A pre-employment medical check is a structured health assessment that determines whether a candidate can safely perform the documented inherent requirements of a specific job. It is conducted after a conditional offer of employment and is calibrated to the role’s physical, sensory, and cognitive demands — not a general health examination.
What a pre-employment medical check actually is
The term “pre-employment medical check” is used loosely in Australian workplaces — sometimes to mean a GP visit, sometimes a nurse-led functional screen, sometimes a comprehensive occupational medicine assessment. In evidence-based OHS practice, a pre-employment medical check is a structured, role-specific clinical process that answers one question: can this candidate safely perform the inherent requirements of this job?
The key word is “specific.” A valid pre-employment medical check is not interchangeable across roles. A check conducted for a heavy construction labourer includes different components — at different intensity thresholds — than one for an administrative coordinator or a warehouse picker. The role dictates the assessment, and the role demands are captured in the Inherent Requirements of the Job (IROJ) document.
Without an IROJ, a pre-employment medical check is legally indefensible. If a candidate is declined on the basis of a health finding, and the employer cannot demonstrate that finding is directly relevant to a documented, genuine inherent requirement of the role, they face significant exposure under the Disability Discrimination Act 1992 and state anti-discrimination legislation.
What is assessed — components by demand level
The components of a pre-employment medical check are determined by the IROJ demand profile. Australian Standards classify physical demands across five categories — sedentary, light, medium, heavy, and very heavy — each with defined lifting, carrying, and postural requirements. The check is assembled from the components that are directly relevant to those demands.
Musculoskeletal screen
Applies to: Medium demand and above; all roles with specific postural or repetitive movement requirements
Range of motion assessment for the spine, upper limbs, and lower limbs relevant to the documented IROJ physical demands. For high-demand roles, this may include a functional movement screen or targeted strength assessment. The finding is interpreted against the IROJ demand category — a minor cervical restriction may be irrelevant for a sedentary role but significant for an overhead trades position.
Functional capacity evaluation (FCE)
Applies to: Heavy and very heavy demand roles; roles with specific manual task requirements in the IROJ
A structured assessment of the candidate's ability to perform the specific manual tasks documented in the IROJ — floor-to-bench lifting, carry distances, push/pull forces, sustained postures. The FCE is calibrated to the IROJ demand profile, not generic population norms. This is the primary clinical basis for fitness determination in high-demand roles and the strongest legal protection against discrimination claims.
Vision assessment
Applies to: Safety-critical roles (vehicle operators, plant operators, healthcare); roles with specific visual acuity requirements in the IROJ
Snellen visual acuity (corrected and uncorrected where the IROJ specifies), colour vision where documented as a genuine requirement (electrical, transport, aviation, emergency services). The vision standard must be traceable to the IROJ — not a general "good eyesight" criterion.
Hearing (audiometry)
Applies to: Noise-exposed roles at or above 85 dB LAeq; safety-critical communication roles
Pure-tone audiogram providing the pre-exposure baseline for ongoing health surveillance, and assessment of whether existing hearing status is compatible with safety communication requirements in the IROJ. Record retention is triggered from the baseline — 30 years for Schedule 14 hazardous work.
Drug and alcohol screen
Applies to: Safety-critical roles where a D&A policy applies; mining, transport, construction, and utilities roles under enterprise agreements or principal contractor requirements
AS 4308:2023 (urine) or AS 4760:2019 (oral fluid) collection and chain of custody. Confirmation testing for non-negative results via NATA-accredited laboratory. The D&A component is policy-driven — it applies where the employer's D&A policy covers the role, not universally.
Cardiovascular fitness
Applies to: FIFO/remote roles; roles with documented cardiovascular demand (emergency response, physically arduous roles); roles with limited medical access post-commencement
Resting ECG, blood pressure measurement, submaximal exercise test where indicated by IROJ demand category and individual risk profile. AHA/ACC cardiovascular risk stratification for high-demand roles. The cardiovascular component is indicated by the role demands and access context — not by age alone.
