invasive pre-employment medical questionnaire

by Alison Green on October 3, 2012

A reader writes:

With the help of your blog, I accepted an entry-level job as a scientist for a consulting firm within a few months of graduating college. Thank you for your sound advice, and keep it coming!

I have a question about pre-employment physicals. After I accepted my offer, I worked with HR to set up an exam. I understand the need to check for drugs and alcohol, and to rule out any pre-existing conditions that may prevent me from doing the job in which I was hired. I will be working outside in all weather conditions and probably need to carry some heavier equipment. I also risk exposure to contaminants on the job, since I will be conducting assessments for sites that need remediation. But I am amazed at the pre-employment medical questionnaire that the HR representative emailed me, and asked me to bring to the physical.

According to the paperwork, my physical will include a chest x-ray; the medical questionnaire I must fill out; blood/urine analysis; height and weight; MD exam; pulmonary function test; vital signs; EKG; vision and audiometry; and drug screen collection and breath alcohol tests.

The questionnaire is 12 pages long. You read that right. Twelve pages. It includes every medical (and non-medical) question you can imagine. I have to provide my social security number, how often I wear a seat belt, any current and past medical conditions, the full health history of my parents and family members (which includes detailed questions and asks specifically about if/how they died), any past exposure to…well, anything. It’s unbelievably detailed and over-reaching, in my opinion. I am in my mid-20’s and healthy. I know I am fit for the job, that is not my concern. I just don’t know why questions like, “Have your job duties changed recently?” “If you get a cold, does it usually go to your chest?” “Have you ever encountered improper lighting on your job?” and “Do you have any sexual difficulty?” are relevant to a pre-employment physical. Companies do not need to know all that personal information, so I’m a bit amazed at this exam (chest x-ray?) and paperwork.

Is this standard practice at environmental firms, or should I be concerned about the insurance company they are using? Is the insurance company “phishing” for pre-existing conditions so they will not have to pay for them later? Is the company covering their assets? If I don’t fill out everything on the sheet, the company will probably rescind my offer. But I feel like this is too much. Am I overreacting, or is there something bigger going on here? How would you go about filling out the questionnaire?

I suspect that they’re doing it for two reasons: (1) to make sure they’re not putting you in conditions that for medical reasons you shouldn’t be in, and (2) so that in case you file a worker’s comp claim or sue them in the future, alleging that your working conditions caused you any medical problems, they’ll have a medical history to evaluate. (In other words, if you report right now that you have back problems, you won’t be able to successfully collect against them later for causing you back problems.)

I agree with you that it’s invasive, but I suspect it’s tied to the nature of the work you’ll be doing.

Anyone have more experience in this than I do and want to weigh in?

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{ 70 comments }

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  1. The IT Manager*

    I’m no expert, but before I got to Alison’s answer I was guessing that #2 might be a possibility. For example if your chest X-ray shows something odd now, they have “proof” that it wasn’t caused by exposure to toxins on the job.

    1. twentymilehike*

      I was thinking that if you are exposed to toxins, and you have to get an x-ray done later on, then they will have your orignal one to use a baseline … as probably the other things. Say later on you become impotent, but you were already having difficulty sexually, then they can pull your file and say, “well, hey, you were already going down that road, buddy.”

      Try to look at it in a good light … that way if something effects your health at work, you’ll be able to tell how much. If I were in your shoes, I’d be honest, but brief.

      1. Jamie*

        “Say later on you become impotent, but you were already having difficulty sexually, then they can pull your file and say, “well, hey, you were already going down that road, buddy.””

        This caused me to have a 4 paper towel incident with my coffee!

        Can I just say that anything involving sexual difficulties – or sexual anything – tops the list of things I don’t ever want to discuss with my employer. Ever.

        The only part of me which concerns my company is the part of my head you can see over my monitors.

        1. Anom*

          The husband of a college friend had a job working on some kind of Radar equipment. He had a yearly (job required) physical & part of the physical was a sperm count.

          Yes, you read that right. Apparently the equipment he worked on could cause a decrease in sperm count, so they monitored it.

        2. twentymilehike*

          This caused me to have a 4 paper towel incident with my coffee!

          Oh dear Jamie … you always find a way to make my morning!

          Can I just say that anything involving sexual difficulties – or sexual anything – tops the list of things I don’t ever want to discuss with my employer. Ever.

