Key Takeaways
Fitness for Duty Evaluations (FFDEs) help employers assess whether an employee can safely perform their job due to concerns about their psychological or cognitive health. Employers consider FFDEs when there are signs of behavioral changes, emotional instability, or declining performance that may affect safety or job duties.
The FFDE process includes several steps:
Referral & Clarification: Discuss concerns and evaluation scope.
Document Review: Examine relevant records.
Clinical Interview: Conduct a structured interview with the employee.
Testing: Administer standardized psychological or neuropsychological tests.
Collateral Information: Gather insights from others, if authorized.
Analysis: Combine all findings to assess the employee's fitness for duty.
Written Report: Provide a report detailing fitness, safety concerns, and recommendations without disclosing unrelated medical information.
FFDEs are not disciplinary actions; they focus on job-related functioning and help employers make informed decisions while ensuring compliance with legal standards like the ADA and FEHA. Properly conducted FFDEs protect both employees and employers by clarifying concerns and recommendations.
When is a Fitness for Duty Evaluation (FFDE) Appropriate?
Employers and attorneys often reach out to me when they’re facing one of the most challenging situations in workforce management: an employee whose behavior, emotional functioning, or cognitive abilities have raised legitimate concerns about safety, performance, or judgment. These moments are stressful for everyone involved. Leaders want to do the right thing; protect the organization, support the employee, and comply with legal requirements, but they often don’t know where to start.
A Fitness for Duty Evaluation is designed to answer one essential question:
Is the employee psychologically and/or cognitively capable of performing their job safely and effectively?
This blog will walk you through what employers can expect from the FFDE process, what I am evaluating in a psychological or neuropsychological FFDE, how decisions are made, and how the results can support defensible, ethical workforce management.
Before we begin, one important clarification: I do not conduct Fitness for Duty Evaluations for FAA-regulated pilots or aircrew. These evaluations require FAA-designated examiners and specialized aviation protocols and are outside my scope.
Let’s explore what the FFDE process looks like for the many other safety-sensitive and high-responsibility roles employers manage every day.
Why Do Employers Request Fitness for Duty Evaluations?
Employers typically consider an FFDE when there is objective evidence that an employee may be struggling with psychological, emotional, or cognitive functioning in a way that affects their work. Common triggers include:
Behavioral changes or erratic conduct
Emotional instability or difficulty regulating mood
Cognitive concerns following medical or neurological events, or as a result of noticeable cognitive decline over time
Safety incidents or near-misses
Declining performance that appears health-related
Concerning interactions with coworkers, patients, students, or the public
Return to work after psychiatric hospitalization or extended leave
Reports of impaired judgment, confusion, or disorientation
In these situations, employers are often balancing multiple priorities: safety, legal compliance, employee rights, and organizational risk. An FFDE provides the clarity needed to move forward responsibly.
What an FFDE Is—and What It Is Not
A Fitness for Duty Evaluation is a clinical and occupational assessment, not a disciplinary action. It is not designed to punish or “catch” an employee doing something wrong. Instead, it is a structured, evidence-based process that evaluates:
Psychological functioning
Cognitive abilities
Behavioral patterns
Risk factors
Job-specific demands
The exact type of testing (psychiatric/emotional vs. cognitive/neuropsych) will depend on the referral question, the nature of the problem, and the nature of the job. The goal of testing is to determine whether the employee can safely perform essential job duties with or without accommodations.
An FFDE is not:
A general medical exam
A routine wellness check
A performance evaluation
A substitute for supervision or HR processes
A tool for diagnosing unrelated medical conditions
It is a targeted assessment focused solely on job-related functioning, performed to answer a specific question.
The Legal Framework: ADA, FEHA, and Business Necessity
Employers often worry about whether they are “allowed” to request an FFDE. The answer is yes, when it is job-related and consistent with business necessity.
Under the Americans with Disabilities Act (ADA) and California’s FEHA, employers may request an FFDE when:
There is objective evidence that an employee may be unable to perform essential job functions safely
The employee’s behavior raises legitimate concerns about safety or impairment
The evaluation is necessary to determine fitness, accommodations, or risk
The key is documentation. Employers should be able to articulate the specific behaviors or incidents that prompted concern. This is where legal counsel can be invaluable in FFDE cases. An attorney can help ensure the referral question is clear, appropriate, and defensible. This protects everyone involved, including the employee.
