The Russian Ministry of Health has changed the rules for medical examinations of workers

Based on Order of the Ministry of Health and Social Development No. 302n, employees of enterprises, educational institutions, and retail outlets undergo an annual mandatory medical examination. For managers, personnel examination eliminates worries about risks to the health of others and protects them from paying compensation. According to Art. 212 and 302n of the Labor Code, the cost of undergoing a medical examination is borne by the employer.

Order of the Ministry of Health and Social Development of Russia dated April 12, 2011 N 302n “On approval of lists of harmful and (or) hazardous production factors and work, during which mandatory preliminary and periodic medical examinations (examinations) are carried out, and the Procedure for conducting mandatory preliminary and periodic medical examinations (examinations) workers engaged in heavy work and work with harmful and (or) dangerous working conditions"

Article 212 of the Labor Code of the Russian Federation “Obligations of the employer to ensure safe conditions and labor protection”

Article 213 of the Labor Code of the Russian Federation “Medical examinations of certain categories of workers”

Purposes of mandatory medical examinations of workers

A medical examination is a comprehensive exercise for diagnosing pathologies and preventing occupational diseases. The procedure is periodic. The purposes of the medical examination are:

• employee health monitoring;
• reducing the number of injuries sustained at work;
• compliance with the terms of medical supervision of representatives of certain professions;
• tracking the dynamics of employee illnesses;
• detection of the initial stage of pathologies that develop due to harmful factors;
• monitoring possible obstacles to certain activities;
• prevention of infectious diseases;
• eliminating the risk of accidents at work.

A person who has undergone a periodic medical examination receives a conclusion from a medical commission. Based on this, he can ask the employer to transfer to a less dangerous production site.

Concept and purposes of medical examination

A medical examination is a set of activities and interventions that are aimed at diagnosing human pathological conditions and preventing the risks of developing occupational and other diseases. Periodic procedures are carried out to monitor the health of employees and reduce occupational injuries. For each type of profession, there are deadlines within which the employee must see doctors.

Periodic medical examinations are aimed at monitoring and promptly responding to changes in health status. It is thanks to such events that it is possible to recognize the development of occupational diseases at the initial stages and begin timely treatment. The results of the survey may prompt the employer to transfer the employee to a less dangerous area of ​​production. The verdict of the medical commission ultimately either confirms the employee’s suitability to perform his duties, or, conversely, does not allow him to perform them.

Types of medical examinations for workers

Depending on the frequency, there are three types of surveys.

Types of Medical Exams

Mandatory preliminary medical examination

Preliminary medical examination of employees is a one-time procedure before being hired by the enterprise. The candidate receives a referral from the employer or undergoes an examination as a mandatory stage in drawing up an employment contract. Applicants are rejected based on unsatisfactory results.

You need to undergo a preliminary and, upon admission to the staff, an annual scheduled medical examination:

• job candidates under 18 years of age;
• applicants planning to perform heavy or dangerous work;
• applicants for employment in the Far North;
• athletes, pilots, drivers, machinists;
• employees of the Ministry of Emergency Situations, customs, judges;
• railway workers.

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Organizations that violate these rules are subject to an administrative fine. For other business categories, undergoing a medical examination remains at the discretion of management.

Important! When an applicant is not suitable due to health conditions, the refusal is sent in writing. If you do not agree to undergo an examination to sign an employment contract, management has the right to refuse employment.

Periodic medical examination of employees

According to para.
12 hours 2 tbsp. 212 of the Labor Code for enterprise specialists is subject to an annual scheduled medical examination. Diagnostic procedures can be performed in a public hospital or a licensed private clinic. During the medical examination, specialists conduct analyzes and tests that are different for professions, ages, and genders. All employees are required to undergo a number of procedures. These include examination by a therapist, neurologist, surgeon, ophthalmologist, general blood tests, urine tests, fluorography, and an ECG. The result of the examination is entered into the medical record.