          I wonder if they are taking cues from the guy who sued the motorcycle company because he claims the seat gave him a two year erection? You never know with people these days …

      2. AgilePhalanges*

        I agree that an X-ray is probably within the realm of acceptable, given the circumstances, but I think that sexual question is definitely overreaching, and some of the other examples might be, too. I’d be a lot more inclined to be honest on a survey like that if it was administered, stored, maintained, and accessed only by a third party unrelated to the employer OR insurance company of the employer, and only the relevant part(s) of it could later be used in a workers’ comp or similar issue. I wouldn’t want it in my personnel file at work, where just any old HR person could see it, nor would I want the entire file read if I later developed issues with one specific body part/system.

    2. RG*

      It’s (likely) for baseline information. I worked in a quality control lab that dealt with certain potentially toxic (if high enough exposure) formulations, and when I started they did a baseline blood draw for future comparisons. If I had stayed, I would have had to have a test every 3 years or so, I think.

      1. shiroduckie*

        Yeah, I was wondering if radiation might somehow be involved with the position, since he said he’s a scientist. :/

  2. Judy*

    When working as an engineer in a factory environment, I’ve had to have a hearing test and a pulmonary capacity test at the start of employment, and had to re-do the hearing test just before moving to a department that had responsibility over an area that had hearing protection requirements.

  3. Joey*

    That’s exactly correct and the testing is typically the result of high comp claims of the same nature.

  4. Reader That Asked The Question*

    I found out, after starting my OSHA 40-hour HAZWOPER training, that the pre-employment physical and everything included in my exam are required by law. A qualified physician must clear the new employee for duty at the pre-employment physical as well as during employment. The employer must pay for a follow-up physical each year that the employee works at the company. A post-employment physical is also conducted upon termination of the employee, and medical records must be kept by the company for 30 years after employee termination or leave. The chest x-ray is to rule out any pre-existing lung conditions that can be exacerbated by exposure to asbestos or lead, and the pulmonary exam is for respirator use. I’m surprised that the Occupational Safety and Health Administration cares that much.

    1. Kou*

      I’m gonna go out on a limb and say that having lungs and breathing is a condition that can be exacerbated by exposure to asbestos and lead.

      2. Zee*

        Depending on the state the asbestos is in, breathing it in can hurt someone who doesn’t even have any health/lung problems. If asbestos is wet, it stays together and won’t be as harmful. If it is dry and is flying around in the air, then you can breathe it in, and it will be dangerous. In either case, it’s not a good idea to be around it.

        1. AgilePhalanges*

          “Depending on the state the asbestos is in…”

          At first I thought this was another one of those “But California is an exception” things, and wondered how on earth THAT could be the case, though California does have stricter health standards for a LOT of substances, hence all those warnings about things that are “known to the state of California to cause cancer” that everyone ignores.

          1. Reader That Asked The Question*

            Hmm…California’s state rock is serpentinite, which is made up of asbestos minerals (i.e. chrysotile). So actually, working on remediation in the state of California could theoretically put more employees in danger of exposure, depending on the disturbance of the rock. But I digress..

    2. Michele*

      Hospital employees also need a full physical examination upon hire, and an annual re-evaluation. For some positions, like building engineers, there are some more detailed examinations needed, including being fitted for protective gear. But even an admin like me must be physically cleared every year in order to stay employed.

      1. TL*

        I work for a hospital (but in the research department) and all they wanted was immunizations. Might be different if you have actual patient interactions, though.

    4. Josh S*

      HAZWOPER. That is the explanation for everything above. You are going to be sent into some nasty environments, and they want to be absolutely clear about what is caused/aggravated by those environments vs. what was pre-existing.

      That said, they really ought to use a 3rd party. I would be very uncomfortable sharing that information with my employer, especially without knowing exactly who will have access to the information, when, and for what purpose.

    5. EH&S*

      Yep, it’s the HAZWOPER. As I read your question, I figured you were doing some sort of environmental work.

      The pulmonary function test is to see if you can wear your respirator. All of the questions are part of the respirator testing. The chest x-ray is a baseline. Lots of bloodwork as a baseline, as well. All part of working in the environmental field. I’m surprised they didn’t tell you that when they sent you for all of this testing.

        1. Anonymous*

          I totally imagined a kitty in a paper crown flanked by “Can I haz Whopper?” in Arial Bold when people started talkign about the HAZWOPER.

  5. Reader That Asked The Question*

    The Federal OSHA standards I spoke of are published in Title 29 of the Code of Federal Regulations (29 CFR).

