NORFOLK SOUTHERN MEDICAL DEPARTMENT RESOURCE BOOK FOR EMPLOYEES

Transcription

1 NORFOLK SOUTHERN MEDICAL DEPARTMENT RESOURCE BOOK FOR EMPLOYEES Norfolk Southern Medical Department (NSMD) resources listed below provide you with direct contact information for your assigned NSMD case coordinator and information about the return-to-work process to help you return-to work as quickly as possible. These resources also include a medical fax cover sheet that you can use when sending records to the NSMD as well as exam checklists for physicals. This resource book is available from your supervisor through Material Management on a zip drive Product ID This book and the resources described below are also available: on the ERC go to the ERC, click on Employee Self-Service, then, click on Medical Information. at nscorp.com click here or go to nscorp.com, click on EMPLOYEES, then click on Medical. From these locations, you can view, print or transfer the resource to your computer, ipad or Smartphone: View the resource by simply clicking on the resource name. Print the resource by clicking on the resource name to open and view, then click the print icon, or click File and Print. Each of these resources is a PDF file that can be saved on your computer and/or stored on your Smartphone or ipad. 1. Contact Information Red Flyer for Employees this 8 X 10 flyer provides direct contact information for the NSMD case coordinator assigned to the employee s case. Medical Department Personnel Phone Directory provides phone numbers for NSMD personnel. 2. General Information Resources Summary Chart for Employees this chart provides the employee with a quick summary of available NSMD resources, forms and documents, including where the resources can be accessed. NSMD procedure for handling Local and General Chairmen calls guidance for Local and General Chairmen when calling the NSMD on behalf of a member.

2 NSMD Resource Book for Employees 3. Links step by step picture guides to help you quickly access medical resources. How to access NSMD forms, documents and other resources this step by step picture guide describes how to access NSMD resources on the ERC or outside the NS network at nscorp.com. How to access the Federal Motor Carrier Safety Administration s web page this step by step picture guide describes how to access the Federal Motor Carrier Safety Administration s web page for helpful information about driver fitness-for-duty requirements, specialty programs (Diabetes and Vision Exemption programs), and answers to frequently asked questions. 4. Physical Exams Checklists for designated jobs these checklists describe the examination components for physical exams that are required by the company or federal regulation. Exam checklists are available for: Brakeman CDL Initial certification for other than Signalman/signal maintainer. CDL initial certification for Signalman/Signal Maintainer. CDL/Non-CDL Driver recertification Crew Transporter Non-CDL Driver initial certification T&E and other specified crafts - recertification 5. Medical Condition and Medication Guidance Medical Condition and Medication Guidance describes the responsibilities that an employee has with respect to his/her medical condition and medication to help ensure his/her safety at work. This guidance also describes additional responsibilities that safety-related employees, yardmasters, crew haulers and NS police officers have regarding their medical conditions, medical events, medication and workplace safety. RX Med Form this form describes NSMD prescription medication guidance by category for safety-related employees, yardmasters, crew haulers and NS police officers. This form is a supplement to NSMD Medical Condition and Medication Guidance. 6. Return-to-Work Return-to-Work Checklist this checklist describes important steps for an employee to take when he/she marks off work medically, and also provides helpful information about the return-to-work process. Return-to-Work Information Sheet this document provides direct contact information for the NSMD case coordinator assigned to the employee s case; provides general medical documentation requirements for specific conditions; describes general return-to-work procedures and describes how to send medical records to the NSMD.

3 NSMD Resource Book for Employees Medical Fax Cover Sheet interactive fax cover sheet for use by employees when sending records to the NSMD. Health Questionnaire for employees with non-medical absences of a year or longer due to, furlough, military leave, discipline, etc. 7. Educational Material about Medication - educational material about medication is available to help employees: actively manage the benefits and risks of their medication; read a drug label; talk with a pharmacist; select the right over-the-counter medication; understand drug interactions; and drive safely if they are taking medication. What s on the Label? Tips for Talking with a Pharmacist Be an Active Member of Your Health Care Team Think it Through: A Guide to Managing the Benefits and Risks of Medicines Over-the-Counter Medication: What s Right for You? Drug Interactions: What You Should Know Driving When You Are Taking Medications Opioid Painkillers: What you need to know before you start taking them 8. Vocational Rehabilitation Services (VRS) this flyer describes VRS services provided as well as VRS contact information. 9. Drug and Alcohol Rehabilitation Services (DARS) How Can You Help Someone Who May Be In Drug & Alcohol Trouble? this brochure describes what you can do to help a co-worker who may have a drug or alcohol problem, and also provides information about the Norfolk Southern DARS program, a confidential service available to help all NS employees without jeopardizing employment. This brochure is also available on the DARS website at Peer to Peer Program: Railroaders for Recovery this brochure describes a program supported by Norfolk Southern and promoted by employee volunteers, that will assist all NS employees impacted by drugs and alcohol in the workplace through awareness and education. These brochures are also available on the DARS website at

4 Medical Condition and Medication Guidance Page 1 Medical Condition and Medication Guidance Medical conditions, medication and dietary supplements may impair your ability to safely perform your job duties. Some medications and supplements taken alone or in combination can cause serious side effects that may impair your safe job performance. These medications include both prescription and non-prescription drugs. This guidance describes what you must do if or when you have a medical condition or are taking medication or dietary supplements. You can access this guidance and other helpful resources described below on the ERC [Click on Employee Self Service, then, on Medical Information.] or, at [Click on EMPLOYEES, then, on Medical]. If you do not have access to a computer, please call the NSMD at for help. 1. You have responsibilities to help ensure your safety at work with respect to your medical conditions and your use of prescription and over-the counter medications, and dietary supplements. These responsibilities include: a. Staying off work (do not report to work or remain at work) if your ability to safely perform your duties is compromised by your medical condition, medication and/or dietary supplement. b. Knowing and understanding the potential adverse effects of any medication and dietary supplement you are taking. i. Read the medication and dietary supplement labels. Pay particular attention to label warnings that indicate use may compromise the safe performance of your duties such as may cause drowsiness or do not take this medication while driving a vehicle or operating heavy equipment. ii. iii. Comply with label recommendations if the over-the-counter (OTC) medication or dietary supplement label indicates that use may compromise the safe performance of your duties. If prescribed a medication, talk to your prescribing health care provider about potential side effects from the drug (when taken alone or in combination with other medication or dietary supplement) that may compromise your ability to work safely. c. Talking to your treating healthcare provider if you question whether your medical condition may compromise your ability to work safely. d. Providing to the Norfolk Southern Medical Department (NSMD) medical information requested to enable a determination of your fitness-for-duty. A fitness-for-duty evaluation determines your ability to perform safely your essential job functions with respect to your medical condition, medication and any reasonable accommodation. This includes your disclosure of medical conditions and medications during periodic medical evaluations required either by the company or by Federal regulation. A fitness-for-duty determination is based upon an individualized assessment of your specific situation. Revision Date: 7/28/15

5 Medical Condition and Medication Guidance Page 2 e. Complying with any work restriction(s) that your health care provider and/or the NSMD have imposed on you with respect to your medical condition and/or medication, as well as any applicable regulatory medical standards. 2. If you are a safety-related employee 1, yardmaster, crew hauler or NS police officer, you also have the responsibility to: a. Notify your treating healthcare provider(s) about the full extent of your duties. b. Notify at least one of your healthcare providers of all your prescription and over-the-counter medication, and dietary supplements to help ensure that your use is consistent with the safe performance of your duties. c. Notify the NSMD if you have a reportable medical condition or medical event as outlined in Appendix A. Appendix A also includes a reporting form for your use. Appendix B provides NSMD contact information. i. The list in Appendix A focuses on some medical conditions and events that may compromise your mental functioning and result in sudden impairment. This list is not allinclusive and serves as a starting point to guide you. ii. If you question whether you have been diagnosed with a medical condition or had a medical event listed in Appendix A, please provide the list to your treating health care provider, and ask him/her for help. d. Follow NSMD guidance for prescription medication described in RX Med Form. For answers to frequently asked questions about NSMD medication guidance, please refer to page 2 of the form. 3. Educational material about medication is available to help you: actively manage the benefits and risks of your medication; read a drug label; talk with a pharmacist; select the right over-the-counter medication for you; understand drug interactions and drive safely if you are taking medication. 1 Safety-related employee - any agreement or non-agreement employee who: is covered under the hours of service laws; inspects, installs, constructs, repairs, or maintains track, roadbed, bridges and signal and communication systems; inspects, repairs, or maintains locomotives, passenger cars or freight cars, or other on-track equipment when such equipment is in service that constitutes a train movement; determines that an on-track roadway maintenance machine or hi-rail vehicle may be used without repair of a non-complying condition; directly instructs, mentors, inspects, or tests, as a primary duty, any person while that other person is engaged in a safetyrelated task; or is responsible for conducting periodic tests and inspections of safety-related employees. Revision Date: 7/28/15

6 Medical Condition and Medication Guidance Page 3 Appendix A: Reportable Medical Conditions and Events (For safety-related employees, yardmasters, crew haulers and NS police officers.) Remember, your medical information is confidential. When the NS Medical Department requests your medical information for a fitness-for-duty determination, you should not reveal your medical information to any NS employee except Medical Department personnel. REPORTABLE MEDICAL CONDITIONS AND EVENTS This list highlights some medical conditions and events that may compromise your mental functioning and result in sudden, unsafe impairment. If you question whether you have been diagnosed with a medical condition or had a medical event listed below, please provide this list to your treating health care provider and ask him/her for help. This list is not all-inclusive. If you have questions or concerns about your medical condition/event and safe work performance, talk to your health care provider. Your NS Medical Department case coordinator (please see Appendix B for contact information) is also available to help you. A new diagnosis or change in a prior stable, medical condition, and/or a recent (e.g., within the prior 6 months) medical event for one of the following: New diagnosis or change in prior stable, medical condition: Cardiac (heart) or cardiovascular condition: Angina (heart-related chest pain or discomfort) Heart attack Cardiac arrest (heart suddenly stops beating) requiring cardio-pulmonary resuscitation (CPR) or use of a defibrillator Serious Cardiac Arrhythmia (abnormal heart rate or rhythm) requiring medical treatment Severe Hypertrophic or Dilated Cardiomyopathy (enlarged heart or heart failure) Severe Aortic Valve Stenosis (heart valve problem) Neurologic (brain, spinal cord and nerves) condition: Bleeding inside the skull (intracranial) or bleeding inside the brain (intracerebral) Stroke or Transient Ischemic Attack Seizure Disorder, such as Epilepsy, Complex Partial Seizure Disorder or Simple Partial Seizure Disorder Recent (e.g., within the prior 6 months) medical event: Seizure of any kind Loss of consciousness or fainting (syncope) episode that: occurred two or more times in the prior six months or is due to a cardiac (heart), cardiovascular or neurological (brain and nerves) condition Severe hypoglycemic event (low blood sugar event requiring the assistance of another person and/or causing confusion, loss of consciousness or seizure) Revision Date: 7/28/15

7 Medical Condition and Medication Guidance Page 4 Appendix B: How to notify the NSMD about your reportable medical condition or event (For safety-related employees, yardmasters, crew haulers and NS police officers). Remember, your medical information is confidential. When the NSMD requests your medical information for a fitness-for-duty determination, you should not reveal your medical information to any NS employee except Medical Department personnel. 1. The best way to notify the NSMD is to contact directly your assigned case coordinator. Please provide your case coordinator with your full name and employee identification number. Please describe your reportable medical condition and/or medical event (including the date of your diagnosis, date your condition changed or date you experienced the medical event). First letters of employee s last name Your Assigned Case Coordinator PHONE FAX A Cm Cn GL Gm K L O P Sg Sh Z You can also use the Medical Condition and Medical Event Reporting Form to notify the NSMD. In order to expedite the fitness-for-duty review, the NSMD prefers this format, but will accept the information in other formats. Please complete and fax the form directly to your assigned case coordinator, or the form to the [email protected]. Revision Date: 7/28/15

8 Medical Condition and Medication Guidance Page 5 Medical Condition and Medical Event Reporting Form For safety-related employees, yardmasters, crew haulers or NS police officers please complete this form and provide the completed form directly to the Norfolk Southern Medical Department (NSMD). EMPLOYEE INFORMATION Name (Print) Last First Middle Initial Home Address City State Zip Phone No: Work Home Cell Employee ID No. Date of Birth: / / Job title: Employee s preferred method of contact: (check one) * Phone Either or phone *If preferred, employee s SUPERVISOR INFORMATION Supervisor's Name Title Department Supervisor's Phone No.: Location (City/State): TO: NSMD SUBJECT: REPORTABLE MEDICAL CONDITION OR MEDICAL EVENT Please describe your new medical condition (diagnosis), change in your prior stable condition, and/or your recent (e.g., within the prior 6 months) medical event. Please note the date you were diagnosed, date your condition changed and/or date you experienced the medical event. DATE FORM COMPLETED: The best way to send this form is to fax it directly to your NSMD assigned case coordinator. Your case coordinator s contact information is located in Appendix B of the Medical Condition and Medication Guidance. Alternatively, you can this form to [email protected]. Revision Date: 7/28/15