The procedure for undergoing a medical examination every year is mandatory for:

• workers in production associated with harmful or dangerous factors;
• catering company employees;
• people working at heights;
• doctors, representatives of health authorities, pharmaceutical specialists;
• personnel of educational institutions;
• citizens working in the field of poultry farming, livestock farming and water utilities.

Employees under 21 years of age, drivers, machinists and pilots undergo periodic examinations before starting a shift.

On a note! Organizations whose personnel spend more than 50% of their working time at the computer can order an on-site medical examination. Its results are equivalent to “ordinary”.

Extraordinary medical examination of employees

The legislation of the Russian Federation does not establish a clear procedure for conducting a medical examination out of turn. An employee can undergo it on his own initiative if there is a suspicion of deterioration in his health. Most often these reasons are related to professional activities.

Representatives of a medical institution can give recommendations when undergoing an unscheduled examination after a periodic examination. The reason is an additional examination or medical examination initiated by occupational safety specialists who suspect that conditions at work have sharply deteriorated, and an annual analysis has revealed suspicious symptoms.

What it is

A medical examination is a combination of certain laboratory tests and a visit to a number of doctors. It is mandatory for employees of all enterprises and is aimed at the timely detection of diseases dangerous to others.

With the help of a medical examination, changes in health are observed and a decision is made on the possibility of performing professional activities. Thanks to this procedure, it is possible to detect the development of pathologies associated with the fulfillment of job obligations.

Professional medical examinations are divided into 3 categories:

• preliminary;
• periodic;
• unscheduled.

Each applicant for a position in the organization undergoes a preliminary medical examination. The company issues a referral to the applicant to undergo a medical examination, based on the results of which a decision is made on his employment.

Periodic medical examination is a mandatory event for all employed citizens. The frequency of this procedure is established at the legislative level and depends on the worker’s profession. In each individual organization, all employees undergo a mandatory medical examination according to the established schedule.

An unscheduled examination is carried out when indications for its appointment are discovered during a periodic examination.

To conduct mandatory medical examinations of employees, the organization must enter into an agreement with a licensed medical institution. The license must indicate permission to conduct medical examinations. After concluding a contract with a medical institution, the employer must draw up a list - a contingent containing information about the positions available at the enterprise and harmful or dangerous types of work.

There is no established template for this document, so it can be drawn up in free form. This list is compiled once and is valid until changes occur in the organization. Within 10 working days after compilation, the contingent, certified by the head of the organization, must be transferred to Rospotrebnadzor for approval.

To undergo a medical examination, the employee must be given an appropriate referral.

Who should undergo a medical examination

The legislation of the Russian Federation clearly establishes who exactly undergoes a routine medical examination - they are checked annually:

• employees who are exposed to hazardous or harmful factors when performing work;
• employees whose place of employment requires them to undergo an annual examination;
• specialists ensuring the movement of vehicles;
• citizens under 21 years of age - Art. 213 TK;
• people employed in underground work - order No. 302n, clause 12 of Appendix 2;
• employees of catering enterprises, the food industry, trade, water supply communications, medical institutions and child care institutions - Art. 213 TK;
• athletes - on the basis of clause 3 of Art. 383 TK;
• workers under 18 years of age - art. 266 TK.

  
  Medical examination of workers

Important! The basis for undergoing a medical examination is Order No. 302n of 2012.

Article 266 of the Labor Code of the Russian Federation “Medical examinations of persons under the age of eighteen”

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Article 383 of the Labor Code of the Russian Federation “Procedure for consideration of labor disputes”

How to send an employee for a periodic medical examination

To undergo a mandatory periodic medical examination, an employee of an organization must present a referral from the enterprise to a medical institution.
It is issued to each employee, who must sign for its receipt. The referral is issued in accordance with the form contained in the appendix to Order No. 302n and contains the required information:

1. Employer information. Name of the organization, its organizational and legal form, activity codes.
2. Details of the health care institution that will conduct medical examinations of employees. Its address, name and OGRN must be indicated. Before making referrals to employees, a formal agreement on the provision of services of this kind must be concluded with a medical organization.
3. Type of medical commission – periodic or preliminary.
4. Full name of the employee to whom the referral is issued, his position and occupation.

