Pre-employment medical
An occupational health check, usually after a job offer, to confirm you can do a specific role safely and to identify any reasonable adjustments you may need.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- It checks whether you can do a specific job safely and what reasonable adjustments might help — not whether to reject you.
- Health questions are normally only allowed after a job offer, and using the result to discriminate can be unlawful.
- Occupational health is impartial: it advises both you and the employer and is not the employer's doctor.
- Your clinical details stay confidential; the employer usually receives only a fitness opinion and any adjustments, with your consent.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your specialist will give you advice for your situation.
Helps ensure you are placed in a role you can do safely.
Before a job offer, when health questions are generally not permitted under the Equality Act 2010.
You discuss your health and the job, are examined where relevant, and talk through any adjustments that might help.
A clear fitness opinion with practical, role-specific adjustment recommendations.
You discuss your health and the job, are examined where relevant, and talk through any adjustments that might help.
With your consent, a fitness opinion and any recommended adjustments are sent to the employer, usually without...
Occupational health may request a specialist report or your GP's input before giving a final opinion.
Any agreed adjustments should be in place; for hazardous roles a health surveillance schedule may begin.
What is a pre-employment medical?
A pre-employment medical, more accurately called a pre-placement assessment, is an occupational health check that looks at whether you can carry out the specific tasks of a job safely and effectively, and whether you need any reasonable adjustments. It is usually arranged after a job offer has been made.
The aim is not to screen people out. Under the Equality Act 2010, an employer generally cannot ask about your health before offering you a job, and the assessment is meant to support a safe placement — including adjustments for a disability — rather than to find reasons to reject you. Using a health assessment to discriminate against a disabled applicant who could do the job with reasonable adjustments may be unlawful.
Occupational health is impartial. The clinician advises both you and the employer and is not 'the employer's doctor'. Your clinical details stay confidential: the employer normally receives only an opinion on your fitness for the role and any adjustments, not your diagnoses, unless you give specific consent.
For some safety-critical or hazardous roles — for example driving, working at height, or exposure to noise or certain substances — the check is more detailed and may form a health baseline for future monitoring.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
Pre-employment medical versus a GP fitness certificate
| Feature | Pre-employment medical | GP fitness certificate |
|---|---|---|
| Focus | This specific job and its risks | General fitness for a purpose |
| Acts for | You and the employer, impartially | You |
| Adjustments | Core part of the advice | Limited |
| Confidentiality | Only fitness opinion shared | You hold the certificate |
Occupational health knows the job and its hazards and advises on adjustments; a GP medical is more general and is held by you.
Preparing for your test
- Read the job description so you understand the tasks and any physical or safety demands.
- Complete any health questionnaire honestly — it is confidential to occupational health, not your manager.
- Bring a list of your medicines, conditions and any relevant specialist reports.
- Bring glasses, hearing aids or other aids you use, as the role may involve vision or hearing checks.
- Think about adjustments that have helped you before, so these can be discussed.
- Know that you can ask what information will be shared and give or withhold consent.
- For safety-critical roles, follow any instructions about fasting, alcohol or medicines before testing.
What happens
An occupational health nurse or doctor reviews your health in relation to the job's specific tasks and risks. This may begin with a questionnaire, followed where needed by a discussion and an examination appropriate to the role — for example blood pressure, vision, hearing or lung function.
The clinician's job is to decide whether you are fit for the role, fit with adjustments, or whether further information or a specialist opinion is needed. They will discuss any helpful adjustments with you. Because occupational health is impartial, they consider both your interests and the employer's duty to keep people safe.
With your consent, a short report or certificate goes to the employer stating your fitness for the role and any recommended adjustments. It does not normally include your diagnoses or clinical details. You can usually see what will be said about you, and you control consent to its release.
Is this test right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- Before a job offer, when health questions are generally not permitted under the Equality Act 2010.
- As a way to screen out disabled applicants who could work with reasonable adjustments.
- As a substitute for treating or diagnosing a health condition, which is not its purpose.
- When the real issue is an existing employee's health, where a management referral fits better.
Delay or rearrange if…
- Key specialist reports or records needed to judge fitness are not yet available.
