What to expect from an occupational health examination?

Chapters of the article

• What is the purpose of a medical examination?
• What makes occupational health examinations compulsory?
• What types of occupational medical examinations are known and to whom do they apply?
  • Initial medical examination
  • Regular (periodic) medical examination of the employee
  • Exceptional medical examination
  • Exit medical examination
• Organisational aspects of occupational health examinations
• Obligations of the employer

What is the purpose of a medical examination?

The purpose of any medical examination is, of course, to determine the health status of the client or patient. In this case, however, the aim is not so much to detect and cure a disease, but rather to rule out diseases or conditions that limit or prevent the applicant’s or employee’s fitness for a particular job. The employer is supposed to assign employees only to work that corresponds to their state of health. However, each job involves different requirements for the employee’s medical condition. We can certainly imagine different criteria, for example, for the job of a police officer, a miner, an airman, a professional driver, or even an office clerk or telephone operator. While some require physical fitness, excellent eyesight and good health, others do not mind a few diopters, colour blindness or being significantly overweight. Risk factors and a list of diseases that limit or exclude fitness for work are laid down in legislation.

You may now be asking yourself a worrying question: will my new employer now know all my current diagnoses? This is not a pleasant thought. You may have a history of an illness that carries a certain stigma in society that you do not want to expose yourself to. And it doesn’t even have to be about diagnoses as serious as HIV or mental health problems – honestly, who wants to discuss, say, their skin problems, acid reflux or undergoing liposuction with colleagues at work? But you don’t have to worry about any of that. As part of an occupational health examination, the doctor sticks to the framework of the job category your occupation falls into (there are 4 such categories in total). He or she will only assess whether you are fit to perform the job. He or she does not write the reason for your unfitness or any health problems that are not related to the job in the report. Even though he is an occupational physician who works closely with the employer, he must respect medical confidentiality.

What makes occupational health examinations compulsory?

The general framework is mentioned in the Labour Code and the Specific Health Services Act. Specific legislation is mainly based on the Occupational Health Services Ordinance. The latter mainly lists the necessary medical examinations in connection with employment. These are the initial, periodic and emergency medical examinations, which are intended to assess health in relation to work as a precautionary measure, and the exit examination and the medical examination after the end of hazardous work, which are carried out to assess the state of health in order to determine whether, for example, the hazardous work has had a negative impact on it.

What types of occupational health examinations are known and to whom do they apply?

The range of people covered by each examination is determined primarily by the type of examination:

Initial medical examination

An employee should have an initial medical examination before starting a new job. There is both an obligation for the employer to order such an examination and for the employee to undergo it. Therefore, you cannot refuse it, or theoretically you can, but the employer will probably not employ you because he/she may be sanctioned. However, if the employer requires specialist examinations, but the assessing doctor does not order them, you are not obliged to undergo such examinations.

The purpose of the medical examination is primarily to determine whether the employee can perform the job, and there are several categories of jobs that have different requirements.

The employer is required to provide an initial medical examination:

• before the employment relationship begins (i.e. before the date agreed in the employment contract as the date of commencement of work),
• beforethe legal relationship based on an agreement on work outside the employment relationship is established, if the work is hazardous or involves an activity for the performance of which medical fitness conditions are laid down by law,
• before the establishment of a relationship similar to an employment relationship, which may be, for example, the employment relationship of soldiers or judges.

Your employer may have a relationship with a specific doctor to provide preventive health care or may refer you to your GP. However, only employees whose job falls into job category 1 may be referred to a GP. Your employer will usually provide you with an initial medical examination request form, samples of which can be downloaded from the internet.

The cost of an initial medical examination is usually around 500 crowns, but the employer should cover the full cost of the examination. The applicant pays for the initial medical examination at the start of the employment relationship and the employer reimburses it after the employment relationship has started (but they can agree that it will be reimbursed even if the employment relationship has not started). If the check-up is arranged by your GP, he or she will usually provide you with a receipt which you will then have your employer reimburse.

If an employer fails to arrange medical examinations for its employees, it commits an offence which can result in a fine of up to CZK 2 million.

Regular (periodic) medical examination of the employee

By means of periodic medical examinations, the employer is to check whether the employee is still fit to perform the work in question. However, the legislation quite logically sets different time periods for different positions. For example, while for a professional firefighter the period is 12 months, for a regular civil servant it would be 6 years. Whether the worker is under 50 or over 50 also plays a role. As the age increases, the interval shortens.

In practice, these obligations are often overlooked, particularly by smaller employers.

Exceptional medical examination

In some cases, it is also necessary to carry out an emergency medical examination if there are concerns that there has been a loss or change in fitness for work. This may be where the employee has not worked for more than 8 weeks following a work-related injury with severe consequences or for other reasons. The employer also has the right to order an extraordinary occupational examination if it has doubts about the employee’s medical fitness.

Exit medical examination

An exit medical examination is carried out after the end of the work. This is legally obligatory, for example, if the employee has performed work classified under the Public Health Protection Act in the second, third or fourth risk category, or if an occupational disease or threat of occupational disease, if any, was recognised at the time of employment with the current employer.

Organisational aspects of occupational health examinations

If the doctor’s office hours and the employee’s working hours permit, the employee should be examined during his/her working hours (this does not apply to the initial examination, which takes place before the start of the employment relationship). A work-related medical examination is considered to be an ‘other important personal obstacle to work’, where the employee is granted leave of absence for the necessary period of time.

Obligations of the employer

As the above lines indicate, employers have two types of obligations. First, they must have a written contract for the provision of occupational health services and classify each of the jobs performed into one of four categories. Failure to do so exposes them to a fine of up to CZK 1 million.

In addition, employers must provide an initial medical examination and, where applicable, periodic, emergency, exit and follow-up medical examinations. If an employer fails to provide an initial medical check-up, he/she commits an offence for which a fine of up to CZK 2 million may be imposed.