The aim of pre-employment examinations is to screen job applicants who may have an increased risk for occupational disease or injury while on the job. By not employing job applicants with an increased risk, disease or injury will be prevented but it comes at the cost for the applicants of not having a job. Another option is to remedy the problems found at the examination through work accommodation or training of physical fitness. Many employers and other stakeholders believe that health examinations of job applicants thus prevent occupational diseases and sickness absence.
We found seven studies, including 5872 participants that evaluated the whole process of health examinations including rejection of applicants with increased risks of occupational disease, injury or sickness absence. One of these studies found that a general examination did not reduce sick leave significantly among administrative workers compared to no intervention. One study found a decrease in sick leave with a more job focused pre-employment examination compared to a general health examination. Three studies evaluated the inclusion of functional capacity evaluation in the pre-employment examination with contradictory effects on injury rates and number of medical visits. One study found a decrease in occupational asthma after incorporating a bronchial challenge test in the pre-employment examination. Two studies with 2164 participants compared job applicants that passed the health examination without problems to those who got recommendations for addressing the health problems that were found. Neither of the studies found a difference in injury rates between groups. This indicated that the problems identified were effectively mitigated. The rates of rejecting job applicants varied from 2% to 35%.
We rated the evidence from all studies as very low quality.
We concluded that problem focused health examinations could be effective but there is a need for more high quality studies. Future studies should also take into account the costs of rejecting workers.