Respiratory function (spirometry)
Applies to: Roles with respiratory hazard exposure (silica, asbestos, isocyanates, grain dust); roles requiring respirator use
Baseline spirometry providing the pre-exposure reference for ongoing respiratory surveillance. Also used to assess fitness for respirator use where the IROJ requires self-contained breathing apparatus or supplied-air respirator. Triggered by hazard exposure, not general health screening.
Why the IROJ is the clinical anchor
The Inherent Requirements of the Job document is a structured clinical description of what the role actually demands — physically, cognitively, and sensorially. It captures demand categories (sedentary through very heavy), specific task frequencies, postural requirements, environmental exposures, safety-critical functions, and any regulatory fitness standards that apply to the role.
In a pre-employment medical check, the IROJ performs three critical functions. First, it determines which components the check needs to include — a role with no lifting requirement needs no FCE; a role with documented audiometric exposure needs a baseline audiogram. Second, it calibrates the intensity thresholds for each component — what weight, what frequency, what distance. Third, it provides the reference standard for fitness determination — the clinical decision is whether the candidate can meet the documented demands, not whether they have a perfect health status.
This last point is critical for anti-discrimination compliance. Many health conditions — managed diabetes, hypertension, previous musculoskeletal injury, controlled mental health conditions — do not prevent a person from meeting the inherent requirements of most roles. Without the IROJ, the assessing clinician has no principled basis for distinguishing between a finding that is job-relevant and one that is not. With it, the decision is defensible.
OccuSpan approach
OccuSpan pre-fills the pre-employment medical check protocol from the IROJ demand profile for each role. When the IROJ is updated — because the role changes, a task is added, or an exposure threshold is revised — the check protocol updates automatically. Every assessment references the current IROJ version, creating an auditable chain from role demand to clinical finding to fitness determination.
The legal conditions for a lawful pre-employment medical check
Australian anti-discrimination legislation — the Disability Discrimination Act 1992 at Commonwealth level, and state equivalents — permits employers to require candidates to meet the inherent requirements of the job. A pre-employment medical check is the clinical mechanism for making that determination. Three conditions must be satisfied for the check to be lawful.
Conducted after a conditional offer
The offer of employment must exist before any health screening begins. It can be conditional on satisfactory medical check outcome, but it must be made. Conducting a medical check as part of shortlisting, before any offer is made, is direct disability discrimination in all Australian jurisdictions. This sequencing requirement is non-negotiable.
Calibrated to the IROJ
Every component of the check, and every criterion used to make a fitness determination, must be traceable to the documented inherent requirements of the specific role. A finding is only relevant to the employment decision if it demonstrably affects the candidate's ability to meet a documented, genuine requirement. General health findings with no bearing on role demands cannot be used.
Applied consistently across candidates
The same check protocol and the same fitness criteria must be applied to every candidate assessed for the same role. Inconsistent application — different components, different thresholds, different interpretation — creates discrimination liability. The IROJ is the consistent reference standard that makes this achievable at scale.
Privacy obligations — who sees the results
Medical information collected in a pre-employment medical check is sensitive health information under the Privacy Act 1988. The information may only be collected, used, and disclosed in ways that are consistent with the purpose for which it was collected — determining fitness for the documented role demands.
In practice, this means the assessing clinician provides the employer with a fitness outcome — fit, fit with restrictions, or unfit — and the specific functional limitations relevant to the IROJ. The clinician does not share the full medical record, diagnoses, or health history with the employer. The employer receives what they need to make an employment decision; the clinical record remains with the clinical provider.
Candidates must be informed, before the check is conducted, of what information will be collected, who will see it, how long it will be retained, and what happens to it if employment does not proceed. Informed written consent should be obtained before any assessment begins.
Pre-employment medical checks in high-risk industries
Several Australian industries have regulatory or enterprise-agreement requirements that specify the minimum content of a pre-employment medical check. These do not replace the IROJ-based assessment — they add mandatory components on top of it.