  6. clobbered*

    Not in the environmental field, but another field where a physical is required, so take what I say with a grain of salt:

    In my field these results are not going to be shared with your employer. The doctor or company that they use will take the information into account and issue a go/no-go to your employer.

    …. but yeah, if there is litigation down the road, these things will come up.

    I’d answer the questionnaire as accurately as possible, and try to keep in mind that the form is probably a boilerplate form they use for many things and in no way personally directed at you.

    1. Jenn*

      You’re correct. We recently implemented this type of program a couple of weeks ago, in an effort to reduce our Worker’s Comp claims (we’re a healthcare organization).

      It’s pretty detailed, but it’s meant to ensure that the people we hire can actually do the physical aspects of the job: lifting, pushing, etc. Apparently we had a lot of new hires with pre-existing conditions who obtained those conditions from working elsewhere, would work at our facility for two weeks, would aggravate their condition and then end up unable to work.

      1. Jenn*

        And we don’t get the details on anyone’s medical history/condition. We just get a “go/no go” notification.

  7. Rachel B*

    My husband works in a lab for a large hospital network. When he started his position last year, he had to fill-out an extensive questionnaire, complete two physical exams (one with a physician and one with an occupational therapist), x-rays and blood work, including drug/alcohol/nicotine testing. It was unsettling for him, as a somewhat-paranoid-about-American-insurance British national, but “standard operating procedure” for his employer.

  8. OR*

    I used to order pre-employment physcials as a recruiter for a private employer with no regulations requiring it. We did it to keep our workers comp low. We would NEVER get any details from the physicians except, Yes they passed or No they did not pass unless the prospective employee revealed the condition to us.

        1. Kate*

          I’m based in Australia. It’s fairly common in some sectors (especially government) for offers to be made conditional on passing the pre-employment medical, obtaining a security clearance or passing a background check. So the contract of employment does not take effect unless and until the conditions precedent to contract are met.

          It’s also been my experience that the employer generally only sees the examining doctor’s assessment in a standard report format.(Eg, medically fit/not medically fit for duties, plus any comments on existing medical conditions that might be aggravated by the type of work the employee has been hired to do, or which might require restrictions or adjustments for safe work.) They don’t get the employee’s questionnaire.

          If the OP is in doubt about why he or she has been asked to disclose certain medical information, it might be worth asking the physician (or ringing the surgery ahead of time) how it will be taken into account in assessing fitness for the particular duties in their role.

  9. ooloncoluphid*

    I agree with Alison. They’re covering their butts, and your butt as well. There may be certain medical conditions that can be exacerbated by exposure to certain environments.

  10. Student*

    #1 – Ask about the privacy policy on this. This is a medical exam, so HIPAA will come into play in some capacity. Ask who will be getting copies of this information. Then, ask the same question when you go in for the exam. Perhaps the employer doesn’t get this info, but the medical office and/or the insurer do. At minimum, they will absolutely have to have you sign a document that describes exactly where all this information will go.

    #2 Ask why they’re doing this. Ask the HR person and your boss or a co-worker. Maybe they’ll just tell you.

    #3 Ask about your health insurance policy. Ask what is and isn’t covered. The pre-existing conditions thing seems unlikely if you are in the US. It was outlawed by Obamacare, set to take effect in 2014 if I understand it properly (IANAL). The insurance company could be playing it up to the wire on that 2014 deadline, or hoping for a repeal after the election, but many of them are biting the bullet early to avoid bad PR and lawsuits.

  11. Elizabeth West*

    I used to work for an environmental firm, and yes, field personnel had to have annual physicals which included pulmonary and hearing tests. Given that you described the job as being very physical, with heavy equipment carrying, they may be asking about sexual difficulty to weed out a hidden heart condition. Coronary artery disease often first presents with ED in males. That’s only a guess, though; I don’t know why else they would ask it.

    I agree with Student; ask them. I definitely would want to know why all that information was necessary and what they plan to do with it. It’s YOUR information.

    1. bob*

      “sexual difficulty to weed out a hidden heart condition.”

      Uncontrolled hypertension is a more common unrealized cause for sexual dysfunction (ED).

    2. EAST*

      Sexual difficulty in men / women is also potentially indicative of lower back and or pelvic injury.

