As an employer, you need to be as certain as possible that your new hires can perform their job requirements. Employees account for 70% of a company’s expenses, including payroll, benefits, and taxes. After interviewing applicants for a position, selecting the best candidate, and making a contingent job offer, it’s wise to require a medical assessment before finalizing the employment.

Regulations Surrounding Pre-Employment Medical Exams

Before scheduling a pre-employment examination, be aware of federal regulations that prevent discrimination among job candidates.

No examination can be done prior to a contingent job offer. Employers are prohibited from asking about health conditions or any questions that are disability-related. Pre-offer interviews can only discuss non-medical qualifications, although candidates may be asked to demonstrate essential job tasks, such as lifting in a fit for work testing situation, for example. (Learn more in "Uses of Pre-Employment Medical Exams and Differences From Fit-For-Work Testing".)

For companies covered under the American with Disabilities Act (ADA) of 1990, a pre-employment physical examination may only be performed if:

• All other candidates in the same job category are required to take the exam.
• Any medical information (protected health information) obtained is treated with confidentiality, including secure storage separate from other files.
• Results of any assessment are not used to discriminate against a candidate who might be covered by the ADA.

When to Require a Pre-Employment Exam

Besides demonstrating compliance with ADA guidelines, the World Health Organization (WHO) recommends that a medical assessment be required for potential employees that:

• Will work in a hazardous environment.
• Must have a certain level of fitness to perform the job tasks.
• Maintain safety of other workers while doing their job.
• Are required by law to prove fitness, such as DOT workers.

How to Conduct a Pre-Employment Exam

Pre-employment examinations should be done in a medical setting by an independent agency that understands the legal and confidentiality issues of the assessment. The practitioner who performs the exam should be separate from anyone who collected samples for drug screening and from the employer. A Medical Review Officer (MRO), who is a physician credentialed to interpret drug screening results, should be included if the employer has a Drug-Free Workplace program.

Following the conditional job offer, the candidate is scheduled for a medical examination. The employer covers all costs for the examination. Inform the candidate that the assessment takes 1-2 hours. Tell the candidate if a drug screen is part of the examination. Remind the candidate to bring:

• Driver’s license or photo I.D..
• Glasses or contact lenses, if prescribed.
• Hearing aids, if prescribed.
• List of current medications, including vitamins and supplements.
• Immunization record.

What’s included in a typical medical examination?

• Health history.
• Current health status or concerns.
• Medication review.
• Measurement of height and weight.
• Vital signs: Blood pressure, pulse, temperature.
• Respiratory evaluation.
• Cardiac assessment.
• Review of immunization records.
• General physical examination.
• Vision and hearing tests.

Depending on the job duties, the candidate may also be required to take an additional fit for work test at a later time (Learn more in "How to Set Up a Fit-for-Work Testing Program".) that might include testing for:

• Color blindness.
• Physical ability: strength, stamina, flexibility.
• Infectious diseases (for medical or public employees).
• Mental health issues.
• Job-specific medical or health requirements.

What’s NOT included?

Personal examinations unrelated to the job, such as prostate or breast cancer screenings.

Drug Screening

Drug screens may be part of the pre-employment assessment. For companies regulated by the DOT, or with some federal contracts, drug and alcohol testing is required. (Learn more in "DOT vs. Non DOT Testing: What's the Difference?") Companies with more than 15 employees who have an elective Drug-Free Workplace program (the 1988 federal act ended in 2010) can require job candidates to submit a sample for screening. It’s important to note that the ADA prohibits discrimination against an employee or candidate based solely on a history of drug use.

A 5-Panel Drug Screen is the standard test, used by the DOT and is compliant with mandatory guidelines for workplace drug testing. (Learn more in "Introduction to the 5 Panel Drug Test".) Candidates submit a urine sample, obtained at the time of the medical examination, under the supervision of a health care staff member. The sample is sent to an independent laboratory and screened for THC (marijuana), opiates, cocaine, amphetamines, and PCP. (Learn more in "Drug Abbreviations Used in Drug Testing".) If the initial screen has a positive result, the sample is sent for confirmatory testing, using qualitative analysis. All screening results are reviewed by the MRO; if more information is needed from the candidate, the MRO follows up.

Benefits of a Pre-Employment Medical Exam

Requiring a pre-employment medical examination has benefits for the employer. It ensures that a candidate will not be at risk or put others at risk while performing job duties due to an underlying condition, even with ADA accommodation. Employees are less likely to be injured or absent due to injuries when they are well matched with their responsibilities, and insurance and Worker's Compensation costs can be minimized. (Learn more in "8 Step To Reduce Worker's Compensation Costs".) When all candidates receive the same assessment, liability and discrimination claims are reduced.

For a potential employee, there are also the benefits of receiving a free medical examination from an impartial health care provider, as well as the possibility of learning about an issue that was unknown or undiagnosed.

While the results of a medical examination are useful, they may not be used to discriminate against a candidate. A contingent job offer may not be withdrawn from a qualified candidate unless it is:

1. Job-related.
2. Consistent with business necessity.
3. A direct threat to workplace safety.
4. Unreasonable to provide necessary accommodation.
5. Providing necessary accommodation would cause hardship.

When requiring a pre-employment medical examination or assessment, be certain that company policies and practice are consistently applied. Consult an employment attorney who is familiar with both federal and state laws before creating a pre-employment medical examination policy.