Medical examinations of employees: how to organize and formalize

Conducting medical examinations - preliminary and periodic - is one of the main responsibilities of the employer, and a major cost item for labor protection.
The fine for lack of a medical examination is also one of the largest. In this article we will tell you how to properly organize this event, what documents to prepare, and in what case you need to fire an employee or refuse a candidate for a position if there are medical contraindications. Article navigation

• For whom medical examinations are required?
• How to organize a preliminary medical examination
• Referral for preliminary medical examination
• How to organize a periodic medical examination
• What changes in the procedure for conducting medical examinations does the Ministry of Health promise in 2021?

Useful materials

Sample referral for preliminary medical examination

Sample order for periodic medical examination

Sample of a reasoned refusal to hire due to identified medical contraindications

For whom medical examinations are required?

Conducting preliminary and periodic medical examinations of workers is regulated by Order No. 302n of the Ministry of Health and Social Development of Russia dated April 12, 2011 (as amended on December 13, 2019).

This order approved lists of harmful and dangerous production factors, as well as work that requires medical examinations of workers (Appendices 1 and 2). This order also has Appendix 3 - the procedure for conducting medical examinations. The order was registered with the Ministry of Justice of Russia on October 21, 2011 under No. 22111, so its implementation is mandatory for all employers.

Attention! Some employers and inexperienced labor protection specialists may be confused by the first paragraph of Article 213 of the Labor Code of the Russian Federation. A literal reading of this norm states that a medical examination is mandatory for workers in hazardous working conditions and certain categories operating vehicles.

Thus, from Article 213 of the Labor Code of the Russian Federation it follows that a medical examination is mandatory for drivers of all vehicles, as well as for all those working in harmful and dangerous working conditions. Therefore, if an employee has acceptable working conditions of class 2, then a medical examination may not be carried out, but this contradicts order No. 302n if he performs work according to list No. 2.

Examples:

№1. An electrician works for the organization. His working conditions are acceptable. But a medical examination is mandatory for him, since the list of works includes maintenance of electrical installations (clause 2 in Appendix 2 to Order 302n).

№2. Accountant-economist in a trade organization. His working conditions are also not harmful or dangerous. But he works in trade, even though he is an office worker, but paragraph 15 does not contain any separate clarifications; if the staff carries out work in a trade organization, he undergoes a medical examination every year, regardless of the class of working conditions and contact with goods, such as food, and industrial.

Until the legal conflict between Article 213 of the Labor Code of the Russian Federation and Order No. 302n is eliminated, medical examinations need to be carried out not only for “harmful workers”, but also for workers with acceptable working conditions if they are affected by the factors specified in Appendix 1 or they perform work according to Appendix 2 .

The fine for workers not undergoing a medical examination is multiplicative. This means that it is summed up by the number of workers whose labor rights were violated. Therefore, the inspector may issue a fine from 110,000 to 130,000 rubles , and the court will not consider such an offense on the part of the employee to be insignificant and will not replace it with a warning, since the employer’s actions entail a threat to the life and health of the employee.

It does not matter what specific medical examination was not carried out - preliminary or periodic, the fine will still be set according to the number of persons who did not undergo the mandatory medical examination.

Remember that each enterprise must compile a list of contingents , in which you must indicate all professions or positions of employees that are subject to medical examination.

Advice from an expert: one copy of the list of contingents must be submitted by notification to the territorial department of Rospotrebnadzor at the location of the employer. By notification means that the list is sent by letter to Rospotrebnadzor within ten days after approval by the employer, and there is no need to approve it or confirm receipt in a special way.

Therefore, compose a registered letter with zero cost, attach a postal notification to it, and keep the track code of the postal item or a copy of the receipt. The original receipt will be useful to the accounting department for reimbursement of postage costs.

How to organize a preliminary medical examination

A preliminary medical examination is carried out at the time of personnel selection. They do this on the direction of the employer and exclusively at the expense of the company.

We remind you that a medical examination is necessary for those who will be employed:

• at work with harmful or dangerous working conditions (Article 213, 330.3 of the Labor Code);
• when working with traffic, including drivers (Articles 213 and 328 of the Labor Code, Article 23 of Law No. 196-FZ of December 10, 1995);
• at enterprises of the food industry, catering and trade, water supply facilities, medical and preventive care and children's institutions (Article 213 of the Labor Code);
• in departmental security (Article 6 of the Law of April 14, 1999 No. 77-FZ).

