v4 · Apr 2026

Executive Diagnostic — Client Intake

NAOHP occupational health program valuation, staffing assessment & leadership diagnostic

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Organization profile
Basic details used to scale all volume projections and populate the report header. Fields marked * are required.
Primary scaling variable — all service volumes derive from this figure
Total reported operating cost for the occ health / employee health program
Program profile
Select all specialty programs currently active in your occupational health program.
Respiratory protection program
OSHA 1910.134 — fit testing, PFTs, PAPR enrollment
Hazardous medication surveillance
Chemo / cytotoxic drug exposure — periodic medical monitoring
Research personnel medical surveillance
Lab / research staff under institutional health monitoring
Animal lab / animal allergy program
Research animal exposure monitoring and allergy surveillance
High-consequence infectious disease (HCID) program
Formal preparedness / response coordination program
Safe patient handling training program
Formal injury prevention training for patient care staff
Staffing and capacity target
Enter current FTE by role. The model calculates projected demand at your target utilization rate and shows the variance.
75%
At 75%, utilization is lower — better patient throughput and scheduling flexibility. Lower operating margin per visit.
RoleCurrent FTEDemand basis
Physician / APP20 min/injury · 15 min/FFD · 15 min/POPA Visit-based
Nurse / MA15 min/injury · 15 min/FFD · 15 min/POPA · 20 min/drug · 20 min/PFT · 15 min/audio Visit-based
Registration / Admin15 min/injury visit Visit-based
RN Case Manager25–30 active WC cases per FTE (CMSA benchmark) Caseload-based
Your actual service volumes
Please enter your actual annual service volumes for each service line below. If you don't track a particular service or it doesn't apply to your organization, leave it blank.
These volumes will be compared against industry benchmarks in your diagnostic report to identify opportunities and calculate precise replacement value.
Financial detail
Capture financial performance, cost structure, fee schedule, and revenue cycle metrics. All fields are optional — leave any field blank if it isn't tracked or isn't yet available. Items you skip can be addressed during the onsite review.
If your occupational health and employee health are currently combined on a single balance sheet, that's expected — fill in what you can and use the toggle below to flag the structure.
Service-line P&L (most recent fiscal year)
Service lineAnnual revenue ($)Annual direct cost ($)
Occupational Health
Employee Health
Workers' Compensation
Financials are not separated
Occupational Health and Employee Health share a single balance sheet
Cost allocation methodology
Current fee schedule (top services)
Enter your current fees for the most-billed services. Leave blank if not applicable. Use the employer rate column only if you have a separate negotiated rate for direct-bill employer accounts.
ServiceStandard fee ($)Employer direct-bill rate ($)
Injury visit (initial)
Pre-placement exam
Fitness for duty exam
Drug screen collection
Audiogram
Spirometry / PFT
Influenza immunization
IGRA test
Revenue cycle metrics
Payer mix (% of total revenue)
Approximate percentages — total should sum to 100%. Leave fields blank if you don't track payer mix at this level of detail.
Downstream revenue contribution
Estimated annual revenue contribution this program brings to other parts of the health system (imaging, therapy, specialty care, surgical services, etc.). A rough estimate is fine.
Operations & relationships
Capture site, provider, and key employer detail. Names can be redacted (e.g., "Site A", "Provider 1", "Manufacturer 1") if you'd prefer to anonymize identifiers at this stage. All rows are optional — add as many or as few as is useful.
Site detail
List each clinic site with capacity and annual visit volume.
Site name City Sq ft Exam rooms Hours/wk Annual visits
Provider roster
List active providers with FTE allocation and (optionally) anticipated retirement timing. Use generic labels like "Provider 1" if preferred.
Name / label Credential FTE Primary site Anticipated retirement
Top employer accounts
Top 10–15 employer accounts by visit volume, with current contract and relationship status. Use generic labels if preferred.
Account name / label Industry Annual visits Contract type Status
Leadership interview
Please share your perspective on 10 topics covering strategy, financial performance, market position, staffing, and growth. Click any section to expand. All responses are optional, but the more context you provide, the more tailored your diagnostic report will be — anything you skip can be discussed during the onsite visit instead.
All responses save automatically as you type. Progress indicators next to each section show how many questions have been answered.
Capability ratings & strategic priorities
Self-assessment of organizational capabilities and ranking of strategic priorities. Use the 1–5 scale for each capability, where 1 = critical gap and 5 = strong/high.
Growth priority ranking
Rank or describe the most important strategic initiatives for the program over the next 12–24 months. Add or edit as needed.
# Strategic initiative / priority Timeframe Owner
Review & submit
Review your submission below. Once submitted, your intake — including all qualitative responses — will be saved to the NAOHP working file and your advisor will be notified. No diagnostic results will be shared until the advisor has completed their review.
By submitting, you confirm the information provided is accurate to the best of your knowledge. Your NAOHP advisor will follow up within 3–5 business days.