Pre-employment medical exams under the ADA: before and after the offer
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The Americans with Disabilities Act splits hiring into stages for medical questions. Before a job offer, an employer may not give a medical exam or ask about disability at all. After a real conditional offer and before the person starts work, it may require a medical exam, as long as every entering employee in the same job category gets the same one. Once someone is employed, any exam must be job related and consistent with business necessity. The rules come from 42 U.S.C. § 12112(d) and apply to employers with 15 or more employees.
This page is about exams and health questions in the hiring process: what counts as a medical exam, what makes an offer "real," how to run a post-offer exam, and what to do if the results raise a concern. For accommodations during interviews, see ADA accommodations in interviews; for drug screens, see drug testing laws in hiring.
Not legal advice. This page summarizes the ADA, the EEOC's regulations and its 1995 enforcement guidance, as of October 2026. The EEOC withdrew or changed several guidance documents in 2025 and 2026, but we found no change to the rules or guidance on pre-employment medical exams. State law can be stricter, as California's is. Check with counsel before setting a medical exam policy.
The three stages
| Stage | Medical exams | Disability-related questions | Legal standard |
|---|---|---|---|
| Before an offer (application, screen, interview) | Not allowed | Not allowed. You may ask whether the person can perform job-related functions | 42 U.S.C. § 12112(d)(2); 29 CFR 1630.13(a) |
| After a conditional offer, before work starts | Allowed if everyone entering the same job category gets it | Allowed on the same basis; need not be job related | § 12112(d)(3); 29 CFR 1630.14(b) |
| During employment | Only if job related and consistent with business necessity, or part of a voluntary health program | Same | § 12112(d)(4) |
The regulation in 29 CFR 1630.14(b)(3) spells out the catch in the middle row: post-offer exams "do not have to be job-related and consistent with business necessity," but if their results are used to screen someone out, the exclusionary criteria must be, and the person must be unable to perform the essential functions even with reasonable accommodation.
What counts as a medical exam
The EEOC's Enforcement Guidance on Preemployment Disability-Related Questions and Medical Examinations (October 10, 1995, still published as of October 2026) uses eight questions to decide whether a test is a medical exam:
- Is it administered by a health care professional or someone trained by one?
- Are the results interpreted by a health care professional or someone trained by one?
- Is it designed to reveal an impairment or the state of someone's physical or mental health?
- Is the employer trying to determine the applicant's physical or mental health or impairments?
- Is it invasive, for example drawing blood or taking urine or breath?
- Does it measure physiological responses to performing a task, rather than performance of the task?
- Is it normally given in a medical setting?
- Is medical equipment used?
Applied to tests that come up in hiring:
| Test | Medical exam? | Earliest point |
|---|---|---|
| Physical agility or fitness test (run, lift, carry) | No, unless it measures heart rate, blood pressure or similar | Before an offer, if given to everyone in the job category |
| The same test with heart rate or blood pressure taken afterwards | Yes | After the offer |
| Test for current illegal drug use | No, by statute (42 U.S.C. § 12114(d)) | Before an offer under federal law; check state law |
| Alcohol breath or blood test | Yes | After the offer |
| Psychological test that could identify a mental disorder | Yes | After the offer |
| Personality or honesty test not designed to identify a disorder | Generally no | Before an offer, subject to the questions it asks |
| Vision test by an ophthalmologist | Yes | After the offer |
What recruiters and interviewers may ask before an offer
The line is between ability and disability. Asking whether someone can do the job is fine; asking about their health is not. The 1995 guidance gives examples on both sides.
| Allowed before an offer | Not allowed before an offer |
|---|---|
| "This role involves lifting boxes of up to 50 pounds several times an hour. Can you do that, with or without reasonable accommodation?" | "Do you have a back condition?" or "Have you ever been injured lifting?" |
| "The shifts are 6 a.m. to 2 p.m. Can you meet the attendance requirements?" or "How many days were you absent from your last job?" | "How many days were you sick last year?" |
| "Do you have a valid commercial driver's license?" | "Do you take any medication that might affect driving?" |
| "Are you currently using illegal drugs?" | "Have you ever been treated for addiction?" |
| "Do you drink alcohol?" (the guidance allows this) | "How much do you drink?" or "Have you been treated for alcoholism?" |
| Describing the job and asking how the person would perform a specific task | "Have you ever filed a workers' compensation claim?" |
If a candidate volunteers a diagnosis or a health condition, do not follow up on it and do not write it in the interview notes. Thank them, ask whether they need anything for the rest of the process, and return to the job. See what not to write in interview notes and the wider list of illegal interview questions.
