NHS Occupational Health Check: Pre-Employment Clearance

Occupational health screening isn't unique to the NHS — most UK employers run some version of it for new starters. What's genuinely specific to NHS occupational health is the depth of clinical screening involved for patient-facing roles: Hepatitis B and TB checks, a professional duty around exposure-prone procedures, and — for shift-based clinical staff — a statutory right to periodic health assessment tied to night working. This guide covers all of that in detail, alongside the general purpose of the process and what happens if something is flagged, because a lot of unnecessary anxiety around occupational health comes from not knowing what's actually being assessed or why.

Pre-employment vs ongoing: which one is this?

Occupational health touches NHS staff at more than one point, and mixing these up is a common source of confusion. This page is primarily about the pre-employment side — the screening that happens around when you join a trust — plus the statutory periodic screening some staff (mainly regular night workers) are entitled to during employment. It is not about an occupational health referral, which is a separate, targeted process triggered by something specific happening after you've already started a role.

If you're trying to understand a referral you've been asked to attend because of an absence, a health concern, or an adjustments conversation, go straight to our NHS occupational health referrals guide — it covers triggers, the appointment itself, confidentiality and typical outcomes in detail, and we won't duplicate that ground here. Everything below is about the process most people mean when they ask about an "NHS occupational health check": the pre-employment assessment, and the statutory periodic screening that sits alongside it for some staff.

From conditional offer to start date: the timeline

NHS Employers' Work Health Assessments Standard says the assessment takes place after an offer of employment but before the start of employment, placement or training, and that employers must make clear the offer is conditional on completing pre-appointment checks, including a relevant work health assessment. The Handbook and NHS Employers do not set a single national timescale, so the stages below are in order, and the timing depends on your trust's occupational health service.

What the pre-employment assessment actually covers

In general terms, an NHS pre-employment occupational health check typically includes some combination of the following, though the exact depth and content varies depending on the specific role and its demands:

The exact combination and depth of these elements depends heavily on the role itself — a ward-based clinical post with direct patient contact and possible EPP involvement is assessed far more extensively than a desk-based administrative role, even though both may go through some form of occupational health process.

The health questionnaire and the clearance outcomes

The NHS Employers standard describes a two-statement form. You choose either a statement that you are not aware of a health condition or disability that might impair your ability to do the duties of the post effectively, or a statement that you do have a condition or disability that might affect your work and may need adjustments. Either way, the occupational health practitioner makes their own assessment of any additional requirements or reasonable adjustments, so ticking the first box does not stop occupational health asking follow-up questions about immunisation and the role.

The practitioner then issues a clearance outcome to the employer. The standard describes three:

The third outcome is immunisation and/or exposure-prone-procedure (EPP) clearance required: you cannot be cleared for the relevant duties until a vaccination course, test or clearance is complete. Examples of adjustments listed in the standard include practical changes to premises, altering working hours, allowing absence for medical treatment during working hours, and special equipment. The Access to Work scheme may help with the cost of expensive adjustments.

• ✓ Confidentiality: the standard says health information should not form part of your personnel record but be held separately, accessible only by the occupational health service. A summary can be held on the personnel record where agreed with you.
• ✓ What your manager sees: the clearance certificate, meaning the outcome and any recommended adjustments, not your clinical history.
• ✓ Agency, bank and contractor staff: the standard expects written confirmation from a SEQOHS-accredited provider that an appropriate assessment has been done, the worker is fit to start and what adjustments are needed.
• ✓ Moving jobs: a new assessment applies when you move to a different NHS organisation, or to a role in the same organisation with a significantly changed environment or new exposure-prone procedures. Employers should check the electronic staff record to avoid duplicating immunisation requirements.

Statutory vs discretionary screening: what the law actually requires

Not every part of an NHS occupational health check rests on the same legal footing, and it's worth understanding the difference, because it explains why some elements feel non-negotiable while others are framed more as trust policy and good practice:

• • Statutory / professionally mandated: TB screening before starting patient-contact duties, EPP clearance (a professional duty on the healthcare worker, not just a trust preference) for exposure-prone-procedure roles, and a night worker's right to a free health assessment under the Working Time Regulations 1998.
• • Discretionary / trust-led occupational health practice: the general fitness-for-role assessment, the health declaration questionnaire, and most reasonable-adjustments conversations — shaped by each trust's own occupational health policy and by NHS Employers' national guidance, rather than a single specific statute.

None of this means the discretionary elements matter less in practice — a trust's own occupational health policy is what actually governs your assessment day to day — but it's useful to know which parts trace back to a specific legal or professional-body requirement (and are therefore applied fairly consistently across the NHS) versus which parts are shaped more by local trust practice.

