Coal Board Medicals

At Newcastle Health Solutions,

we specialise in providing comprehensive medical assessments for the coal mining industry in line with state regulations. Our goal is to keep your workforce safe, compliant, and work-ready.

NSW Coal Board Medicals Order 45

Coal Services Health Monitoring Requirements for the NSW Coal Industry

The re-identification of coal workers’ pneumoconiosis in 2016 led to a comprehensive review of health monitoring across the NSW coal industry. This resulted in strengthened clinical and regulatory standards designed to better protect the long-term health and safety of coal mine workers.

From 1 January 2026, the Coal Services Health Monitoring Requirements for Coal Mine Workers — Order No. 45 replace the former Order 43 and introduce a unified, risk-based framework for health assessments across NSW.

Order 45 builds on previous systems while introducing clearer requirements, enhanced clinical governance, and improved monitoring of occupational health risks.

What is an Order 45 Health Assessment?

Under Order 45, coal mine workers are required to complete a single, standardised health assessment, which replaces the separate pre-placement and periodic medicals previously required under Order 43.

The purpose of the Order 45 Health Assessment is to:

Key Changes Under Order 45

Unified Health Assessment

One Order 45 Health Assessment replaces all previous Order 43 pre-placement and periodic medicals.

Employers must assign a risk category to each worker, which determines the scope of clinical testing required.

A formal medical review is required if a condition is identified that may affect work safety or capacity.

Chest X-rays must meet ILO standards and be dual-read by qualified B-readers.

No longer a mandatory part of the health assessment (may be arranged separately if required by the employer).

Formalised under Order 45 and managed separately through Coal Services.

Employers are required to complete a Role Requirement Form and assign one of the following risk categories for each worker:

  • Category A — Safety Critical
  • Category B — Safety Sensitive
  • Category C — Non–Safety Sensitive

The health assessment cannot be submitted without a risk category, as it determines the required medical scope.

  • Employers must ensure that a worker has a valid Order 45 Health Assessment completed within the past three (3) years before commencing work in a coal mine role.
  • Existing Order 43 medicals remain recognised only if the worker does not change employers.
  • Order 43 pre-placement medicals are not transferable to a new employer.
  • All workers starting with a new employer on or after 1 January 2026 must complete an Order 45 Health Assessment, regardless of any prior Order 43 assessment.

Order 45 strengthens chest imaging standards to support early detection of dust-related lung disease.

Key requirements include:

  • Chest X-rays must meet ILO classification standards
  • All chest X-rays must be dual-read by qualified ILO B-readers
  • Dual reading may attract an additional cost and longer turnaround times
  • Imaging intervals are determined by exposure risk and clinical findings

Shorter imaging intervals may apply where clinically indicated.

Our Approach at Newcastle Health Solutions

At Newcastle Health Solutions, Order 45 Health Assessments are delivered under the clinical leadership of our Occupational & Environmental Physician, Dr Jessica Maistry.

We focus on:

Our goal is to support regulatory compliance while prioritising worker wellbeing and safe, sustainable operations.

Ready to Ensure a Healthy Workforce?

Book your pre-employment medical assessments with Newcastle Health Solutions today and prioritise the health, safety, and productivity of your workforce.