- You are acutely unwell and need care before being assessed for work.
- Required role-specific testing cannot yet be completed.
- Consent for sharing the outcome has not been properly discussed.
Alternatives to discuss
- A pre-placement questionnaire review alone where no examination is needed.
- A targeted specialist opinion where one condition is the key question.
- Workplace adjustments agreed directly where fitness is not in doubt.
- No assessment where the role carries no relevant health or safety requirement.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Benefits
- Helps ensure you are placed in a role you can do safely.
- Identifies reasonable adjustments before you start, so problems are avoided.
- Keeps your clinical details confidential, sharing only a fitness opinion.
- Creates a health baseline for jobs with specific hazards.
- Gives you an impartial professional, not the employer, assessing your health.
Risks & complications
- Feeling judged or anxious about disclosing health information.
- A recommendation for adjustments that you and the employer then need to agree.
- The need for further information or a specialist report before a decision.
- A short delay to your start date while the assessment is completed.
- An opinion of 'fit with adjustments' that the employer says it cannot fully meet.
- An unexpected health finding that needs follow-up with your own GP.
- Disagreement about what the role safely requires.
- An opinion that you are not currently fit for a specific safety-critical task.
- Concern that an employer is misusing the process to discriminate, which may be unlawful.
The most important safeguard is that this assessment should support a safe placement, not exclude you unfairly. If you have a disability and could do the job with reasonable adjustments, the law expects the employer to consider those adjustments. If you feel a health assessment is being used to withdraw an offer unfairly, that may be discrimination, and you can seek advice from ACAS or the Equality and Human Rights Commission.
Published figures to discuss
This is an assessment, not a procedure, so there are no complication rates to quote. What varies is the likelihood of being found fit, fit with adjustments, or needing more information — this depends on the role's demands, your health and the standards that apply. For safety-critical roles, the threshold reflects the risk to you and others if a sudden health event occurred, and may follow external standards such as those used for driving.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Physical harm from the assessment itself | Very low | This is usually history, examination and targeted tests, not treatment; the important risk is an inaccurate fitness decision. | HSE — Health surveillance and occupational healthhse.gov.ukSource-linked context |
| Fitness opinion limited by incomplete information | Recognised occupational-health risk | Role demands, medicines, past records and specialist evidence may be needed before a reliable opinion can be given. | HSE — Health surveillance and occupational healthhse.gov.ukSource-linked context |
| Equality Act or discrimination pitfall | Key consent/governance issue | Health questions before a job offer are tightly restricted, and disability should trigger adjustment advice rather than automatic rejection. | Guide sourcesClinical context |
| Over-disclosure to the employer | Avoidable with good consent | The employer usually needs a functional fitness opinion, not full diagnoses or private clinical detail. | Guide sourcesClinical context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
There is no physical recovery. 'Afterwards' is about the fitness opinion sent to the employer, any adjustments recommended, and what happens if further information is needed.
- Being assessed as fit for the role, with or without adjustments.
- A short wait while a report is written or further information sought.
- A discussion with your employer about putting adjustments in place.
- Being entered into a health surveillance programme for a hazardous role.
Aftercare
- Check the adjustments recommended for you are actually put in place before or as you start.
- Keep a note of what was agreed and who is responsible for it.
- Follow up with your own GP on any new health finding the assessment raised.
- Ask occupational health if you are unsure what was shared with your employer.
- Attend any baseline or follow-up health surveillance appointments for hazardous roles.
- Raise concerns through HR, ACAS or the EHRC if you feel the process was misused.
- A copy of the job description with its physical and safety demands
- Completed health questionnaire (confidential to occupational health)
- Medicine and condition list
- Glasses, hearing aids or other aids you use
- Notes on adjustments that have helped you before
- Understanding of what will be shared and your consent rights
⚠ Get urgent help if…
- A new or worsening health problem found at the assessment that needs urgent care.
- Chest pain, breathlessness, fainting or sudden weakness — seek urgent help.
- Feeling pressured to hide a condition that could affect your or others' safety.
- An employer asking detailed health questions before any job offer was made.
