Cities are not required by federal or state laws to administer pre-employment medical examinations or physical ability tests for firefighters or police officers. Even the Occupational Safety and Health Administration Respiratory Protection Standard does not require a complete medical examination for firefighters, but does require a medical questionnaire, medical screening, and fit test to determine if a firefighter can wear a respirator. Cities may administer medical examinations or physical ability tests so long as the tests do not have an adverse impact on a protected class (42 U.S.C., Section 2000 e-(h)). A protected class would be persons protected by the Federal Civil Rights Act by virtue of their age, race, color, religion, sex, or national origin, or the Americans with Disabilities Act.

The Barry Brady Act requires that full-time firefighters be given an annual medical physical exam and cancer screenings for the covered cancers if the employee requests it. Many Tennessee municipalities plan in advance for these evaluations and only allow the firefighters to opt out of the examination at their option.

The National Fire Protection Association (NFPA) develops consensus standards relating to aspects of the fire service. These consensus standards are not law, but they are a nationally recognized standard that outlines best practices. More specifically, NFPA 1582 Standard on Comprehensive Occupational Medical Program for Fire Departments sets a framework for pre-hire and incumbent members of the fire service.

NFPA 1582 Chapter I of the standard addresses the administration of the standard. Chapter I specifies that this standard applies to public, governmental, military, private, and industrial fire department organizations providing rescue, fire suppression, emergency medical services, hazardous materials mitigation, special operations, and other emergency services.

NFPA 1582 Chapter 6 of the standard addresses Medical Evaluations of Candidates. The standard specifies that a medical evaluation of a candidate shall be conducted before the candidate is placed in training programs or fire department emergency response activities.

NFPA 1582 Chapter 7 of the standard addresses the Occupational Medical Evaluation of Members (incumbent). The standard specifies that medical evaluations shall be conducted as a baseline for surveillance and annually thereafter.