The direction must reflect information about the harmfulness or danger of the work of a particular employee and his length of work in these conditions. The document must be certified by the head of the enterprise or another authorized person.

Frequency of medical examination

Based on the type of activity of the organization, the timing of the medical examination is established. For whom an annual scheduled medical examination is required for 2021, you can find out from the table.

Crane operators, elevator operators, electricians, and employees of transportation and scaffolding companies must be examined once every 2 years.

At the place of work, specialists are examined, the quality of their health and work is affected by noise, light, temperature, physical and sensory stress.

On a note! A complete list of dangerous and harmful factors is contained in Order of the Ministry of Health and Social Development No. 302n.

Medical examination of persons working in hazardous and hazardous industries

Depending on the category of hazardous factors, the deadlines for employees to undergo a mandatory medical examination are established. It is worth taking into account that, regardless of work experience and profession, the following persons are subject to annual examination:

• up to 21 years old;
• hired in the Far North region (including in equivalent regions) from another area;
• working on a rotational basis.

Let's consider the frequency of medical examination depending on the working conditions (profession).
Medical examination for employees of hazardous (hazardous) production

Do not forget that there is a professional periodic medical examination, which must be completed at the occupational pathology center once every five years.

The procedure for conducting medical examinations of enterprise employees

Responsibility for ensuring that staff undergo annual scheduled medical examinations rests with the employer. The medical center with which the organization has an agreement forms a medical commission. A complete list of doctors is available in Order No. 302n. The procedure for conducting a medical examination is established by law.

Step 1. Conclude an agreement

The company's management selects a medical institution and signs an agreement with it. The terms of medical examination are selected and agreed upon after drawing up the contract.

Important! The clinic must have a license to perform diagnostic examinations of workers.

Step 2. Making a list

The employer makes two lists:

• contingent - a list of employees and positions;
• name - list of personnel.

The first document is sent to the territorial Rospotrebnadzor within 10 days. The second is submitted to the medical center 2 months before the date of examination.

Step 3. Making a plan

The executing party (medical center) that accepted the list of names must develop a calendar plan within 10 days from the date of receipt and 14 days before the medical examination. It indicates by day which specialists to see and which tests to take. The employer approves the plan with his signature and seal.

Sample medical examination plan

Step 4. Prepare the order

The employer draws up an order on the need for a medical examination and the order of its priority. Employees become familiar with the text of the document 10 days before the medical examination. The order reflects:

• grounds for periodic medical examination are Art. 213, 266 and 212 TK;
• the need to approve the list of employees and the inspection schedule;
• medical institution where personnel are sent;
• documents that citizens need to have in their hands;
• obligation to maintain earnings (based on Article 139 of the Labor Code);
• mandatory provision of a medical report;
• a way for the heads of the employee department to familiarize themselves with the order.

Important! The document should indicate the persons controlling its execution.

Sample order for a medical examination

Article 139 of the Labor Code of the Russian Federation “Calculation of average wages”

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Step 5. Issue directions

The legislation of the Russian Federation does not establish a unified form of referral. The company draws it up randomly and hands it to the employee.

Step 6. Workers undergo inspection

Having a referral for a medical examination from the employer, a passport, company representatives come to the medical center with which the company has an agreement. During the period when diagnostic measures are carried out, employees retain their average salary.

Sample referral for medical examination

Periodic medical examination

This type of inspection is carried out on the basis of lists of names. They include all employees who have worked for 5 years in hazardous or harmful work (subclasses 3.1-3.4, class 4), indicating their position and harmful factor. Workers with occupational diseases or persistent consequences of industrial accidents undergo examinations at occupational pathology centers every 5 years. If there are no such centers in the regions of the Far North and equivalent centers, they turn to mobile teams of medical specialists from occupational pathology centers.

