A pre-employment medical assessment determines whether a candidate can safely perform the inherent requirements of a specific job. It is conducted after a conditional offer of employment, calibrated to the IROJ, and results in a fitness determination — not a general health report — for the employer.
What makes a pre-employment medical assessment different from a GP medical
A general practitioner medical is designed to assess and manage a patient’s overall health. A pre-employment medical assessment serves a fundamentally different purpose: it answers a single occupational question — can this candidate perform the documented demands of this specific role, safely and sustainably?
The distinction is not merely semantic. An employer who bases an employment decision on a GP medical report — rather than an IROJ-calibrated occupational assessment — lacks the clinical evidence to demonstrate that their decision was job-related. That gap creates direct exposure under the Disability Discrimination Act 1992. Courts and tribunals have repeatedly found against employers who excluded candidates on the basis of health findings that were not demonstrably linked to the inherent requirements of the role.
The pre-employment medical assessment is the clinical bridge between the documented role demands (IROJ) and the individual candidate’s functional capacity. It is conducted by an occupational health clinician who has the IROJ in hand, understands the specific demands the candidate will face, and applies those demands as the fitness criteria.
The six-step process — in the correct sequence
The sequencing of these steps is not optional. Steps 1 and 2 must occur before any clinical assessment begins. Reversing the order — particularly conducting any health enquiry before the conditional offer — creates discrimination liability that cannot be remedied after the fact.
- 1
Confirm the IROJ is current
Before commissioning an assessment, confirm the Inherent Requirements of the Job document for the specific role is current, signed by a qualified OHS clinician, and accurately reflects the actual demands of the role as it will be performed. An outdated or generic IROJ undermines the entire assessment.
- 2
Make the conditional offer
Issue the conditional offer of employment in writing before scheduling the assessment. The offer should state that it is conditional on satisfactory outcome of a pre-employment medical assessment. This step is legally required before any health information is collected.
- 3
Obtain informed consent
Provide the candidate with a written information statement before the assessment. It should cover what is assessed, who sees the outcome, how long records are retained, and how to dispute a finding. Obtain signed consent.
- 4
Commission the IROJ-calibrated assessment
Refer the candidate to an occupational health provider with the IROJ, not a generic medical form. The assessing clinician needs the documented demands to calibrate the assessment and apply the correct fitness criteria.
- 5
Receive the fitness outcome
The assessing clinician provides a fitness outcome — fit, fit with restrictions, or unfit for the specific role — with clinical reasoning referencing the IROJ. The employer does not receive the full medical record.
- 6
Document the employment decision
Record the employment decision and the basis for it. If the decision follows a fit outcome, retain the fitness report. If the decision declines an unfit candidate, document the specific IROJ demands that could not be met and whether reasonable adjustments were considered.
What a pre-employment medical assessment covers
The assessment content is determined by the IROJ demand profile of the role. For a sedentary role with no specific physical, sensory, or safety-critical demands, the assessment may be brief — a health declaration review and a targeted musculoskeletal screen. For a heavy-demand safety-critical role, the assessment may include multiple components assessed at clinical intensity.
Physical demands
- ›Musculoskeletal screen (spine, upper and lower limb)
- ›Functional capacity evaluation — lifting, carrying, push/pull calibrated to IROJ demand category
- ›Postural tolerance and endurance assessment
Sensory demands
- ›Visual acuity (corrected and uncorrected per IROJ)
- ›Colour vision where documented as an IROJ requirement
- ›Audiometry for noise-exposed roles and safety communication requirements
Cardiovascular and respiratory
- ›Resting ECG and blood pressure
- ›Spirometry for roles with respiratory hazard exposure or respirator use
- ›Submaximal exercise test for high cardiovascular demand roles
Safety-specific
- ›Drug and alcohol screen (AS 4308:2023 / AS 4760:2019) for policy-covered roles
- ›Fit-for-function assessment for high-risk work licence roles
- ›Vaccination status for patient-facing healthcare roles
Interpreting the assessment outcome
A pre-employment medical assessment produces one of three outcomes, each of which requires specific employer action.
Fit for the role
The candidate meets all IROJ demands without restriction. The employment can proceed. Retain the fitness report with the candidate's employment record. Note the date — relevant for baseline surveillance obligations.
