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Pre-employment physical exams, also known as pre-hire medical exams, are common practice for many employers in the United States. While not legally required for most jobs, many companies use these exams to assess a candidate’s ability to perform essential job functions safely and determine if accommodations need to be made.

In this blog post, we’ll explore the typical components and requirements of a standard pre-employment physical in more detail.

Legal Guidelines Around Pre-Employment Exams

By law, pre-employment medical exams and questions are prohibited until after a conditional offer of employment is extended. Employers are also not allowed to collect medical information before a job offer.

Certain medical conditions and disabilities are protected under the Americans with Disabilities Act (ADA). Employers cannot refuse to hire someone solely based on a disability or medical condition unless it would pose a “direct threat” to health and safety in that particular job.

Any medical information collected as part of a pre-employment exam must be kept confidential, stored separately from personnel files, and only shared with managers or supervisors on a need-to-know basis.

Common Components of a Standard Exam

While there is no official standard, here are some typical components included in a basic pre-employment physical exam in the United States:

Medical History Questionnaire

This form asks about prior or current health issues, surgeries, medications, allergies, and other health factors.

Physical Assessment

The examiner will check vital signs like temperature, pulse, respiration rate, and blood pressure. They may also do a basic physical exam of eyes, ears, nose, throat, lungs, heart, abdomen, extremities, and neurological functions and note any abnormalities.

Vision and Hearing Screening

Visual acuity and hearing are tested to ensure any job requirements can be safely performed. Color blindness screening may be included in some jobs.

Drug/Alcohol Screening

Both urine and saliva samples are commonly collected to check for illegal or prescription drug use based on company policy.

Respirator Clearance

Additional lung function tests may be needed if a respirator like a dust mask is required.

Immunizations and Titers

Proof of immunizations like hepatitis B, MMR, and tetanus may be verified. Serology blood tests check for immunity.

Additional Tests Based on Job Requirements

Some jobs require extra tests tailored to potential job hazards and essential functions. These may include:

  • Audiogram: For noise-exposed environments, establish a baseline.
  • Chest X-ray: For healthcare or manufacturing jobs with exposure risks.
  • EKG/Stress Test: Roles involving strenuous physical activity.
  • Respiratory Questionnaire: Detects signs of asthma or lung disease.
  • Functional Capacity Evaluation: Determine physical abilities for strenuous or safety-sensitive roles.
  • Vaccinations: Jobs like healthcare may require flu, COVID-19, or other added immunizations.

Timeline and Process

After a candidate accepts a conditional job offer, the employer will provide:

  • Information on the exam requirements and process.
  • A designated medical facility will conduct the exam.
  • Notice that the employer covers any costs.

The physical is typically scheduled within 1-2 weeks of receiving the offer and conducted by an occupational health provider. Exam results must be reviewed by an evaluating physician. Clearance is usually provided within 3-5 business days in most cases.

Positive drug tests or health issues that could impact job duties may result in revoking the conditional offer. Candidates are entitled to a full explanation and an opportunity to address findings. Accommodations can often still allow someone to perform essential duties safely.


Pre-employment physical exams are common but not a legal requirement in the United States for most jobs. The goal is safety, injury prevention, and determining if any accommodations are needed. Requirements are tailored to job risks and duties.

While medical privacy laws must be followed, physical readiness for work is appropriately assessed through exams during the hiring process when conducted legally and ethically by employers.

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