Types of Mandatory Medical Examinations
Bulgarian legislation provides for two main types of mandatory medical examinations for workers, regulated by Ordinance No. 3 of 28.02.1987 and Ordinance No. 3 of 25.01.2008:
Preliminary Medical Examinations
Preliminary medical examinations are conducted before starting employment. Their purpose is to determine whether the candidate's health condition permits the performance of the specific work activity without risk to their health or the health of others.
The employer is obligated not to allow persons who have not passed a preliminary medical examination to start work. The occupational health service issues a fitness-for-work certificate, indicating whether the person is fit, unfit, or fit with restrictions for the specific position.
Periodic Medical Examinations
Periodic examinations are conducted at specific intervals to monitor the health status of employees over time. The frequency depends on the type of risks the employee is exposed to:
- Annual — for workers exposed to specific risks (chemical agents, noise above permissible levels, vibrations, ionizing radiation, etc.)
- Every 2-3 years — for workers with VDU work over 4 hours daily, night work, and other moderate risks
- Every 5 years — for workers without specific occupational hazards
According to NSSI data, companies with regular medical examinations report up to 35% fewer sick days annually compared to those without systematic health monitoring. Early detection of diseases through preventive examinations saves significant resources for both employers and the healthcare system.
Medical Specialties in the Examinations
Avalon OHS organizes examinations from the following medical specialties, depending on the risks identified during the risk assessment:
| Specialty | What Is Examined | When It Is Required |
|---|---|---|
| Internal Medicine (Therapist) | General health status, cardiovascular system, lung function, blood pressure | For all workers — basic examination |
| Neurologist | Nervous system, reflexes, coordination, limb sensitivity | For work with vibrations, heavy physical labor, night work |
| Ophthalmologist (Eye Doctor) | Visual acuity, color vision, intraocular pressure, eye fundus | For VDU work, precision visual work, drivers |
| Otolaryngologist (ENT) | Hearing (audiometry), upper respiratory tract, vestibular apparatus | For work in environments with noise above permissible levels |
| Surgeon / Orthopedist | Musculoskeletal system, joints, spine | For heavy physical labor, forced working posture |
| Dermatologist | Skin diseases, allergic reactions, contact dermatitis | For work with chemicals, cleaning agents, allergens |
| Psychiatrist / Psychologist | Mental health, stress, cognitive functions | For positions with increased responsibility, drivers, security guards |
How the Process Works: Step by Step
Organizing medical examinations through Avalon OHS is a structured and seamless process:
Determining the Scope of Examinations
Based on the risk assessment, the OHS determines which medical specialties are needed for each position and the frequency of examinations.
Preparing the List and Schedule
A list of employees subject to examination is created, specifying position, risk factors, and required specialists. A convenient schedule is agreed upon.
Conducting the Examinations
Examinations are conducted by a team of certified medical specialists. They can be performed at the workplace or at a medical center.
Issuing Fitness-for-Work Certificates
An individual certificate is issued for each employee: fit, unfit, or fit with restrictions. If issues are identified, specific recommendations are provided.
Summary Analysis and Recommendations
The OHS prepares a summary report analyzing the workforce's health status with specific recommendations for improving working conditions.
Medical Examination Costs
The price of medical examinations depends on the number and type of specialists, the number of employees, and the specifics of the activity. Here is an approximate cost comparison:
| Examination Type | Included Specialties | Approximate Price (per person) | Frequency |
|---|---|---|---|
| Basic Package | Therapist + laboratory tests | BGN 40 - 60 | Annual / every 5 years |
| Standard Package | Therapist + Ophthalmologist + laboratory | BGN 60 - 90 | Annual / every 2-3 years |
| Extended Package | Therapist + Ophthalmologist + Neurologist + laboratory | BGN 90 - 130 | Annual |
| Full Package | 4+ specialties + extended laboratory + ECG | BGN 130 - 180 | Annual |
| Preliminary Examination | As required for the position | BGN 30 - 80 | One-time upon hiring |
According to Article 287 of the Labour Code, all costs for mandatory medical examinations are borne by the employer. The employee cannot be required to pay for them. The time for examinations is counted as working time with the right to full remuneration.