What Can Employers Expect From the FFDE Process?
Although each case is unique, the FFDE process generally includes the following steps.
1. Referral and Clarification of the Evaluation Question
The process begins with a consultation between the employer (or attorney) and the evaluating psychologist. During this conversation, we clarify:
The specific concerns prompting the referral
The employee’s essential job functions
Relevant policies, safety standards, or regulatory requirements
The scope of the evaluation
What the employer needs to know to make a decision
If there are any company-specific forms required from the evaluation
A well-defined referral question is the foundation of a defensible FFDE.
2. Document Review
Before meeting the employee, I review all relevant materials, which may include:
Incident reports
Supervisor statements
HR documentation
Medical notes (if provided by the employee)
Job descriptions
Performance records
Prior evaluations or accommodations
This information helps contextualize the concerns and ensures the evaluation is tailored to the job.
3. Clinical Interview
The employee participates in a structured clinical interview covering:
Psychological history
Current symptoms or concerns
Work history and job demands
Stressors, coping strategies, and functioning
Medical or neurological conditions
Substance use (if relevant)
The interview is conducted respectfully and professionally. Employees often arrive anxious, which is understandable; part of my role is to create a calm, neutral environment where they can provide accurate information.
4. Standardized Psychological and/or Neuropsychological Testing
Testing is a core component of working with an FFDE psychologist in Los Angeles because it provides objective data. Depending on the referral question, testing may include:
Psychological Testing
Mood and anxiety measures
Personality assessments
Trauma-related symptom inventories
Behavioral and impulse-control measures
Neuropsychological Testing
Memory
Attention and concentration
Processing speed
Executive functioning
Problem-solving and reasoning
Cognitive flexibility
These tests help identify whether cognitive or emotional factors are impairing job performance. A test battery will be tailored to meet the needs of the individual evaluation, and only standardized, validated scientific measures are used.
5. Collateral Information (When Appropriate)
With proper authorization, I may gather collateral information from:
Treating providers
Supervisors
HR representatives
Occupational health
Attorneys involved in the case
This step is especially important when there are discrepancies between reported symptoms and observed behavior, or when an employee has limited insight into their behavior or cognitive changes.
6. Integration and Analysis
Once all data is collected, I integrate:
Interview findings
Test results
Behavioral observations
Collateral information
Job-specific requirements
This comprehensive analysis allows me to determine whether the employee is:
Fit for duty
Fit with accommodations
Temporarily unfit
Unfit for duty
The goal is clarity that allows employers and employees to move forward with a plan, with a rationale based on substantial evidence.
7. The Written Report
Employers receive a functional, job-focused report that addresses:
Whether the employee is fit for duty
Any safety or risk concerns
Recommended accommodations (if applicable)
Return-to-work guidance (if applicable)
Suggested monitoring, treatment, or follow-up
Importantly, the report does not include private medical details or diagnostic information unrelated to job functioning. This protects employee privacy and ensures compliance with ADA and FEHA.
Profession-Specific Considerations
Different industries have different expectations, risks, and regulatory frameworks. Here’s what employers in key sectors can expect.
Law Enforcement and Public Safety
Law enforcement FFDEs require specialized expertise. Evaluations may include:
Use-of-force decision-making
Impulse control and emotional regulation
Trauma-related symptoms
Judgment and reliability
Cognitive functioning relevant to situational awareness
Reports are written with awareness of POST-related expectations, union considerations, and administrative review processes.
Healthcare Professionals
Healthcare FFDEs often involve concerns about:
Impairment affecting patient care
Boundary issues or professionalism
Stress, burnout, or emotional exhaustion
Cognitive functioning relevant to clinical decision-making
These evaluations are conducted with sensitivity to licensing implications and hospital system requirements.
First Responders
Firefighters, EMTs, and dispatchers face unique stressors. Evaluations may assess:
Trauma exposure
Stress tolerance
Emotional resilience
Cognitive functioning under pressure
Corporate, Industrial, and High-Risk Roles
For employees in high-liability roles such as heavy equipment operators, security personnel, or laboratory workers, evaluations may focus on:
Attention and concentration
Reliability and judgment
Behavioral concerns
Psychological stability
Safety-critical cognitive skills
How Do FFDEs Protect Employers and Support Employees?
A well-conducted FFDE benefits everyone involved.