9 RED FLYER FOR EMPLOYEES DIRECT CONTACTS FOR NS MEDICAL DEPT CASE COORDINATORS MEDICAL CASES ARE ASSIGNED BY THE FIRST LETTERS OF AN EMPLOYEE S LAST NAME IF YOU NEED HELP WITH OR HAVE QUESTIONS ABOUT: RETURN-TO-WORK PROCESS REPORTABLE MEDICAL CONDITIONS AND EVENTS MEDICATION GUIDELINES PHYSICAL EXAMINATIONS OR HEALTH QUESTIONNAIRES DISABILITY/SICKNESS BENEFIT FORM COMPLETION YOUR CASE COORDINATOR S DIRECT CONTACT INFORMATION IS: A-Cm Phone: L-O Phone: Fax: Fax: Cn-Gl Phone: P-Sg Phone: Fax: Fax: Gm-K Phone: Sh-Z Phone: Fax: Fax: FOR VOCATIONAL REHABILITATION QUESTIONS, YOUR CASE COORDINATOR S DIRECT CONTACT INFORMATION IS: A-Z Phone: Fax: Best way to send records: Fax or your records directly to your case coordinator (call your case coordinator for his/her direct address). Alternate ways: to [email protected], or Fax to , or Mail to NS Medical Department. 8/3/2015 NS Medical Department Phone Three Commercial Place Norfolk, VA YOUR MEDICAL RESOURCES Available on website: Click on EMPLOYEES, then on Medical. Medical Condition and Medication Guidance RX Med Form medication guidelines by category Educational resources about medication Return-to-Work Checklist Return-to-Work Information Sheet Medical fax cover sheet Health Questionnaire (non-medical absence >1 yr) Med Dept Resource Book for Employees and more Available on ERC: Click on Employee Self Service tab, then on Medical Information. All of the above resources, and Red Flyer for Employees Resources Summary Chart for Employees Physical Exam Checklists (for T&E / CDL driver)

10 MEDICAL DEPARTMENT PERSONNEL PHONE DIRECTORY Norfolk Southern Corporation Medical Services Three Commercial Place Norfolk, VA Toll-free number: Director Medical Services ADMINISTRATIVE SERVICES Manager Medical Administration Medical Secretary Medical Case Coordinator Employees w/ last name initial A-Cm Medical Case Coordinator Employees w/ last name initial Cn-Gl Medical Case Coordinator Employees w/ last name initial Gm-K Medical Case Coordinator Employees w/ last name initial L-O Medical Case Coordinator Employees w/ last name initial P-Sg Medical Case Coordinator Employees w/ last name initial Sh-Z CLINICAL SERVICES Associate Medical Director Medical Services Clinician Employees w/ last name initial A-D Medical Services Clinician Employees w/ last name initial E-K Medical Services Clinician Employees w/ last name initial L-Rod Medical Services Clinician Employees w/ last name initial Roe-Z Manager Vocational Rehabilitation Services Vocational Rehabilitation Services Case Coordinator DRUG AND ALCOHOL TESTING SERVICES Substance Abuse Testing Manager Drug and Alcohol Testing Coordinator Drug and Alcohol Testing Coordinator Drug and Alcohol Testing Coordinator DRUG AND ALCOHOL REHABILITATION SERVICES (DARS) Manager DARS Norfolk, VA DARS COUNSELORS Austell, GA Charlotte, NC Decatur, IL Harrisburg, PA Hartford City, IN Knoxville, TN Pittsburgh, PA Roanoke, VA August 2015

11 NS Medical Department Resources Summary Chart for Employees RESOURCE (If you do not have access to a computer, please call the NS Medical Department at for help) Contact Information Medical Department Personnel Phone Directory Red Flyer for Employees (Direct Contacts for Case Coordinators) Authorized Medical Facility Listing (for company approved exams) Links (step by step guide) FMCSA s Driver Medical Fitness for Duty page How to Access NS Medical Department Resources General Information Medical Dept Resources Summary Chart for Employees Employee Resource Center (Click on Employee Self Service, then on Medical Information.) (Click on EMPLOYEES, then, on Medical ) Employee Medical Resource Book Forms Fax Cover Sheet Available through Material Management System (zip drive) Health Questionnaire for non-medical absences of > 1 year Checklists for physical exams Physical Exam Checklist for Brakeman Physical Exam Checklist for CDL Initial Cert Other than Signalman/Signal Maintainer Physical Exam Checklist for CDL Initial Cert Signalman/Signal Maintainer Physical Exam Checklist for CDL and Non-CDL Driver Recert Physical Exam Checklist for Crew Transporter Physical Exam Checklist for HAZWOPER/Sentinel Initial Exam Physical Exam Checklist for HAZWOPER/Sentinel Periodic Exam August 2015

12 NS Medical Department Resources Summary Chart for Employees RESOURCE (If you do not have access to a computer, please call the NS Medical Department at for help) Checklists for physical exams - continued Physical Exam Checklist for Police/Forest Personnel Physical Exam Checklist for T&E and Other Specified Crafts Recert Medical Condition, Medication and Return-to-Work Employee Resource Center (Click on Employee Self Service, then on Medical Information. Look in the yellow window) (Click on EMPLOYEES, then, on Medical ) Medical Condition and Medication Guidance RX Med Form medication guidance by category Return-to-Work Checklist Return-to-Work Information Sheet Educational Medical Resources Educational resources regarding medication Available through Material Management System August 2015

13 NS Medical Department handling of calls from Local and General Chairmen General Chairmen have an open line to the NS Medical Directors. When calling NS Medical Department ( ), the General Chairman should identify himself as a General Chairman and request to speak with the Medical Director. NS Medical Department handles the following types of Local Chairmen calls: What is the employee s status? What records have been received and/or what medical information is still needed? Why there is a delay in the employee s return to work? Why is a Functional Capacity Evaluation or a Medical Specialty Examination (such as an evaluation by an Orthopedic doctor) needed? What is the purpose of the requested evaluation? When calling the Medical Department on behalf of a member, the Local Chairman should first contact the member s assigned case coordinator listed on the Red Flyer for Employees or on page 2 of the Return-to-Work Information Sheet. The Red Flyer can be accessed on the ERC (Click on Employee Self Service, then on Medical Information and look in the yellow window). The Returnto-Work Information Sheet can be accessed on the medical information page on the ERC and at (Click on EMPLOYEES, then, on Medical ). If more help is needed, the case coordinator will refer the call to the assigned clinician handling the case. NS Medical Department will refer Local and General Chairmen calls to Labor Relations as appropriate, such as the following: DARS related case question to include status of return to work or assistance with benefit continuation. Initial requests for neutral or third party doctors (must be handled in accordance with CBA). Local Chairman or General Chairman understands the medical handling/medical decision (e.g. why the employee was placed on medical hold or why a Functional Capacity Evaluation is needed even though the treating doctor released the employee ) and is disputing either the medical handling and/or medical decision (to include a medical disqualification or medical hold) in a case. Any questions involving a case with an existing labor claim or questions about filing a new claim. NOTE: In responding to a chairman s call, the NS Medical Department must of course comply with its legal obligations regarding confidentiality. Basically, that means the Medical Department cannot provide details about the employee s medical condition, which the employee has not shared with the chairman. So, the more information about his condition(s) and his doctors that the employee voluntarily chooses to share with the chairman, the more specific the Medical Department s response to the chairman s questions can be. For example, if the chairman knows that Conductor Smith had a heart attack and is under Cardiologist Dr. Johnson s care, or is recovering from back surgery and is under the care of Orthopedist Dr. Jones, the Medical Department can advise the chairman that the NSMD is waiting on a stress test report from Dr. Johnson, and Dr. Johnson s cardiology office visit notes dated since June 5 th, or the Medical Department is waiting for Orthopedist Dr. Jones s response to a questionnaire faxed on July 16 th The chairman should also have the employee s EIN available to enable the Medical Department s access to the employee s medical file. As an additional safe guard, the local chairman will be asked by the Medical Department to provide his/her own EIN to verify his/her status. August 1, 2013

14 Where can you find NS Medical Department s forms, documents and other resources? On the Medical page on the ERC, or Outside the NS network at: August 2015

15 On the Medical page on the ERC 1 Go to Employee Self Service 2 Click on Medical Information Then, look here

16 Outside the NS Network just a few clicks 1 Go to nscorp.com 2 Click on EMPLOYEES

17 3 Click on Medical

18 Then, look here

19 Federal Motor Carrier Safety Administration (FMCSA) s Medical web page How to get to this page (step by step picture guide) Links to helpful resources, like: National Registry of Certified Medical Examiners Fitness for Duty Requirements Medical exemption programs (e.g., Diabetes and Vision) April 2015

20 Then, click on Regulations Go to

21 Click on Medical on the dropdown menu

22 Here you go!

23 {NS employee: please take this checklist with you and give it to the NS approved facility conducting your physical. For exam questions, call } EMPLOYEE PHYSICAL FOR: Physical Exam Checklist NORFOLK SOUTHERN PHYSICAL EXAMINATION REQUIREMENTS BRAKEMAN not applicable if certified conductor The employee should have the Employee Exam Packet forms: EMPLOYEE-EXAM FORM MED-AUDIO FORM The following exam components are required: Medical History Physical Exam includes Blood Pressure, Pulse, Height, and Weight Vision Distant each eye, uncorrected and corrected Color Ishihara or Titmus Field of Vision Audiogram Company Policy urine drug screen split collection (this is not a Federal test) The following exam components are not required: Rectum and prostate exam Stool test (blood) and digital rectal exam Medical facility handling of completed exam forms: 1) Within 24 hours, provide the Norfolk Southern Medical Department (NSMD): EMPLOYEE-EXAM and MED-AUDIO Forms: [email protected] or fax # Custody and Control Form: fax # ) Provide to employee: copy of completed Work Status Report (p. 4 of EMPLOYEE- EXAM form). 3) Retain originals of the EMPLOYEE-EXAM, MED-AUDIO, and Custody and Control forms for your file. Rev. March 2015

24 {NS Employee: please take this checklist with you and give it to the NS approved facility conducting your physical. For exam questions, call } EMPLOYEE PHYSICAL FOR: INITIAL CERTIFICATION FOR CDL DRIVER (26,001+ LBS VEHICLE) FOR OTHER THAN SIGNALMAN/SIGNAL MAINTAINER The employee should have the CDL Initial Cert Packet forms: CDL-I FORM MED-AUDIO FORM FMCSA Commercial Driver s Medical Exam Report (Form 649-F) FMCSA Medical Examiner s Certificate (Form 651) The following exam components are required: Medical History Physical Exam includes Blood Pressure, Pulse, Height, and Weight Vision Distant each eye, uncorrected and corrected Color Ishihara or Titmus Field of Vision Audiogram Urine dipstick for glucose, blood and protein Federal DOT-FMCSA urine drug screen initial CDL cert The following exam components not required: Rectum and prostate exam Stool test (blood) and digital rectal exam Medical facility handling of completed exam forms: 1) Within 24 hours, fax to the Norfolk Southern Medical Department (NSMD): CDL- I, MED-AUDIO, 649-F, and 651 forms fax # Custody and Control form fax # ) Form 651 (Medical Examiner s certificate): Physical Exam Checklist NORFOLK SOUTHERN PHYSICAL EXAMINATION REQUIREMENTS Provide original certificate to employee. Retain a copy of the certificate for your file. 3) Work Status Report (p. 4 of CDL-I form) provide copy to employee 4) Retain originals of the CDL-I, MED-AUDIO, 649-F, and Custody and Control forms for your file. Rev. March 2015

25 Physical Exam Checklist NORFOLK SOUTHERN PHYSICAL EXAMINATION REQUIREMENTS {NS employee: please take this checklist with you and give it to the NS approved facility conducting your examination. For exam questions, call } EMPLOYEE PHYSICAL FOR: INITIAL CERTIFICATION FOR CDL DRIVER (26,001+ LBS VEHICLE) FOR SIGNALMAN/SIGNAL MAINTAINER The new hire should have the CDL Initial Cert Packet forms: CDL-I FORM MED-AUDIO FORM FMCSA Commercial Driver s Medical Exam Report (Form 649-F) FMCSA Medical Examiner s Certificate (Form 651) The following exam components are required: Medical History Physical Exam includes Blood Pressure, Pulse, Height, and Weight Vision Distant each eye, uncorrected and corrected Color Ishihara or Titmus Field of Vision Audiogram Urine dipstick for glucose, blood and protein Federal DOT-FRA urine drug test Initial CDL cert for Signalman/Signal Maintainer The following exam components are not required: Rectum and prostate exam Stool test (blood) and digital rectal exam Medical facility handling of completed exam forms: 1) Within 24 hours, fax to the Norfolk Southern Medical Department (NSMD): CDL- I, MED-AUDIO, 649-F, and 651 forms fax # Custody and Control form fax # ) Provide to employee: original 651 form (Medical Examiner s certificate) retain a copy for your file. copy of completed Work Status Report (p. 4 of CDL-I form). 3) Retain originals of the CDL-I, MED-AUDIO, 649-F, and Custody and Control forms for your file. Rev. March 2015

26 {NS employee: please take this checklist with you and give it to the NS approved facility conducting your physical. For exam questions, call } EMPLOYEE PHYSICAL FOR: RECERTIFICATION FOR CDL DRIVER (26,001+ LBS VEHICLE) OR NON-CDL DRIVER (10,001 26,000 LBS VEHICLE) The employee should have the CDL Recert Packet forms: CDL-R FORM MED-AUDIO FORM FMCSA Commercial Driver s Medical Exam Report (Form 649-F) FMCSA Medical Examiner s Certificate (Form 651) The following exam components are required: Medical History Physical Exam includes Blood Pressure, Pulse, Height, and Weight Vision Distant each eye, uncorrected and corrected Color Ishihara or Titmus Field of Vision Audiogram Urine dipstick for glucose, blood and protein Company Policy urine drug screen split collection (this is not a Federal test) The following exam components are not required: Rectum and prostate exam Stool test (blood) and digital rectal exam Medical facility handling of completed exam forms: 1) Within 24 hours, fax to the Norfolk Southern Medical Department (NSMD): CDL- I, MED-AUDIO, 649-F, and 651 forms fax # Custody and Control form fax # ) Provide to employee: Physical Exam Checklist NORFOLK SOUTHERN PHYSICAL EXAMINATION REQUIREMENTS original 651 form (Medical Examiner s certificate) retain a copy for your file. copy of completed Work Status Report (p. 4 of CDL-I form). 3) Retain originals of the CDL-I, MED-AUDIO, 649-F, and Custody and Control forms for your file. Rev. March 2015

