihistamines
(drugs that
temporarily
relieve runny
nose or reduce
sneezing, itching
of the nose or
throat, and itchy
watery eyes due
to hay fever or
other upper
respiratory
problems)
before use if you are taking:
■ sedatives or tranquilizers
■ a prescription drug for high blood
pressure or depression
you have:
■ glaucoma or difficulty in
urination due to an enlarged
prostate gland
■ breathing problems, such as
emphysema, chronic bronchitis or
asthma
■ alcohol, sedatives and tranquilizers may increase drowsiness
■ avoid alcoholic beverages
Category
Antitussives
Cough Medicine
(drugs that
temporarily reduce Ask a doctor before use if
you have:
cough due to
■ glaucoma or difficulty in
minor throat and
bronchial irritation
prostate gland
as may occur with
a cold)
Ask a doctor before use if you:
heart disease, high blood
(drugs for the
pressure,
thyroid disease,
temporary relief
diabetes or difficulty in urination
of shortness of
due to an enlarged prostate gland
breath, tightness of
■
have ever been hospitalized
chest and wheezing
for asthma or are taking a
due to bronchial
prescription drug for asthma
asthma)
Bronchodilators
■ have
Laxatives
(drugs for the
temporary relief
of constipation)
Nasal
Decongestants
(drugs for the
temporary relief of
nasal congestion
due to a cold, hay
fever or other
upper respiratory
allergies)
you have:
■ kidney disease and the laxative
contains phosphates, potassium or
magnesium
■ stomach pain, nausea or
vomiting
heart disease, high blood
pressure, thyroid disease,
diabetes or difficulty in
prostate gland
■ have
Category
Nicotine
Replacement
Products
■ have high blood pressure not controlled by medication
■ have heart disease or have had a
recent heart attack or irregular
heartbeat since nicotine can
increase your heart rate
(drugs that
reduce
withdrawal
symptoms
associated with
quitting smoking,
including nicotine
craving)
■ taking a prescription drug for
depression or asthma (your dose
may need to be adjusted)
■ using a prescription non-nicotine
stop-smoking drug
Do not use:
you continue to smoke, chew
tobacco, use snuff or use other
nicotine-containing products
■ if
Nighttime Sleep
Aids
(drugs for relief
of occasional
sleeplessness)
you have:
■ a breathing problem such
as emphysema or chronic
bronchitis
■ glaucoma
■ difficulty in urination due to
an enlarged prostate gland
alcoholic beverages
■ avoid
Category
Pain Relievers
Ask a doctor before taking
if you:
■ consume three or more alcoholcontaining drinks per day
(drugs for the
temporary relief
of minor body
aches, pains and
headaches)
Stimulants
(drugs that help
restore mental
alertness or
wakefulness
during fatigue
or drowsiness)
Topical Acne
Products
(drugs for the
treatment of
acne)
(The following ingredients are found
in different OTC pain relievers: acetaminophen, aspirin, ibuprofen, ketoprofen, magnesium salicylate and
naproxen. It is important to read the
label of pain reliever products to
learn about different drug interaction
warnings for each ingredient.)
■ limit the use of foods, beverages
and other drugs that have
caffeine – too much caffeine can
cause nervousness, irritability,
sleeplessness and occasional rapid
heartbeat
■ be aware that the recommended
dose of this product contains about
as much caffeine as a cup of coffee
dryness or irritation of
the skin may occur immediately
following use of this product or if
you are using other topical acne
drugs at the same time. If this
occurs, only one drug should be
used unless directed by your
doctor
■ increased
This information is brought to you by the
Council on Family Health in cooperation with
the National Consumers League and
the U.S. Food and Drug Administration.
Council on Family Health
www.cfhinfo.org
National Consumers League
www.nclnet.org
www.fda.gov
To order one copy of this booklet, write:
Federal Citizen Information Center
Drug Interactions: What You Should Know
Pueblo, CO 81009
www.pueblo.gsa.gov
3/2004
Driving when you are taking
medications.
For most people, driving represents freedom,
control and independence. Driving enables
most people to get to the places they want or
need to go. For many people, driving is
important economically – some drive as part of
their job or to get to and from work.