Hepatitis B, TB and exposure-prone procedures: the specifics for clinical roles

This is the area of NHS occupational health that's most specific to healthcare, and where a lot of the anxiety and confusion in search queries about "occupational health screening" tends to concentrate. Here's the general shape of it, based on UK Health Security Agency and NHS Employers guidance:

TB (tuberculosis) screening

New starters who will have contact with patients or clinical specimens are generally expected to complete a TB screen or health check before beginning patient-contact duties — or to provide documentary evidence of a TB screen carried out within the preceding 12 months, if they've had one recently (for example with a previous NHS employer). The purpose is to identify and manage active TB before someone begins clinical duties; a positive latent-TB result is a different, generally manageable clinical finding, not an automatic bar to starting — occupational health will explain what a specific result means and what, if anything, needs to happen next.

Hepatitis B immunisation and immunity screening

For many clinical roles, occupational health checks your Hepatitis B immunity status, commonly via a blood test, and arranges or confirms a vaccination course if you're not already immune. This protects both you and the patients you work with — a well-established, standard principle in healthcare occupational health generally, not something unusual to any one trust.

Exposure-prone procedures (EPPs)

EPPs are a specific, narrower category: procedures where there's a risk that injury to the worker could result in their blood contaminating a patient's open tissues — certain surgical and other invasive procedures. Healthcare workers who will carry out EPPs have a professional duty to be tested and assessed for HIV, Hepatitis B and Hepatitis C, and to be confirmed as non-infectious, before being cleared to perform them. This is a distinct, additional layer on top of general pre-employment screening — it applies specifically to EPP-involving roles, not to every clinical post.

Night worker health assessments: an ongoing, statutory right

This is the one part of NHS occupational health that isn't a one-off pre-employment step. Under the Working Time Regulations 1998 — UK-wide employment law, not something NHS-specific — workers classed as "night workers" (broadly, those who normally work at least three hours during the night-time period of 11pm to 6am) have a statutory right to a free health assessment before starting night work, and to the opportunity of a further assessment at appropriate intervals afterwards for as long as they remain a night worker. This sits alongside the separate 8-hour average working-time limit that also applies to night workers.

Many NHS trusts fold this statutory health assessment into their wider occupational health service for shift-based clinical staff, rather than running it as a completely separate process — so if you work nights regularly, it's worth asking your trust's occupational health team how (and how often) this periodic assessment is offered to you. For the fuller legal picture of night-worker protections generally, including the working-hours limits that run alongside this right, see our separate NHS Working Time Regulations guide — we won't repeat that full framework here.

If something is flagged: what actually happens

It's worth being direct about this, because a lot of unnecessary anxiety around occupational health checks comes from a mistaken assumption about their purpose. Occupational health's role in NHS recruitment is generally to assess whether you can safely and effectively perform the specific duties of the role you've been offered — and, where there's a question mark over that, to consider whether reasonable adjustments, a phased start, or a short deferral would resolve it. It is not generally designed as a filter to look for reasons to withdraw a job offer.

This matters in practice for several common situations:

• ✓ Disclosing a health condition or disability: employers, including NHS trusts, operate under equality legislation that generally requires them to consider reasonable adjustments rather than simply rejecting a candidate on that basis.
• ✓ Disclosing mental health history: the same general principle applies as to physical health information — the purpose is to assess fitness for role and consider adjustments, not to penalise disclosure.
• ✓ A non-immune Hepatitis B result or a flagged TB screen: typically leads to a vaccination, monitoring or treatment plan, and possibly a short delay to your start date while it's addressed — not an automatic withdrawal of the offer, except in the narrower case of EPP-specific clearance.
• ✓ A physical fitness concern: often leads to a conversation about adjustments (equipment, altered duties, a phased start) before any conclusion about whether the role's core demands can be safely met.

Can a job offer be withdrawn after occupational health?

Yes in principle, because the offer is conditional on satisfactory pre-appointment checks, including the work health assessment. But withdrawal on health grounds is not meant to be automatic or hasty. NHS Employers' standard says no individual should be refused employment on health grounds unless:

• ✓ expert occupational medical advice has been sought, and
• ✓ the applicant has had the opportunity to discuss the issues raised with an occupational health professional.

The standard also says the recruiting manager retains the decision on appointment, and must record their justification where they appoint despite occupational health concerns. And the employer must consider reasonable adjustments as far as is reasonably practicable, so that people with disabilities are not disadvantaged in recruitment and are treated fairly when working arrangements are considered.

If you think an offer has been withdrawn unfairly, ask for the reason in writing and for a copy of the occupational health recommendation, ask whether adjustments were considered, and take advice promptly because time limits for discrimination claims are short. We cannot say whether a particular withdrawal is lawful, because that depends on the facts. See also disability and reasonable adjustments at work.

