A pre-employment physical is the occupational health assessment after a conditional job offer: whether the person can safely do the job they were offered, with or without restrictions. Copy the free form, see a hospital nurse and a warehouse worker after shoulder surgery, and check what the employer gets to see and what stays in the clinic record.
Blank pre-employment physical template
FreePRE-EMPLOYMENT PHYSICAL Occupational health assessment after a conditional job offer Candidate: [Name, date of birth] Date of assessment: [Date, or each date if tests ran over more than one visit] Employer: [Organization, and the contact who receives the outcome] Job offered: [Job title, department, start date] Conditional offer: [Date of the offer letter or the employer's referral] Examiner: [Name, credentials, clinic] Consent: [Consent to the assessment, and to the outcome going to the employer; what the employer will and won't receive, explained] JOB DEMANDS Source: [Employer's job description or physical demands analysis, with its date] Physical: [Weights lifted, from what height to what height, how often; carrying, pushing, standing, walking, climbing, kneeling] Senses: [Vision, color vision, or hearing the job needs] Schedule and mental demands: [Shift length, nights, working alone, safety-critical decisions] Exposures: [Noise, respirator use, blood and body fluids, chemicals, dust, heat, cold, heights] Vehicles and equipment: [Driving, forklifts, powered pallet jacks, machinery, or none] HEALTH HISTORY Conditions that bear on the job: [Past injuries, surgery, heart, lung, seizure, sleep, or other conditions relevant to the demands above, with current status] Past work injuries or restrictions: [Dates, what happened, any restriction still in place] Medications: [Each medicine; any that cause drowsiness or affect safety-critical work] Allergies: [Medicines, latex, or none] Current symptoms: [Pain, breathlessness, or none] IMMUNIZATIONS AND TB, WHEN THE JOB NEEDS THEM Immunity: [Each vaccine or blood test the employer's policy asks for, with dates and results] Given today: [Vaccines given and any follow-up due, or none] TB screening: [Risk questions, symptom screen, test type, dates placed and read or drawn, result; chest X-ray if positive] VISION AND HEARING Visual acuity: [Right and left, with or without correction, chart used] Color vision and visual fields: [Result, when the job needs them, or not required] Hearing: [Whispered voice result, or a baseline audiogram for jobs in a noise program] VITAL SIGNS Blood pressure and pulse: [Reading, and a repeat after rest if high] Height, weight, and BMI: [Measurements] FOCUSED EXAMINATION [The systems the job's demands call for: spine, shoulders, knees, heart, lungs, skin of the hands, nerves; findings with side, range of motion, and strength] JOB-SPECIFIC TESTS Lifting or functional test: [Task, weight, start and end height, repetitions, who tested, result] Respirator clearance and fit test: [Questionnaire reviewed, spirometry if indicated, model and size passed, or not required] Audiometry or spirometry for exposure programs: [Result, or not required] Drug or alcohol test: [Only if the employer's program requires it: type, collection date, result after review, or not part of the program] OUTCOME FOR THE EMPLOYER Outcome: [Fit; fit with restrictions or accommodations; not fit; or pending, with what it waits on] Restrictions or accommodations: [Each one in work terms: weight, height, frequency, hours, tasks; or none] How long: [Temporary until a date, or permanent] Review: [Date and what will be repeated, or none needed] Also shared, if the job's program needs it: [Respirator clearance, fit-test model, immunity status meets policy, or nothing else] CLINIC RECORD ONLY Not sent to the employer: [Health history, diagnoses, test results, and exam findings] Advice to the candidate: [Findings to follow up with their own clinician, or none] Regulated job: [If a regulator sets its own medical standard, such as for commercial driving or flying, the regulator's form and recognized examiner used; or not applicable] Signed: [Examiner name, credentials, date]
Use it for
Each one follows the template. Use them to judge how much detail every part needs.
Hospital occupational health, 2 visits after a conditional offer
26-year-old registered nurse, offered a full-time post on a surgical unit on Thursday, October 15, 2026, starting Monday, November 16. Seen on Monday, October 19, and Wednesday, October 28. She agreed to the assessment and to the outcome going to her unit manager. Told that her history and results stay with occupational health.
From the hospital’s job description: moving and turning patients with ceiling lifts and slide sheets, pushing beds, and on her feet most of a 12-hour shift, days and nights in rotation. Contact with blood, body fluids, and sharps. Wears an N95 respirator for patients on airborne precautions.
Asthma as a child: no inhaler, wheeze, or night cough in the past 9 years. Strained her lower back moving a patient in her final year of nursing school; 6 physiotherapy sessions, no pain since, and no time off. No other conditions. Takes an oral contraceptive only. No latex or medicine allergies.
