Occupational safety International framework and country guides
Are pre-employment and periodic medical examinations required for workers in the United States?
Part of: Occupational safety and health in United States: law, authorities and employer duties
Short answer
Not generally. Federal OSHA requires examinations only under specific standards such as respirator use, noise at or above 85 dBA, silica, lead, asbestos and benzene. Each sets its own timing, for example annual audiograms and silica examinations at least every three years.
Not as a general rule. Federal OSHA law has no duty to examine every worker before employment or at fixed intervals. Medical examinations are required only by specific standards for particular exposures or equipment, and each standard sets who is examined, by whom, what tests and how often.
Short answer
- No universal pre-employment or periodic examination under federal OSHA law.
- Standard-specific surveillance: for example asbestos, benzene, cadmium, lead, chromium(VI), silica, formaldehyde, bloodborne pathogens, HAZWOPER, noise and respirator use.
- Respirators: medical evaluation by a physician or other licensed health care professional (PLHCP) before fit testing or first use.
- Noise: baseline audiogram within 6 months of first exposure at or above 85 dBA (8-hour average), then at least annually.
- Silica: in general industry, workers at or above the action level for 30 or more days a year (in construction, workers required to wear a respirator for 30 or more days a year) are offered an initial examination within 30 days of assignment and repeat examinations at least every 3 years.
- Records: medical records kept for the duration of employment plus 30 years (1910.1020).
Which standards require examinations
OSHA's guide Medical Screening and Surveillance Requirements in OSHA Standards (OSHA 3162) lists them standard by standard. Requirements differ: some standards require pre-placement examinations (for example asbestos, benzene and cadmium), others do not (bloodborne pathogens requires offering hepatitis B vaccination instead; noise requires a baseline audiogram), and some depend on exposure level, years of exposure or age.
| Exposure or equipment | Standard | Key requirement |
|---|---|---|
| Respirator use | 1910.134(e) | Medical evaluation by a PLHCP, using the OSHA questionnaire or an examination, before fit testing or use |
| Noise at or above 85 dBA 8-hour average | 1910.95(g) | Baseline audiogram within 6 months (1 year with a mobile test van, with hearing protection meanwhile), then annually |
| Respirable crystalline silica | 1910.1053(i), 1926.1153(h) | Initial examination within 30 days of assignment (unless one was done in the last 3 years), then at least every 3 years or more often if the PLHCP recommends |
| Benzene, lead, cadmium, asbestos and other substances | Substance-specific standards in Subpart Z | Pre-placement and periodic examinations, with frequency set in each standard |
| Bloodborne pathogens | 1910.1030 | Hepatitis B vaccination offered; post-exposure evaluation and follow-up |
The standards typically require surveillance at no cost to the worker and limit what the employer learns. Under the silica standard, for example, surveillance is free to the employee, and the employer's written opinion contains only the examination date, a statement that it met the standard and any respirator restrictions, unless the worker authorises more.
Pre-employment physicals for other reasons
Many US employers run pre-employment or "fitness for duty" examinations for business reasons or under other laws, for example commercial driver medical certification under transport rules. These are not OSHA requirements. They are limited by federal disability discrimination law, which restricts medical examinations before a conditional job offer; employers should take legal advice before introducing them.
Example: A foundry in Pennsylvania (federal OSHA) employs 40 workers. Grinders are exposed to silica above the action level for more than 30 days a year and to noise above 85 dBA, and they wear respirators. They need a PLHCP respirator evaluation before fit testing, a silica examination within 30 days of assignment and then at least every 3 years, and a baseline audiogram within 6 months then annually. Office staff need none of these.
Compared with the EU and Türkiye
The EU Framework Directive requires health surveillance appropriate to the risks, organised under national systems. Türkiye goes further: Law No. 6331 Art. 15 requires examinations at recruitment, on change of job, on return to work after a work accident, an occupational disease or repeated health-related absences if the worker asks, and periodically at intervals set by the ministry; workers in hazardous and very hazardous classes cannot start work without a health report confirming fitness.
Common mistakes
- Running general annual physicals and assuming OSHA is satisfied. The standard-specific tests (audiograms, spirometry, the silica examination content) must be done as each standard specifies.
- Fit testing before the medical evaluation. The respirator evaluation comes first.
- Destroying medical records when a worker leaves. Keep them for employment plus 30 years.
Related on excodex
- Occupational safety and health in United States: law, authorities and employer duties
- Must an employer in the United States appoint a safety professional or an occupational physician?
- Respiratory protection programme and fit testing
- What does the OSHA bloodborne pathogens standard require?
Standards and further reading
- OSHA 3162, Medical Screening and Surveillance Requirements in OSHA Standards: A Guide (2014): https://www.osha.gov/sites/default/files/publications/osha3162.pdf
- 29 CFR 1910.134 Respiratory protection: https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.134
- 29 CFR 1910.95 Occupational noise exposure: https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.95
- 29 CFR 1910.1053 Respirable crystalline silica: https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.1053
- 29 CFR 1910.1020 Access to employee exposure and medical records: https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.1020
This article is general occupational safety and health information prepared by the excodex editorial team. It does not replace the applicable legislation, standards, manufacturers' instructions or the assessment of a competent OSH professional or occupational physician.
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Part of: Occupational safety and health in United States: law, authorities and employer duties