To know which candidates need to be sent for a medical examination, the occupational safety specialist provides the personnel officer with a list of contingents approved by the head of the organization. If the position for which the candidate is applying is on this list, hiring without a preliminary mandatory medical examination is prohibited.

In the direction for a medical examination, harmful (dangerous) production factors that exist in the candidate’s future workplace are indicated.

Frequency of medical examinations at the enterprise

The systematicity of surveys is established depending on the specifics of the organization’s activities. So, in 2021 the following must undergo the appropriate examination:

Referral for preliminary medical examination

If a candidate does not undergo a medical examination, that is, receives a medical certificate indicating that he is not fit to perform work for a certain position, an employment contract cannot be concluded with him. Such an applicant will receive a reasoned refusal to hire.

Sample of a reasoned refusal to hire due to identified medical contraindications

We remind managers, personnel officers and labor protection specialists. If an organization hires a recently dismissed employee, he must also be sent for a preliminary medical examination. The duration of dismissal does not matter (Article 213 of the Labor Code, letter of the Ministry of Labor dated April 28, 2017 No. 15-2/OOG-1224).

Remember that the cost of the preliminary medical examination is borne by the employer, not the applicant. In the referral for a medical examination, be sure to indicate the details of the medical organization to which you are sending the applicant.

Many people ask whether it is necessary to send office workers for a preliminary and then periodic medical examination. Let's answer this: if office workers work at a computer at least 50% of their working time, they must undergo medical examinations without fail.

Who compiles and in what time frame

Employers must check the health status of certain categories of employees.
This check, including a sample of the final medical examination report according to order 302n, must be completed correctly. The final act of the periodic medical examination, no later than 30 days after its conduct, is drawn up by the medical institution, which summarizes the results of the examinations together with Rospotrebnadzor and representatives of the employer. The supervisory authority studies the information provided and, if necessary, develops recommendations for the employer on the implementation of a number of health-improving measures in the institution. If there are no comments, the document is signed by all parties involved, including representatives of the employer.

How to organize a periodic medical examination

Employees who have previously undergone a preliminary medical examination are sent for periodic medical examinations. We must also not forget that in addition to Order No. 302n, there are also industry documents that also regulate the procedure for conducting medical examinations (Article 213 of the Labor Code and Article 24 of the Law of November 21, 2011 No. 323-FZ).

For example, employees employed in public railway transport (Order of the Ministry of Transport dated July 16, 2010 No. 154) or in construction (clause 13.1 of SanPiN 2.2.3.1384-03) must be sent for mandatory medical examinations.

Employees under the age of 18, as well as professional athletes, also undergo mandatory medical examinations (Articles 69, 266, 348.3 of the Labor Code).

If the period for undergoing a mandatory medical examination is once every 2 years, then after the preliminary medical examination is completed by the employee, the next medical examination is periodic and will take place no later than two years.

Example:

The employee underwent a preliminary medical examination on June 1, 2021. The frequency of medical examination is at least once a year. Therefore, the periodic medical examination must be completed, and the conclusion must be issued no later than the same date next year - 2021. Thus, starting from June 2, 2021, the employer has the right to be fined under Part 3 of Article 5.27.1 of the Code of Administrative Offenses of the Russian Federation. Therefore, do not take risks and conduct a medical examination with a reasonable amount of time.

The medical examination procedure differs only in documentation. Unlike a preliminary medical examination, the employee must be familiarized with the medical examination schedule in writing - no later than ten days from the planned date of the medical examination .

The employee receives a referral for a medical examination. It is issued by the personnel officer, because this document contains personal information. After the medical examination, the employee must show the HR officer the conclusion. If there are no contraindications, then the employee is allowed to work, and the employer is not required to draw up a separate order for admission. If there are contraindications, the employee will have to be removed from work and offered available vacancies; if there are no vacancies, he will have to be fired. This is also the responsibility of the personnel officer, not the occupational safety specialist.

Order to conduct periodic medical examination

While the employee undergoes a medical examination, his position and average salary are retained, and even if additional examinations are required, all expenses for the medical examination will be borne by the employer.