27 {NS employee: please take this checklist with you and give it to the NS approved facility conducting your physical. For exam questions, call } EMPLOYEE PHYSICAL FOR: Physical Exam Checklist NORFOLK SOUTHERN PHYSICAL EXAMINATION REQUIREMENTS CREW TRANSPORTER / JITNEY DRIVER The employee should have the Employee Exam Packet forms: EMPLOYEE-EXAM FORM MED-AUDIO FORM The following exam components are required: Medical History Physical Exam includes Blood Pressure, Pulse, Height, and Weight Vision Distant each eye, uncorrected and corrected Color Ishihara or Titmus Field of Vision Audiogram Company Policy urine drug screen split collection (this is not a Federal test) The following exam components are not required: Rectum and prostate exam Stool test (blood) and digital rectal exam Medical facility handling of completed exam forms: 1) Within 24 hours, provide the Norfolk Southern Medical Department (NSMD): EMPLOYEE-EXAM and MED-AUDIO Forms: [email protected] or fax # Custody and Control Form: fax # ) Provide to employee: copy of completed Work Status Report (p. 4 of EMPLOYEE- EXAM form). 3) Retain originals of the EMPLOYEE-EXAM, MED-AUDIO, and Custody and Control forms for your file. Rev. March 2015

28 NS employee: please take this checklist with you and give it to the NS approved facility conducting your physical. For exam questions, call } EMPLOYEE PHYSICAL FOR: INITIAL CERTIFICATION FOR NON-CDL DRIVER (10,001 26,000 LBS VEHICLE) The employee should have the CDL Initial Cert Packet forms: CDL-I FORM MED-AUDIO FORM FMCSA Commercial Driver s Medical Exam Report (Form 649-F) FMCSA Medical Examiner s Certificate (Form 651) The following exam components are required: Medical History Physical Exam includes Blood Pressure, Pulse, Height, and Weight Vision Distant each eye, uncorrected and corrected Color Ishihara or Titmus Field of Vision Audiogram Urine dipstick for glucose, blood and protein Company Policy urine drug test split collection (this is not a Federal test) The following exam components are not required: Rectum and prostate exam Stool test (blood) and digital rectal exam Medical facility handling of completed exam forms: 1) Within 24 hours, fax to the Norfolk Southern Medical Department (NSMD): CDL- I, MED-AUDIO, 649-F, and 651 forms fax # Custody and Control form fax # ) Provide to employee: Physical Exam Checklist NORFOLK SOUTHERN PHYSICAL EXAMINATION REQUIREMENTS original 651 form (Medical Examiner s certificate) retain a copy for your file. copy of completed Work Status Report (p. 4 of CDL-I form). 3) Retain originals of the CDL-I, MED-AUDIO, 649-F, and Custody and Control forms for your file. Rev. March 2015

29 {NS employee: please take this checklist with you and give it to the NS approved facility conducting your physical. For exam questions, call } EMPLOYEE PHYSICAL FOR: RECERTIFICATION FOR TRAIN & ENGINE SERVICE AND OTHER SPECIFIED CRAFTS CONDUCTOR STUDENT ENGINEER LOCOMOTIVE ENGINEER HOSTLER The employee should have the Employee Exam Packet forms: EMPLOYEE-EXAM FORM MED-AUDIO FORM The following exam components are required: Physical Exam Checklist NORFOLK SOUTHERN PHYSICAL EXAMINATION REQUIREMENTS REMOTE CONTROL OPERATOR LOCOMOTIVE SERVICING ENGINEER Medical History Physical Exam includes Blood Pressure, Pulse, Height, and Weight Vision Distant each eye, uncorrected and corrected Color Ishihara or Titmus Field of Vision Audiogram Company Policy urine drug screen split collection (this is not a Federal test) The following exam components are not required: Rectum and prostate exam Stool test (blood) and digital rectal exam Medical facility handling of completed exam forms: 1) Within 24 hours, provide the Norfolk Southern Medical Department (NSMD): EMPLOYEE-EXAM and MED-AUDIO Forms: [email protected] or fax # Custody and Control Form: fax # ) Provide to employee: copy of completed Work Status Report (p. 4 of EMPLOYEE- EXAM form). 3) Retain originals of the EMPLOYEE-EXAM, MED-AUDIO, and Custody and Control forms for your file. Rev. March 2015

30 Norfolk Southern Medical Department Medication Guidance By Category RX Med Form 8/2015 Safety-related employees, yardmasters, crew haulers or NS police officers Please provide this chart to your prescribing health care provider. Ask if your prescription medication falls within one of the categories described below. If it does, follow the applicable guidance. Prescription Medication Category / NSMD Guidance If you are prescribed a Narcotic for treatment of opioid dependence, promptly contact NSMD for a fitness-for-duty evaluation. Examples of narcotics used to treat opioid dependence: Suboxone, Subutex, (Buprenorphine), Methadone. If you are prescribed a Narcotic (for other than treatment of opioid dependence) or a Benzodiazepine, NSMD medication guideline prohibits use of the medication while at work. Or, for a minimum number of hours prior to reporting for work. The time period is equivalent to the dosing interval as written on the prescription label. If you cannot meet this guideline, promptly contact NSMD for a fitnessfor-duty evaluation. Narcotics (opioids/opiates) are commonly used to treat acute and chronic pain. Other uses include cough suppression, and treatment of opioid dependence. Side effects may include drowsiness, lightheadedness and dizziness. Examples of narcotics Generic name (brand name): Codeine (Tylenol #3; many brand names for cough suppressants), Hydrocodone (Lortab, Norco, Vicodin, Vicoprofen, many brand names for cough suppressants), Fentanyl Transdermal System (Duragesic), Hydromorphone (Dilaudid), Meperidine (Demerol), Morphine (Avinza, Kadian), Oxycodone (OxyContin, Percocet), Oxymorphone (Opana). Benzodiazepines are commonly used to treat anxiety. Other uses include treatment of insomnia, panic disorder and seizure disorder. Side effects may include drowsiness, dizziness and decreased alertness. Examples of benzodiazepines Generic name (brand name): Alprazolam (Xanax), Chlordiazepoxide (Librium), Clonazepam (Klonopin), Diazepam (Valium), Lorazepam (Ativan). This form is a supplement to the NSMD Medical Condition and Medication Guidance, which is available on the medical information page on the ERC, and also at nscorp.com. If you have any questions or concerns, please contact your NSMD case coordinator or call NSMD at For answers to frequently asked questions, please refer to page 2 of this form. 1

31 Norfolk Southern Medical Department Frequently Asked Questions About NSMD Medication Guidance RX Med Form 8/ Which NS employees are governed by the medication guidance in the RX Med form? This medication guidance applies to safety-related employees*, yardmasters, crew haulers and NS police officers. 2. I am prescribed a medication in one of the categories listed on RX Med form. I meet the NSMD medication guideline. Do I need to contact NSMD for a fitness-for-duty evaluation? No. You do not need to contact NSMD for a fitness-for-duty evaluation, unless you do not meet the medication guidelines and/or you are prescribed a narcotic for treatment of opioid dependence. 3. I am prescribed a medication in one of the categories listed on RX Med form. I cannot follow the medication guideline. Will I be removed from work? Each case is evaluated on an individual basis. A fitness-for-duty assessment will be based on your specific situation. This evaluation typically begins with a request for you to have your health care provider provide NSMD with more information about your medication, medical condition and any recommended work restrictions or accommodations. If you are unable to meet the applicable medication guideline, you may be restricted by an NSMD clinician from performing your safety-related duties pending completion of the fitness-for-duty evaluation. These are guidelines only. It is your responsibility to use good judgment. Do not compromise your safety at work. Stay off work Do not report to work or remain at work if you are unsafely impaired by your medication. 4. What is the dosing interval referred to in the medication guidelines? The dosing interval refers to either the minimum time that your health care provider prescribed for you to wait between taking doses of the medication. For example, if your medication is prescribed for use every 4 to 6 hours, the minimum dosing interval is 4 hours. 5. Does RX Med form list all of the prescription medication that may cause unsafe impairment? No. This form provides you with NSMD prescription medication guidance for two major medication categories. These commonly prescribed medications may cause unsafe impairment at work. This list is not all-inclusive. There are many medication categories and numerous medications not listed that also can cause unsafe impairment. This list is subject to change and will be updated periodically. 6. Should I change or stop the prescription medication on my own if I cannot follow NSMD medication guidelines? No. Always follow the prescription directly as written. Never stop the medication on your own. Never change the dose or frequency of use unless advised to do so by your prescribing health care provider. 7. Where can I find more guidance about safe use of medication? Talk to your prescribing health care provider. Ask your pharmacist. Contact NSMD. Educational resources about medication are also available on the ERC and at nscorp.com. 8. Where can I find my NSMD case coordinator s direct contact information? It is listed in the NSMD Medical Condition and Medication Guidance, Red Flyer, and Return-to-Work Information Sheet available on the ERC and at nscorp.com. Medical information is available at nscorp.com. Click on EMPLOYEES. Then, click on Medical. It is also available on the ERC. Go to the ERC, click on Employee Self-Service. Then, click on Medical Information. *Safety-related employee - any agreement or non-agreement employee who: is covered under the hours of service laws; inspects, installs, constructs, repairs, or maintains track, roadbed, bridges and signal and communication systems; inspects, repairs, or maintains locomotives, passenger cars or freight cars, or other on-track equipment when such equipment is in service that constitutes a train movement; determines that an on-track roadway maintenance machine or hi-rail vehicle may be used without repair of a non-complying condition; directly instructs, mentors, inspects, or tests, as a primary duty, any person while that other person is engaged in a safety-related task; or is responsible for conducting periodic tests and inspections of safety-related employees. 2

32 NS Medical Department Medical Absence and Return-to-Work Checklist Notify your supervisor of your medical leave of absence. rev. August 1, 2015 Start your benefits. If you are eligible for benefits, submit the Railroad Retirement Board (RRB) Sickness Benefit forms to the RRB and/or claim forms to your disability insurance carrier. You must file RRB Form SI-1ab, Application for Sickness Benefits, within ten (10) days from the first day you want to claim benefits. Applications can be obtained from your local RRB field office ( ), RRB s web site at or your labor organization. If you are covered by a supplemental disability or sickness plan, you may have a Summary Plan Description booklet. It will contain the information you need to file a claim. Assistance is available through the insurance carrier or your labor organization. Please ask both RRB and your insurance carrier for the end date of your coverage. Keep track of this date throughout your medical absence. Knowing the end date of your coverage can help prevent lapses of coverage. This is especially important during the time period after your doctor has cleared you to work and before you have been medically qualified to work by the NS Medical Department. Know where to find helpful medical resources: Medical resources described below are available on at nscorp.com. Click on EMPLOYEES. Then, click on Medical on the dropdown menu. These resources are also available on the ERC. Go to the ERC, click on Employee Self-Service. Then, click on Medical Information. NOTE: If you do not have access to a computer, please call the NS Medical Department at for help. Identify your NS Medical Department case coordinator. Your case coordinator can provide you with helpful information about the return-to-work process, and help you get back to work as quickly as possible. Your personal case coordinator s direct phone number is listed on the Red Flyer for Employees and on the Return-to-Work Information Sheet. Call your case coordinator for more contact information, and share the best way for him/her to reach you. My Case Coordinator is Case Coordinator s Phone Case Coordinator s Fax Case Coordinator s Know your responsibilities related to your medical condition, medication and safe returnto-work described in the NSMD Medical Condition and Medication Guidance and Returnto-Work Information Sheet. If you are in a designated safety-related job, follow the guidance for your additional responsibilities regarding your medication and reportable medical conditions and events. Be proactive; get started early! Call or your case coordinator as soon as possible after you have marked off for an extended medical absence. Your case coordinator will let you know what medical records and information, if any, will be needed by NSMD to determine your ability to return-to-work.

33 NSMD Medical Absence and Return-to-Work Checklist rev. August 1, 2015 Page 2 You can expedite your return-to-work by faxing or ing a copy of requested medical records and information directly to your personal case coordinator as soon as you know your targeted return-to-work date. In many cases, even earlier! There is an easy to use Fax Cover Sheet available to you for faxing medical records to us. Please be sure to provide us with your full name, your employee ID number, and your correct phone number and address when sending us your records. You should contact your case coordinator the same business day to ensure that your records were received. At your doctor s office: Please provide your doctor with a copy of any letter you receive from us requesting medical records or information. You will need to sign a medical records release for the requested records to be sent to you or directly to us. Please ask each of your doctor s staff about their medical records release process and complete all the necessary steps. If you choose to have your records released directly to us, please ensure that your doctor provides only the requested information pertaining to your condition that caused the absence. If possible, give your doctor s staff the completed NS Medical Department fax cover sheet. Ask your doctor for your targeted return-to-work date. After your doctor has released you to work: If you have not been medically cleared by the NS Medical Department, we will complete your RRB Sickness Benefit forms and insurance claim forms while we determine your fitness-for-service. Please fax these forms to your case coordinator, who will help with their completion. In order to ensure your continued disability certification, please quickly provide the required medical documentation to the Medical Department. When you are medically qualified to return to work by the NS Medical Department: Your case coordinator will personally notify you. Please make sure that your case coordinator has your correct phone number and address! You should contact your supervisor to expedite your return-to-work. Finally: Communicate with us throughout your return-to-work process. By working together, we can make sure you get back to work as quickly as possible!