      1. Elizabeth West*

        Both of those, bob and EAST, could cause difficulties if he’s doing a lot of physical work. I’m only guessing at this question, though; it may simply be an inquiry to help determine overall health.

  12. Anonymous*

    I had the same physical and questionnaire when an environmental assessment company hired me, and that was in 1988. So, no, not unusual. Lay off the poppy seed bagels!

  13. Brett*

    I’ve had physicals for two types of jobs.

    The first was an office job for an auto company. It was a bit silly because I had to have a hearing test and all kinds of other things that would make sense for plant workers. However I suppose many engineers do end up visiting the production lines for their jobs, so doing the same for everyone makes a certain kind of sense.

    The second was for a job in a very remote location, living in a “company town.” Nearest medical help beyond the company clinic was in the best case a 12 hour journey and with bad weather you could be waiting a week for a medevac.

    Anyway, I wouldn’t think much of it. Pre-employment physicals usually include a complete medical history (which would include things like sexual function).

  14. Hannah*

    I wonder what happens if you are adopted and don’t know anything about your birth parents. How would you fill out all of the history questions, and would the fact that you wouldn’t really be able to disqualify you from the job?

    1. Ask a Manager* Post author

      Nah, I’m sure you’re not penalized for it. They want the info if you have it, but some people don’t. Some people raised by their biological parents don’t know their parents’ medical history too.

  15. ChristineH*

    Everything I’m seeing here seems mostly reasonable to me given the nature of the work, although I’m not so sure about the sexual impotence part. That seems over the line unless, as has been suggested, they’re covering their tushes in the event of a Worker’s Comp situation.

    I used to work at a human tissue bank (used to implant into patients for things like spinal surgery, tendon or bone repair); although I was a data entry clerk, I vaguely remembering having a pretty extensive physical, including the Hep-B vaccine and the TB test. Although not everybody went near the processing areas frequently, it’s probably easier to just have everyone go through the exams (my office was near those areas, though, during the first 3 years).

  16. Jess*

    My husband’s previous job was as an engineer at a company that decommissioned old nuclear facilities. His job was a desk job, but he very occasionally had to enter sites where there was radioactive materials. He had to undergo a similar medical screening, and also had to have a chest xray both when he started and when he left the job. He also had to do the HAZWOPER training too!

    Funny enough, his current job also involves having to very occasionally enter sites that have radioactive materials, but I don’t think he had to undergo the medical screening for this one. He didn’t have to get a chest xray again, at least.

    1. Lynda*

      Now I’m wondering what relationship there is between the Americans with Disabilities Act and practices that exclude people with pre-existing conditions. I have a feeling that unless the condition prevents you from doing your job, or puts you at risk if you do your job, then it’s a problem to refuse to hire you.

      1. Ask a Manager* Post author

        Yes, that would be illegal — but it’s legal for them to define certain physical fitness requirements as a condition of the job if they can justify it due to the nature of the work.

    2. BL*

      I worked for a school district in a facilities/maintenance/engineering type position and everyone in the district was required to have a pre-employment physical. Mine included some common sense restrictions because of a health condition but didn’t prevent me from doing the job. As I was leaving the position, they were beginning to make the physicals more representative of the job for things like janitors, mechanics, etc where there were a lot of workers comp claims.

  18. Second Time Poster*

    Wow, that is SOME pre-employment exam/questionnaire!! I have no answers, but just one thought: I know SOMEONE has to do these jobs (and I’m very glad that there ARE people who are stronger and braver than I), but I sure hope one is getting paid a LOT of money if their job would expose them to so much potential for harm!

    This thread also brings to mind the first responders on 9/11 and all the hazardous material they didn’t even have time to consider before they rushed in to help.

  19. Lynn*

    I’ve worked as a project assistant for similar remedial and environmental companies and had to set up physicals for new hires. The questionaire and scope of the physical are pretty much par for the course for this type of work.

  20. Amanda*

    I had to pass a physical exam that included a chest x-ray to get a student visa to live & study in France a few years ago. At that time, the chest x-ray was explained to me as a way to test for tuberculosis.

      1. Reader That Asked The Question*

        The only reason I can think that they would want the chest x-ray for TB is because I would not have to return a few days later to have the under-the-skin-bubble checked. But I would rather get the skin test than be exposed to radiation.

    2. Rana*

      I always have to get the x-ray. I was exposed to TB as a child and now test pretty strongly for it, despite having been successfully treated for it.