Fit with restrictions
The candidate can meet the role's inherent requirements with specific modifications or accommodations. The clinical report will specify the restriction — for example, "no sustained overhead work above shoulder height" or "no manual handling above 15 kg without mechanical assistance." The employer must assess whether the restriction can be accommodated without fundamentally altering the role, and document that assessment.
Unfit for the role
The candidate cannot meet one or more inherent requirements of the role, and reasonable accommodation is not practicable. The clinical reasoning must reference specific IROJ demands. The employer should review whether the IROJ accurately reflects what the role genuinely requires — if the contested demand is not truly inherent, the unfit finding should be reconsidered. The candidate has the right to seek a second clinical opinion.
Reasonable adjustments — when they must be considered
Australian anti-discrimination law does not permit an employer to decline a candidate simply because a health condition is present. The question is whether the candidate can perform the inherent requirements of the role — with or without reasonable adjustment. Where a health condition creates a functional limitation, the employer must consider whether a reasonable adjustment could bridge that gap before the employment decision is made.
Reasonable adjustments might include modified task allocation within a role, modified equipment or tooling, staged introduction to the full demands of the role, or a temporary restriction with a defined review date. What constitutes “reasonable” is assessed against factors including cost, operational impact, and the nature of the role.
The employer does not have to make adjustments that impose unjustifiable hardship. But the employer does have to genuinely consider them and document that consideration before declining to hire on the basis of a medical assessment outcome. An employer who receives an unfit finding and immediately declines without engaging with the reasonable adjustment question is exposed to discrimination claims even where the clinical finding was sound.
Frequently asked questions
What is a pre-employment medical assessment?
A pre-employment medical assessment is a structured health evaluation conducted after a conditional offer of employment to determine whether a candidate can safely and effectively perform the documented inherent requirements of a specific role. Unlike a general medical, it is calibrated to the IROJ (Inherent Requirements of the Job) — assessing fitness for specific physical, sensory, cognitive, and safety demands of the role rather than general health status.
Who should conduct a pre-employment medical assessment in Australia?
Pre-employment medical assessments should be conducted by a registered medical practitioner or occupational health nurse with training in functional capacity evaluation and knowledge of anti-discrimination obligations. For high-demand or safety-critical roles, occupational physicians are appropriate. The critical requirement is that the clinician has access to the IROJ and can apply its demand profile to the assessment — generalist GPs without OHS context frequently produce assessments that are not calibrated to role demands and cannot support a defensible fitness determination.
Can a pre-employment medical assessment be required for all new employees?
An employer can require all candidates for a given role to undergo a pre-employment medical assessment, provided the assessment is calibrated to the documented inherent requirements of that role. However, the same standard must be applied consistently — an employer cannot selectively require assessments for some candidates and not others for the same role. Different roles can have different assessment requirements, but within each role the standard must be consistent.
What is the difference between a pre-employment medical assessment and a pre-employment screening?
In common usage, the terms are often interchangeable. In clinical practice, a pre-employment medical assessment typically emphasises the medical components — musculoskeletal review, physician evaluation, cardiovascular assessment. Pre-employment screening is a broader term that encompasses all fitness-for-role processes including functional capacity evaluation, D&A testing, and baseline health surveillance. Both must be calibrated to the IROJ to be legally defensible. See our pre-employment screening guide for the full framework.
How should an employer handle an "unfit" pre-employment medical assessment outcome?
When an assessing clinician returns an unfit outcome, the employer should: (1) review the clinical reasoning — which specific IROJ demands cannot be met; (2) consider whether reasonable adjustments to the role could enable the candidate to meet those demands; (3) if adjustments are not reasonably practicable, document that consideration; and (4) communicate the employment decision to the candidate. The candidate has the right to seek a review of the clinical finding through an independent clinical opinion. Employers should have a clear, documented process for handling disputed outcomes.
Pre-Employment Screening — Complete Framework
IROJ-based screening, legal conditions, and documentation standards.
Pre-Employment Screening — Process Overview
Building a compliant, consistent screening process at scale.
Pre-Employment Medical Check
What a check involves component by component.
Pre-Employment Screening Service
OccuSpan's platform for IROJ-calibrated assessments.
OccuSpan PES Module
Assessment process — from IROJ to outcome, documented
OccuSpan links every pre-employment medical assessment to the current IROJ for the role, automates the conditional offer workflow, and stores fitness outcomes with clinical reasoning against the worker and role profile.
See the PES module