34 Page 1 of 7 (rev. August 2015) Return-to-Work Information Sheet The Norfolk Southern Medical Department s (NSMD) process for returning you to work following a non-medical absence of one year or longer or a medically-related absence will depend on your specific situation. NSMD will conduct an individualized assessment of your fitness-for-duty (your ability to return to work and safely perform your essential job functions with respect to your medical condition and any reasonable accommodation). Most cases involve the same general steps 1 that are described in this information sheet. This information sheet also: describes resources that are available to help you through the return-to-work process, provides direct contact information for your assigned NSMD case coordinator who can help you quickly return-to-work, describes how to send medical records to the NSMD, and provides general medical documentation requirements and return to work procedures and/or requirements for specific conditions. You can access this Return-to-Work Information Sheet and other helpful resources described below on the ERC [Click on Employee Self Service, then, on Medical Information.] or, at [Click on EMPLOYEES, then, on Medical]. If you do not have access to a computer, please call the NSMD at for help. 1. Return-to-Work Checklist. A checklist is available to help you with some steps to take when you mark off for an extended medical absence, and help you through the return-to-work process. 2. Your Personal Case Coordinator. You will be assigned a NSMD case coordinator based upon your questions and the first letters of your last name. Your case coordinator will help you through the return-to-work process and help you get back to work quickly. Be proactive and get started early by contacting your personal case coordinator as soon as possible after you have marked off work for an extended medical absence. Your case coordinator can help answer questions about what medical records and information, if any, are needed to determine your ability to return-to-work. a) For help with questions about: Return-to-work process Reportable medical conditions and events Medication guidelines Physical examinations or health questionnaires Disability/sickness benefit form completion 1 This is intended as an overview of the return-to-work process. Because an individualized assessment is always conducted, the exact return-to-work process may vary on a case-by-case basis. NSMD reserves the right to modify its policies at any time.

35 Return-to-Work Information Sheet (rev. August 2015) Page 2 of 7 Here is your case coordinator s direct contact information: First letters of your last name Your Personal Case Coordinator PHONE FAX A - Cm Cn - Gl Gm - K L - O P - Sg Sh - Z b) For any questions about VOCATIONAL REHABILITATION SERVICES: Here is your case coordinator s direct contact information: Your Personal Case Coordinator PHONE: FAX: NOTE: You can also find your case coordinator s direct contact information using the Red Flyer for Employees. 3. How you can provide requested medical records and information to the NSMD There are several ways that you can provide the NSMD with requested medical records and information: Send the records directly to your personal case coordinator (recommended): Fax (or ) the records directly to your assigned case coordinator. There is an easy to use Medical Fax Cover Sheet available to you for faxing records to us. Other ways you can send records to the NSMD: the records to [email protected] Fax the records to toll-free fax number

36 Return-to-Work Information Sheet (rev. August 2015) Page 3 of 7 Mail the records to: Norfolk Southern Corporation Medical Services Three Commercial Place Norfolk, VA NOTE: When sending us records, please be sure to provide your full name, including middle initial, employee identification number, and a correct phone number and address. 4. Fitness-for-duty Documentation Requirements. a) Non-Medical Absences (less than one year) Unless there is a fitness-for-duty issue, no additional information or evaluation is necessary if you have been out of work for less than one year due to a non-medical absence. b) Non-Medical Absences (one year or longer) If you have been out of work due to a non-medical absence (such as furlough, leave of absence, discipline or military leave) for one year or longer, you must complete a Health Questionnaire (Form/Item ) for review and determination of your fitness-for-duty by the NSMD. An interactive version of this Health Questionnaire is available on the ERC or at nscorp.com. You can also obtain this questionnaire from your supervisor. You should complete the Health Questionnaire for the time period of your recent nonmedical leave of absence, then, forward the completed questionnaire directly to the NSMD. The preferred method is to fax or the questionnaire directly to your personal case coordinator. The completed questionnaire can also be faxed to toll-free fax # , ed to [email protected] or mailed to Norfolk Southern Corporation, Medical Services, Three Commercial Place, Norfolk, VA When evaluating your fitness-for-duty, the NSMD may also request additional medical records and information for your medical condition(s) that occurred during the time period of your non-medical absence. Once these records and information are received and reviewed, your personal case coordinator will let you know if any additional information is needed to determine your fitness-for-duty. Finally, when a determination is made that you are fit-for-duty, your case coordinator will personally notify you. Please make sure that your case coordinator has your correct phone number and address! You should notify your supervisor to expedite your return-towork. The NSMD will also notify your supervisor (or administrative assistant) that you are medically cleared to return-to-work.

37 Return-to-Work Information Sheet (rev. August 2015) Page 4 of 7 c) Medical Absences In general, when you are returning to work from other than a minor medical absence, a work release from your treating doctor(s) including any recommended work restrictions and/or accommodations should be furnished to your supervisor and the NSMD. When evaluating your fitness-for-duty, the NSMD may also request that your treating doctor(s) provides additional medical records and information regarding your specific medical condition that caused the absence. Please contact your personal case coordinator for information about whether any specific medical records and information will need to be provided. Once these records and information are received and reviewed, your case coordinator will let you know if any additional medical information is needed to determine your fitness-for-duty. Your case coordinator will also personally contact you when you are medically qualified to return-to-work. Please make sure that your case coordinator has your correct phone number and address! You should notify your supervisor to expedite your return-to-work. The NSMD will also notify your supervisor (or administrative assistant) that you are medically cleared to return-to-work. 5. Your Medical Condition, Medication and Return-to-Work Medical conditions, medication and dietary supplements may impair your ability to safely perform your job duties. Some medications and supplements taken alone or in combination can cause serious side effects that may impair your safe job performance. These medications include both prescription and non-prescription drugs. NSMD Medical Condition and Medication Guidance describes your responsibilities to help ensure your safe return-to-work with respect to your medical conditions and your use of prescription and over-the counter medications, and dietary supplements. If you are in a designated safety-related job, Medical Condition and Medication Guidance also describes your additional responsibilities regarding your medical conditions, medical events, and medication. Educational material about medication is available to help you: actively manage the benefits and risks of your medication; read a drug label; talk with a pharmacist; select the right over-the-counter medication for you; understand drug interactions; and drive safely if you are taking medication.

38 Return-to-Work Information Sheet (rev. August 2015) Page 5 of 7 6. General guidance on medical records and information requested for specific medical conditions. The following provides general guidance on medical information and records that may be requested by the NSMD to assist in determining your fitness-for-duty for the medical condition(s) that resulted in the medical absence or that occurred during the time period of your non-medical absence. The records and information requested may vary depending on your individual case. Please see section 4 of this sheet for more information about the fitness-for-duty process. a) Attention Deficit Disorder Written statement from your treating doctor that addresses: o any current symptoms (including inability to remain focused and alert) o treatment, including prescribed medication and any adverse medication side effects you may be experiencing o recommended work restrictions and/or accommodations, and if any, their anticipated duration b) Diabetes mellitus Office visit notes from your treating doctor (including any treating endocrine specialist) Most recent fasting blood sugar level and most recent Hemoglobin A1C level, if available Home blood glucose monitoring log for the past 2 weeks, if available Your treating doctor s (including any treating endocrine specialist s) recommended work restrictions and/or accommodations, and if any, their anticipated duration c) Fracture or broken bone Most recent office visit note from your treating doctor: Written statement (or office visit note) from your treating doctor that addresses: o whether your fracture is clinically healed o your treating doctor s recommended work restrictions and/or accommodations, and if any, their anticipated duration d) Heart condition or procedure (such as heart attack, stent placement ) Office visit notes from your treating cardiologist (and any other treating specialist) The results of the most recent stress test prior to your heart attack, angioplasty, and/or stent placement, if applicable The results of a stress test following your heart attack, angioplasty and/or stent placement, if applicable Operative/procedure report (such as cardiac catheterization, stent placement, angioplasty, CABG ), if applicable This report may be obtained from your surgeon s office or from the hospital where the surgery was performed. It is not necessary to provide all of the hospital records.

39 Return-to-Work Information Sheet (rev. August 2015) Page 6 of 7 If hospitalized, the hospital admission summary and physician s discharge summary. Please request these documents from the Medical Records Department of the hospital. It is not necessary to provide all of the hospitalization records. Your treating cardiologist s (and any other treating specialist s) recommended work restrictions and/or accommodations, and if any, their anticipated duration e) Mental health condition (such as Anxiety or Depression) Office visit note or written statement from your treating doctor (your treating psychiatrist and psychologist, if any) that addresses: o prescribed medication and any adverse medication side effects you may be experiencing o current control and stability of your condition o recommended work restrictions and/or accommodations, and if any, their anticipated duration f) Orthopedic, bone or joint condition Office visit notes from your treating doctor (including any treating orthopedic doctor) Operative report, if applicable This report may be obtained from your surgeon s office or from the hospital where the surgery was performed. It is not necessary to provide all of the hospital records. Diagnostic test results, such as the most recent X-ray or MRI report - please do not send X-ray or MRI films! Physical therapy discharge summary, if applicable Your treating doctor s (including any treating orthopedic doctor s) recommended work restrictions and/or accommodations, and if any, their anticipated duration g) Pregnancy, childbirth, or its complications If you are returning to work to a physically demanding job from pregnancy, childbirth, miscarriage, or complication of pregnancy, a work release from your personal doctor noting any recommended work restrictions and/or accommodations should be provided. h) Seizure or convulsion (single episode) with no prior diagnosis of Seizure Disorder Office visit notes from your treating doctor (including treating neurologist, if any). Recent office visit note or written statement from your treating doctor addressing: o likely cause of seizure o date of last known seizure o risk of experiencing a recurrent seizure within the next 6 months to one year o recommended work restrictions and/or accommodations, and if any, their anticipated duration If hospitalized, the hospital admission summary and physician s discharge summary. Please request these documents from the Medical Records Department of the hospital. It is not necessary to provide all of the hospitalization records.

40 Return-to-Work Information Sheet (rev. August 2015) Page 7 of 7 Diagnostic test results, including EEG report Lab results (e.g., medication levels) i) Seizure Disorder (such as Epilepsy, Complex Partial Seizure Disorder ) Office visit notes from your treating neurologist. Office visit note or written statement from your treating neurologist addressing: o date of last known seizure o treatment, including prescribed medication and any adverse medication side effects you may be experiencing o risk of experiencing a recurrent seizure within the next 6 months to one year. o recommended work restrictions and/or accommodations, and if any, their anticipated duration If hospitalized, the hospital admission summary and physician s discharge summary. Please request these documents from the Medical Records Department of the hospital. It is not necessary to provide all of the hospitalization records. Diagnostic test results, including EEG report Lab results (e.g., medication levels) j) Sleep Apnea Office visit notes from your treating doctor (including any treating sleep specialist) Sleep study report of the initial sleep study that established the diagnosis of sleep apnea, and any subsequent sleep study such as CPAP titration A downloaded CPAP log for the past 2 weeks. Compliance guidelines are defined as CPAP use for at least 4 hours per day on at least 70% of days, for at least the prior 2 weeks. Your treating doctor s (including any treating sleep specialist s) recommended work restrictions and/or accommodations, and if any, their anticipated duration k) Surgery - simple surgical procedures and other specified surgeries: Examples: Ear, nose and throat surgery (such as sinus surgery) Stomach and digestive system (such as appendectomy, gallbladder surgery and laparoscopic procedures) Urinary and reproductive systems (such as hernia repair not involving mesh or extensive reconstruction, hysterectomy and C-section) Skin biopsies and removal of minor skin lesions Other similar surgical procedures or surgery Your treating surgeon s work release noting type of surgery, date of surgery and any necessary work restrictions and/or accommodations. Ask your personal case coordinator if this guidance applies to your surgical procedure or surgery, and whether any additional medical information and records are needed to enable a determination of your fitness-for-duty.