Driving is a complex skill. Our ability to drive
safely can be affected by changes in our
physical, emotional and mental condition. The
goal of this brochure is to help you and your
health care professional talk about how your
medicine may affect your ability to drive safely.
How can medications affect
my driving?
People use medicines for a variety of reasons,
including:
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allergies
anxiety
cold
depression
diabetes
heart and cholesterol conditions
high blood pressure
muscle spasms
pain
Parkinson’s disease
schizophrenia
Medicines include medications that your doctor
prescribes and over-the-counter medications
that you buy without a doctor’s prescription.
Many individuals also take herbal supplements.
Some of these medicines and supplements may
cause a variety of reactions that may make it
more difficult for you to drive a car safely.
These reactions may include:
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sleepiness
blurred vision
dizziness
slowed movement
fainting
inability to focus or pay attention
nausea
Can I still drive safely if I am
taking medications?
Yes, most people can drive safely if they are
using medications. It depends on the effect
those medicines – both prescription and overthe-counter – have on your driving. In some
cases you may not be aware of the effects. But,
in many instances, your doctor can help to
minimize the negative impact of your medicines
on your driving in several ways. Your doctor
may be able to:
◆ Adjust the dose;
◆ Adjust the timing of doses or when you
use the medicine;
◆ Add an exercise or nutrition program to
Often people use more than one medicine at a
time. The combination of different medicines
can cause problems for some people. This is
especially true for older adults because they use
more medicines than any other age group. Due
to changes in the body as people age, older
adults are more prone to medicine related
problems. The more medicines you use, the
greater your risk that your medicines will affect
your ability to drive safely. To help avoid
problems, it is important that at least once a
year you talk to your doctor, nurse, or
pharmacist about all the medicines – both
prescription and over-the-counter – you are
using. Also let your doctor know what herbal
supplements, if any, you are using. Do this even
if your medicines and supplements are not
currently causing you a problem.
lessen the need for medicine; and
◆ Change the medicine to one that causes
less drowsiness.
What can I do if I am taking
medications?
Talk to your doctor honestly.
When your doctor prescribes a medicine for
you, ask about side effects. How should you
expect the medicine to affect your ability to
drive? Remind your doctor of other medicines
– both prescription and over-the-counter – and
herbal supplements you are using, especially if
you see more than one doctor. Talking honestly
with your doctor also means telling the doctor
if you are not using all or any of the prescribed
medicines. Do not stop using your medicine
unless your doctor tells you to.
Ask your doctor if you should drive —
especially when you first take a medication.
Using a new medicine can cause you to react in
a number of ways. It is recommended that you
do not drive when you first start using a new
medicine until you know how that drug affects
you. You also need to be aware that some overthe-counter medicines and herbal supplements
can make it difficult for you to drive safely.
Talk to your pharmacist.
Get to know your pharmacist. Ask the
pharmacist to go over your medicines with you
and to remind you of effects they may have on
your ability to drive safely. Be sure to request
printed information about the side effects of
any new medicine. Remind your pharmacist of
other medicines and herbal supplements you
are using. Pharmacists are available to answer
questions wherever you get your medicine.
Many people buy medicines by mail. Mailorder pharmacies have a toll-free number you
can call and a pharmacist available to answer
your questions.
Monitor yourself.
Learn to know how your body reacts to the
medicine and supplements. Keep track of how
you feel after you use the medicine. For
example, do you feel sleepy? Is your vision
blurry? Do you feel weak and slow? When do
these things happen?
Where do I find out more
about medications?
Your first step is to talk with your health care
professional. You also can contact the:
◆ U.S. Food and Drug Administration at
1-888-INFO-FDA (1-888-463-6332)
or visit online at www.fda.gov/cder
M
HU
Also, senior centers, religious, and other local
service groups often offer transportation
services for older adults in the community.
Driving
When
You Are Taking
Medications
AN
SER
V I CE S •
US
A
HEALTH &
rides with family and friends;
taxi cabs;
shuttle buses or vans;
public buses, trains and subways; and
walking.
