Ken,

Here you go. This is the consent our clinic uses with our agility tests. Our physician and nurses also do some more simple functional and lift testing which we do not require this form to be signed if it's part of a physical or RTW. If you need any other guidance, please reach out to me directly and I'd be happy to help.

Thank you,

Dave

Dave Stoklosa MS,ATC,CSCS,CEAS

Assistant Director McLeod Occupational Health - Health and Safety

Email: dstoklosa@mcleodhealth.org

Office: (843) 777-5156

Cell: (843) 409- 5339

From: MCOH-EH <mcoh-eh-bounces+dstoklosa=mcleodhealth.org@mylist.net> on behalf of Subin, Kenneth, MD <ksubin@cayugamedicalassociates.org>
Sent: Thursday, January 5, 2023 12:37 PM
To: mcoh-eh@mylist.net <mcoh-eh@mylist.net>
Subject: [MCOH-EH] In Office Lift Test

**External Email**

All, if anyone does lift testing in their offices, do you have the post-offer employee sign a release of liability in the event of an injury while testing? If so, would you be willing to share such document?

This is a new service for our office. Any other issues I should consider before implementing?

Thank you in advance for your feedback.

Ken

Kenneth Subin, MD, MPH, DipABLM

Chief Medical Officer, Cayuga Medical Associates, PC

Occupational Medicine, Cayuga Medical Associates, PC

16 Brentwood Drive

Ithaca, NY 14850

P (607) 339 - 0680

F (607) 319 - 5532

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