41 FAX COVER SHEET DATE: FAX TO: Norfolk Southern Medical Department ATTN: Fax Number: Phone Number: FROM: Name: Phone Number: Fax Number: Pages (including cover sheet) SUBJECT: (Please check all applicable) OFF-DUTY ILLNESS OR OFF-DUTY INJURY WORK RELATED ILLNESS OR ON-DUTY INJURY (INCIDENT DATE: ) MEDICAL RECORDS OTHER: RE: Employee Name: Employee ID #: Job Title: Phone Number: Employee s preferred method of contact: (please check one) Phone Either or phone

42 NORFOLK SOUTHERN CORPORATION / MEDICAL SERVICES Form/Item (10/2012) NORFOLK SOUTHERN RAILWAY COMPANY Page 1 of 2 THREE COMMERCIAL PLACE, NORFOLK, VA Telephone (800) HEALTH QUESTIONNAIRE FOR EMPLOYEES RETURNING TO WORK FROM NON-MEDICAL ABSENCES OF ONE YEAR OR LONGER (e.g., Furlough, Military leave, Discipline, Leave of Absence) To the employee: please complete this health questionnaire for the time period during your recent non-medical leave of absence. Please forward the completed questionnaire directly to the Norfolk Southern Medical Department (see bottom page 2). Upon receipt and review of your questionnaire responses, the Norfolk Southern Medical Director will evaluate your medical qualification to return to work. When a determination is made that you are medically qualified, the Norfolk Southern Medical Department will notify your supervisor to allow you to promptly return to work. A. EMPLOYEE INFORMATION: Name (Print) Last First Middle Initial Home Address City State Zip Business Phone No. Home Phone No. Date of Birth Employee ID No. Present Occupation address: B. SUPERVISOR INFORMATION: Supervisor's Name Title Department Supervisor's Phone No.: Location (City/State) C. For every item in the chart below, please respond to the following question (by checking Yes or No or write Don t Know ). For the time period of your recent non-medical absence, have you had or do you now have any of the following? ITEM YES NO # ITEM YES NO Head / Brain injury or disorder (e.g., stroke, 1 concussion ) 17 Neck or back injury/pain/condition 2 Numbness, weakness or paralysis 18 Shoulder, arm, elbow, wrist or hand injury/pain/condition 3 Epilepsy, seizure or fits 19 Hip, leg, knee, ankle or foot injury/pain/ condition Loss of consciousness, fainting spell, vertigo Missing or impaired arm, hand, finger, leg, foot or 4 20 or dizziness toe Loss of or impaired memory, alertness or Swollen and/or painful joints (e.g., arthritis, 5 21 concentration gout ) 6 Migraines / headaches requiring prescription Skin rash or condition (e.g., eczema, psoriasis, 22 medication etc ) 7 High blood pressure 23 Allergies (e.g., dust, coal tar, bees, etc ) 8 Heart disease or heart rhythm problem, heart Sleep disorder or problem (e.g., sleep apnea, attack, chest pain/angina, heart 24 insomnia, narcolepsy, etc ) surgery/procedure (e.g, stents, cath., ) 9 10 Diabetes, Thyroid/Addison s disease or Cushing s syndrome Asthma or other lung problem (e.g., short of breath, cough...) Eye disorder / impaired vision (excludes corrective lenses) Ear disorder or impaired balance or hearing (excludes hearing aids) 11 Tuberculosis or other infectious disease Stomach/digestive problems; liver or kidney 12 disease Mental health/ psychiatric diagnosis, treatment or 13 Anemia or other blood disorder medication use for (e.g., depression, anxiety, 27 attention deficit disorder, post-traumatic stress 14 Cancer or Tumor disorder, drug or alcohol dependence/abuse, (etc.) 15 Hospitalization or Surgical procedure 16 Broken bones (cracked/fractured) 28 Other medical conditions, illnesses or injuries

43 Employee Name (Print):Last First MI Employee ID No.: Form/Item (10/2012) Page 2 of 2 PLEASE EXPLAIN ANY YES ANSWERS NOTED IN THE CHART ABOVE: PLEASE LIST ALL MEDICATIONS (INCLUDING PRESCRIBED / NON-PRESCRIBED MEDICATION(S) AND SUPPLEMENTS) TAKEN IN THE LAST 30 DAYS: PLEASE ANSWER THE FOLLOWING QUESTIONS: (1) Have you used tobacco (including smokeless)? Yes No. If Yes, how much over what time period (e.g., # packs smoked per day, week, & # years smoked) and when last used?. (2) Have you consumed alcohol? Yes No. If Yes, (a) describe when last used and (b) describe approximate amount/frequency of alcohol use: (specify: # of drinks) per (e.g., day, week, weekend ) (3) Do you use or have you used illicit drugs? Yes No. If Yes, describe drug(s), frequency of use and when last used: (4) If the purpose of your leave was military leave, have you been discharged from military service for medical reasons? Yes No If yes, specify date of denial, removal or discharge, and medical reason: (5) Have you filed a claim or lawsuit because of an illness/injury (including a worker s compensation claim)? Yes No If yes, specify date, illness/injury (6) Are you now drawing or have you applied for disability benefits (including Social Security, VA, Longshore and/or RRB)? Yes No. If yes, specify disability(ies) RELEASE, VERIFICATION AND DISCLOSURE STATEMENT: PLEASE READ THE FOLLOWING STATEMENT CAREFULLY AND SIGN BELOW. I certify that the answers given herein are true and complete to the best of my knowledge. I authorize whatever investigation is deemed necessary to confirm statements contained in my responses to this questionnaire. If it is determined, through investigation or otherwise at any time, that any answers are untrue or misleading, or material information is omitted, I understand my employment may be terminated. Signature of Employee: Date signed: Please forward the completed questionnaire directly to the Norfolk Southern Medical Department: Preferred method FAX TO # Other methods Fax (toll-free) to: # Mail to: Norfolk Southern Corporation, Three Commercial Place, Norfolk, VA to: [email protected]

44 What s on the Label All nonprescription, over-the-counter (OTC) medicine labels have detailed usage and warning information so consumers can properly choose and use the products. Below is an example of what the new OTC medicine label looks like. Active Ingredient Therapeutic substance in product; amount of active ingredient per unit Drug Facts Purpose Product action or category (such as an antihistamine, antacid, or cough suppressant) Uses Symptoms or diseases the product will treat or prevent WArnings When not to use the product; conditions that may require advice from a doctor before taking the product; possible interactions or side effects; when to stop taking the product and when to contact a doctor; if you are pregnant or breastfeeding, seek guidance from a health care professional; keep product out of children s reach Active ingredient (in each tablet) Purpose Chlorpheniramine maleate 4 mg...antihistamine Uses temporarily relieves these symptoms due to hay fever or other upper respiratory allergies: sneezing runny nose itchy, watery eyes itchy throat Warnings Ask a doctor before use if you have glaucoma a breathing problem such as emphysema or chronic bronchitis trouble urinating due to an enlarged prostate gland Ask a doctor or pharmacist before use if you are taking tranquilizers or sedatives When using this product you may get drowsy avoid alcoholic drinks alcohol, sedatives, and tranquilizers may increase drowsiness be careful when driving a motor vehicle or operating machinery excitability may occur, especially in children If pregnant or breast-feeding, ask a health professional before use. Keep out of reach of children. In case of overdose, get medical help or contact a Poison Control Center right away. Directions adults and children 12 years and over take 1 tablet every 4 to 6 hours; not more than 6 tablets in 24 hours children 6 years to under 12 years take 1/2 tablet every 4 to 6 hours; not more than 3 tablets in 24 hours children under 6 years ask a doctor Other information store at O C (68-77 O F) protect from excessive moisture Inactive ingredients D&C yellow no. 10, lactose, magnesium stearate, microcrystalline cellulose, pregelatinized starch Inactive Ingredients Substances such as colors or flavors The Drug Facts labeling requirements do not apply to dietary supplements, which are regulated as food products, and are labeled with a Supplement Facts panel. Directions Specific age categories, how much to take, how to take, and how often and how long to take Other information How to store the product properly and required information about certain ingredients (such as the amount of calcium, potassium, or sodium the product contains) DEPARTMENT OF HEALTH & HUMAN SERVICES USA For more information visit: or call INFO-FDA U.S. Department of Health and Human Services Food and Drug Administration

45 After you have the medicine, and before you leave the pharmacy Look to be sure you have the right medicine. If you ve bought the medicine before, make sure this medicine has the same shape, color, size, markings, and packaging. Anything different? Ask your pharmacist. If it seems different when you use it, tell your pharmacist, doctor, or other healthcare professional. Be sure you know the right dose for the medicine and you know how to use it. Any questions? Ask your pharmacist. Make sure there is a measuring spoon, cup, or syringe for liquid medicine. If the medicine doesn t come with a special measuring tool, ask your pharmacist about one. (Spoons used for eating and cooking may give the wrong dose. Don t use them.) Be sure you have any information the pharmacist can give you about the medicine. Read it and save it. Get the pharmacy phone number, so you can call back. Go to to learn about choosing the medicine that s best for you buying medicine from sources you can trust using medicine to increase its safety and effectiveness U.S. Department of Health and Human Services Food and Drug Administration INFO-FDA Publication No. (FDA) CDER STOP Stop and remember that all medicines have risks LEARN Learn how to use your medicine to increase the benefits GO Go inside this brochure for the U.S. Food & Drug Administration s Tips for Talking with Your Pharmacist to learn how to use medicines safely U.S. Department of Health and Human Services Food and Drug Administration

46 Use these tips for talking with your pharmacist. Your pharmacist can help you learn how to use your prescription and nonprescription (over-the-counter) medicines safely and to increase the benefits and decrease the risks. You can also use these tips when talking with your other healthcare professionals. Tell your pharmacist Tell your pharmacist... everything you use. Keep a record and give it to your pharmacist. Make sure you put all the prescription and nonprescription medicines, vitamins, herbals, and other supplements you use. Your pharmacist will use this to keep his/her records up-to-date and help you use medicine safely. if you ve had any allergic reactions or problems with medicines, medicines with dietary supplements, medicines with food, or medicines with other treatments. anything that could affect your use of medicine, such as, if you have trouble swallowing, reading labels, remembering to use medicine, or paying for medicine. before you start using something new. Your pharmacist can help you avoid medicines, supplements, foods, and other things that don t mix well with your medicines. if you are pregnant, might become pregnant, or if you are breast feeding. Ask your pharmacist What are the brand and generic (non-brand) names? What is the active ingredient? Can I use a generic? What is this for, and how is it going to help me? How and when should I use it? How much do I use? How long should I use it? Can I stop using it, or use less if I feel better? What should I do if I miss a dose or use too much? Will this take the place of anything else I am using? When will the medicine start working? How should I expect to feel? Are there any special directions for using this? Should I avoid any other medicines, dietary supplements, drinks, foods, activities, or other things? Is there anything I should watch for, like allergic reactions or side effects? What do I do if I get any? Will I need any tests to check the medicine s effects (blood tests, x-rays, other)? When will I need those? How and where should I keep this medicine? Is there a medication guide or other patient information for this medicine? Where and how can I get more written information? More important tips on the back

47 Q UESTION GUIDE Use this guide to gather the information you need to know from your health care team. When it comes to using medicine, there is no such thing as completely safe. All medicines have risks. The U.S. Food and Drug Administration (FDA) approval of a drug means that the benefits outweigh the known risks that are outlined on the drug s label. Physicians, physician assistants, nurses, pharmacists and YOU make up your health care team. To reduce the risks related to using medicines and to get the maximum benefit, you need to play an active role on the team. What are the brand and generic names of the medicine? Can I use a generic form? What is the medicine for and what effect should I expect? Does this drug replace any other medicine I have been using? How and when will I use it, what amount will I use, and for how long? What do I do if I miss a dose? Should I avoid any other medicines, (prescription or over-the-counter), dietary supplements, drinks, foods or activities while using this drug? When should I notice a difference or improvement? When should I report back to the team? Will I need to have any testing to monitor this drug s effects? Can this medicine be used safely with all my other medications and therapies? Could there be interactions? What are the possible side effects? What do I do if a side effect occurs? What other medicines or therapies could be used to treat this condition? How do the risks and benefits compare? How and where do I store this medicine? Where and how can I get written information about this medicine? What other sources of information can I use to make my decision? For more information, visit our web site at or call INFO-FDA. SERVICES DEPARTMENT OF HEALTH & HUMAN USA (FDA) Be An Active Member of Your Health Care Team U.S. Department of Health and Human Services Food and Drug Administration

48 Speak up The more information your health care team members know about you, the better they can develop a plan of care tailored to you. ALL of the members of your team need to know: your medical history any allergies and sensitivities you have the medications you take routinely and occasionally prescription and over-the-counter any dietary supplements you use, including vitamins and herbals other therapies you use anything that may affect your ability to use the medication Ask Questions Your health care team members help you make the best-informed choices, but you have to ask the right questions. When you meet with a team member, have your questions written down and take notes. You may also want to bring along a friend or relative to help you understand and remember the answers. Use the Question Guide on the back of this brochure to help you gather the information you need from your health care team. If you don t understand an answer, ask again. Learn the Facts Before you purchase a prescription or over-thecounter medicine, learn and understand as much about it as you can, including: generic and brand names active ingredients proper uses (indications/contraindications) instructions warnings and precautions interactions with food, dietary supplements, other medicines side effects/adverse reactions expiration dates Drug information designed for the consumer is available from a variety of sources your pharmacy, the manufacturer, the library, the bookstore and the internet. If there is something you don t understand, ask your health care team. Balance the Benefits and Risks Make Your Decision After you have exchanged all the information, weigh all your options. At this point you must decide if the benefits you hope to achieve from the medicine outweigh its known risks. The final choice is yours. Follow Directions When you are ready to use the medicine, maximize the benefits and minimize the risks by following the instructions printed on the drug label: Read the label every time you fill your prescription before you leave the pharmacy. Be sure you have the right medicine and understand how to use it. Read the label every time you are about to use the medicine to be sure it s the right medicine, for the right patient, in the right amount, in the right way, at the right time. Take the recommended dose exactly as prescribed no matter how tempted you are to use more to feel better faster. Finish all the medicine as directed even if you start to feel better before all your medicine is completed. Report Back to the Team Pay attention to how you feel and notify your health care team of any problems. If you have doubts that the medicine is working effectively, don t stop taking it without checking with the team. Some medications take longer to show a benefit, and some need to be withdrawn gradually to decrease undesirable effects. If you experience a side effect, let your health care team know immediately. An adjustment in the dosage or a change in medication may be needed. Go to or call 1 (888) INFO-FDA for more information about how to be an active member of your health care team and additional drug information.

