Hiring complianceRead at source, 30 September 2026

Can Employers Require a Pre-Employment Physical? The Employer’s Guide

Yes, but under the Americans with Disabilities Act only after a conditional job offer, only if every new hire in that job category gets the same exam, and with the results kept confidential in a separate medical file. You may withdraw the offer over a result only if it shows the person can’t do the job’s essential functions, even with reasonable accommodation, or would pose a direct threat to safety. Before the offer you may describe the physical demands and ask whether the applicant can meet them, but no medical questions and no exam.

The ADA rule: after the offer, the same exam for everyone in the job category, confidential records

Before an offer, the ADA bans medical exams outright. 29 CFR 1630.13(a): “it is unlawful for a covered entity to conduct a medical examination of an applicant or to make inquiries as to whether an applicant is an individual with a disability or as to the nature or severity of such disability.” The rule covers employers with 15 or more employees; many state laws reach smaller ones.

After an offer, 1630.14(b) allows an “employment entrance examination” before the person starts work, and you “may condition an offer of employment on the results,” on three conditions:

• Everyone in the job category. The exam must be given to “all entering employees in the same job category … regardless of disability.” Sending one candidate for a physical because of something you noticed in the interview is what the rule forbids.
• Separate, confidential file. Results are “collected and maintained on separate forms and in separate medical files.” Supervisors may learn necessary work restrictions and accommodations, first aid and safety staff may be told when emergency treatment might be needed, and government investigators get relevant information on request. The EEOC also allows disclosure to state workers’ compensation offices and carriers under state law, and use for insurance purposes; beyond that, the file stays closed.
• A real offer. The EEOC says an offer is real if you have “evaluated all relevant non-medical information which it reasonably could have obtained and analyzed prior to giving the offer.” Finish the interview, references and license checks first.

The exam itself does not have to be job-related. What you do with it does. If a result screens someone out, 1630.14(b)(3) requires the reason to be “job-related and consistent with business necessity,” and the essential functions must be impossible even with reasonable accommodation. A safety-based rejection must show a direct threat: in the EEOC’s words, “a significant risk of substantial harm” that accommodation cannot reduce.

What a pre-employment physical can include, and what it can’t

After the offer, the ADA lets you ask disability-related questions and run medical tests, including questions about medications, as long as every entering employee in the job category gets the same ones. A frontline physical might cover a health history questionnaire, vital signs, vision and hearing, and checks tied to the work, such as a lift test or a respirator evaluation.

What it can’t include:

• Genetic information, including family medical history. Under 29 CFR 1635.8(d), the ban on acquiring genetic information “applies to medical examinations related to employment,” and you “must tell health care providers not to collect genetic information, including family medical history.” Put that instruction in writing to your clinic, and stop using a provider that keeps asking.
• Anything given only to some hires in the same job category.
• Any of it before the offer. That includes a psychological test the EEOC would treat as medical, and physiological measurements such as heart rate after a lift.

A drug test is not a medical exam under the ADA (42 U.S.C. 12114(d)), so its timing and rules are separate; see pre-employment drug screening.

Who pays for a pre-employment physical

Federal law has no general rule that the employer pays for a pre-employment physical. Three things change that:

• State law. California’s Labor Code 222.5 bars requiring “any prospective employee or applicant for employment to pay, any fee for, or cost of, any pre-employment medical or physical examination taken as a condition of employment.” Check your state before you pass the cost on.
• OSHA-required medical steps. Under the bloodborne pathogens standard, the hepatitis B vaccination series for workers with occupational exposure must be “made available at no cost to the employee.”
• Practice. A frontline applicant told to pay for their own exam before a first paycheck is an applicant who takes the job down the road. Paying for it is usually the cheaper choice.

