Occupational health clearance

Every NHS employer must run a work health assessment for new staff. It is one of the NHS Employment Check Standards published by NHS Employers. NHS Employers says the main purpose is to help prevent work-related illness, injury and the spread of infection, and to see whether any adjustments are needed. The assessment is carried out by the employer's occupational health (OH) service, whose clinicians give confidential advice to you and the employer. The result is often called OH clearance, and you cannot start a clinical role until you have it.

Assessments apply to everyone working in the NHS, including employees, temporary workers, students, trainees and volunteers.

NHS Employers says assessments take place after an offer of employment but before you start. Under the Equality Act 2010 it is unlawful for employers to ask about your health or disability before making a job offer, apart from limited exceptions such as checking whether you need adjustments at interview. Offers to international recruits are therefore conditional on OH clearance along with the other checks, such as right to work and DBS.

1. A health questionnaire asking whether you have any condition that may affect your work or need adjustments.
2. Immunisation history. UK Green Book guidance says staff in direct patient care should be up to date with routine immunisations such as MMR, and lists further vaccines for some staff, including hepatitis B for those exposed to blood, BCG for some staff at risk of TB, and varicella for those who are not immune.
3. Standard health clearance. Department of Health guidance recommends that all new healthcare workers are checked for tuberculosis, offered hepatitis B immunisation, and offered tests for hepatitis C and HIV. It also says staff new to the NHS from countries with a high incidence of TB should have a TB skin or blood test.
4. Additional clearance for EPPs. If you will perform exposure-prone procedures, such as many surgical, dental and midwifery tasks, you must be tested for HIV, hepatitis B and hepatitis C, and the results decide whether you can perform those procedures.

• Collect vaccination records and blood test reports in English, with dates, batch numbers where possible, and the clinic's details.
• Bring evidence of immunity such as hepatitis B antibody levels, if you have it.
• Tell OH early about any condition or adjustment you need; the information is confidential.
• Expect repeat tests if records are incomplete or not verifiable.

For the wider set of steps before your first NHS post, see our nurses in the UK and doctors in the UK guides.

• Missing records delay start dates.
• Late EPP testing for surgical, dental or midwifery posts.
• Moving between NHS employers: NHS Employers says existing records should be checked so immunisation assessments are not duplicated, though a new assessment may be needed if the role changes significantly.