29.3 The collection of health information by Australian employers is a well established practice in a number of situations including pre-employment medicals, periodic medicals to assess fitness for duty, occupational health and safety assessments, workers’ compensation claims and retirement medicals. Of these, pre-employment health screening of job applicants and ongoing health surveillance of employees are amongst the most important.
29.4 Genetic information is a form of health information and it is likely, as clinical genetics develops, that it will become more difficult to distinguish it from other forms of health information. In addition, as the cost of genetic testing falls and the number, accuracy and reliability of available tests increases there is reason to expect an increased use of genetic information in employment.
29.5 A large number of Australian employees are required to undergo health screening as a pre-condition of employment. This form of screening can involve a medical examination, a questionnaire, the taking of a medical and/or occupational history, or the use of medical tests or samples. In certain industries, pre-employment or pre-placement medical examinations are requiredby occupational health and safety regulations, for example, where the applicant will be employed in activities that may be hazardous, such as operating machinery in mines.
29.6 Genetic screening—a subset of health screening—involves examining the genetic status of an employee or job applicant for certain inherited traits, disorders or susceptibilities for the purpose of excluding high-risk persons from the workplace or providing alternative work that may present fewer risks.
29.7 Professor Richard Johnstone has commented that employers often see pre-employment screening as part of their ‘managerial prerogative’ to hire and fire as they choose. In practice, however, employers’ ability to conduct pre-employment health screening is constrained by Commonwealth, state and territory anti-discrimination legislation. This is discussed further in Chapters 30 and 31.
29.8 Health surveillance is conducted in industries involving workplace exposure to hazardous substances or agents. The National Occupational Health and Safety Commission has prepared a package of regulations, standards and codes of practice in relation to health surveillance of employees, and each Australian jurisdiction has implemented the package in regulations under their principal occupational health and safety legislation.
29.9 Health surveillance involves monitoring a person’s health on an ongoing basis to identify changes in health status as a result of workplace exposure to hazardous substances. Surveillance may involve monitoring individual employees or groups of employees to identify risks to the entire exposed population. Employers must conduct health surveillance in industries involving exposure to hazardous substances such as asbestos, carcinogenic substances or inorganic lead.
29.10 Genetic monitoring—a subset of health surveillance—involves the periodic testing of employees to evaluate the genetic damage caused by exposure to a workplace hazard. Genetic damage may take the form of chromosomal damage or genetic alterations or mutations. This is discussed further in Chapter 32.
Other health assessments
29.11 In addition to pre-employment health screening and health surveillance other forms of health assessment include:
sick leave examinations conducted to determine whether a person’s illness or injury has resulted in a permanent or temporary disability, which may impact on work arrangements;
workers’ compensation examinations required where an employee has claimed compensation for work related injury or disease (see Chapter 33);
executive health examinations of senior management to provide feedback on current state of health, and information to enable lifestyle and health improvement; and
retirement examinations, which may be carried out to advise retiring employees of any health problems or to discuss the need for ongoing medical surveillance.
Drug and alcohol testing
29.12 Drug and alcohol testing also involves the use of applicants’ and employees’ health information. Testing may be undertaken to detect alcohol, prescription and over-the-counter pharmacy drugs, as well as illicit drugs such as cannabis, cocaine, amphetamines and heroin. Testing is usually conducted by analysing bodily samples such as blood, urine, breath, hair and saliva.
29.13 Some industry-specific legislation provides for drug and alcohol testing. Employers also justify drug and alcohol testing in the workplace by reference to their duty to ensure the health and safety of their employees and third parties. Australian employers have conducted alcohol and drug testing on railway employees, prison officers, coal miners, airline workers, law enforcement officers and members of the Australian Defence Force. While the use in Australia of workplace drug and alcohol testing is generally acknowledged to be widespread, the Inquiry is not aware of recent statistics regarding its use.
29.14 Although workplace drug and alcohol testing has been introduced in a number of industries, concerns have been raised about privacy, the accuracy of test results, the ability to measure the impact on an employee’s work performance, and the economic costs and benefits associated with testing.
 R Johnstone, ‘Pre-employment Health Screening: The Legal Framework’ (1988) 1 Australian Journal of Labour Law 115, 115–116. The Australasian Faculty of Occupational Medicine of the Royal Australasian College of Physicians has issued guidelines for employment health assessments. See Australasian Faculty of Occupational Medicine, Guidelines for Health Assessment for Work (1998) Royal Australasian College of Physicians.
Mines Inspection Act 1901 (NSW) s 18A.
 US Congress — Office of Technology Assessment, Genetic Monitoring and Screening in the Workplace (1990), US Government Printing Office, Washington, 5.
 R Johnstone, ‘Pre-employment Health Screening: The Legal Framework’ (1988) 1 Australian Journal of Labour Law 115, 117.
 See National Occupational Health and Safety Commission, National Model Regulations for the Control of Workplace Hazardous Substances [NOHSC: 1005 (1994)] (Updated for Amendments), Commonwealth of Australia; National Occupational Health and Safety Commission, National Standard for the Control of Inorganic Lead at Work [NOHSC: 1012 (1994)], Commonwealth of Australia.
 US Congress — Office of Technology Assessment, Genetic Monitoring and Screening in the Workplace (1990), US Government Printing Office, Washington, 4.
 See Australasian Faculty of Occupational Medicine, Guidelines for Health Assessment for Work (1998) Royal Australasian College of Physicians, 6–10.
 The Privacy Committee of New South Wales, Drug Testing in the Workplace, 64 (1992), Privacy Committee of New South Wales, Sydney, 5.
 For example, see Rail Safety Act 1993 (NSW) s 61; Australian Federal Police Act 1979 (Cth) s 40M.
 The Privacy Committee of New South Wales, Drug Testing in the Workplace, 64 (1992), Privacy Committee of New South Wales, Sydney, 7.
 In 1991, nine of the top 600 Australian companies (being 1.5%) reported having drug testing procedures for employees. In 1992, a survey found that 11.5% of a range of private and public sector organisations had some form of drug and alcohol testing program: Ibid, 9–11.
 Ibid, 19–25.