DOT physicals for CDL drivers

For drivers of commercial motor vehicles the physical is a federal requirement, not your choice. 49 CFR 391.41 says a driver “must not operate a commercial motor vehicle unless he or she is medically certified as physically qualified to do so.” The exam must be done by an examiner on FMCSA’s National Registry of Certified Medical Examiners (391.43(a)), and a driver must be re-examined at least every 24 months, sooner if the examiner sets a shorter period (391.45).

The June 2025 change: on or after June 23, 2025, a CDL or CLP holder with a current medical certificate “no longer needs to carry on his or her person the medical examiner’s certificate” (391.41(a)(2)(i)(B)). Drivers with a medical variance must still carry that documentation, and where FMCSA’s electronic record and a paper certificate conflict, the electronic record controls. Non-CDL drivers of regulated vehicles still get and carry the paper certificate.

How the certificate goes into the driver qualification file, and what else the file needs, is on our driver qualification file checklist.

Healthcare hires: TB testing, immunizations and state and CMS requirements

For clinical hires the physical usually carries a TB screen. The CDC and National Tuberculosis Controllers Association’s 2019 recommendations say “all U.S. health care personnel should have baseline TB screening, including an individual risk assessment,” with a symptom evaluation and a blood test (IGRA) or skin test (TST) for anyone without documented prior TB or latent infection. After baseline, routine annual testing is not recommended “in the absence of known exposure or evidence of ongoing TB transmission,” though staff should get annual TB education.

If you use the skin test, the CDC says baseline testing of health care personnel should be two-step, and each test is read “between 48 and 72 hours after administration” (CDC). That is up to four visits: two placements and two readings, with the second test 1 to 3 weeks after the first. An IGRA needs one blood draw, which is why many employers use it to protect the start date.

Immunizations: OSHA requires hepatitis B vaccination to be offered “within 10 working days of initial assignment” to employees with occupational exposure, at no cost. Nursing homes must run an infection prevention and control program covering staff under 42 CFR 483.80. The specific TB and vaccine timing for a nursing home, hospital or home health agency usually comes from state licensing rules, so check your state health department. The license and registry checks that run alongside are on healthcare background checks.

Physical ability tests for warehouse and trades roles

A lift test or an obstacle course is not a medical exam. The EEOC’s guidance says a physical agility test, “in which an applicant demonstrates the ability to perform actual or simulated job tasks, is not a medical examination under the ADA,” and neither is a fitness test that measures “running or lifting.” You can give it before the offer.

Two rules keep it lawful:

• Test the job, not the body. If you measure blood pressure or heart rate after the lift, the EEOC says the test becomes medical and must wait until after the offer.
• Job-related and consistent with business necessity. The ADA bars tests that “screen out or tend to screen out” people with disabilities unless the test meets that standard (42 U.S.C. 12112(b)(6)). Match the test to the job description: the weight, the height, the repetitions a warehouse picker or roofer actually does, and give it to everyone in the job category.

Where the physical fits in a fast frontline hiring process

Every condition between yes and the first shift is a chance to lose the hire. The physical is often the slowest one. To keep it short:

• Make the offer conditional in writing and name the physical. Our conditional job offer guide covers the wording.
• Book the appointment during the offer call, not after the letter goes out.
• Combine visits. Ask your clinic to do the physical, drug collection and any TB blood test in one appointment.
• Give a start date that assumes a normal result, and stay in contact while the results come back.

The full set of pre-hire rules is on our hiring compliance hub.

Frequently asked questions

Sources: 42 U.S.C. 12112(b)(6) and (d), 12114(d); 29 CFR 1630.13 and 1630.14; EEOC, Enforcement Guidance: Preemployment Disability-Related Questions and Medical Examinations; 29 CFR 1635.8; 49 CFR 391.41, 391.43 and 391.45 (eCFR); CDC and NTCA, TB screening, testing and treatment of U.S. health care personnel (MMWR, 2019); CDC, Tuberculin Skin Test; 29 CFR 1910.1030; 42 CFR 483.80; California Labor Code 222.5. General information, not legal advice. Last verified 30 September 2026. Read at source 30 September 2026.