Fitness for Duty Tests and the AMA Guides: Assessing Risk, Capacity, and Tolerance to Work

26 Jul

Is an Employee Safe to Work?

Determining whether a person is able to work safely can be difficult and challenging: it has the potential to affect individuals’ livelihoods as well as employers’ human resources by influencing workers’ employability, job transfers, promotions, workers compensation, and disability determinations. Conducting an FFD examination is both a science and an art. According to the AMA Guides to the Evaluation of Work Ability and Return to Work, when assessing ability to work, the evaluator should consider three primary factors: risk, capacity, and tolerance. Assessment of the first two of these factors, risk and capacity, can be correlated to federal guidelines established by the ADA.


Risk refers to the chance that a worker will cause harm to self or others when performing work. The FFD evaluator primarily determines risks related to known medical conditions. No one can expect an FFD evaluator to know with 100% certainty that an employee can work without risk of being injured or injuring someone else. However, the expectation is that the FFD evaluator will make decisions based on a reasonable degree of medical certainty. When it comes to assessing risk, the ADA provides the “direct threat” standard as the bar that the evaluator may use.


Capacity refers to scientifically measurable physical abilities, such as strength, flexibility, and endurance. A well-designed FFD examination adequately measures these physical parameters. Therefore, combining the evaluator’s medical expertise with the objective measures derived from valid FFD tests, in most cases, provides an effective means to assess work ability within a reasonable degree of medical certainty. Regarding capacity, the ADA provides that the FFD evaluator should compare the employee’s strength, flexibility, and aerobic capacities to the “essential physical demands” of the job.


Tolerance presents the greatest challenge to the FFD evaluator, especially in return-to-work cases. Tolerance refers to the ability to tolerate performing sustained work or work at a certain level. This factor can be positively or negatively affected by psychosocial or psychological factors, such as motivation to return to work, and therefore defies scientific measurement or verification.

WorkSaver Fitness for Duty Evaluation

The WorkSaver FFD Evaluation, since 1993, has proven to be highly effective in determining risk and capacity for work and provides a good estimate regarding work tolerance, although work tolerance as indicated above defies objective measurements. Since administration of WorkSaver testing, WorkSaver has documented savings to employers in the millions of dollars related to injury prevention and improved work productivity. These savings were prevented by proper screening using job-simulated testing based on validated functional job descriptions.

For more information regarding the WorkSaver process, please call (800) 414-2174 or e-mail Dr. Bunch at or Trevor Bardarson, PT, OCS, CBES, President at


Gross, DP, and Reneman, MF, (2011) Functional Capacity Evaluation in Return-to-Work Decision Making: Risk, Capacity, and Tolerance. In AMA Guides to the Evaluation of Work Ability and Return to Work, 2nd ed., 87-98

Comments are closed.

Leave a Reply

Test Orientation Video Evaluator Training Video

WorkSaver Employee Testing Systems
478 Corporate Dr.
Houma, LA 70360