After all employees have undergone a periodic medical examination, the employer will receive its own copy of the final report. Then the employer and the medical organization will sign an acceptance certificate for the work performed under the contract for the provision of medical examination services. After this, the contract is considered fulfilled and the medical examination is passed.

Procedure for undergoing a medical examination

The head of the organization is responsible for conducting timely medical examinations of employees.

The procedure consists of the following steps:

1. An agreement is concluded with an accredited healthcare institution.
2. A list of professions is compiled, as well as a list of employees by name. The list of positions must be submitted to Rospotrebnadzor no later than ten days before the event.
3. Based on the list of names, a calendar plan for carrying out periodic inspections is drawn up.
4. An order is issued about the time of the medical examination and the procedure for passing it. Delegated employees familiarize themselves with the document no later than ten days before the start date.

Based on the medical examination plan, the employer’s responsibilities also include sending employees for examination in a timely manner.

Mandatory medical measures and doctors

The medical commission includes the following doctors: ophthalmologist, surgeon, neurologist, ENT, gynecologist, psychiatrist, narcologist, therapist. Based on their findings, the therapist or occupational pathologist grants permission to work. The exact list of specialists and the scope of research depends on the industry of employment.

At the initial stage of the medical examination, employees are required to take a fluorogram, cardiogram, and also take blood and urine tests. Fluorography is an annual mandatory procedure due to the risk of tuberculosis. If less than a year has passed since the last fluorogram, you must provide a certificate about this. For women over 40 years of age, an ultrasound scan of the mammary glands is performed.

For professions where it is necessary to have a medical book, a course of lectures is conducted, as well as a check of the sanitary minimum.

Who pays

The employer pays for the medical examination in the following cases:

• if the examination is planned;
• when there is a need for unscheduled examinations of an employee on his initiative.

The frequency of employee surveys is determined by labor law.

There are the following payment options for medical examination:

• the organization has an agreement with a healthcare institution, payment for services is made by bank transfer;
• the employee chooses the place of passage, pays for the examination himself, and the employer, based on the receipts provided, reimburses the medical examination.

Costs are not subject to value added tax, and social charges are not levied on their amounts.

What changes in the procedure for conducting medical examinations does the Ministry of Health promise in 2021?

The Ministry of Health has prepared amendments to order No. 302n . It is unknown when they will be accepted. The bill is currently undergoing an independent anti-corruption review. The project entails major changes in the procedure for conducting medical examinations:

• The health passport may be cancelled, and the conclusion will indicate all the harmful factors that are contraindicated for the employee, as well as his health group. What is positive for the employer in the new project: he will be able to receive his own copy of the medical report, and not wait for the employee to provide him with this information upon request. This will make it easier and faster to remove an employee.
• The employer will be able to send an employee for a medical examination after long-term disability; currently he does not have such a right, and many employees abuse it.
• Clinics, with the permission of the employee, will transfer information about their health status to the Social Insurance Fund. It is also planned to take into account the results of the employee’s medical examination when conducting mandatory medical examinations. This is necessary to reduce the burden on medical commissions. However, whether this will affect the cost of medical examinations is unknown.
• A new term will appear for shift workers - mobile medical code . If the bill is passed, it will officially be allowed to conduct medical examinations on the road as part of a mobile team. This is not yet permitted, since medical services can only be provided at the address in the license. Time will tell how this will be implemented once the bill comes into force.

Purposes of conducting medical examinations at the enterprise

Passing a production certification involves a whole range of medical examinations by key specialists. The employer, in this case, pursues the following goals:

1. Establishing the level of well-being of a subordinate;
2. Reducing the number of emergency incidents that may be caused by poor health of employees;
3. Compliance with legislator requirements regarding systematic health checks of workers;
4. Tracking the dynamics of diseases;
5. Detection and prevention of initial infection of the body;
6. Monitoring and recording various factors that may become an obstacle to the performance of work functions;
7. Prevention of infections.

Employees, in turn, also benefit from undergoing medical examinations. Firstly, the level of health is constantly monitored and monitored, and, secondly, if health deteriorates, you can reduce the workload or even ask the manager to transfer to another structural unit.

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