The list of subjects to be examined is prepared no later than two months before the start of the inspection.

Immediately before starting periodic medical examinations under order 302n, the employer gives employees directions, which are drawn up in the same way as during a preliminary examination.

The medical organization with which the employer has an agreement prepares a schedule of examinations, which is provided to the employer no later than 14 days before the start of the examination. The process follows the same procedure as the preliminary one and ends with the issuance of conclusions to employees. Then the medical organization summarizes the results obtained and reflects them in the final report. This document states:

• number of employees who underwent inspection;
• number of employees with contraindications;
• how many employees need treatment and additional examination, and so on.

The act is drawn up electronically and on paper in five copies, which are certified by the head of the commission. One copy is sent to the enterprise, the second remains in the medical institution, the third - in the center of occupational pathology, the fourth - in the territorial executive body responsible for the sanitary and epidemiological situation, the fifth - in the Social Insurance Fund.

What to do after the examination

After the annual scheduled medical examination of the organization’s personnel is completed, the medical center has 30 days to draw up a conclusion report. The document is certified by the director of the clinic and then submitted for approval to the territorial Rospotrebnadzor.

The employer collects medical books from employees with the results of medical examinations, signatures and seals of doctors. According to the medical report, the person’s membership in the dispensary group is established. In the medical record, doctors need to indicate recommendations for maintaining health. If there are pathologies, provide data on observation, therapy and rehabilitation.

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.

Medical examination costs

The employing company compensates 100% of the personnel costs for undergoing the inspection.
During the period of the survey, employees retain their average earnings. At the end of the event, employees must hand over the medical book to the employer. Depending on the region, management pays the medical center 1,500-5,000 rubles, but most companies give a discount. The state compensates part of the funds through the Social Insurance Fund.

The employer also pays for a medical examination upon hiring. If an employee independently paid for the services of specialists, he is entitled to a refund. To do this, you will need to write an application and attach payment receipts.

Legislation on the medical examination procedure

The employer is entirely responsible for occupational safety. The law entrusts him with the obligation to promptly organize a medical examination when applying for a job or during his working life. The following legal documents regulate this obligation:

• Labor Code of the Russian Federation.
• Order of Rosminzdrav of 2004, establishing a list of dangerous and harmful production work, the performance of which requires periodic medical examinations of workers.
• Order of Rosmindravmedprom, which contains information about the category of employees subject to mandatory medical examination, indicating its frequency.
• Industry documents (sanitary rules and regulations).

The Labor Code obliges employers to organize a medical examination for an employee, who must comply with the requirements of medical control. Violation of the rules by an employee or employer may result in administrative liability. Failure to undergo a periodic medical examination on time will result in the employee being removed from duty. Moreover, if it is the employer’s fault, then the duration of the downtime will be paid. Otherwise, the person will remain without wages.

Consequences of failure to undergo a medical examination

Legislation establishes liability measures for management and employees who have not undergone periodic medical examinations.

Sanctions for personnel

If a citizen refuses to undergo a scheduled inspection, the employer has the right to remove him from work and not pay wages until the violator passes the examination. If a person does not want to undergo a medical examination upon employment, he is denied employment. If there are good reasons, the employee receives a salary for the entire period of unemployment.

Sanctions for the employer

An employer who ignores the annual scheduled medical examination of its employees is subject to a fine depending on the type of ownership.
Individual entrepreneurs pay 15 thousand rubles, legal entities - 110 thousand rubles. If an employee misses an inspection for reasons independent of him and management, the head of the company pays for downtime in the amount of 2/3 of the person’s salary.

The frequency of medical examination depends on the professional qualifications of specialists. For most types of activities it is regular - once a year. Adhering to the passage algorithm will protect the employer from a fine, and the staff will not be suspended from work.