Mining (coal and metalliferous)
Chest X-ray and respiratory function baseline for dust-exposed roles. AS 4308:2023 D&A screen for safety-critical functions. Audiometry baseline. State-specific requirements vary — QLD coal mines have specific Medical Assessment of Fitness requirements under the Coal Mining Safety and Health Act 1999.
Transport (commercial vehicle drivers)
Austroads medical standards apply for commercial driver licence holders. Vision, cardiovascular, and neurological assessment against Austroads criteria. The IROJ documents the driving demands; Austroads provides the regulatory fitness standard.
Construction and civil
Principal contractor D&A policies typically specify AS 4308:2023 or AS 4760:2019 testing at pre-employment, with ongoing surveillance. Site access rules may require valid clearance documentation. Physical demand FCE calibrated to heavy or very heavy IROJ categories for plant operation and manual trades roles.
Healthcare and aged care
Infection control requirements — vaccination status (hepatitis B, influenza, COVID-19) as a condition of employment for patient-facing roles. Specific manual handling FCE for clinical and support roles with patient handling demands.
FIFO and remote operations
Cardiovascular fitness and emergency response capacity are typically included given limited medical access on site. Fitness for confined space, working at heights, and emergency evacuation functions may be required by the IROJ for specific roles.
Frequently asked questions
What does a pre-employment medical check involve?
A pre-employment medical check assesses whether a candidate can safely and effectively meet the documented physical, sensory, and health demands of a specific role. It typically includes a musculoskeletal screen, functional capacity evaluation calibrated to the IROJ (Inherent Requirements of the Job), vision and hearing tests where required by the role, and a drug and alcohol test for safety-critical positions. The components vary by role — a sedentary office role requires far less than a heavy mining or construction position.
Can an employer refuse to hire based on a medical check result?
An employer can decline to hire if a candidate cannot meet the genuine, documented inherent requirements of the role. However, the decision must be based on specific functional limitations relating to the IROJ — not general health status. The Disability Discrimination Act 1992 and state equivalents prohibit using health information to exclude candidates unless the health condition prevents them from meeting genuine, necessary job demands. The employer must also consider whether reasonable adjustments could make the role achievable.
Does a pre-employment medical check need to happen before or after the job offer?
After. In Australia, pre-employment medical checks must occur after a conditional offer of employment has been made. Conducting health screening before an offer creates direct disability discrimination exposure. The offer can be conditional on satisfactory medical check outcome, but it must be made first. This is one of the most commonly misunderstood requirements in Australian pre-employment practice.
How long does a pre-employment medical check take?
For sedentary to light-demand roles, a standard pre-employment medical check typically takes 30–60 minutes. For medium to heavy-demand roles with functional capacity evaluation, 60–90 minutes is typical. Where additional components are required — cardiovascular fitness testing, specialist audiometry, or extended musculoskeletal assessment — allow 90–120 minutes. Drug and alcohol collection adds approximately 15 minutes, with laboratory confirmation results available within 24–48 hours.
What is the difference between a pre-employment medical check and a fitness for work assessment?
A pre-employment medical check is the process of assessing a new candidate before they commence employment. A fitness for work assessment can occur at any point in the employment lifecycle — after illness or injury, following a safety incident, or as part of ongoing health surveillance. Both use the IROJ as the reference standard for fitness determination, but the trigger and regulatory context differ. See our fitness for work assessment guide for a detailed comparison.
Related guides
Pre-Employment Screening — Practical Guide
The complete framework for IROJ-based screening in Australia.
Pre-Employment Medical Test — What Tests Are Included
Detailed breakdown of each test component and when it applies.
Pre-Employment Medical Assessment — Employer Guide
How to structure the full assessment process from IROJ to outcome.
Pre-Employment Screening Service
OccuSpan's IROJ-calibrated PES platform.
OccuSpan PES Module
IROJ-calibrated medical checks — defensible by design
OccuSpan pre-fills pre-employment medical check protocols from the IROJ demand profile for each role. Consistent criteria, documented clinical reasoning, and auditable records from conditional offer through to fitness determination.
See the PES module