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52 Distributed as a public service by the U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration and the Consumer Healthcare Products Association CONTENTS Advice for Americans About Self-Care OTC Know-How: It s on the Label Drug Interactions: A Word to the Wise Time for a Medicine Cabinet Checkup Pregnancy and Breast-Feeding Kids Aren t Just Small Adults Protect Yourself Against Tampering...12 CHPA FOUNDED 1881 C H P A ONSUMER EALTHCARE RODUCTS SSOCIATION Advancing Quality Healthcare Through Over-the-Counter Medicines and Nutritional Supplements R JP-12/03-150M FDA

53 ADVICE FOR AMERICANS ABOUT SELF-CARE Access + Knowledge = Power A merican medicine cabinets contain a growing choice of nonprescription, over-the-counter (OTC) medicines to treat an expanding range of ailments. OTC medicines often do more than relieve aches, pains and itches. Some can prevent diseases like tooth decay, cure diseases like athlete s foot and, with a doctor s guidance, help manage recurring conditions like vaginal yeast infections, migraines and minor pain in arthritis. The U.S. Food and Drug Administration (FDA) determines whether medicines are prescription or nonprescription. The term prescription (Rx) refers to medicines that are safe and 1

54 effective when used under a doctor s care. Nonprescription or OTC drugs are medicines FDA decides are safe and effective for use without a doctor s prescription. FDA also has the authority to decide when a prescription drug is safe enough to be sold directly to consumers over the counter. This regulatory process allowing Americans to take a more active role in their health care is known as Rx-to-OTC switch. As a result of this process, more than 700 products sold over the counter today use ingredients or dosage strengths available only by prescription 30 years ago. Increased access to OTC medicines is especially important for our maturing population. Two out of three older Americans rate their health as excellent to good, but four out of five report at least one chronic condition. Fact is, today s OTC medicines offer greater opportunity to treat more of the aches and illnesses most likely to appear in 2

55 our later years. As we live longer, work longer and take a more active role in our own health care, the need grows to become better informed about self-care. The best way to become better informed for young and old alike is to read and understand the information on OTC labels. Next to the medicine itself, label comprehension is the most important part of self-care with OTC medicines. With new opportunities in selfmedication come new responsibilities and an increased need for knowledge. FDA and the Consumer Healthcare Products Association (CHPA) have prepared the following information to help Americans take advantage of selfcare options. 3

56 OTC KNOW-HOW: IT S ON THE LABEL Y ou wouldn t ignore your doctor s instructions for using a prescription drug, so don t ignore the label when taking an OTC medicine. Here s what to look for: PRODUCT NAME ACTIVE INGREDIENTS therapeutic substances in medicine PURPOSE product category (such as antihistamine, antacid or cough suppressant) USES symptoms or diseases the product will treat or prevent WARNINGS when not to use the product, when to stop taking it, when to see a doctor and possible side effects DIRECTIONS how much to take, how to take it, and how long to take it OTHER INFORMATION such as storage information INACTIVE INGREDIENTS substances such as binders, colors or flavorings 4

57 You can help yourself read the label too. Always use enough light. It usually takes three times more light to read the same line at age 60 than at age 30. If necessary, use your glasses or contact lenses when reading labels. Always remember to look for the statement describing the tamper-evident feature(s) before you buy the product and when you use it. When it comes to medicines, more does not necessarily mean better. You should never misuse OTC medicines by taking them longer or in higher doses than the label recommends. Symptoms that persist are a clear signal it s time to see a doctor. Be sure to read the label each time you purchase a product. Just because two or more products are from the same brand family doesn t mean they are meant to treat the same conditions or contain the same ingredients. Remember, if you read the label and still have questions, talk to a doctor, nurse or pharmacist. 5

58 DRUG INTERACTIONS: A WORD TO THE WISE A lthough mild and relatively uncommon, interactions involving OTC drugs can produce unwanted results or make medicines less effective. It s especially important to know about drug interactions if you re taking Rx and OTC drugs at the same time. Some drugs can also interact with foods and beverages, as well as with health conditions such as diabetes, kidney disease and high blood pressure. Here are few drug interaction cautions for some common OTC ingredients: Avoid alcohol if you are taking antihistamines, cough-cold products with the ingredient dextromethorphan or drugs that treat sleeplessness. Do not use drugs that treat sleeplessness if you are taking prescription sedatives or tranquilizers. 6

59 Check with your doctor before taking products containing aspirin if you re taking a prescription blood thinner or if you have diabetes or gout. Do not use laxatives when you have stomach pain, nausea or vomiting. Unless directed by a doctor, do not use a nasal decongestant if you are taking a prescription drug for high blood pressure or depression, or if you have heart or thyroid disease, diabetes or prostate problems. This is not a complete list. Read the label! Drug labels change as new information becomes available. That s why it s important to read the label each time you take medicine. 7

60 TIME FOR A MEDICINE CABINET CHECKUP Be sure to look through your medicine supply at least once a year. Always store medicines in a cool, dry place or as stated on the label. Throw away any medicines that are past the expiration date. To make sure no one takes the wrong medicine, keep all medicines in their original containers. 8

61 PREGNANCY AND BREAST-FEEDING D rugs can pass from a pregnant woman to her unborn baby. A safe amount of medicine for the mother may be too much for the unborn baby. If you re pregnant, always talk with your doctor before taking any drugs, Rx or OTC. Although most drugs pass into breast milk in concentrations too low to have any unwanted effects on the baby, breast-feeding mothers still need to be careful. Always ask your doctor or pharmacist before taking any medicine while breast-feeding. A doctor or pharmacist can tell you how to adjust the timing and dosing of most medicines so the baby is exposed to the lowest amount possible, or whether the drugs should be avoided altogether. 9

62 KIDS AREN T JUST SMALL ADULTS O TC drugs rarely come in one-size-fitsall. Here are some tips about giving OTC medicines to children: Children aren t just small adults, so don t estimate the dose. Read the label. Follow all directions. Follow any age limits on the label. Some OTC products come in different strengths. Be aware! Know the difference between TBSP. (tablespoon) and TSP. (teaspoon). They are very different doses. Be careful about converting dose instructions. If the label says two teaspoons, it s best to use a measuring spoon or a dosing cup marked in teaspoons, not a common kitchen spoon. Don t play doctor. Do not double the dose just because your child seems sicker than last time. Before you give your child two medicines at the same time, talk to your doctor or pharmacist. Never let children take medicine by themselves. 10

63 Never call medicine candy to get your kids to take it. If they come across the medicine on their own, they re likely to remember that you called it candy. CHILD-RESISTANT PACKAGING Child-resistant closures are designed for repeated use to make it difficult for children to open. Remember, if you don t re-lock the closure after each use, the child-resistant device can t do its job keeping children out! It s best to store all medicines and dietary supplements where children can neither see nor reach them. Containers of pills should not be left on the kitchen counter as a reminder. Purses and briefcases are among the worst places to hide medicines from curious kids. And since children are natural mimics, it s a good idea not to take medicine in front of them. They may be tempted to play house with your medicine later on. If you find some packages too difficult to open and don t have young children living with you or visiting you should know the law allows one package size for each OTC medicine to be sold without child-resistant features. If you don t see it on the store shelf, ask. 11

64 PROTECT YOURSELF AGAINST TAMPERING Makers of OTC medicines seal most products in tamper-evident packaging (TEP) to help protect against criminal tampering. TEP works by providing visible evidence if the package has been disturbed. But OTC packaging cannot be 100 percent tamperproof. Here s how to help protect yourself: Be alert to the tamper-evident features on the package before you open it. These features are described on the label. Inspect the outer packaging before you buy it. When you get home, inspect the medicine inside. Don t buy an OTC product if the packaging is damaged. Don t use any medicine that looks discolored or different in any way. If anything looks suspicious, be suspicious. Contact the store where you bought the product. Take it back! Never take medicines in the dark. 12

65 For free bulk quantities, visit DEPARTMENT OF HEALTH & HUMAN SERVICES USA U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration CHPA FOUNDED 1881 CONSUMER HEALTHCARE PRODUCTS ASSOCIATION The Consumer Healthcare Products Association (CHPA) is a national organization representing companies dedicated to providing consumers with safe and effective overthe-counter (OTC) medicines and nutritional supplements and the information to use them properly.

66 DRUG INTERACTIONS: WHAT YOU SHOULD KNOW Council on Family Health

67 Drug Interactions There are more opportunities today than ever before to learn about your health and to take better care of yourself. It is also more important than ever to know about the medicines you take. If you take several different medicines, see more than one doctor or have certain health conditions, you and your doctors need to be aware of all the medicines you take to avoid potential problems, such as drug interactions. Drug interactions may make your drug less effective, cause unexpected side effects or increase the action of a particular drug. Some drug interactions can even be harmful to you. Reading the label every time you use a nonprescription or prescription drug and taking the time to learn about drug interactions may be critical to your health. You can reduce the risk of potentially harmful drug interactions and side effects with a little bit of knowledge and common sense. Drug interactions fall into three broad categories: Drug-drug interactions occur when two or more drugs react with each other. This drugdrug interaction may cause you to experience an unexpected side effect. For example, mixing a drug you take to help you sleep (a sedative) and a drug you take for allergies (an antihistamine) can slow your reactions and make driving a car or operating machinery dangerous. Drug-food/beverage interactions result from drugs reacting with foods or beverages. For example, mixing alcohol with some drugs may cause you to feel tired or slow your reactions. Drug-condition interactions may occur when an existing medical condition makes certain drugs potentially harmful. For example, if you have high blood pressure you could experience an unwanted reaction if you take a nasal decongestant.

68 Drug Interactions and Overthe-Counter Medicines Over-the-counter (OTC) drug labels contain information about ingredients, uses, warnings and directions that is important to read and understand. The label also includes important information about possible drug interactions. Further, drug labels may change as new information becomes known. That s why it s especially important to read the label every time you use a drug. The Active Ingredients and Purpose sections list: the name and amount of each active ingredient the purpose of each active ingredient The Uses section of the label: tells you what the drug is used for helps you find the best drug for your specific symptoms The Warnings section of the label provides important drug interaction and precaution information such as: when to talk to a doctor or pharmacist before use the medical conditions that may make the drug less effective or not safe under what circumstances the drug should not be used when to stop taking the drug The Directions section of the label tells you: the length of time and the amount of the product that you may safely use any special instructions on how to use the product The Other Information section of the label tells you: required information about certain ingredients, such as sodium content, for people with dietary restrictions or allergies The Inactive Ingredients section of the label tells you: the name of each inactive ingredient (such as colorings, binders, etc.) The Questions? or Questions or Comments? section of the label (if included): provides telephone numbers of a source to answer questions about the product

69 Learning More About Drug Interactions Talk to your doctor or pharmacist about the drugs you take. When your doctor prescribes a new drug, discuss all OTC and prescription drugs, dietary supplements, vitamins, botanicals, minerals and herbals you take, as well as the foods you eat. Ask your pharmacist for the package insert for each prescription drug you take. The package insert provides more information about potential drug interactions. Before taking a drug, ask your doctor or pharmacist the following questions: Can I take it with other drugs? Should I avoid certain foods, beverages or other products? What are possible drug interaction signs I should know about? How will the drug work in my body? Is there more information available about the drug or my condition (on the Internet or in health and medical literature)? Know how to take drugs safely and responsibly. Remember, the drug label will tell you: what the drug is used for how to take the drug how to reduce the risk of drug interactions and unwanted side effects If you still have questions after reading the drug product label, ask your doctor or pharmacist for more information.

70 Remember that different OTC drugs may contain the same active ingredient. If you are taking more than one OTC drug, pay attention to the active ingredients used in the products to avoid taking too much of a particular ingredient. Under certain circumstances such as if you are pregnant or breast-feeding you should talk to your doctor before you take any medicine. Also, make sure to know what ingredients are contained in the medicines you take to avoid possible allergic reactions. The following are examples of drug interaction warnings that you may see on certain OTC drug products. These examples do not include all of the warnings for the listed types of products and should not take the place of reading the actual product label. Category Drug Interaction Information Acid Reducers H2 Receptor Antagonists (drugs that prevent or relieve heartburn associated with acid indigestion and sour stomach) Antacids (drugs for relief of acid indigestion, heartburn and/or sour stomach) For products containing cimetidine, ask a doctor or pharmacist before use if you are: taking theophylline (oral asthma drug), warfarin (blood thinning drug) or phenytoin (seizure drug) Ask a doctor or pharmacist before use if you are: allergic to milk or milk products if the product contains more than 5 grams lactose in a maximum daily dose taking a prescription drug Ask a doctor before use if you have: kidney disease

71 Category Antiemetics (drugs for prevention or treatment of nausea, vomiting or dizziness associated with motion sickness) Antihistamines (drugs that temporarily relieve runny nose or reduce sneezing, itching of the nose or throat, and itchy watery eyes due to hay fever or other upper respiratory problems) Drug Interaction Information Ask a doctor or pharmacist before use if you are: taking sedatives or tranquilizers Ask a doctor before use if you have: a breathing problem, such as emphysema or chronic bronchitis glaucoma difficulty in urination due to an enlarged prostate gland When using this product: avoid alcoholic beverages Ask a doctor or pharmacist before use if you are taking: sedatives or tranquilizers a prescription drug for high blood pressure or depression Ask a doctor before use if you have: glaucoma or difficulty in urination due to an enlarged prostate gland breathing problems, such as emphysema, chronic bronchitis or asthma When using this product: alcohol, sedatives and tranquilizers may increase drowsiness avoid alcoholic beverages