  21. Not So NewReader*

    I might be cynical, but I think ask for copies of every you submit- xrays, etc. After you get the twelve pager filled out, make a copy of it before submitting. Keep everything together and store it. Keep it, even if you leave the job.

  22. EM*

    I work as an environmental scientist, and I’ve had my 40-hour OSHA HAZWOPER certification for about 3 or 4 years now. Yes, it is standard practice, and it is required by law. It’s not so much for CYA for your company as it is to establish a pre-exposure baseline so that if there are any significant changes that might point to an exposure through work. Yes, it’s invasive, and yes it sucks, but it’s really there for your protection. Before these invasive exams, people dropped dead on the job from black lung disease (coal miners)….

    Also, as an entry level person, expect to do the nastiest, most physically-demanding tasks. If you can stand a few years of it, you move up to the less-nasty stuff or a supervisory role. At least that’s how it works at my company, which is tiny. This isn’t meant to discourage you, but to give you a heads up. If you haven’t done the work on the ground, you won’t be able to write (or evaluate, depending if you are a consultant or a regulator) a work plan or budget for similar work in the future. I know that many people complain that they have a college degree and shouldn’t have to do manual labor, but it’s how you get started in this field. The folks without college degrees to the manual labor for most, if not all of their careers rather than just a few years.

  23. Lisa*

    I work with radiation, and when I started, I had to have a urinalysis and a thyroid exam to establish a baseline. I suspect they’re taking every precaution with the types of hazards you’re bound to encounter on the job.

    And just a shot in the dark, but I would guess that question about improper lighting would serve to establish whether you could have an increased risk of migraines or seizures…

  24. Lanya*

    After reading all of this, it sounds like you are probably going to get cancer if you take this job. Apply elsewhere!

  25. class factotum*

    I don’t remember a questionnaire, but when I finished my Peace Corps stint, I had to have an HIV test and other tests that involved collecting samples of body products that I never thought I would have to collect, much less put in small glass vials and deliver to a lab.

    I understood the Peace Corps’ stance – that they didn’t want claims years out from people who said they’d gotten whatever as a volunteer – better than my next employer, whose pre-employment physical involved a hearing test, a physical exam, and a blood draw. Fine for the people working in the noisy factories, but what did that have to do with office work?

    I’m still convinced the blood draw was to identify someone sick or pregnant who would affect the health insurance.

  26. NDR*

    My husband works at an environmental firm, and yes, this is quite common. As are the annual exams that other posters mention. The first one is to establish a baseline; each subsequent annual exam is to determine if anything you’ve been exposed to during your field or lab work has impacted your health.

    If you are in any kind of clean up (or evaluation), you have to remember that whomever you’re cleaning up for/after may not always be truthful (or may not know) exactly what toxins are lingering in their facilities, sites, etc., so even if they present it as a fairly harmless job, there might be something hanging out in the ground water, soil, concrete, etc. that might affect your health.

  27. BL*

    My current employer “encourages” us to complete a health survey and biometric screening each year. Last year, we received a discount off of our premiums for completing them. This year, you are only eligible for one plan if you do not complete them. When I got the screening, the nurse practitioner talked about how invasive the process was. Questions included things like how many sexual partners you currently had and how often you wore a seat belt. My biggest complaint is that these had to be completed before I even know what the premiums will be for next year.

  29. J*

    I must take a very very intensive physical every few years. Not only to get the job but also to maintain it. I am in a very very very (cannot stress this enough) safety related position. I make sure firefighters, police,rescue squads and other people like that are doing their jobs safely and properly… People can easily die or be seriously injured if I do not do my job correctly.

    The questions you have are just a few of what I have to deal with. It bothers me, but the pay grade of my job does not. They straight up ask me everything from what household chemicals I have to how often I take ANY over the counter drugs. I get questions about my sexual activities (I’m married and only sleep with my wife) to questions about how many times I day I go number 2.

    The good news is I believe the majority of these questions don’t actually go to the employer though. The employer gets one of three answers. Fit for duty, Fit for duty with accommodations, or unfit for duty. Either way though it is one hell of an intensive physical with EKG, Chest X-rays, tons of respiratory tests, bloodwork, urine work, mental stress tests, physical stress test, pain tolerance tests, eye, ear, taste, and respirator fitting all in the same physical. It takes an entire day of test and basically you get one doctor and nurse the entire day. It cost my company around 20,000 dollars to do this for me. (The crazy thing is no drug tests…i know right????)

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