- An offer being withdrawn on health grounds without reasonable adjustments being considered.
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your specialist gives you.
Results & realistic expectations
A good outcome is a clear, impartial opinion on whether you can do the specific role safely, with practical adjustments where they would help. It supports a placement that works for both you and the employer.
The assessment does not predict your future health, does not diagnose or treat conditions, and is specific to the role assessed — a different job may need a different assessment. A 'fit' opinion is not a guarantee that no health issue will ever arise at work.
A pre-placement opinion relates to the role at the time of assessment. If your health or your job changes substantially, a fresh assessment may be needed. For hazardous roles, ongoing health surveillance continues at set intervals throughout your employment rather than being a one-off.
Related tests, treatments or support
A pre-employment medical often sits alongside health surveillance for jobs with specific hazards, and may overlap with the pre-placement health questionnaire review that triggers it. If issues arise later in employment, a management referral assessment is the usual route, as described in the related guides.
Follow-up & long-term care
With your consent, the fitness opinion goes to the employer, who arranges any adjustments. Occupational health may review you again if adjustments need monitoring, if a hazardous role requires surveillance, or if your health changes. New health findings should be followed up with your own GP.
- Attend scheduled health surveillance appointments for hazardous roles.
- Tell occupational health if your health changes in a way that affects your work.
- Keep a record of agreed adjustments and review them if your role changes.
Repeat, follow-on and what comes next
- A 'fit with adjustments' opinion needs the employer to agree and implement the adjustments.
- A fresh assessment may be needed if your health or the role changes.
- Hazardous roles involve repeated health surveillance rather than a single check.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- A clear fitness opinion with practical, role-specific adjustment recommendations.
- Confirmation of what was, and was not, shared with the employer.
- A route to discuss or correct the report, and to raise discrimination concerns.
- Onward referral to your GP for any new health finding, and surveillance follow-up where relevant.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- Whether the assessment is a questionnaire review or a full examination.
- How safety-critical or hazardous the role is.
- Which specific tests are required, such as hearing, lung function or vision.
- Whether drug and alcohol testing is needed for the role.
- Whether a specialist report or further information must be obtained.
- Whether a baseline for ongoing health surveillance is being established.
- What the assessment includes and which tests are covered.
- Who receives the report and what information it will contain.
- That clinical details remain confidential unless you consent otherwise.
- Whether you will see the report before it is sent.
- Turnaround time for the fitness opinion.
- What happens, and any further cost, if more information or a specialist opinion is needed.
On the NHS? Pre-employment and pre-placement assessments are an employer-arranged occupational health service, not NHS care that individuals can request for themselves.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Not understanding that occupational health is impartial, not the employer's doctor.
- Not knowing what will be shared with the employer versus kept confidential.
- Not being offered sight of the report before it is sent.
- An employer using health information to discriminate, contrary to the Equality Act 2010.
Marketing red flags
- Suggesting the medical is there to 'weed out' unsuitable candidates.
- Implying clinical details will be passed routinely to managers.
- Asking detailed health questions before any job offer.
- Treating reasonable adjustments as optional rather than a legal duty.
Choosing a specialist safely
- Check the specialist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good specialist will welcome every one of these.
- What exactly will be assessed, and which tasks of the job are you checking me against?
- What information will be shared with my employer, and what stays confidential?
- What reasonable adjustments could help me do this role?
- Will I be able to see the report or opinion before it is sent?
- If I am not assessed as fit today, what could change that?
- Will this role involve ongoing health surveillance, and how often?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the specialist who carries out my test, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this test not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Can an employer ask about my health before offering me a job?
Will my employer see my medical details?
Can I be turned down because of my health?
Is occupational health on the employer's side?
Do I have to disclose everything?
Is this available on the NHS?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: EHRC — Pre-employment health questions (Equality Act 2010) ACAS — Reasonable adjustments at work HSE — Health surveillance and occupational health Faculty of Occupational Medicine — Good Occupational Medical Practice Society of Occupational Medicine — Work and health resources
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
Related guides: Pre-placement health questionnaire review · Management referral assessment · Sickness absence review · Medicals and fit-to-work certificates · Cabin crew medical