Making the offer real first
A post-offer exam is lawful only after a real offer. The 1995 guidance says an offer is real if the employer "has evaluated all relevant non-medical information which it reasonably could have obtained and analyzed prior to giving the offer." In practice that means finishing everything else first:
- Interviews, references, skills tests and assessments complete.
- Background checks, where they are allowed before an offer, complete or at least run, so the medical exam is not the last unknown.
- The decision to hire made, subject only to the exam and anything that genuinely cannot be done earlier.
The point of the rule is that if the offer is withdrawn after the exam, it should be clear the medical information was the reason, so the employer must be able to justify it under the standard below.
Running a post-offer exam
- Same exam for the whole job category. The statute says "all entering employees"; the regulation says all entering employees in the same job category. Do not send only some hires, such as older candidates or those who mentioned an injury.
- Before work starts. The exam happens after the offer and before the employee begins duties. An exam after the start date is an employee exam under the stricter standard.
- Tell the clinic what not to collect. Under GINA, 29 CFR 1635.8(d) requires the employer to tell health care providers not to collect genetic information, including family medical history, as part of an exam intended to determine ability to do a job. The regulation includes safe-harbor wording you can put in the request.
- Keep results separate and confidential. The statute requires results to be kept on separate forms, in separate medical files, as confidential medical records. Supervisors may be told about work restrictions and accommodations, first aid and safety staff may be told if emergency treatment might be needed, and government officials investigating compliance may see the records. Hiring managers do not get the file.
- Use results only as the ADA allows. § 12112(d)(3)(C) limits use of the information to purposes consistent with the ADA.
If the results raise a concern
Withdrawing an offer because of exam results is where most medical exam claims arise. Before anyone decides:
- Identify the essential functions the result is said to affect, in writing.
- Ask whether a reasonable accommodation would let the person perform them, and talk to the person about it.
- Apply a job-related standard. Under 1630.14(b)(3), the exclusionary criterion must be job related and consistent with business necessity. Where the concern is safety, the ADA's direct threat standard requires an individualized assessment based on current medical knowledge, not a general assumption about a condition.
- Document the reasoning and keep it in the confidential medical file, not the hiring file.
State law can be stricter
California is the clearest example. Under Gov. Code § 12940(e)(3), a post-offer exam or inquiry must itself be job related and consistent with business necessity, and all entering employees in the same job classification must get the same exam. The state's regulations at 2 CCR § 11071 let applicants submit independent medical opinions before a final decision to disqualify them. Other states have their own disability laws, some covering smaller employers than the ADA's 15-employee threshold, so check each state where you hire.
A checklist for a post-offer medical exam program
- No health questions on applications, screening scripts, questionnaires or interview guides.
- Agility tests, if used before an offer, take no heart rate, blood pressure or other physiological measurements.
- The offer letter states that it is conditional on the exam, and the offer is made only after all non-medical steps are done.
- One exam protocol per job category, applied to every entering employee in it.
- A written instruction to the clinic not to collect genetic information or family medical history.
- Results go to a named person outside the hiring team and into a separate locked or access-restricted file.
- Any withdrawal is reviewed by HR or counsel against the job's essential functions and the accommodation options before it happens.
- The state-law version of each rule checked for every state you hire in.
Questions people ask
Can an employer require a medical exam before a job offer?
No. Under 42 U.S.C. 12112(d)(2), an employer may not conduct a medical examination or ask whether an applicant has a disability, or about its nature or severity, before making a job offer. It may ask whether the applicant can perform job-related functions, with or without reasonable accommodation.
Is a post-offer medical exam legal?
Yes, if it happens after a real conditional offer and before the person starts work, and if all entering employees in the same job category get the same exam regardless of disability. The results must be kept confidential in a separate medical file, and an offer can be withdrawn only for reasons that are job related and consistent with business necessity.
Is a drug test a medical exam under the ADA?
No. The ADA says a test to determine the illegal use of drugs is not a medical examination, so it can be given before an offer under federal law. State laws on drug testing, especially for marijuana, may still restrict it.
Can a physical agility test be given before an offer?
Usually yes. The EEOC's 1995 guidance says a physical agility test, such as running or lifting, is not a medical examination, as long as it does not measure physiological responses. If the employer takes blood pressure or heart rate as part of it, it becomes a medical examination and must wait until after the offer.
Can a post-offer exam ask about family medical history?
No. Under GINA, 29 CFR 1635.8, employers may not request genetic information, which includes family medical history, and must tell health care providers not to collect it as part of an employment medical exam.