Are pre-employment and periodic medical examinations required for workers in Saudi Arabia?

Yes. The Labor Law requires a comprehensive medical examination at least once a year for workers exposed to the occupational diseases listed in the schedules of the Social Insurance Law (Article 143). The Regulation on Occupational Fitness Examinations and Non-Communicable Diseases, issued by Ministerial Decision No. 33232 of 11/3/1447 AH (September 2025) and published by the National Council for Occupational Safety and Health (NCOSH), adds pre-employment, periodic and exceptional examinations, by a team supervised by an occupational medicine physician accredited by the Saudi Commission for Health Specialties.

Short answer

• Annual: at least once a year for workers exposed to scheduled occupational diseases, with results kept in the employer's records and the worker's file (Article 143).
• Pre-employment: under the 2025 regulation, candidates must pass a fitness examination before appointment, using the approved form for the occupation.
• Periodic: at intervals set for each occupation and level of risk; some occupations, such as aviation, diving, food handling, firefighting and work with explosives or radioactive materials, carry legally restricted periodic checks.
• Exceptional: after a work injury, after long sick leave (more than eight continuous weeks), when fitness is in doubt, on change of job or work environment, or when new equipment is introduced; and at retirement after exposure to agents with long latency such as asbestos.
• Confidentiality: the employer receives only the decision (fit, fit with restrictions, unfit), not the diagnosis.
• Start date and phasing: the regulation applies 180 days after publication in the Official Gazette. The MHRSD procedural guide (first edition, published June 2026) phases it in: pre-employment examinations for all new workers in the first 6 months, then gradual extension to existing workers over 12 months with high-risk establishments first, then full application.

What the 2025 fitness regulation requires

The regulation applies to the public, private and non-profit sectors, including temporary, seasonal and remote workers and trainees. The employer must:

1. Make sure examinations are carried out on the approved forms for each occupation and give workers the means to attend.
2. Provide the resources needed to carry out the examinations.
3. Tell the occupational physician about exposures and risks in the job.
4. Keep confidential occupational health records in line with the Personal Data Protection Law.
5. Find alternative work where a worker is medically barred, adjust working conditions if needed, and reassess when health improves.

Periodic examinations have four layers: mandatory basic checks (questionnaire, vital signs, clinical examination, senses, laboratory and imaging), mandatory advanced checks set by risk assessment (for example lung function and respirator fit tests), exposure-based checks the establishment adds for chemical, physical or biological hazards, and optional advanced checks set by employer policy. The regulation stresses that examinations are a monitoring tool and never replace engineering and organisational controls.

Workers may object to a fitness result within 30 days; an independent committee in the NCOSH secretariat decides within 15 days. Records must be kept for at least 10 years after the last examination or 5 years after employment ends, whichever is longer, and for at least 30 years after exposure ends (and until the worker reaches 75) for agents such as asbestos or ionising radiation.

Inspection and fines

MHRSD inspectors check health certificates and medical examination records. The violations table in force since February 2026 (Ministerial Decision No. 112377 of 21/8/1447 AH) replaced the earlier table, which had a per-worker fine for missing annual examinations; we found no separate line for Article 143 in the new table. Its general line for not applying OSH rules carries SAR 5,000, 2,500 or 1,500 for establishments of 50 or more, 21 to 49 and 20 or fewer workers, and employing workers in hazardous occupations without meeting the set conditions carries SAR 1,000, 500 or 300 per worker.

Common mistakes

• Relying on the residence permit medical. Immigration health checks do not replace occupational fitness examinations for the job's exposures.
• Asking for diagnoses. The employer is entitled only to the fitness decision and any restrictions.
• Treating examinations as protection. The regulation forbids relying on them instead of controls.

Related on excodex

• Occupational safety and health in Saudi Arabia: law, authorities and employer duties
• Must an employer in Saudi Arabia appoint a safety professional or an occupational physician?
• Health surveillance and medical examinations: which tests for which exposure

Standards and further reading

• Labor Law Article 143: hrsd.gov.sa
• Regulation on Occupational Fitness Examinations and Non-Communicable Diseases, Ministerial Decision No. 33232 of 11/3/1447 AH: ncosh.gov.sa; procedural guide (2026): ncosh.gov.sa
• MHRSD violations and penalties table, Ministerial Decision No. 112377 of 21/8/1447 AH: hrsd.gov.sa
• ILO Technical and ethical guidelines for workers' health surveillance (1998).

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.