Easter Seals Project ACTION
(Accessible Community Transportation
In Our Nation) can direct you to
transportation resources near you.
Call 1-800-659-6428 or visit online at
www.projectaction.org.
Always wear your safety belt when you are
driving or riding in a car. Make sure that every
person who is riding with you also is buckled
up. Wear your safety belt even if your car has
air bags.
OF
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Contact your regional transit authority
to find out which bus or train to take.
Wear your safety belt
NT
You can keep your independence even if you
have to cut back or give up on your driving due
to your need to use a medicine. It may take
planning ahead on your part, but it will get you
to the places you want to go and the people
you want to see. Consider:
Call the ElderCare Locator at
1-800-677-1116 and ask for the phone
number of your local Office on Aging, or
go to their website at www.eldercare.gov.
You also can get a copy of the “Age Page
On Older Drivers” from the National
Institute on Aging by calling
1-800-222-2225, or by going to their
website at www.niapublications.org/
TM
E
What if I have to cut back or
give up driving?
Who can I call for help with
transportation?
DE PAR
Let your doctor and pharmacist know what
is happening.
No matter what your reaction is to using a
medicine – good or bad – tell your doctor and
pharmacist. Both prescription and over-thecounter medicines are powerful—that’s why
they work. Each person is unique. Two people
may respond differently to the same medicine.
If you are experiencing side effects, the doctor
needs to know that in order to adjust your
medicine. Your doctor can help you find a
medicine that works best for you.
U.S. Department of Health
and Human Services
Food and Drug
Administration
Opioid painkillers: What you need
to know before you start taking them
Opioids are powerful medications that are prescribed for many types of pain, the flu or a cough.
Common reactions
While opioids are very effective medications, you can have reactions to them. They can make you:
These reactions can happen suddenly and while taking the
usual dose of your medicine. Be careful to follow your doctor’s
or pharmacist’s instructions. Many opioids will take about
90 minutes to become fully active in your body. Be sure to
check the warning labels on the bottle: you may need to be
careful going about ordinary activities such as driving.
EXAMPLES OF OPIOID CONTAINING MEDICINES
SHORT-ACTING
• sleepy
• sick to your stomach
• constipated
• feel confused
• dizzy
1.4 million
emergency room
visits in 2011 were
related to the
misuse or abuse
of prescription
medicines, an
increase of 114%
since 2004.1
National Safety Council
1121 spring lake drive
itasca, il 60143-3201
(800) 621-7619
nsc.org
LONG-ACTING
• clammy skin
• weak muscles
• dangerously low blood pressure
• slowed or stopped breathing
• coma
• death
Brand Name
morphine
MSIR, Roxanol
oxycodone
OxyIR, Oxyfast,
Endocodone
oxycodone
Roxilox, Roxicet,
Percocet, Tylox,
Endocet
hydrocodone
Vicodin, Lorcet,
Lortab, Zydone,
Hydrocet, Norco
hydromorphone
Dilaudid, Hydrostat
morphine
MSContin,
Oramorph SR,
Kadian, Avinza
oxycodone
Oxycontin
fentanyl
Duragesic patch
(with acetaminophen)
(with acetaminophen)
Serious reactions
If you take more than prescribed, or combine opioids
with alcohol or some other drugs, such as sleep aids
and anti-anxiety medications, they can cause
Generic
Do not share opioid pain medications
Never share medication your doctor has given you; even with family members. You
may be endangering someone’s life if you let them take your medicine.
Long-term problems
If you take opioids for a long time, your body can feel less of their effect, and you may feel the
need to use more of the drug to get results. Do not use more without talking to your doctor.
Taking more opioids can increase the chance that you may have side effects or overdose. Opioids
are highly addictive medications so it’s important to work closely with your doctor.
What can I do to prevent problems?
While these drugs are effective for pain, you may want to ask your doctor if you can try a non-opioid drug first.
Also, if you do take opioids, talk to your doctor about limiting the time you take them. Tell your doctor about all
other medications and drugs you take and about how much alcohol you consume. Ask your doctor about whether,
and when you can drive and be sure to discuss the nature of your work and how you may be impaired.