Records show 2 doses each of MMR and varicella vaccine, and Tdap at 23. Hepatitis B: 3 doses as a child, never tested after. Anti-HBs drawn on October 19: 4 mIU/mL, below the 10 mIU/mL that shows protection. One extra dose given October 28; repeat anti-HBs booked for Monday, December 14, and the rest of a second series if it is still below 10. Flu vaccine given October 28. TB: no risk factors or symptoms. Two-step tuberculin skin test: placed October 19, read October 21, 0 mm; placed October 26, read October 28, 0 mm.
Snellen 20/20 in each eye with contact lenses. Whispered voice test normal on each side. BP 112/70, pulse 68. Height 165 cm, weight 61 kg, BMI 22.4.
Chest clear, with no wheeze on forced breathing out. Heart sounds normal. Lower back: no tenderness; bending forward, back, and to each side full and pain-free; straight leg raise negative on both sides. Shoulders and knees move fully without pain. Squats to the floor and stands without using her hands. Skin of the hands intact, no dermatitis.
The respirator questionnaire flagged her childhood asthma, so spirometry was done: FEV1 96% of predicted, FEV1/FVC 0.84, normal. Cleared to wear an N95. Passed a qualitative fit test on the hospital’s medium N95 and on a second model as a backup. No drug test: not part of the hospital’s program.
Fit for the post, no restrictions, from November 16. Cleared for N95 use; both fit-tested models recorded for the respiratory protection program. Immunizations and TB screen meet hospital policy, with the hepatitis B follow-up tracked by occupational health.
Childhood asthma, the back strain, the spirometry, and the hepatitis B result stay in the occupational health record. Advised to come back if wheeze returns while wearing a respirator, and to use the lifts and slide sheets for every transfer.
Occupational health clinic, referred by the employer after a conditional offer
49-year-old man, offered a full-time order selector job at a distribution warehouse on Monday, November 2, 2026, starting Monday, November 16. Seen on Thursday, November 5. He agreed to the assessment, and was told the employer receives only the outcome and any restrictions.
From the employer’s physical demands analysis: picking cases of 5 to 23 kg, or 11 to 50 lb, from pallets and racks, between floor level and the top rack at about 150 cm, or 5 ft, repeated through an 8-hour shift. Walking and standing all shift. Drives a powered pallet jack after training. No noise program, respirator, immunizations, or TB screen required.
Arthroscopic repair of a torn right supraspinatus 18 months ago, after a fall from a ladder at home. 4 months of physiotherapy; discharged by the surgeon at 1 year with no limits. No pain at rest now; the shoulder aches after long spells of overhead reaching. Spent the past 11 years as a retail store manager, with light lifting only. No medicines, no allergies.
Snellen 20/25 right, 20/20 left, with glasses. Whispered voice test normal on each side. BP 146/92 on arrival, 140/88 after 5 minutes seated. Pulse 74. Height 178 cm, weight 88 kg, BMI 27.8.
Right shoulder: healed portal scars, no tenderness. Active forward flexion 160° on the right, 175° on the left; abduction 155° right, 175° left. Supraspinatus strength 4/5 on the right, pain-free; external rotation 4+/5 right; all 5/5 on the left. Neck and lower back move fully, without pain. Hips and knees normal. Grip, sensation, and pulses in both arms normal.
Lift test with the clinic’s physiotherapist, using a weighted crate. Floor to waist: 23 kg, 10 lifts, good form. Carry: 23 kg over 15 m, steady. Waist to shoulder: safe up to 14 kg, or 30 lb; at 18 kg he hitched the right shoulder and slowed, so the test stopped there. No drug test: not part of the employer’s program.
Fit with temporary restrictions for 8 weeks, from November 16, 2026, to January 10, 2027. Lifting from waist to shoulder height: up to 14 kg, or 30 lb. No lifting above shoulder height. No limit on floor-to-waist lifts or carrying, up to the job’s 23 kg, or 50 lb. Lift test to be repeated on Thursday, January 7, 2027. The employer is asked to confirm whether it can assign picks from the lower racks until then.
The shoulder surgery, exam findings, and blood pressure stay in the clinic record. Given a rotator cuff and shoulder blade strengthening program, 3 times a week, before the retest. Blood pressure of 140/88 after rest: advised to have it rechecked by his own clinician within a month. It doesn’t affect this job and isn’t shared with the employer.
Human rights and disability laws decide when an employer can require a medical exam, what it may learn, and when the results can cost someone the job. These rows cover US federal law and Ontario, with one regulated job in each country. Other states and provinces, collective agreements, and regulators add their own rules.
The assessment answers one question: can this person safely do this job? Start with proof of the offer and the job’s real demands, in the employer’s own document.
Avoid: Assessing with no job description. Without the demands, the outcome can only be a general health opinion, which the employer can’t use.
The history that bears on the job’s demands: past injuries and surgery, conditions that could affect safety, and medicines that cause drowsiness.
