Pre-Employment Medical Exam

The ADA's three stages

The ADA treats medical exams and disability-related questions differently at each stage:

1. Before an offer: employers may not require medical exams or ask disability-related questions. They can ask whether the candidate can perform the job's functions, with or without accommodation.
2. After a conditional offer, before starting: employers may require a medical exam, even one not strictly job-related, if it is required of all entering employees in the same job category. The offer can only be withdrawn if the results show the person cannot perform essential functions even with reasonable accommodation, or poses a direct threat that accommodation cannot reduce.
3. During employment: exams must be job-related and consistent with business necessity. This is where fitness for duty exams belong, for example after an injury or when there is objective evidence that an employee cannot perform safely.

This is why the exam is usually listed as a condition in a contingent job offer.

What it typically covers

It depends on the job. A warehouse role may include a lift test and musculoskeletal screen. Commercial drivers need a DOT physical under Federal Motor Carrier Safety Administration rules. Healthcare workers often need immunization records and tuberculosis screening. Firefighters and police officers usually face role-specific medical standards. A physical abilities test that measures only job tasks, such as lifting a 50-pound box to a shelf, may not count as a medical exam at all, but rules here are technical, so keep it to genuine job demands.

Confidentiality and GINA

Medical information from these exams must be kept confidential, on separate forms, in a separate medical file, not in the personnel file. Supervisors may be told only about necessary work restrictions and accommodations; first aid and safety staff only when emergency treatment might be needed.

The Genetic Information Nondiscrimination Act bars employers from requesting genetic information, which includes family medical history. Ask clinicians not to collect family history, and use the EEOC's suggested safe harbor language in requests to providers. Drug tests for illegal drugs are not medical exams under the ADA and follow separate rules; see drug test.

Practical tips

• Define the job's essential functions and physical demands in the job description before you design the exam.
• Apply the same exam to everyone entering the job category, not only candidates who look less fit or who disclosed a condition.
• Schedule exams quickly; in high-volume hiring, a two-week wait for a clinic slot loses candidates.
• If results raise a concern, start the interactive accommodation process before deciding anything.
• Several states add their own rules, so check the work location. Outside the US, many countries restrict pre-employment health checks further.