| Federal regulations affect the medical
information you gather and maintain in
your files at camp. ACA health forms have
been prepared in light of those regulations,
and have been reviewed by legal counsel
and the American Academy of Pediatrics.
Approval by the Academy of Family Physicians
is also pending, and their input was utilized
in the development of the form. Because
of the changing legal climate and changes
in the management of health care, you should
be sure that any health form you use has
undergone legal and medical review within
the past 18-24 months.
OSHA Regulations
on Recordkeeping
Medical records and logs of health
care activity must be separate for campers
and staff. OSHA expects to see employee
(or staff) records in logs that are for
employees only. OSHA expects employee records
to be maintained for 20 years, with the
exception of records for employees who
report an exposure incident to bloodborne
pathogens. Those records must be maintained
for the period of their employment plus
30 years.
Americans
With Disabilities Act and Health Information
The ADA permits the gathering of health information
for the purposes of providing adequate service to
campers or staff, but it restricts how and when that
information may be gathered. See below for a description
of the requirements that affect both campers and
staff.
It should be noted that the ADA mandates
that health information on staff be kept
separate from other personnel records,
and that information on all persons with
disabilities be treated as confidential
except for those with a clear need to know.
The American Camping Association believes
that the intent of gathering health information
on employees and campers in camp is to
provide accurate and helpful information
to those providing health care to the individual,
not to assist in making employment or enrollment
decisions. Therefore, we suggest gathering
camper and staff health information on
the same form (not a different form for
staff) since the form is designed for the
same purpose: to provide health background
information to health providers.
Health History and
Health Examination Considerations for Campers
The ADA prohibits unnecessary
inquiries into the existence of a
disability. The intent of questions on
the health form should be to ensure safe
participation in camp activities. Knowledge
of allergies, medical conditions, and
previous surgery such as knee reconstruction,
can clearly be seen to affect one’s
safety in camp. However, such information
may not be used to screen out
children with disabilities from camp.
As the first stop in providing health
care for campers, camps may find it necessary
to have additional information on hand
to assist them in providing treatment until
professional medical care is reached, or
to identify appropriate professional care
needed. In light of concerns for discrimination
under both ADA and civil rights legislation,
ACA recommends any additional questions
you wish to add to the health form be cleared
by the camp’s legal and medical counsel.
Asking About
Camper Disabilities
There is no question that camps
need to know if adaptations or special
accommodations are required to help a camper
participate fully in camp program. This
information may not be used
to discriminate against the enrollment
of the camper.
Many camps are including on their camp
application (not the health form) a question
such as "Please identify any special
adaptations or accommodations necessary
to assist the camper to participate in
camp program.
Health History and
Health Examination Considerations for Staff
The Americans With Disabilities
Act (1990) provides specific guidelines
on health information and its use with
reference to staff. These guidelines affect
WHAT information you gather, WHEN you gather
it, and HOW it is maintained and utilized.
- Pre-hire. Medical inquiries
are not permitted by the ADA prior to
offering the individual a job. You may
NOT ask for a health history, ask about
disabilities, or ask about preexisting
medical conditions prior to offering
the individual a job. You may ask about
the employee’s ability to perform
the essential functions of the job.
In the reference/screening process, you may
also inquire if the individual is, in the reference
giver’s opinion, able to perform specific
essential job functions that you identify.
However, you may not ask for information in
a reference that you are not permitted to ask
on an application form or in an interview.
- Post-hire/Pre-employment. From
the time you make a job offer (send a
contract) until the first day of work,
you may ask staff anything about health
conditions, whether or not it is related
to the job they will be performing. You
MAY NOT USE this information in a discriminatory
manner, but you may gather it. For instance,
since the camp health lodge is the first
stop for health care for campers and
seasonal staff, camp officials may gather
and maintain information on previous
health conditions, current medications,
etc. But you may not withdraw
the employment offer based on the fact
that the health form indicates the individual
has epilepsy or some other health condition,
unless that condition hears a significant
risk of substantial harm to that individual
or others such as co-employees or those
he or she would supervise.
To avoid confusion, camps should obtain
health information needed to provide adequate
levels of health care for staff at this point
in the process . . . after the job
offer but prior to the starting date (first
day of staff training).
- Post-employment. The ADA dictates
that once a person reports for
work (e.g., comes to precamp training),
questions concerning medical and health
issues may be asked only if they are
job-related and consistent with business
necessity. It would he appropriate to
ask a maintenance employee whose job
requires lifting about a back condition,
for instance.
Since ACA health forms have not been
developed for employment purposes, but rather
for health care purposes, there may be some
questions on these forms that appear questionable
under the ADA when asked post-employment.
If your procedure is to gather health information
on employees after they begin work, we advise
you to seek medical counsel, and legal counsel
from an attorney familiar with the labor regulations
of the ADA.
Therefore, so you do not need to develop
multiple health history or examination
forms, ACA recommends you develop a procedure
to collect all health information on
staff after you offer the job, but before
they begin work. Our health
history and examination forms have been
developed with that intent. These forms
have been prepared based on the
assumption that this information is gathered
primarily to assist you in providing health
care to all persons in camp, NOT as part
of the screening process in employing staff.
Additional Questions
and Observations
- Why doesn’t ACA have questions
about HIV status on the health form?
The American Academy of Pediatrics
(AAP) does not recommend universal
testing/screening for lily, even
for health care workers. Their rationale
for children is that most are not
seen as being at high risk for HIV.
Additionally, the law requires the
use of universal precautions at all
times. It is the responsibility of
the camp to train staff and provide
appropriate protective equipment
to implement this mandate.
- May I deny enrollment to a camper
or staff member with AIDS?
If you are a public accommodation
under the definitions of the Americans
With Disabilities Act, and while
you are covered by the employment
provisions of that act, you may not
deny enrollment or employment exclusively
on health status. Persons with AIDS
and persons who test positive for
the HIV virus are protected under
the ADA.
- My state requires me to obtain parental
permission to dispense over-the-counter
drugs we stock in our health lodge
for common illnesses like headache,
diarrhea, upset stomach, and so forth.
How do we handle that?
Many camps have developed a sheet in
addition to the health history form that identifies
common illnesses and identifies those over-the-counter
preparations used for same. After identifying
the illness and the medication utilized, they
ask the parent to sign the form giving permission
for the camp to use that medication in the
situations identified. This way the camp has
specific permission to utilize acetaminophen,
meds for upset stomach and so forth. Such a
sheet could he developed in conjunction with
your camp physician and inserted inside the
health form when sent to parents.
- I have other questions that I want
on my health form. What should I do?
We suggest you provide an addendum
to the health form to gather additional
information. Check with your local legal
and medical counsel about the appropriateness
of material you wish to add. Keep in
mind that the ACA form is a copyrighted
document. Copying it without permission
is a violation of federal copyright law.
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