Opioid painkillers can be dangerous and need to be disposed of promptly and properly. If you have any medicine
left over, you can bring your medication to a drug take-back collection site or event. Take-back programs allow
the public to bring unused drugs to a central location for proper disposal. If your community does not have a
take-back program, you can visit nsc.org\disposalresources to learn how to throw away the medicine safely.
Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. (2013) The DAWN Report: Highlights of the 2011 Drug Abuse Warning
Network (DAWN) Findings on Drug-Related Emergency Department Visits. Rockville, MD. Retrieved from http://www.samhsa.gov/data/2k13/DAWN127/sr127-DAWN-highlights.htm
0414 900004621
©2014 National Safety Council
Putting ABILITY
back to WORK!
Vo c a t i o n a l R e h a b i l i t a t i o n S e r v i c e s ( V R S )
Service activities may include:
On-line career assessment
Vocational counseling and guidance
Education and job training/placement
assistance
Linkage and referral to local employment
resources where employees reside
Vocational Rehabilitation Services
Eligibility
The Vocational Rehabilitation
Services program is not available
to those employees who have been
medically approved to return to
their current or previous positions,
or where no employment relationship exists between the Company
and the employees. Norfolk Southern Corporation reserves
the right to amend or terminate the VRS Program at any time.
NORFOLK SOUTHERN
SUPPORTS SUCCESS!
38.1112.6355.1000
Putting ABILITY
back to WORK!
Vo c a t i o n a l R e h a b i l i t a t i o n S e r v i c e s ( V R S )
Norfolk Southern Helps
Eligible Employees Return To Work
The company’s Vocational Rehabilitation
Services (VRS) program offers help for
Norfolk Southern employees injured on the
job, or medically disqualified from service.
The good news is that even a continuing
personal illness/medical condition does not
necessarily prevent employees from working again. Through the assistance
offered by the VRS program, many eligible employees are able to return to
work. VRS allows employees to continue to make meaningful contributions
toward their personal and corporate success as well as continue to provide
financial security for themselves and their families.
VRS activities are customized to assist employees in meeting their individual
needs. This may include evaluation of job skills, training, job placement,
and/or referral to community resources. Depending on qualifications and
response to vocational rehabilitation, program participants may be considered
for placement within currently vacant positions within Norfolk Southern,
or in some cases, coordination with outside job placement services may be
the best option.
Vocational Rehabilitation Services
Offers Employees A Choice
The Vocational Rehabilitation Services (VRS) program is available at no cost
for eligible agreement and nonagreement employees, including those on
medical leave. Participation is entirely
voluntary, and employees may leave or
decline the program at any time.
Here’s How
To Get Started
The VRS program is administered by the
Human Resources Department. All service
activities are coordinated and monitored by a
nationally Certified Rehabilitation Counselor (CRC).
Eligible employees who are interested in taking advantage of the
program should contact contact Vocational Rehabilitation Services
at (800)-552-2306 ext. 664-5047, Fax: (757) 823-5981, online
at www.nscorp.com/VRS, or via E-Mail at [email protected].
How can you
help someone
drug alcohol
who may be in
&
trouble?
DARS
Drug and Alcohol Rehabilitation Services
www.nscorp.com/DARS
Nr
Norfolk Southern / Conrail
A safe, healthy, and
drug-free workplace
is everyone’s business.
Sometimes, a co-worker’s behavior
may indicate there is a potential problem
that may need attention. Everyone’s safety
is at stake when these problems continue,
especially if it is suspected they involve drugs
or alcohol. Employees with an active drug
or alcohol abuse problem affect safety,
productivity, personal health, and have a
negative financial impact on the company.
You may be in a
unique position to help!
What can NS employees do to help a co-worker?
Norfolk Southern’s Drug and Alcohol Rehabilitation Services
(DARS) program is designed to help employees identify drug
or alcohol problems. Employees can and should use the DARS
program before their problems cause rule violations or declining
health. NS recognizes addiction as a diagnosable disease with
treatable solutions. NS provides DARS as a confidential service
available to help all NS employees without jeopardizing employment.