For Employers
Reduces liability
Supports defensible decision-making
Ensures compliance with ADA, FEHA, and EEOC
Protects workplace safety
Provides clear, actionable recommendations
For Employees
Ensures concerns are evaluated fairly
Identifies needed accommodations
Supports safe return-to-work planning
Helps connect employees with appropriate care when needed
An FFDE is not about “siding” with the employer or the employee—it is about providing objective, evidence-based information that gives everyone involved a clear path forward.
Confidentiality and Information Sharing
Employers often worry about what they can legally receive. The answer is simple:
You receive a functional, targeted report, not private medical details.
This includes:
Fitness determination
Safety considerations
Job-related recommendations
The employee’s personal health information that is unrelated to the fitness for duty evaluation remains confidential.
Clarity, Safety, and Fairness: Final Thoughts From an FFDE Psychologist in Los Angeles, CA
Fitness for Duty Evaluations are one of the most powerful tools employers have for navigating complex situations involving employee behavior, emotional functioning, or cognitive concerns. When conducted properly, they provide clarity, protect safety, reduce liability, and support ethical decision-making.
If you are an employer, HR manager, attorney, or risk manager facing a challenging situation, you don’t have to navigate it alone. A well-structured FFDE through my California practice can give you the information you need to move forward with confidence.
Get the Expert Evaluation Your Organization Needs With Fit for Duty Testing in Los Angeles
Making sound, legally defensible decisions about employee fitness doesn't have to feel overwhelming. The right process makes all the difference. A Fitness for Duty Evaluation (FFDE) gives employers the clarity and confidence needed to protect both their workforce and their organization's integrity.
Dr. Stacy Reger is a licensed psychologist specializing in psychological and neuropsychological FFDEs for employers, attorneys, and safety-sensitive industries across California. Based in Los Angeles, Dr. Reger conducts evaluations statewide, and in qualifying circumstances, telehealth options may be available. Getting started is straightforward:
Request a consultation: Contact us to discuss your referral question and determine the right evaluation approach
Submit relevant documentation: Incident reports, job descriptions, medical records, and related materials help shape a thorough evaluation
Schedule with a qualified FFDE psychologist in Los Angeles: Dr. Reger will coordinate a time and location that works for your organization
Receive your report: Expect a clear, well-supported report with findings and actionable recommendations
Additional Services Dr. Stacy Reger Provides in Los Angeles and Throughout California
When you partner with Dr. Stacy Reger for a Fitness for Duty Evaluation, you're working with a psychologist whose depth of experience extends well beyond the workplace. From the initial evaluation through a comprehensive, defensible report, Dr. Reger is committed to providing clarity and actionable insight at every step of the process.
Fitness for Duty Evaluations are just one component of Dr. Reger's broad range of psychological and neuropsychological assessment services. She also conducts neuropsychological testing and psychological assessments addressing cognitive decline and learning difficulties, as well as capacity assessments for financial and testamentary matters. Her med-legal assessment services include Independent Medical Evaluations, workers' compensation psychological and neuropsychological evaluations as both a Qualified Medical Evaluator and Agreed Medical Evaluator, and adult neuropsychological evaluations for conditions such as TBI, stroke, ADHD, and dementia.
Dr. Reger also performs pre-surgical psychological evaluations for procedures including spinal cord stimulator implantation, bariatric surgery, and organ transplants. Beyond assessments, she is available as an expert witness, public speaker, and consultant, and provides individual psychotherapy and specialized therapy for older adults. To learn more about the full scope of Dr. Reger's services, explore her blog. And when you're ready to take the next step, she welcomes you to reach out directly.
About the Author
Dr. Stacy Reger is a licensed clinical psychologist (PSY #27639) with nearly two decades of experience in psychological and neuropsychological assessment. She earned her Ph.D. in Clinical Psychology from an APA-accredited program at the University of Nevada Las Vegas, and completed advanced training in clinical geropsychology at the San Francisco VA Medical Center. Her extensive background in neuropsychological testing, including building and directing a neuropsychological testing clinic at the Long Beach VA Healthcare System, gives her a uniquely rigorous foundation for conducting Fitness for Duty Evaluations. Having worked across interdisciplinary teams in complex medical, cognitive, and behavioral settings, Dr. Reger brings both clinical precision and real-world insight to every FFDE, helping employers and organizations make informed, defensible decisions about workforce safety and employee wellbeing.