The Equality Act: what employers can ask, and when

Section 60 of the Equality Act 2010 says an employer must not ask about an applicant's health before offering work, or before including them in a pool of people to be offered work, other than for limited purposes. The exceptions in section 60(6) include finding out whether reasonable adjustments are needed for an assessment such as an interview, deciding whether the applicant can carry out a function that is intrinsic to the work, monitoring diversity, and a small number of other purposes. NHS Employers' standard reflects this: health questions come after the offer, in the work health assessment, rather than on the application form or at interview.

• • Before an offer: health questions on an application form or at interview are generally unlawful unless an exception applies, for example asking whether you need an adjustment to attend an interview.
• • After a conditional offer: a health questionnaire and occupational health assessment are normal and lawful, but any decision made because of a disability or health condition remains subject to the Equality Act.
• • Disability: per GOV.UK, a disability is a physical or mental impairment with a substantial and long-term negative effect on normal daily activities, with long-term meaning 12 months or more. Some conditions, including cancer, HIV infection and multiple sclerosis, count from diagnosis.
• • Enforcement: a breach of section 60 is enforced by the Equality and Human Rights Commission, rather than through an individual claim, but if you are turned down after being asked improper health questions, that fact can be relied on as evidence in a disability discrimination claim. Take advice before relying on it.

Sources: the standard is NHS Employers' Work health assessments standard; the law is section 60 of the Equality Act 2010 and GOV.UK on the definition of disability.

Does every role need it, or just clinical, patient-facing ones?

Most NHS roles go through some form of occupational health assessment, but the depth varies sharply by role:

How this fits alongside the other pre-employment checks

Occupational health clearance typically runs in parallel with other standard NHS pre-employment checks once you've accepted a job offer — most commonly a DBS check and, where relevant, right-to-work verification — rather than happening strictly before or after them. None of these processes are designed to catch you out; they're standard steps most new NHS starters go through, and delays in any one of them — occupational health included, particularly where blood tests or a vaccination course are involved — are a common, ordinary reason the gap between a job offer and an actual start date can run to several weeks. See our full how to join the NHS guide for how all of these pieces fit together.

Practical advice and realistic timings

• ✓ Complete your health declaration honestly — the purpose is to assess fitness for role and identify adjustments, not to find reasons to reject you
• ✓ Don't panic if you don't know your immunisation or TB screening history — occupational health teams can typically check your status directly rather than relying on records you don't have
• ✓ Ask early if you think Hepatitis B or TB follow-up might be needed — a vaccination course or repeat blood test can take weeks, so raising it as soon as you're asked to complete a declaration helps avoid a late surprise to your start date
• ✓ If you're a regular night worker, ask how your periodic health assessment is arranged — this is a statutory entitlement, not something you need to request specially, but trusts vary in exactly how they schedule it
• ✓ Ask questions if you're unsure how something will be assessed — occupational health teams are used to fielding questions about specific conditions, disclosures or adjustments before you formally declare anything
• ✓ Respond promptly to requests for information or appointments, since occupational health is often one of several checks running in parallel and delays here can push back your start date

Why trust this guide

• ✓ Explains the general purpose and structure of occupational health checks, including the Hepatitis B, TB and exposure-prone-procedure specifics, rather than avoiding them entirely
• ✓ Distinguishes statutory requirements (TB screening, EPP clearance, night-worker health assessment rights) from discretionary trust-led practice, rather than treating the whole process as one undifferentiated policy
• ✓ Clearly separates this pre-employment and statutory-periodic guide from our separate occupational health referrals guide, and cross-links rather than duplicates that content
• ✓ Directly addresses the common, understandable anxiety around disclosing health conditions or a flagged screening result, rather than glossing over it
• ✓ Points to NHS Employers' and the UK Health Security Agency's own guidance as the authoritative national reference for anything role-specific
• ✓ Independent and not affiliated with the NHS, DHSC, UKHSA, or any individual trust's occupational health service

Related guides

The bottom line

An occupational health check is a standard, sensible part of NHS pre-employment screening, built around assessing whether you can safely do the specific role you've been offered and identifying any adjustments that would help — not around finding reasons to reject you. For clinical and patient-facing roles, that generally extends to Hepatitis B and TB screening, and, where relevant, exposure-prone-procedure clearance; for regular night workers, it extends further still into a statutory right to periodic health assessment throughout employment, not just at the start. Be honest on your declaration, don't panic over gaps in your immunisation or screening history, and ask questions if you're unsure how something will be handled. If you're dealing with a referral to occupational health during your employment rather than this pre-employment process, our separate occupational health referrals guide covers that instead. For the current, authoritative national standards behind the process, see NHS Employers' and the UK Health Security Agency's own guidance rather than relying on general descriptions like this one for anything role-specific.