Co-workers are in a unique position to observe negative changes
and offer alternatives. They can spot early warning signs of job
performance problems or changes in behavior that could be due to
drug or alcohol abuse. Frequently the troubled employee is the last
one to realize there is a problem.
1
What is drug and alcohol dependency/abuse?
Loss of Control – The inability to consistently predict when
one will drink next, how much will be consumed, or where drinking
or drug use will occur.
Once the “loss of control” line is crossed, the symptoms are
progressive. They will always get worse instead of better. In many
cases the addicted employee is the last to recognize his/her loss of
control. You, the co-worker, are in a unique position to help because
co-workers are frequently the first to spot a change.
Following are some examples of substance abuse and dependence.
The word substance applies to either drugs or alcohol.
Substance abuse can be viewed as any serious incident
involving drugs or alcohol in a 12-month period—but not
believed to be pattern behavior or include craving or loss of
control. Some examples include:
■
Failure to meet obligations – irresponsible behavior at work,
school, or home; declining job performance, health, missed
personal goals, etc.
■
Hazardous use – DUI, operating machinery impaired, positive
breath, or urinalysis at work.
■
Legal problems – arrests, domestic disputes.
■
Interpersonal problems – family arguments, physical fights,
social withdrawal.
Substance dependence (alcoholism—addiction) has some
or all of following symptoms, and can usually be seen as an
increasing pattern of behavior.
2
■
Obsession – A strong urge or need to use drugs or alcohol,
sometimes despite previous or impending negative
consequences.
■
Craving – Not being able to stop once the drinking or use
begins. Drinking/using more than intended. Drinking/using
at a time or place that causes problems.
■
Tolerance – The need for greater amounts to get the same
effect or to “get high”.
■
Blackout or Pass out – Not remembering what happened while
drinking or using, or losing consciousness due to over-use.
■
Physical addiction – Withdrawal symptoms such as sweating,
shakiness, nausea, trouble sleeping, or extreme anxiety
after stopping drinking or using. In extreme cases, seizures
or overdose.
3
Experience shows that an employee who is losing control
affects the workplace in 3 ways:
How much is too much?
First, any use of illegal drugs is too much. Secondly, the medical
policy on drugs at Norfolk Southern does not permit the employment
of persons who use drugs which may impair sensory, mental, or
physical functions. The word “drugs” refers to prohibited or
controlled substances as defined by law. Of course, this same
good health advice is true for family members.
How about alcohol? What counts as a drink?
Many people are surprised to learn what counts as a drink.
Beer – 12 oz. (5% alcohol)
Wine – 5 oz. (12% alcohol)
Liquor – 1.5 oz (80 proof spirits)
■
They are preoccupied with thinking/planning about getting
high or drinking.
■
They are physically under the influence of drugs and/or alcohol.
■
They are getting over the effects of using drugs and/or alcohol.
All affect the workplace. Although two are emotional states
that cannot be physically tested for, they will often manifest
themselves in job performance or behavior problems.
As a co-worker, what can I do to assist employees with alcohol
and drug abuse problems?
Co-workers can use the Constructive Intervention process to
identify and refer employees to DARS for assistance. Co-workers
are NOT being asked to get someone in trouble or diagnose
addiction. Even for professionals, addiction assessment is
challenging. The co-worker should keep his/her focus on job
performance or changing behavior measurements that are
characteristic of an employee or family member who has a
drug or alcohol abuse problem.
How can you tell what’s reasonable?
(Lowest risk) Social – 1-2 drinks, 1-2 times weekly
Binge drinking – 5 or more, 1 time in 30 days
Heavy drinking – 5 or more, 5 times in 30 days
(Highest risk) Alcoholic – can’t control amounts taken (craving)
or control appropriate time to drink (obsession)
4
5
Patterns of change over time involving attendance, availability,
the quality and quantity of work, and attitude, can indicate
potential addiction problems. They vary from issues such as
arriving late, leaving early, and complaints from co-workers, to
more serious issues such as aggressive and belligerent behavior,
or legal and financial problems.
Your observations of changing behavior or performance can be the
key element of making a co-worker or family member aware there
is a problem.
Following are some examples of job performance or behavior problems you may be
observing. You may be able to add to the list yourself.
