Occupational health checks

An occupational health check is a confidential assessment of whether you can do a job safely and what support you might need. For most public sector roles it is a questionnaire about your health, reviewed by an occupational health nurse or doctor, who then tells the employer “fit”, “fit with adjustments” or, rarely, “not fit”. Clinical NHS roles add vaccination and screening checks. The aim is to find out what support you need, and turning people down on health grounds is rare.

When it happens and who sees it

Under section 60 of the Equality Act 2010, employers generally cannot ask about your health or disability before making a job offer. The exceptions are narrow, such as asking whether you need adjustments for the interview, or checking you can carry out a task that is essential to the job. So the questionnaire normally arrives with your conditional offer, as part of pre-employment checks.

The form goes to the occupational health service, which may be in-house (most NHS trusts have one) or an outside provider (common for councils and schools). Your answers are medical records and stay confidential. The recruiting manager gets an outcome and, with your consent, a note of any adjustments, but not your diagnoses or history.

The questionnaire

Expect questions about:

• current health conditions and any treatment
• past conditions that might affect the work, such as back problems in a manual handling role
• mental health, including anything that has needed time off
• sickness absence in recent years
• medication that could affect alertness or safety
• whether you need any adjustments at work

Answer honestly. The point is to match you to the role safely, and having a health condition is not a reason to withdraw an offer on its own. Leave something out and it can cause problems later if it becomes relevant and the employer never had the chance to put support in place.

For many applicants the questionnaire is the whole process. If something needs more discussion, occupational health may phone you or book an appointment. They may also ask, with your consent, for a report from your GP or specialist.

Vaccinations and screening for NHS roles

Clinical NHS staff, and some other staff with patient contact, need to show immunity to certain infections or be offered vaccination. What applies depends on the role. Commonly checked are:

• measles, mumps and rubella
• chickenpox (varicella)
• hepatitis B, for staff who may be exposed to blood or body fluids
• tuberculosis, through a symptom questionnaire and sometimes screening

Staff who carry out exposure-prone procedures, such as surgeons, dentists, some midwives and theatre staff, also need blood tests for blood-borne viruses before they can do that work. The rules sit in national guidance, including the UKHSA “Green Book” on immunisation.

Gather any vaccination records before the questionnaire arrives: a GP printout, or records from a previous NHS employer or university placement. If you cannot find them, occupational health can arrange blood tests or vaccinations, which takes longer but is normal.

Schools and councils rarely ask about vaccinations, though some roles, such as refuse collection or care work, may include hepatitis B.

Adjustments and support

If you have a disability or long-term condition, the occupational health check is where adjustments get set up. They might be changes to hours, equipment, a phased start, specific shift patterns, or adapted duties. Under the Equality Act, employers must make reasonable adjustments for disabled workers, and occupational health advises them on what is needed.

You can also apply to Access to Work, a DWP grant that pays for practical support such as specialist equipment, travel costs or a support worker. Apply early, as it can take time to arrange; see Access to Work grants. For adjustments during the recruitment process itself, such as extra time in a test, see Asking for reasonable adjustments in recruitment.

Night work, shifts and driving

Some jobs carry their own health requirements. Night workers must be offered a free health assessment, and many NHS and emergency service employers fold this into the occupational health check. Roles with heavy lifting, such as portering, refuse collection or care work, may include questions about musculoskeletal problems or a short practical assessment. Jobs that involve driving, such as ambulance or fleet work, can require a medical to the standard for the driving licence category involved.

If a condition might affect one part of the job, say so and describe how you manage it. Occupational health can often recommend a small change, such as avoiding a particular shift pattern, that lets you take the role.

If the outcome is “not fit”

Occupational health advises and the employer decides. An employer that withdraws an offer on health grounds needs to show it considered adjustments first and that the decision was not discriminatory. If the reason is a disability and reasonable adjustments would have made the job workable, the withdrawal may be unlawful.

If this happens, ask for the reasons in writing and whether adjustments were looked at. A trade union, ACAS or the Equality Advisory and Support Service can help you work out whether to challenge it. More on withdrawn offers is in Conditional job offers.