Economy Industrial Services
&
J Solutions, Inc.

Fit for Duty Annual Physical Consent Form

One (1) of the following courses will be required annually^-

Fit for Duty Office —

This Exam is intended for those employees that will not be performing any work in the field. These employees may include, but are not limited to human resources, accountants, administration, and secretaries. This level will require the individual to complete a basic physical examination only. The exams will be administered by BHP (Baytown & Beaumont).

Fit for Duty Level 1 —

This exam is intended for those employees performing light to medium duty work. These employees may include, but are not limited to inspectors, planners, engineers, safety, supervisors, instrumentation, security, and equipment operators. This level will require the individual to complete a basic physical examination and a level 1 functional capacity exam. The exams will be administered by BHP (Baytown & Beaumont).

Fit for Duty Level 2 —

This exam is intended for those employees performing medium to heavy duty work. These employees may include, but are not limited to welders, insulators, attendants/firewatch, railcar workers, electricians, painters, HVAC workers, blasters, vacuum truck operators, scaffold builders, laborers, boilermakers, riggers and pipefitters. This level will require the individual to complete a basic physical examination and a level 2 functional capacity exam. The exams will be administered by BHP (Baytown & Beaumont).

As a condition of employment and continued employment with Economy Industrial Services, Inc. and J Solutions Inc. , I agree to annual fit for duty testing.

P.O. Box 88
Bridge City, Texas 77611
Telephone (409) 999-6091
Fax (409) 999-6093

Certified Woman-Owned Business Enterprise