Attendance & Availability
of Employee:
Quality & Quantity
of Work Produced:
■ Absent without leave
■ Missed deadlines
■ Arrives late
■ Errors due to inattention
■ Leaves work early
■ Absent from work site
without good reason
■ Excessive sick leave
■ Absent on Mondays,
Fridays, after holidays,
day after payday
■ Repeated absences for
longer periods of time
■ Elaborate, increasingly
improbable reasons for
absences
■ Excessive outside
communication i.e.: cell
phones, pagers, incoming
or out going calls
■ Domestic problems
interfere with work
■ Undependable
and poor judgment
■ Not remembering
instructions
■ Spasmodic work pace
alternating between
periods of high and low
productivity
■ Short periods of good
performance after
corrective interviews
■ Lapses of attention,
inability to concentrate
Attitude
& Behavior:
■ Overreaction to real
or imagined criticism
■ Inability to hear
or accept feedback
■ Aggressive and belligerent
when confronted
■ Undependable
statements
■ Lying
■ Avoidance of associates
■ Unreasonable resentments
toward supervisor, coworkers, the organization
■ Complaints from people
■ Money problems,
■ Fellow workers complain
■ Loss of values
■ Repeated rule violations
■ Mood swings
■ Repeated minor injuries
■ Poor hygiene
outside work unit
on and off job
garnishments of salary
■ Visible physical
deterioration
■ Trouble with law, DUIs,
DWIs, other arrests
6
7
Enabling Behaviors
Co-workers, supervisors, and organizations sometimes think they
can help an employee avoid the direct or indirect consequences
of a drug or alcohol problem.
Some examples of enabling are:
Denial
Frequently the troubled employee or family member is the last one to
realize there is a problem. This phenomenon is sometimes called
DENIAL, but it is more a problem of warped perception rather
than conscious deception. It is sometimes caused by too much
chemical use, but more often it is the nature of mental obsession.
■ Accepts repeated apologies and assurances of improved
performance
■ Fails to confront problems due to poor performance
■ Covers for co-worker
■ Feels sorry for him
■ Afraid he’ll lose a friend
■ Considers “functional alcoholic” to be no problem
■ Protects co-worker from consequences
■ Promises self to confront IF problems get worse
■ “Works around” personality or performance of co-worker
■ Loans money to addicted employee
■ Fails to advise others of noticeable lapses in performance
or behavior
■ Doesn’t realize how much a constructive approach can help
It’s easy to become an enabler by covering for that person,
ignoring complaints of fellow co-workers, and failing to take
action consistent with company policy. But covering for a
co-worker does more harm than good. If we allow that
behavior to continue we put everyone at the work site at risk.
Helping a co-worker realize they have a problem, and that DARS
can offer a variety of solutions, is an important first step to recovery.
8
Some signs include:
■ Problem drinkers or drug users have a definition of alcoholism
or addiction that excludes themselves.
■ Problem drinkers or drug users focus on symptoms of alcoholism
or addiction they do not have, and use this as an excuse to avoid
self-diagnosis.
■ Problem drinkers or drug users change their definition of “problem”
over time in order to exclude their worsening symptoms.
Your willingness to take action can be a vital step to help break
through the misperception that frequently affects drug or
alcohol abusers.
How can you help a co-worker or family member who you suspect
is having drug or alcohol addiction problems?
One way to help is through Constructive Intervention. This
involves observing and evaluating changing behavior over time,
documenting performance problems to provide factual information
to the troubled employee or family member, and referring the
troubled employee to DARS, or other medical resource, to discuss
the issue and gain positive support.
9
Here are the steps that are proven effective to help you approach a co-worker or
family member and motivate them to accept a referral to assistance as a result
of on-going job performance or behavior problems.
Constructive Intervention
Observe and Evaluate:
■ The concerned co-worker observes changes from normal performance or behavior.
■ The concerned employee observes “patterns” of change over time.
■ The concerned employee is objective and non-judgmental. Emotions can distract
from your purpose.
Documentation:
■ A list of your observations makes it easier to approach and discuss your concerns.
