1. (a) The governing board of each school district and the county superintendent of schools office shall provide a pre-employment medical examination form and related information as prescribed in this section to persons being employed for the first time in a California school district or county office in a position requiring certification requirements in accordance with section 44839 of the Education Code.
2. (b) The governing board or office of the county superintendent of schools shall also develop a brief statement of functions involved in the position for which the applicant will be employed and attach it to the medical certification form for the guidance of the physician. Functions should be described in terms of activities which may be performed such as: teaching physical education; being able to readily move about the classroom and playground; climbing flights of stairs or operating mechanical equipment.

3. (c) The governing board of each school district and the county superintendent of schools office shall use the following medical certificate or a similar certificate developed locally and approved by the California Department of Education:

   1. (1) Evidence of lack of ability to demonstrate average physical and emotional capacity for the functions involved.
   2. (2) Evidence of disability which periodically may disable the individual; for example, rheumatoid arthritis, uncontrolled diabetes, asthma.

   3. (3) Evidence of long term disability which may progressively deteriorate; for example, malignancy, Multiple Sclerosis.

      Details

      Check Every Item YES NO

      (Relate to functions to be performed)

      1.

      Is there evidence of disabling disease of the musculo-skeletal, cardio-vascular, nervous, gastro-intestinal, genito-urinary, endocrine systems? ______

      2.

      Is there evidence of disabling disease affecting vision, hearing or speech? ______

      3.

      Is there evidence of disabling metabolic disease? ______

      4.

      Is there evidence of infectious disease in a communicable stage? ______

      5.

      Is there evidence of drug dependency including alcoholism? ______

      6.

      Is there evidence of any other disabling disease? ______

      On the basis of my medical examination on (date) ____________ the above named individual is free from disabling disease, except as noted above, which I believe unfits the individual to instruct, in the position for which application is being made, or to associate with children.

      /

      Signature of Physician

      Date

      /

      Name of Physician (print)

      License #

      To be returned by the examining physician directly to the school district or County Office requesting the examination.

   CERTIFICATE OF MEDICAL EXAMINATION OF APPLICANTS FOR FIRST EMPLOYMENT IN A CALIFORNIA SCHOOL DISTRICT OR COUNTY SUPERINTENDENT OF SCHOOLS OFFICE

   ______________________________(Name) School District; County Office

   Name:

   Last

   First

   Middle

   Address:

   Street

   City

   Zip Code

   To the Physician:

   The medical examination required of a person employed in a certificated position for the first time in a California School District or County Superintendent of Schools Office to determine freedom from any disabling disease unfitting the person to instruct or associate with children should be evaluated on the basis of the function which will be required of the applicant upon employment. A brief description of functions is attached to this form.

   Disabling disease should be considered in terms of:

4. (d) The governing board of each district or county superintendent of schools office shall determine, on the basis of information on the medical examination form, whether or not the applicant is free from any disabling disease unfitting the applicant to perform the functions, required in the position for which application is being made, or to associate with children.
5. (e) The governing board of a school district or the county superintendent of schools office may require certificated employees to undergo a periodic medical examination by a licensed physician and surgeon to determine that the employee is free from any communicable disease unfitting the employee to instruct or associate with children. Such examination shall be at the expense of the school district and may be recorded in a locally developed medical referral form.

Note: Authority cited: Section 44843, Education Code. Reference: Section 44843, Education Code.

History

1. New section filed 1-17-75; effective thirtieth day thereafter (Register 75, No. 3).

2. Amendment of section and repealer of Note filed 9-23-77; effective thirtieth day thereafter (Register 77, No. 39).

3. Renumbering of Section 5505 to Section 5504 filed 11-9-79; effective thirtieth day thereafter (Register 79, No. 45). For history of former Section 5504, see Register 78, No. 45.

4. Change without regulatory effect amending subsections (a) and (c) filed 12-23-2010 pursuant to section 100, title 1, California Code of Regulations (Register 2010, No. 52).