A pre-employment medical assessment is an important tool to help manage workplace risk. Pre-employment medical assessments evaluate the health risks relating to the proposed employment and ensure that the potential employee will be able to meet the physical and mental demands of the job.
In many industries, pre-employment medical assessments are a high priority for the long term health and safety of the business. According to Safe Work Australia, the transportation industry, have the highest number of work fatalities due to fatigue, long work hours, role requirement to stay alert and remain calm in stressful situations. A pre-employment medical assessment in this industry can help an employer make an informed assessment about the employee’s suitability for a role ultimately mitigating risks on the road for workers and those that share the roads with them.
Continue reading to learn more about pre-employment medical assessments, examples of high-risk industries and how pre-employment medical assessments reviewed by a doctor can determine an employees’ suitability for a role, prevent the risk of lost productivity, reduce absenteeism and reduce potential exposure to workers compensation claims.
What is a pre-employment medical assessment (PEM)?
A pre-employment medical is any type of medical assessment completed by a doctor before a decision on employment being made. The information obtained from the assessment is considered as one piece of information along with all the other information obtained in the recruitment process.
The medical assessment will typically include a medical history, an examination and special tests including most commonly hearing, lung function, vision, drug and alcohol testing.
Why do pre-employment medicals?
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Identify whether the candidate is medically fit to perform the inherent requirements of the proposed role,
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Identify whether placing the candidate in the proposed role poses a material risk of aggravating a health condition and compromising the candidate’s health and safety or the health and safety of others, and to
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Obtain a baseline on the candidate’s health before they commence employment.
Additionally, other testing such as drug and alcohol testing will identify those candidates who may have issues committing to the employers’ policy and culture.
Another reason for performing a pre-employment medical assessment is when they are required for compliance with specific industry standards or legislation, such as commercial driver, coal board or rail medical assessments.
What are the benefits of pre-employment medical assessments?
Pre-employment medical assessments are a tool for understanding the workforce as they first enter the workplace. Pre-employment medical assessments can potentially identify those who would be placed at risk of injury or aggravating a physical or mental health condition by undertaking the role and estimate the level of that risk. They are extremely important as a baseline for health surveillance so that any pre-existing health issues can be shown to have pre-dated employment, thereby preventing the employer inadvertently becoming responsible for any pre-existing deficits or conditions.
Pre-employment medical assessments also can assist to:
- Increase health and safety standards in the business
- Lower absenteeism and the risk of lost productivity
- Reduce exposure to workers compensation claims
What tests should be included in a pre-employment medical assessment?
In most circumstances the essential parts of a pre-employment medical assessment are the same as the tools that are used in medicine; that is a good history of the candidate’s medical conditions (past and present) as well as obtaining a good understanding of the impact that those conditions and their treatment have had and continue to have on the candidate. Traditionally, an overview of the history is obtained via a questionnaire that covers all key areas, including mental health. This is followed by a general medical examination focusing on potential issues identified via the history.
All other components of the assessment should be determined by the risks in the proposed role. If there is a risk of hearing damage due to loud noise in the work environment it is essential to obtain a baseline reading of the candidate’s hearing. Without an appropriate baseline, employers can become liable for causing all of the hearing loss an employee identified later, even if much of it is pre-existing. Similarly, if the role involves work with respiratory hazards, such as silica, isocyanates or smoke, and requires the employee to wear a respirator, then the role would be difficult with a significant lung disorder. In these cases, spirometry is required to obtain a baseline and to determine whether the candidate would be able to safely perform the duties. The same thinking applies to all other testings.
How does working in industries such as transport and aged care impact on what testing is performed?
As mentioned above, the testing performed should match the risks associated with the duties to be performed.
In the transport industry, drivers of commercial vehicles require testing that ensures that the candidate meets the national Austroads “Assessing Fitness to Drive” standards. For this to be assessed fully an audiometry test is recommended. The benefit of further musculoskeletal assessment of the candidate should depend on the level of manual handling and physical effort required in the role. For roles that include a significant amount of lifting and carrying or that include opening and closing of heavy truck curtains, a more detailed musculoskeletal assessment with strength and endurance components can be performed.
In aged care, there is a high risk of injury due to work with people who may be losing their physical and mental capabilities. Working in aged care has one of the highest injury rates, with high physical and mental demands. Workers assisting the elderly with their mobility and self-care are often exposed to uncontrollable human weight, lifting, pushing, pulling, repetitive movement and bending which can cause strain to their back, sprains and even bone breaks in some instances. With a high risk of injury, a baseline of physical health such as musculoskeletal testing is recommended depending on the degree of manual handling and physical endurance is required in the role. The pre-employment medical may also cover that of mental health assessment due to the workers’ exposure to mental stress and strain caused by grief of loss for those in the employee care, managing relationships and even physical and verbal abuse from the elderly.
How do organisations interpret the medical information obtained by pre-employment medical assessments and the associated testing?
Some organisations have trained and experienced internal staff that can assess the medical information. Some workplaces have occupational health nurses who can interpret the information provided and relate to the specific proposed role. In recent years, there is fewer of these internal medically trained staff available. I have found over the years that having an independent party with medical expertise to interpret the information provides a more standardised and informed approach. The variety and complexity of medical conditions and their potential impact on work mean that workplaces benefit from expert independent medical advice in assessing candidates.
Is there value in drug and alcohol testing at the pre-employment medical and what form of testing is recommended?
Again the decision of whether to perform this testing depends on the risks inherent in the role would be significantly adversely affected by a candidate with an undeclared drug or alcohol problem. For example, identifying a commercial driver who is a regular user of amphetamines or drinks alcohol to unhealthy levels is key information in the transport industry or where close attention to the task could harm the potential employee, other co-workers, the general public or plant and equipment.
There are various choices of types of tests available. At the pre-employment medical stage for drugs, it is beneficial to see a window of recent drug use (days to weeks) rather than minutes to hours. It would be very easy for even the most ardent drug user to abstain for the few hours required to show a negative result on oral fluid testing. Consequently, urine drug testing is recommended for most industries where it is required.
Screening for drugs and alcohol in the transportation industry indicates whether a potential employee is fit for the role. A driver is operating a dangerous piece of machinery. A dependence on drugs or alcohol can present risks on the road.
Alcohol testing at PEM has very little utility. Most PEMs are booked with at least 12-24 hours’ notice for the candidate. Almost anyone, even with a serious drinking problem will have a blood alcohol level of 0.00% by the time of their test. In my opinion, a candidate’s history of alcohol use and consumption is more informative than this test.
What are the overall benefits of pre-employment medical assessments?
Comprehensive pre-employment medical assessments provide necessary medical information to help make an informed hiring decision. A pre-employment medical assessment can assist to:
- Measure the suitability of a potential employee to a specific role
- Screen potential employees for risk factors that may limit their ability to work in the role
- Protect the potential employee from working in potentially harmful work environments
- Increase health and safety standards in the business
- Improve company morale
- Lower absenteeism and the risk of lost productivity
- Reduce exposure to workers compensation claims