Responsibility for lack of medical examination

If the employee does not pass the medical examination and starts work, then the employer will be fined under Part 3 of Art. 5.27.1 Code of Administrative Offences.

15,000-25,000 rubles per official,

15,000-25,000 rubles for individual entrepreneurs,

110,000-130,000 rubles for organization.

Remember, that:

1. Passing a medical examination is the responsibility of workers in harmful, dangerous jobs, in the catering industry, childcare facilities and with sources of increased danger.
2. Repeated medical examination is carried out according to the schedule in accordance with the Procedure, which is approved by Order No. 302n. Extraordinary only in certain cases.
3. To send workers for a medical examination, you need to prepare lists, send them to the medical institution and Rospotrebnadzor, and issue an order to undergo a medical examination.
4. Medical examination is not a substitute for medical examination.
5. If the employee does not pass the medical examination and continues to work, the employer will be fined.

Answers on questions

Are medical examinations subject to personal income tax and insurance premiums?

Depending on the situation:

1. The employer pays for the medical examination. The payment goes directly to the medical organization; there is no reason to pay personal income tax and contributions for employees. The employer is expected to act this way.

2. The employee pays for the medical examination himself, and then receives compensation. Then you will have to pay personal income tax and insurance premiums. This is a payment to employees, and it is not included in the list exempt from contributions, the Federal Tax Service explains in a letter dated December 24, 2019.

How to send a list of employees to a medical institution and Rospotrebnadzor?

Send the list by registered mail so you don’t have to go anywhere and look for a suitable employee. You will find the address of the medical institution on its website, but you need a regional Rospotrebnadzor.

The need to undergo a medical examination upon hiring and during work

Workers need to undergo a medical examination in order to:

• preserve your health, and in some cases, your life;
• women - to bear and give birth to healthy children;
• obtain permission to perform work;
• newly hired persons - find out whether their health condition will allow them to perform the desired job.

Employers need to organize a medical examination in order to:

• prevent accidents and diseases related to working conditions of workers;
• ensure maximum production efficiency (no need to look for replacements for constantly ill workers, pay sick leave, train new workers hired to replace sick workers);
• ensure sanitary and epidemiological safety in their organizations (relevant for hospitals, pharmacies, kindergartens, schools, canteens, cafes, restaurants, hairdressers, beauty salons, hotels, sports complexes and other public service institutions);
• avoid penalties.

Preparation of medical records

Many workers wonder why they are examined by different specialists and prescribed different tests if they work in the same workshop. This is all explainable and described in the order of the Ministry of Health. The fact is that each profession and harmful factor has its own list of specialists, tests and instrumental examinations.

However, there are some nuances:

• All employees without exception are required to undergo fluorography;
• Women need to be examined by a gynecologist.

Without these tests and studies, the occupational pathologist will not grant permission to work. Based on the description of the regulatory documentation, specialists draw up a medical record for each employee separately, where they prescribe different doctors for a medical examination.

Third stage

Now the medical examination has been completed, but not fully completed, the next step is to process the results. This is what specialists do.

If there are doubts about the employee’s health status, further examinations are carried out

The results of the examination by doctors, the tests performed and instrumental studies are summarized and a conclusion is made on this basis, for example:

1. If, based on the results, the employee has no contraindications, then the occupational pathologist will grant permission to work.
2. If there are doubts about the employee’s health status, further examinations are scheduled.
3. All information is transferred to the person responsible for the medical examination.
4. To carry out additional examinations, transportation of workers to the clinic is organized. Employees are prescribed instrumental examinations, including ultrasound, blood and urine tests, ECHO-kg, Holter and others.
5. If, based on the results of additional examinations, the health status is normal, then the occupational pathologist writes a conclusion on the employee’s permission to work. If, on the contrary, the employee’s health readings do not correspond to normal values, then the employee is suspended from work or diagnosed with an occupational disease, which will adversely affect the enterprise as a whole.