■ Be prepared – put your facts on paper for an orderly, presentable discussion.
■ Your troubled co-worker or family member may try to minimize or avoid the issues.
Documentation provides concrete facts to base the discussion upon.
■ Documentation should be non-personal and non-judgmental.
Discussion:
■ Meet with your co-worker in private – where you both feel comfortable.
■ Discuss job performance or behavior problems and how they impact you and
your other co-workers.
■ Just state the facts as you see them – do not ask questions – they open the
opportunity for excuses.
Referral:
■ Suggest the co-worker discuss their problems with their local DARS counselor, union
representative, or family member and ask for support.
■ When drugs and alcohol are suspected – refer the troubled co-worker or family member
directly to the company DARS program (see page 13 for contact information).
Follow-up:
What can I say to
my co-worker if
I believe they have
a potential addiction
problem?
The “sometimes”
speech is a good
start. Find an
appropriate time
in a private area
and say,
“I’m seeing a change in you,
friend. Sometimes problems
like these are the result of
drug or alcohol abuse going
on outside the workplace.
It may not be true in your
case, and it’s not for me to
diagnose. However, because
it’s true sometimes, the
company has a drug and
alcohol rehabilitation service.
It’s a benefit and is confidential.
It has helped a lot of people
with their problems.”
■ Be a positive supporter if performance improves, regardless of whether or not the
co-worker seeks outside assistance.
■ Do not become an enabler if poor performance or behavior continues.
■ Communicate with your personal support system during the referral process.
Your local DARS counselor is available to provide you confidential support
throughout this process. Call him/her whenever you have questions!
10
11
If my co-worker opts to contact DARS, how will he or she be treated?
DARS participants receive confidential assessment, referral,
and follow-up support. DARS is a benefit provided by Norfolk
Southern, and is at no cost to the employee. However, some
referral resources have separate costs not covered by DARS,
but may be covered by your medical plan. DARS services include:
Assessment and Recovery
4
6
11
2
5
10 8
3
7
9
■ Education about addictive disease
■ Establish counseling, hospital, or 12-Step recovery connections
■ Knowledge to prevent relapses
Referral Resources
■ Education
■ 12-Step programs
■ Outpatient counseling
■ Outpatient hospitalization
■ Residential treatment
(Note that four out of five of the above referral options have no
mandatory out-of-service if utilized prior to rule violations.)
1Atlanta, GA
(404) 529-2225
*529-2225
(GA, except Columbus, GA)
(770) 405-3619
*405-3619
(AL, MS, Columbus, GA)
2Birmingham, AL
3 Charlotte, NC
■ Early referral is a win-win for everyone
Follow-up
4Decatur, IL
■ DARS participation may not require lost time
■ DARS participants receive continuing support by the DARS
program throughout the recovery process.
(704) 378-3701
*332-3701
(SC, NC, WV)
(217) 425-2131
*425-2131
(N.W. IN, IL, MO)
5Harrisburg, PA
12
DARS counselors are located across
the system and are available 24/7.
1
■ Identify, assess, and evaluate drug and/or alcohol abuse problems
■ Encourage family involvement
How can we contact DARS?
(717) 541-2236
*541-2236
(E. PA, NJ, DE,
E. & central NY, Baltimore, MD)
6Hartford City, IN
(765) 348-4561
*672-1171
(N.E. & central IN, central & southern OH)
7Knoxville, TN
(865) 521-1555
*521-1555
(TN, KY, Cincinnati, OH, S. IN)
8 Norfolk, VA
(757) 629-2447
*629-2447
(Norfolk, VA area)
(412) 893-5044
*444-5044
(W. PA., E. OH, W. NY)
9Pittsburgh, PA
10Roanoke, VA
(540) 981-4406
*981-4406
(VA, except Norfolk)
(419) 534-2454
*672-1810
(N.W. OH, MI)
11Toledo, OH
* Denotes microwave
() Denotes service area
13
Additional Information Resources:
National Institute on Alcohol Abuse and Alcoholism
www.niaaa.nih.gov
301-443-3860
National Institute on Drug Abuse
www.nida.nih.gov
301-443-1124
National Clearinghouse for Alcohol and Drug Information
www.ncadi.samhsa.gov
A Clean Body and Clear Mind are the Best Tools for Safety.