72 Category Drug Interaction Information Antitussives Cough Medicine (drugs that temporarily reduce cough due to minor throat and bronchial irritation as may occur with a cold) Bronchodilators (drugs for the temporary relief of shortness of breath, tightness of chest and wheezing due to bronchial asthma) Ask a doctor or pharmacist before use if you are: taking sedatives or tranquilizers Ask a doctor before use if you have: glaucoma or difficulty in urination due to an enlarged prostate gland Ask a doctor before use if you: have heart disease, high blood pressure, thyroid disease, diabetes or difficulty in urination due to an enlarged prostate gland have ever been hospitalized for asthma or are taking a prescription drug for asthma Laxatives (drugs for the temporary relief of constipation) Nasal Decongestants (drugs for the temporary relief of nasal congestion due to a cold, hay fever or other upper respiratory allergies) Ask a doctor before use if you have: kidney disease and the laxative contains phosphates, potassium or magnesium stomach pain, nausea or vomiting Ask a doctor before use if you: have heart disease, high blood pressure, thyroid disease, diabetes or difficulty in urination due to an enlarged prostate gland

73 Category Nicotine Replacement Products (drugs that reduce withdrawal symptoms associated with quitting smoking, including nicotine craving) Nighttime Sleep Aids (drugs for relief of occasional sleeplessness) Drug Interaction Information Ask a doctor before use if you: have high blood pressure not controlled by medication have heart disease or have had a recent heart attack or irregular heartbeat since nicotine can increase your heart rate Ask a doctor or pharmacist before use if you are: taking a prescription drug for depression or asthma (your dose may need to be adjusted) using a prescription non-nicotine stop-smoking drug Do not use: if you continue to smoke, chew tobacco, use snuff or use other nicotine-containing products Ask a doctor or pharmacist before use if you are: taking sedatives or tranquilizers Ask a doctor before use if you have: a breathing problem such as emphysema or chronic bronchitis glaucoma difficulty in urination due to an enlarged prostate gland When using this product: avoid alcoholic beverages

74 Category Pain Relievers (drugs for the temporary relief of minor body aches, pains and headaches) Stimulants (drugs that help restore mental alertness or wakefulness during fatigue or drowsiness) Drug Interaction Information Ask a doctor before taking if you: consume three or more alcoholcontaining drinks per day (The following ingredients are found in different OTC pain relievers: acetaminophen, aspirin, ibuprofen, ketoprofen, magnesium salicylate and naproxen. It is important to read the label of pain reliever products to learn about different drug interaction warnings for each ingredient.) When using this product: limit the use of foods, beverages and other drugs that have caffeine too much caffeine can cause nervousness, irritability, sleeplessness and occasional rapid heartbeat be aware that the recommended dose of this product contains about as much caffeine as a cup of coffee Topical Acne Products (drugs for the treatment of acne) When using this product: increased dryness or irritation of the skin may occur immediately following use of this product or if you are using other topical acne drugs at the same time. If this occurs, only one drug should be used unless directed by your doctor

75 This information is brought to you by the Council on Family Health in cooperation with the National Consumers League and the U.S. Food and Drug Administration. Council on Family Health National Consumers League Food and Drug Administration To order one copy of this booklet, write: Federal Citizen Information Center Drug Interactions: What You Should Know Pueblo, CO /2004

76 Driving when you are taking medications. For most people, driving represents freedom, control and independence. Driving enables most people to get to the places they want or need to go. For many people, driving is important economically some drive as part of their job or to get to and from work. Driving is a complex skill. Our ability to drive safely can be affected by changes in our physical, emotional and mental condition. The goal of this brochure is to help you and your health care professional talk about how your medicine may affect your ability to drive safely. How can medications affect my driving? People use medicines for a variety of reasons, including: allergies anxiety cold depression diabetes heart and cholesterol conditions high blood pressure muscle spasms pain Parkinson s disease schizophrenia Medicines include medications that your doctor prescribes and over-the-counter medications that you buy without a doctor s prescription. Many individuals also take herbal supplements. Some of these medicines and supplements may cause a variety of reactions that may make it more difficult for you to drive a car safely. These reactions may include: sleepiness blurred vision dizziness slowed movement fainting inability to focus or pay attention nausea Often people use more than one medicine at a time. The combination of different medicines can cause problems for some people. This is especially true for older adults because they use more medicines than any other age group. Due to changes in the body as people age, older adults are more prone to medicine related problems. The more medicines you use, the greater your risk that your medicines will affect your ability to drive safely. To help avoid problems, it is important that at least once a year you talk to your doctor, nurse, or pharmacist about all the medicines both prescription and over-the-counter you are using. Also let your doctor know what herbal supplements, if any, you are using. Do this even if your medicines and supplements are not currently causing you a problem. Can I still drive safely if I am taking medications? Yes, most people can drive safely if they are using medications. It depends on the effect those medicines both prescription and overthe-counter have on your driving. In some cases you may not be aware of the effects. But, in many instances, your doctor can help to minimize the negative impact of your medicines on your driving in several ways. Your doctor may be able to: Adjust the dose; Adjust the timing of doses or when you use the medicine; Add an exercise or nutrition program to lessen the need for medicine; and Change the medicine to one that causes less drowsiness. What can I do if I am taking medications? Talk to your doctor honestly. When your doctor prescribes a medicine for you, ask about side effects. How should you expect the medicine to affect your ability to drive? Remind your doctor of other medicines both prescription and over-the-counter and herbal supplements you are using, especially if you see more than one doctor. Talking honestly with your doctor also means telling the doctor if you are not using all or any of the prescribed medicines. Do not stop using your medicine unless your doctor tells you to. Ask your doctor if you should drive especially when you first take a medication. Using a new medicine can cause you to react in a number of ways. It is recommended that you do not drive when you first start using a new medicine until you know how that drug affects you. You also need to be aware that some overthe-counter medicines and herbal supplements can make it difficult for you to drive safely. Talk to your pharmacist. Get to know your pharmacist. Ask the pharmacist to go over your medicines with you and to remind you of effects they may have on your ability to drive safely. Be sure to request printed information about the side effects of any new medicine. Remind your pharmacist of other medicines and herbal supplements you are using. Pharmacists are available to answer questions wherever you get your medicine. Many people buy medicines by mail. Mailorder pharmacies have a toll-free number you can call and a pharmacist available to answer your questions. Monitor yourself. Learn to know how your body reacts to the medicine and supplements. Keep track of how you feel after you use the medicine. For example, do you feel sleepy? Is your vision blurry? Do you feel weak and slow? When do these things happen?

77 Let your doctor and pharmacist know what is happening. No matter what your reaction is to using a medicine good or bad tell your doctor and pharmacist. Both prescription and over-thecounter medicines are powerful that s why they work. Each person is unique. Two people may respond differently to the same medicine. If you are experiencing side effects, the doctor needs to know that in order to adjust your medicine. Your doctor can help you find a medicine that works best for you. What if I have to cut back or give up driving? You can keep your independence even if you have to cut back or give up on your driving due to your need to use a medicine. It may take planning ahead on your part, but it will get you to the places you want to go and the people you want to see. Consider: Who can I call for help with transportation? Call the ElderCare Locator at and ask for the phone number of your local Office on Aging, or go to their website at Contact your regional transit authority to find out which bus or train to take. Easter Seals Project ACTION (Accessible Community Transportation In Our Nation) can direct you to transportation resources near you. Call or visit online at Where do I find out more about medications? Your first step is to talk with your health care professional. You also can contact the: You also can get a copy of the Age Page On Older Drivers from the National Institute on Aging by calling , or by going to their website at Wear your safety belt Always wear your safety belt when you are driving or riding in a car. Make sure that every person who is riding with you also is buckled up. Wear your safety belt even if your car has air bags. Driving When You Are Taking Medications rides with family and friends; taxi cabs; shuttle buses or vans; public buses, trains and subways; and walking. U.S. Food and Drug Administration at INFO-FDA ( ) or visit online at Also, senior centers, religious, and other local service groups often offer transportation services for older adults in the community. DEPARTMENT OF HEALTH & HUMAN SERVICES USA U.S. Department of Health and Human Services Food and Drug Administration

78 Opioid painkillers: What you need to know before you start taking them Opioids are powerful medications that are prescribed for many types of pain, the flu or a cough. 1.4 million emergency room visits in 2011 were related to the misuse or abuse of prescription medicines, an increase of 114% since National Safety Council 1121 spring lake drive itasca, il (800) nsc.org Common reactions While opioids are very effective medications, you can have reactions to them. They can make you: sleepy sick to your stomach constipated EXAMPLES OF OPIOID CONTAINING MEDICINES feel confused dizzy These reactions can happen suddenly and while taking the Generic morphine Brand Name MSIR, Roxanol usual dose of your medicine. Be careful to follow your doctor s oxycodone OxyIR, Oxyfast, or pharmacist s instructions. Many opioids will take about Endocodone 90 minutes to become fully active in your body. Be sure to Roxilox, Roxicet, oxycodone check the warning labels on the bottle: you may need to be (with acetaminophen) Percocet, Tylox, Endocet careful going about ordinary activities such as driving. Serious reactions If you take more than prescribed, or combine opioids with alcohol or some other drugs, such as sleep aids and anti-anxiety medications, they can cause clammy skin weak muscles dangerously low blood pressure slowed or stopped breathing coma death Do not share opioid pain medications Never share medication your doctor has given you; even with family members. You may be endangering someone s life if you let them take your medicine. Long-term problems If you take opioids for a long time, your body can feel less of their effect, and you may feel the need to use more of the drug to get results. Do not use more without talking to your doctor. Taking more opioids can increase the chance that you may have side effects or overdose. Opioids are highly addictive medications so it s important to work closely with your doctor. What can I do to prevent problems? While these drugs are effective for pain, you may want to ask your doctor if you can try a non-opioid drug first. Also, if you do take opioids, talk to your doctor about limiting the time you take them. Tell your doctor about all other medications and drugs you take and about how much alcohol you consume. Ask your doctor about whether, and when you can drive and be sure to discuss the nature of your work and how you may be impaired. Opioid painkillers can be dangerous and need to be disposed of promptly and properly. If you have any medicine left over, you can bring your medication to a drug take-back collection site or event. Take-back programs allow the public to bring unused drugs to a central location for proper disposal. If your community does not have a take-back program, you can visit nsc.org\disposalresources to learn how to throw away the medicine safely. Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. (2013) The DAWN Report: Highlights of the 2011 Drug Abuse Warning Network (DAWN) Findings on Drug-Related Emergency Department Visits. Rockville, MD. Retrieved from National Safety Council SHORT-ACTING LONG-ACTING hydrocodone (with acetaminophen) hydromorphone morphine oxycodone fentanyl Vicodin, Lorcet, Lortab, Zydone, Hydrocet, Norco Dilaudid, Hydrostat MSContin, Oramorph SR, Kadian, Avinza Oxycontin Duragesic patch

79 Putting ABILITY back to WORK! Vocational Rehabilitation Services (VRS) Service activities may include: On-line career assessment Vocational counseling and guidance Education and job training/placement assistance Linkage and referral to local employment resources where employees reside Vocational Rehabilitation Services Eligibility The Vocational Rehabilitation Services program is not available to those employees who have been medically approved to return to their current or previous positions, or where no employment relationship exists between the Company and the employees. Norfolk Southern Corporation reserves the right to amend or terminate the VRS Program at any time. NORFOLK SOUTHERN SUPPORTS SUCCESS!

80 Putting ABILITY back to WORK! Vocational Rehabilitation Services (VRS) Norfolk Southern Helps Eligible Employees Return To Work The company s Vocational Rehabilitation Services (VRS) program offers help for Norfolk Southern employees injured on the job, or medically disqualified from service. The good news is that even a continuing personal illness/medical condition does not necessarily prevent employees from working again. Through the assistance offered by the VRS program, many eligible employees are able to return to work. VRS allows employees to continue to make meaningful contributions toward their personal and corporate success as well as continue to provide financial security for themselves and their families. VRS activities are customized to assist employees in meeting their individual needs. This may include evaluation of job skills, training, job placement, and/or referral to community resources. Depending on qualifications and response to vocational rehabilitation, program participants may be considered for placement within currently vacant positions within Norfolk Southern, or in some cases, coordination with outside job placement services may be the best option. Vocational Rehabilitation Services Offers Employees A Choice The Vocational Rehabilitation Services (VRS) program is available at no cost for eligible agreement and nonagreement employees, including those on medical leave. Participation is entirely voluntary, and employees may leave or decline the program at any time. Here s How To Get Started The VRS program is administered by the Human Resources Department. All service activities are coordinated and monitored by a nationally Certified Rehabilitation Counselor (CRC). Eligible employees who are interested in taking advantage of the program should contact contact Vocational Rehabilitation Services at (800) ext , Fax: (757) , online at or via at [email protected].

