Pre-Employment Medical: What to Expect, Tests & How to Prepare

A pre-employment medical is an occupational health assessment conducted before you begin a new role to determine whether you are physically and medically fit to safely perform the inherent requirements of the job. Unlike a general health check with your GP, a pre-employment medical is specifically designed to assess your fitness for the particular demands of a specific role — the results are compared against the Inherent Requirements of the Role (IRR) document, which describes the physical and health standards needed to perform the job safely.

Pre-employment medicals are standard practice in safety-critical industries including mining, construction, oil and gas, transport, emergency services, and healthcare. They are less common in office-based or low-physical-demand roles, though some organisations request a basic medical for all hires regardless of role type.

The assessment is conducted by an occupational physician, occupational nurse, or registered nurse at an occupational health clinic — not by your own GP. The clinic is engaged by the employer (or the employer's medical screening provider), and the report is provided to the employer, not to you as the primary recipient. You should receive a copy of your results on request, however.

A pre-employment medical is not the same as a police check or reference check — it is specifically about your physical health and fitness for work. Some employers bundle multiple pre-employment checks (police check, medical, drug screen, reference checks) into a single onboarding package coordinated through a provider like Refchecks.

The specific tests included in a pre-employment medical depend on the role and industry, but the following components are standard across most Australian occupational health medicals:

Vision and Hearing Tests

Lung Function (Spirometry)

Musculoskeletal Assessment

Drug and Alcohol Screen

Blood Pressure and Cardiovascular Check

A pre-employment medical does not automatically disqualify you from employment if you have a pre-existing health condition. The assessment determines whether the condition, as it currently presents, prevents you from safely performing the inherent requirements of the specific role. A condition that is relevant in one role may be entirely immaterial in another.

Conditions that are most commonly flagged and assessed include:

• Musculoskeletal conditions: Herniated discs, previous back surgeries, significant joint replacements, or degenerative conditions may be flagged for roles involving heavy lifting or sustained awkward postures. The assessor will determine whether restriction or accommodation is appropriate.
• Cardiovascular conditions: Uncontrolled hypertension, recent cardiac events, or significant arrhythmias may restrict access to roles with cardiovascular demands (emergency services, remote FIFO) pending specialist clearance.
• Respiratory conditions: Uncontrolled asthma, COPD, or significantly reduced spirometry results may restrict access to dust- or fume-exposed environments.
• Diabetes: Insulin-dependent diabetes is closely scrutinised for roles involving shift work, driving, or operation of heavy machinery due to hypoglycaemia risk. Well-controlled diabetes with appropriate management may be accommodated.
• Mental health conditions: Disclosed mental health conditions are assessed only in the context of whether they affect safe task performance. Employers cannot refuse employment on the basis of a mental health diagnosis alone — only on demonstrated functional impairment relevant to the role.
• Visual impairments: Uncorrected vision below required standards for the role (e.g., heavy equipment operator visual standards) will be flagged.

Being flagged for a condition does not automatically mean "unfit." The occupational physician's report will typically recommend "fit," "fit with restrictions," "fit pending specialist review," or "unfit" — with the last category requiring clear evidence that the condition poses an imminent and unmanageable safety risk specific to the role.

Pre-employment medical information is sensitive health data and is protected under the Privacy Act 1988 and the Australian Privacy Principles (APPs). Key rights you have as a candidate:

• Informed consent: You must consent to the medical assessment before it proceeds. The consent form should specify what is being collected, how it will be used, who it will be shared with, and how long it will be retained.
• Relevance: The employer may only request a medical assessment that is relevant to the inherent requirements of the specific role. A blanket health check with no connection to role demands may not be lawful.
• Limited disclosure: The full medical report — including your diagnosis, test results, and clinical notes — should not routinely be disclosed to the employer. Best practice is for the occupational physician to provide a fitness determination only (fit/fit with restrictions/unfit) to the employer, with the clinical detail retained by the clinic. You should be informed if the employer is receiving more than a fitness summary.
• Access: You have the right to access your own medical results. Request a copy of your results from the clinic directly.
• Disability Discrimination Act 1992: Employers cannot refuse employment on the basis of a disability or health condition unless it is an unjustifiable hardship to accommodate the condition, or the condition prevents safe performance of the genuine inherent requirements of the role. The assessment process must be applied consistently across all candidates.

Different industries apply different fitness-for-work standards in pre-employment medicals, reflecting the specific hazards and demands of those environments:

• Mining and resources: Most major mining operations follow the National Standard for Health Assessment of Rail Safety Workers or their own site-specific standard. Coal mining has specific requirements under state Coal Mining Safety and Health Acts. FIFO roles often require a higher fitness standard than day-shift operations due to the remote location, limited medical support, and emergency response implications of any medical event on site.
• Transport: Commercial vehicle drivers (MC, HC, MR licence classes) are assessed against the Assessing Fitness to Drive national standard published by Austroads. Rail safety workers follow a dedicated national standard with graded fitness categories.
• Healthcare: Hospital pre-employment medicals typically include vaccination status verification (in addition to a standard medical) and may require specific immunisation top-ups (hepatitis B, influenza, COVID-19) as a condition of employment.
• Emergency services: Police, fire, and ambulance have specific fitness standards published by each state's emergency services authority. These typically include cardiovascular fitness tests (not just resting assessments) and psychological screening components.
• General industry: For roles without sector-specific standards, the occupational physician applies clinical judgement based on the role's inherent requirements document provided by the employer.

While you cannot change your health status before a pre-employment medical, you can prepare in ways that ensure the assessment is accurate, informed, and goes as smoothly as possible:

• Know what to expect: Ask the employer or the clinic what components are included in your specific assessment so you are not caught off-guard. This guide covers the most common elements, but the exact scope varies.
• Bring your medication list: Carry a current list of all prescription and over-the-counter medications you take, including dosage and frequency. This is critical for the drug screen component and for the medical history review.
• Fast if required: Some assessments include blood glucose or cholesterol testing that requires fasting. Check with the clinic when booking — typically a 4–8 hour fast before the appointment.
• Bring relevant medical history: If you have a known condition that may be relevant (e.g., previous back surgery, cardiac history, respiratory condition), bring copies of your specialist reports or GP summaries. This context helps the occupational physician make a more informed and accurate assessment.
• Wear comfortable clothing: You may be required to perform physical movements. Wear loose, comfortable clothing and closed-toe shoes.
• Disclose honestly: Do not conceal material health information in a pre-employment medical. Concealment of a relevant health condition that later results in a workplace injury may affect your workers' compensation entitlements and could be grounds for termination if discovered.
• Rest well beforehand: Fatigue affects blood pressure readings, spirometry results, and physical performance assessments. Being well-rested gives you the best chance of an accurate result.