800-552-2306
See more about DARS at the
www.nscorp.com/DARS
38.1210.564.20K
We live in a modern day and time.
“The days are over [in substance abuse]
when friends, family and employers can
sit back and wait for someone to hit rock
bottom and ask for help on their own.”
- James Fearing Ph.D.
Workplace Intervention, 2001
“NS has committed to refreshing
our educational efforts and we will
continue to sustain a culture
supportive of identifying and helping
troubled co-workers.”
- Mark Manion
PEER to PEER
EVP & Chief Operating Officer
“We’re encouraging employees to
voluntarily step up and take ownership
of their behavior before something
happens. Through Peer-to-Peer support,
at-risk employees can seek help without
jeopardizing their job.”
- Dr. Paula Lina
Medical Director
To obtain contact information about
your local Peer-to-Peer program, contact
the DARS Manager at 757-629-2447.
Norfolk Southern Corporation | Three Commercial Place
Norfolk, Virginia 23510 | www.nscorp.com
© 2014 Norfolk Southern Corp. — All Rights Reserved | 38.1014.8183.7k
A program, supported by Norfolk
Southern and promoted by Employee
volunteers, that will assist all NS
employees impacted by drugs and
alcohol in the workplace through
awareness and education.
PEER to PEER
How does substance abuse affect
the workplace?
How can I help a co-worker that may
have an alcohol and/or drug problem?
• Over 74% of all current illegal drug users
• Take Action before your co-worker has a
rule violation
work, and over 74% of heavy alcohol users
work (those drinking five or more drinks per
occasion on five or more days in past 30 days).
The Peer-to-Peer program consists of
employee volunteers who:
• Promote an alcohol & drug (A&D) free
workplace
• Promote healthier lifestyles
• Educate co-workers to recognize
at-risk behaviors
• Provide an additional resource for
co-workers to receive guidance concerning
substance abuse issues.
• Contact your Peer-to-Peer Coordinator for
guidance and support
Source: National Drug-Free Workplace Alliance, 2014
• Drinking does not have to occur on the job
to affect the job. Hangovers account for
many workplace productivity losses.
• If you think there is a problem, discuss your
concerns with the co-worker.
- You are in a unique position as a peer
to be helpful
- Your friend/co-worker may listen to
you when he/she won’t hear anyone else
- You want your co-worker to realize
that his/her performance or behavior is
declining and others in the workplace
are noticing
Source: SAMSHA: Workplace Substance Abuse Statistics Fact Sheet, 2006
• On-the-job drug use can lead to an increased
risk of accidents and injuries. It can also
lead to lower levels of productivity and
employee morale, not only among those with
substance abuse problems but also among
those working alongside them.
Source: SAMSHA: Workplace Substance Abuse Statistics Fact Sheet, 2006
• Motivate at-risk co-workers to seek help
• Reduce alcohol & drug rule violations
• Drug-using employees are 3.6 times more
likely to be involved in workplace accidents.
Source: National Drug-Free Workplace Alliance, 2014
Peer-to-Peer volunteers:
• Are available to talk with co-workers
concerning A&D issues
• WILL NOT – Identify Peer-to Peer program
volunteers to management
• WILL NOT – Ignore an employee in need
of assistance
• WILL NOT – Disclose information that would
appear in employee records
• WILL NOT – Give up on our joint goal of
promoting an alcohol and drug free
work-place.
You have the right to work in a drug
and alcohol free workplace
There are resources available to help resolve
A&D issues.
Prevent A&D Rule Violations:
Sometimes, there are early warning signs that a
co-worker has an alcohol/drug problem before a
rule violation occurs.
Co-workers are in an ideal position to notice
job performance problems that could be due to
alcohol or drug abuse.
Alcohol or drug abuse is progressive. It will
lead to serious consequences if not recognized
and treated.
You can make a difference -
Take Action!
To obtain contact information about
your local Peer-to-Peer program,
contact the DARS Manager at
757-629-2447.

Employee Medical Resource Book

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