81 How can you help someone who may be in drug & alcohol trouble? DARS Drug and Alcohol Rehabilitation Services Nr N o r f o l k S o u t h e r n / C o n r a i l

82 A safe, healthy, and drug-free workplace is everyone s business. Sometimes, a co-worker s behavior may indicate there is a potential problem that may need attention. Everyone s safety is at stake when these problems continue, especially if it is suspected they involve drugs or alcohol. Employees with an active drug or alcohol abuse problem affect safety, productivity, personal health, and have a negative financial impact on the company. You may be in a unique position to help! What can NS employees do to help a co-worker? Norfolk Southern s Drug and Alcohol Rehabilitation Services (DARS) program is designed to help employees identify drug or alcohol problems. Employees can and should use the DARS program before their problems cause rule violations or declining health. NS recognizes addiction as a diagnosable disease with treatable solutions. NS provides DARS as a confidential service available to help all NS employees without jeopardizing employment. Co-workers are in a unique position to observe negative changes and offer alternatives. They can spot early warning signs of job performance problems or changes in behavior that could be due to drug or alcohol abuse. Frequently the troubled employee is the last one to realize there is a problem. 1

83 What is drug and alcohol dependency/abuse? Loss of Control The inability to consistently predict when one will drink next, how much will be consumed, or where drinking or drug use will occur. Once the loss of control line is crossed, the symptoms are progressive. They will always get worse instead of better. In many cases the addicted employee is the last to recognize his/her loss of control. You, the co-worker, are in a unique position to help because co-workers are frequently the first to spot a change. Following are some examples of substance abuse and dependence. The word substance applies to either drugs or alcohol. Substance abuse can be viewed as any serious incident involving drugs or alcohol in a 12-month period but not believed to be pattern behavior or include craving or loss of control. Some examples include: Failure to meet obligations irresponsible behavior at work, school, or home; declining job performance, health, missed personal goals, etc. Hazardous use DUI, operating machinery impaired, positive breath, or urinalysis at work. Legal problems arrests, domestic disputes. Interpersonal problems family arguments, physical fights, social withdrawal. Substance dependence (alcoholism addiction) has some or all of following symptoms, and can usually be seen as an increasing pattern of behavior. Obsession A strong urge or need to use drugs or alcohol, sometimes despite previous or impending negative consequences. Craving Not being able to stop once the drinking or use begins. Drinking/using more than intended. Drinking/using at a time or place that causes problems. Tolerance The need for greater amounts to get the same effect or to get high. Blackout or Pass out Not remembering what happened while drinking or using, or losing consciousness due to over-use. Physical addiction Withdrawal symptoms such as sweating, shakiness, nausea, trouble sleeping, or extreme anxiety after stopping drinking or using. In extreme cases, seizures or overdose. 2 3

84 Experience shows that an employee who is losing control affects the workplace in 3 ways: They are preoccupied with thinking/planning about getting high or drinking. They are physically under the influence of drugs and/or alcohol. They are getting over the effects of using drugs and/or alcohol. How much is too much? First, any use of illegal drugs is too much. Secondly, the medical policy on drugs at Norfolk Southern does not permit the employment of persons who use drugs which may impair sensory, mental, or physical functions. The word drugs refers to prohibited or controlled substances as defined by law. Of course, this same good health advice is true for family members. How about alcohol? What counts as a drink? Many people are surprised to learn what counts as a drink. Beer 12 oz. (5% alcohol) Wine 5 oz. (12% alcohol) Liquor 1.5 oz (80 proof spirits) All affect the workplace. Although two are emotional states that cannot be physically tested for, they will often manifest themselves in job performance or behavior problems. As a co-worker, what can I do to assist employees with alcohol and drug abuse problems? Co-workers can use the Constructive Intervention process to identify and refer employees to DARS for assistance. Co-workers are NOT being asked to get someone in trouble or diagnose addiction. Even for professionals, addiction assessment is challenging. The co-worker should keep his/her focus on job performance or changing behavior measurements that are characteristic of an employee or family member who has a drug or alcohol abuse problem. How can you tell what s reasonable? (Lowest risk) Social 1-2 drinks, 1-2 times weekly Binge drinking 5 or more, 1 time in 30 days Heavy drinking 5 or more, 5 times in 30 days (Highest risk) Alcoholic can t control amounts taken (craving) or control appropriate time to drink (obsession) 4 5

85 Patterns of change over time involving attendance, availability, the quality and quantity of work, and attitude, can indicate potential addiction problems. They vary from issues such as arriving late, leaving early, and complaints from co-workers, to more serious issues such as aggressive and belligerent behavior, or legal and financial problems. Your observations of changing behavior or performance can be the key element of making a co-worker or family member aware there is a problem. Following are some examples of job performance or behavior problems you may be observing. You may be able to add to the list yourself. Attendance & Availability of Employee: Absent without leave Arrives late Leaves work early Absent from work site without good reason Excessive sick leave Absent on Mondays, Fridays, after holidays, day after payday Repeated absences for longer periods of time Elaborate, increasingly improbable reasons for absences Excessive outside communication i.e.: cell phones, pagers, incoming or out going calls Quality & Quantity of Work Produced: Missed deadlines Errors due to inattention and poor judgment Not remembering instructions Spasmodic work pace alternating between periods of high and low productivity Short periods of good performance after corrective interviews Lapses of attention, inability to concentrate Complaints from people outside work unit Fellow workers complain Repeated rule violations Attitude & Behavior: Overreaction to real or imagined criticism Inability to hear or accept feedback Aggressive and belligerent when confronted Undependable statements Lying Avoidance of associates Unreasonable resentments toward supervisor, coworkers, the organization Money problems, garnishments of salary Loss of values Mood swings Domestic problems interfere with work Undependable Repeated minor injuries on and off job Poor hygiene Visible physical deterioration Trouble with law, DUIs, DWIs, other arrests 6 7

86 Enabling Behaviors Co-workers, supervisors, and organizations sometimes think they can help an employee avoid the direct or indirect consequences of a drug or alcohol problem. Some examples of enabling are: Accepts repeated apologies and assurances of improved performance Fails to confront problems due to poor performance Covers for co-worker Feels sorry for him Afraid he ll lose a friend Considers functional alcoholic to be no problem Protects co-worker from consequences Promises self to confront IF problems get worse Works around personality or performance of co-worker Loans money to addicted employee Fails to advise others of noticeable lapses in performance or behavior Doesn t realize how much a constructive approach can help It s easy to become an enabler by covering for that person, ignoring complaints of fellow co-workers, and failing to take action consistent with company policy. But covering for a co-worker does more harm than good. If we allow that behavior to continue we put everyone at the work site at risk. Helping a co-worker realize they have a problem, and that DARS can offer a variety of solutions, is an important first step to recovery. Denial Frequently the troubled employee or family member is the last one to realize there is a problem. This phenomenon is sometimes called DENIAL, but it is more a problem of warped perception rather than conscious deception. It is sometimes caused by too much chemical use, but more often it is the nature of mental obsession. Some signs include: Problem drinkers or drug users have a definition of alcoholism or addiction that excludes themselves. Problem drinkers or drug users focus on symptoms of alcoholism or addiction they do not have, and use this as an excuse to avoid self-diagnosis. Problem drinkers or drug users change their definition of problem over time in order to exclude their worsening symptoms. Your willingness to take action can be a vital step to help break through the misperception that frequently affects drug or alcohol abusers. How can you help a co-worker or family member who you suspect is having drug or alcohol addiction problems? One way to help is through Constructive Intervention. This involves observing and evaluating changing behavior over time, documenting performance problems to provide factual information to the troubled employee or family member, and referring the troubled employee to DARS, or other medical resource, to discuss the issue and gain positive support. 8 9

87 Here are the steps that are proven effective to help you approach a co-worker or family member and motivate them to accept a referral to assistance as a result of on-going job performance or behavior problems. Constructive Intervention Observe and Evaluate: The concerned co-worker observes changes from normal performance or behavior. The concerned employee observes patterns of change over time. The concerned employee is objective and non-judgmental. Emotions can distract from your purpose. Documentation: A list of your observations makes it easier to approach and discuss your concerns. Be prepared put your facts on paper for an orderly, presentable discussion. Your troubled co-worker or family member may try to minimize or avoid the issues. Documentation provides concrete facts to base the discussion upon. Documentation should be non-personal and non-judgmental. Discussion: Meet with your co-worker in private where you both feel comfortable. Discuss job performance or behavior problems and how they impact you and your other co-workers. Just state the facts as you see them do not ask questions they open the opportunity for excuses. Referral: Suggest the co-worker discuss their problems with their local DARS counselor, union representative, or family member and ask for support. When drugs and alcohol are suspected refer the troubled co-worker or family member directly to the company DARS program (see page 13 for contact information). Follow-up: Be a positive supporter if performance improves, regardless of whether or not the co-worker seeks outside assistance. Do not become an enabler if poor performance or behavior continues. Communicate with your personal support system during the referral process. What can I say to my co-worker if I believe they have a potential addiction problem? The sometimes speech is a good start. Find an appropriate time in a private area and say, I m seeing a change in you, friend. Sometimes problems like these are the result of drug or alcohol abuse going on outside the workplace. It may not be true in your case, and it s not for me to diagnose. However, because it s true sometimes, the company has a drug and alcohol rehabilitation service. It s a benefit and is confidential. It has helped a lot of people with their problems. Your local DARS counselor is available to provide you confidential support throughout this process. Call him/her whenever you have questions! 10 11

88 If my co-worker opts to contact DARS, how will he or she be treated? DARS participants receive confidential assessment, referral, and follow-up support. DARS is a benefit provided by Norfolk Southern, and is at no cost to the employee. However, some referral resources have separate costs not covered by DARS, but may be covered by your medical plan. DARS services include: Assessment and Recovery Identify, assess, and evaluate drug and/or alcohol abuse problems Education about addictive disease Establish counseling, hospital, or 12-Step recovery connections Knowledge to prevent relapses Encourage family involvement Referral Resources Education 12-Step programs Outpatient counseling Outpatient hospitalization Residential treatment (Note that four out of five of the above referral options have no mandatory out-of-service if utilized prior to rule violations.) DARS participation may not require lost time Early referral is a win-win for everyone Follow-up DARS participants receive continuing support by the DARS program throughout the recovery process Atlanta, GA (404) * (GA, except Columbus, GA) 2 Birmingham, AL (770) * (AL, MS, Columbus, GA) 3 Charlotte, NC (704) * (SC, NC, WV) 4 Decatur, IL (217) * (N.W. IN, IL, MO) 5 Harrisburg, PA (717) * (E. PA, NJ, DE, E. & central NY, Baltimore, MD) 8 How can we contact DARS? DARS counselors are located across the system and are available 24/7. 6 Hartford City, IN (765) * (N.E. & central IN, central & southern OH) 7 Knoxville, TN (865) * (TN, KY, Cincinnati, OH, S. IN) 8 Norfolk, VA (757) * (Norfolk, VA area) 9 Pittsburgh, PA (412) * (W. PA., E. OH, W. NY) 10 Roanoke, VA (540) * (VA, except Norfolk) 11 Toledo, OH (419) * (N.W. OH, MI) * Denotes microwave 12 () Denotes service area 13

89 Additional Information Resources: National Institute on Alcohol Abuse and Alcoholism National Institute on Drug Abuse National Clearinghouse for Alcohol and Drug Information A Clean Body and Clear Mind are the Best Tools for Safety See more about DARS at the Employee Resource Center K

90 We live in a modern day and time. The days are over [in substance abuse] when friends, family and employers can sit back and wait for someone to hit rock bottom and ask for help on their own. - James Fearing Ph.D. Workplace Intervention, 2001 NS has committed to refreshing our educational efforts and we will continue to sustain a culture supportive of identifying and helping troubled co-workers. - Mark Manion PEER to PEER EVP & Chief Operating Officer We re encouraging employees to voluntarily step up and take ownership of their behavior before something happens. Through Peer-to-Peer support, at-risk employees can seek help without jeopardizing their job. - Dr. Paula Lina Medical Director To obtain contact information about your local Peer-to-Peer program, contact the DARS Manager at Norfolk Southern Corporation Three Commercial Place Norfolk, Virginia Norfolk Southern Corp. All Rights Reserved k A program, supported by Norfolk Southern and promoted by Employee volunteers, that will assist all NS employees impacted by drugs and alcohol in the workplace through awareness and education.

91 PEER to PEER The Peer-to-Peer program consists of employee volunteers who: Promote an alcohol & drug (A&D) free workplace Promote healthier lifestyles Educate co-workers to recognize at-risk behaviors Provide an additional resource for co-workers to receive guidance concerning substance abuse issues. Motivate at-risk co-workers to seek help Reduce alcohol & drug rule violations Peer-to-Peer volunteers: Are available to talk with co-workers concerning A&D issues WILL NOT Identify Peer-to Peer program volunteers to management WILL NOT Ignore an employee in need of assistance WILL NOT Disclose information that would appear in employee records WILL NOT Give up on our joint goal of promoting an alcohol and drug free work-place. How does substance abuse affect the workplace? Over 74% of all current illegal drug users work, and over 74% of heavy alcohol users work (those drinking five or more drinks per occasion on five or more days in past 30 days). Source: National Drug-Free Workplace Alliance, 2014 Drinking does not have to occur on the job to affect the job. Hangovers account for many workplace productivity losses. Source: SAMSHA: Workplace Substance Abuse Statistics Fact Sheet, 2006 On-the-job drug use can lead to an increased risk of accidents and injuries. It can also lead to lower levels of productivity and employee morale, not only among those with substance abuse problems but also among those working alongside them. Source: SAMSHA: Workplace Substance Abuse Statistics Fact Sheet, 2006 Drug-using employees are 3.6 times more likely to be involved in workplace accidents. Source: National Drug-Free Workplace Alliance, 2014 Prevent A&D Rule Violations: Sometimes, there are early warning signs that a co-worker has an alcohol/drug problem before a rule violation occurs. Co-workers are in an ideal position to notice job performance problems that could be due to alcohol or drug abuse. Alcohol or drug abuse is progressive. It will lead to serious consequences if not recognized and treated. How can I help a co-worker that may have an alcohol and/or drug problem? Take Action before your co-worker has a rule violation Contact your Peer-to-Peer Coordinator for guidance and support If you think there is a problem, discuss your concerns with the co-worker. - You are in a unique position as a peer to be helpful - Your friend/co-worker may listen to you when he/she won t hear anyone else - You want your co-worker to realize that his/her performance or behavior is declining and others in the workplace are noticing You have the right to work in a drug and alcohol free workplace There are resources available to help resolve A&D issues. You can make a difference - Take Action! To obtain contact information about your local Peer-to-Peer program, contact the DARS Manager at