Avoid: Asking for the whole medical history when the job is light work. Keep the questions to what the job’s demands make relevant.
Only for jobs whose policy needs them, such as health care, labs, and child care. Record proof of immunity, not just the candidate’s memory.
Avoid: Marking immunity as “up to date” from what the candidate recalls. Record documented doses or a blood test result.
The baseline measures most jobs need, plus any standard the job itself sets.
Avoid: Failing a candidate on one high blood pressure reading. Repeat it, and send the follow-up to their own clinician unless it affects safety in the job.
Examine the systems the job will use, then test the tasks it needs. Tests vary by job: a lift test for manual handling, a fit test for respirator users, an audiogram for noise.
Avoid: A full head-to-toe exam for every job. Examine what the job’s demands call for; other systems add findings that don’t bear on the outcome.
What the employer receives: the outcome and any restrictions, written in work terms. No diagnosis and no history.
Avoid: “Fit, but avoid strain on right shoulder.” That shares a diagnosis and gives no usable limit. Write the weight and height instead.
The full assessment stays with the clinic. Note what wasn’t shared and any advice the candidate takes to their own clinician.
Avoid: Filing the full assessment in the employer’s personnel file. Only the outcome goes to the employer.
Medical questions and exams belong after a conditional job offer, preferably in writing. Check the offer date before you start, and record it.
“Fit, history of rotator cuff repair” tells the employer something it didn’t need. Send the outcome and the restrictions in work terms; the history stays with the clinic.
A general physical can’t say whether someone can lift 23 kg to shoulder height for 8 hours. Ask for the job description or physical demands analysis, and test against it.
Most findings lead to fit, or fit with restrictions or accommodations. Reserve “not fit” for a person who can’t safely do the essential duties even with accommodation, and give a review date if it may change.
Give everyone hired into the same job the same assessment. Adding tests only for candidates who disclosed a condition is unfair, and in many places unlawful.
Commercial drivers, pilots, and some other regulated jobs have a medical standard set by their regulator, on its own form, done by an examiner it recognizes. Use that route for the regulated duties.
Vero Scribe drafts the pre-employment physical in your template from the visit, with the candidate’s consent, or from your dictation. You review and edit every section, then copy it into your record or export it to Word or PDF. Vero works in 60+ languages.
The job’s demands from the employer, a health history focused on them, immunizations and TB screening when the job needs them, vision, hearing, and vital signs, an exam of the systems the job will use, and any tests the role needs, such as a lift test, a respirator fit test, or an audiogram. It ends with an outcome for the employer.
Start from the job description, so you know what to test. Record the history, measures, exam, and test results in the clinic part of the form. Then write the outcome for the employer: fit, fit with restrictions or accommodations, or not fit, with each restriction in work terms and a review date if it is temporary. Leave the diagnosis out of the employer’s part.
Any medical assessment done for work: before placement in a new job, at set intervals for exposures such as noise or respirator use, or before going back after an illness or injury. A pre-employment physical is the first of these, done after the job offer.
In many places, no. Human rights and disability laws generally allow a medical exam only after a conditional job offer, and limit what the employer can learn from it. Check the rules where the job is; the table on this page covers two of them.
The outcome and any restrictions or accommodations, with how long they last. When the job’s program needs them, it also gets items such as respirator clearance, or confirmation that immunizations meet policy. Not the diagnosis, the history, or the exam findings; the full record stays with the clinic.
The outcome can be “not fit,” but only when the person can’t safely do the essential duties, even with accommodation. Most findings lead to fit, or fit with restrictions. Whether the employer can accommodate a restriction is the employer’s decision, not the examiner’s.
Only when the employer’s program requires it. The sample is usually collected with a chain-of-custody form, and a medical review officer reviews any non-negative result before it is reported. Some places limit testing before or after a job offer, so check the rules where the job is.
No. Commercial drivers, pilots, and some other regulated jobs follow a medical standard set by their regulator, on the regulator’s own form, done by an examiner it recognizes. The employer’s own pre-employment physical can still cover the job’s other demands.
Yes. Copy it, or download it as a Word or text file. No account needed.
Capacity for one decision at one time: the information given, the four abilities in the patient’s words, the finding, and who decides next.
The clinician’s assessment after a positive screen: ideation, intent, means, the formulation, and the plan.
Falls history, gait and balance tests, orthostatic BP, medication review, and a plan matched to the risk.
The full pre-op assessment before noncardiac surgery: history, capacity, RCRI, airway, medication plan, and a clear recommendation.
System-by-system exam with normal findings written out, space for abnormal findings, and sensitive exams when indicated.
Pre-placement, surveillance, and return-to-work assessments, drafted for your review.
Physicals and work forms, drafted from the visit.
Screening, consent, and the dose record for vaccines given at the visit.
Vero writes your notes and letters in the templates you choose, so you review instead of type.
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