Document Citation: 5 CCR 5504

Header:

CALIFORNIA CODE OF REGULATIONS
TITLE 5. EDUCATION
DIVISION 1. CALIFORNIA DEPARTMENT OF EDUCATION
CHAPTER 6. CERTIFIED PERSONNEL
SUBCHAPTER 1. GENERAL PROVISIONS
ARTICLE 2. EMPLOYMENT AND DISMISSAL

Date:
08/31/2009

Document:
§ 5504. Medical Certification Procedures

(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 withsection 44839 of the Education Code.

(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.

(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:

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

...................... School District; County Office
Name
---
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:

(1) Evidence of lack of ability to demonstrate average physical and emotional capacity for the functions involved.

(2) Evidence of disability which periodically may disable the individual; for example, rheumatoid arthritis, uncontrolled diabetes, asthma.

(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 in- cluding 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.

(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.

(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.