Frequently Asked Questions
Here are answers to the most commonly asked questions from employers and employees regarding medical examinations:
Can an Employee Refuse a Medical Examination?
No. Mandatory medical examinations are a legal requirement and the employee is obligated to attend. Refusal may be grounds for disciplinary action. The employer, in turn, is obligated not to allow a person who has not passed a preliminary examination to start work and to monitor compliance with the periodic examination schedule.
What Happens If an Employee Is Found "Unfit"?
If the fitness-for-work certificate states "unfit" for the specific position, the employer is obligated to offer another suitable job within the enterprise, if available. If there is no suitable position, steps may be taken under the employment law procedure for termination of the employment relationship.
Can Examinations Be Conducted at the Workplace?
Yes. Avalon OHS organizes mobile examinations at the workplace when there is a sufficient number of employees. This saves time and reduces inconvenience for employees. The employer needs to provide a suitable room.
What Do Laboratory Tests Include?
Standard laboratory tests include: complete blood count (CBC), blood sugar, cholesterol, liver enzymes (AST/ALT), creatinine, and complete urinalysis. For specific risk factors, additional tests may be ordered.
How Many Days Before Starting Work Should the Preliminary Examination Be Done?
The legislation does not specify a specific deadline, but best practice is for the examination to be done no more than 1 month before starting work. The fitness-for-work certificate must be issued before signing the employment contract.
Employer Obligations
The employer has several key obligations regarding medical examinations:
- Organizing and Financing — all costs for mandatory examinations are borne by the employer
- Providing Access — the employer must release employees from work for the duration of examinations without deducting their remuneration
- Compliance with Frequency — the employer must monitor compliance with the deadlines for the next examinations as determined by the OHS
- No Work Without Examination — must not allow persons without a completed preliminary examination to start work
- Following Recommendations — when a recommendation for transfer to another position or limitation of certain activities is made, the employer is obligated to comply
Regulatory Requirements: Summary
Here is a summary table of the main legislative acts regulating the medical examinations of workers in Bulgaria:
| Legislative Act | What It Regulates | Key Requirement |
|---|---|---|
| OHSA (Art. 25) | Obligation for OHS coverage | Every employer must have an OHS |
| Labour Code (Art. 287) | Mandatory medical examinations | Costs borne by employer, counted as working time |
| Ordinance No. 3/28.02.1987 | Preliminary and periodic examinations | Defines mandatory specialties and frequency |
| Ordinance No. 3/25.01.2008 | Conditions for VDU work | Eye exam for workers using computers 4+ hours/day |
| Ordinance No. 5/11.05.1999 | Risk assessment | Determines necessary examinations based on risks |
Health Records
A personal health record is created and maintained for each worker or employee. It contains:
- Personal data of the worker
- Information about the workplace and identified risk factors
- Results of all conducted medical examinations
- Fitness-for-work certificates
- Data on temporary incapacity for work, workplace accidents, and occupational diseases
Health records are kept by the occupational health service and are confidential. Upon termination of the service agreement, they are transferred to the new OHS or to the employer.
Annual Health Status Analysis
Based on the results of periodic examinations and sick leave data, the OHS prepares an annual analysis of the health status of workers. This analysis:
- Summarizes the results of examinations and identified diseases
- Analyzes trends in morbidity and temporary incapacity for work
- Proposes specific measures for improving working conditions
- Recommends updating the risk assessment if necessary
Regular medical examinations are not just a formality — they are a tool for early detection of health problems and for protecting the work capacity of your employees.
How to Organize the Examinations?
The easiest and most effective way is through your occupational health service. Avalon OHS organizes the entire process — from determining the required specialists and examination frequency to issuing certificates and maintaining health records.
Contact us to organize medical examinations for your employees. We work with a team of experienced specialists from 4 medical fields.
Key Takeaways
- Two types of mandatory examinations: preliminary (upon hiring) and periodic (from 1 to 5 years)
- 7 medical specialties cover all types of occupational risks
- All costs are borne by the employer; time is counted as working hours
- Companies with regular examinations report up to 35% fewer sick days
- An employee cannot refuse a mandatory examination — it is a legal requirement
- A personal health record is maintained for each employee by the OHS
- Avalon OHS organizes the entire process — from determining required specialists to analyzing results
