Two Requests from HR Two Weeks Before the SMK3 Audit
An occupational physician provides services to a Korean-owned electronics plant in Karawang with 2,300 workers on three shifts; a surveillance audit under SMK3 is two weeks away. HR asks for two things. First, every female applicant in the pre-employment medical examination (38 this month) must have a urine pregnancy test, with the result printed on the health certificate, because 'mothers resign and turnover is expensive'. Second, a 29-year-old QC inspector back from three months' maternity leave has submitted a note from her obstetrician asking that she be excused from night shifts for three months while breastfeeding. HR wants the full antenatal and delivery records 'to verify the note', and the line manager has said that if she cannot work the 22:00–06:00 rotation she should be moved to a lower-paid packing job or be terminated. The plant manager adds that the clinic 'should not create audit problems'. The physician has the employee's file and the applicant list on the desk.
1. Is the blanket pre-employment pregnancy testing request lawful and professionally acceptable? How should the physician respond, and what may legally appear on the certificate?
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Reasoning. A test is only justified in occupational medicine if its result changes a fitness-for-work decision for that specific job. Pregnancy does not predict the ability to assemble circuit boards; it predicts only that the employer may later owe maternity protection. So the test is not a medical examination at all - it is a screening instrument for discrimination. Under UU 13/2003 (Pasal 5–6) employers must give equal opportunity without discrimination, and Permenaker 2/MEN/1980 frames the pre-employment examination as an assessment of fitness for the job concerned, not a reproductive survey. Permenkes 36/2012 on medical confidentiality and Permenkes 290/2008 on informed consent mean the employer is entitled to a fitness conclusion, not to a diagnosis or a pregnancy status. KODEKI obliges the doctor to act in the patient's interest and to keep confidences.
Answer. I would refuse in writing, explaining that the request has no occupational justification, that a pregnancy test performed for the purpose of excluding applicants is discriminatory, and that the clinic will certify fitness only against a written job-demand standard. I would offer the alternative the company actually needs: a validated fitness standard for the assembly job, plus a policy that protects pregnant workers once they are employed.
Certificate content. 'Fit for the position applied for', with restrictions if any, date, and examiner. No diagnosis, no pregnancy status, no laboratory values. If management insists, I would escalate to the K3 committee, then IDI/MKEK and the Disnaker, and record each instruction and refusal in writing.
2. How should the physician handle HR's demand for the antenatal and delivery records, and what exactly should the fitness certificate for the returning QC inspector say?
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Reasoning. The employer's need is operational: can this worker do the 22:00–06:00 rotation for the next three months, and if not, what can she do? That question is answered by the restriction itself, not by the clinical details. The obstetrician's note is already sufficient evidence that a restriction exists; demanding the full record is disproportionate and breaches confidentiality unless the patient gives specific, informed, revocable consent. The doctor can receive the full record as treating information but must disclose only the minimum necessary.
Practical answer. I would meet the worker, explain what the employer has asked for, and ask for written consent to release a one-line restriction statement. If she declines consent, I would still issue a certificate based on my own assessment, since the restriction can be justified from the note and a brief examination.
Certificate wording. 'Fit for day and afternoon shift duties as QC inspector. Temporarily unfit for work between 22:00 and 06:00 for three months (postpartum/lactation), review at three months.' That is a restriction, not a finding of incapacity.
Legal framing to management. Maternity leave is protected under UU 13/2003 (Pasal 82), night work by women carries specific protection obligations (Pasal 76), and the employer's general duty under UU 1/1970 is to protect health, not to penalise a medically justified restriction. Demotion or termination for this reason would be difficult to defend in an industrial dispute. I would propose an equivalent day-shift QC assignment at the same grade, document the recommendation, and diarise the three-month review.
3. The plant manager suggests that signing the certificates without individual examinations, and omitting inconvenient findings, would get the plant through the audit. How should the physician respond, and what are the consequences of compliance?
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Reasoning. An SMK3 audit tests whether the company has a functioning occupational health system. A batch of certificates signed without examination is not a shortcut - it is evidence that the system is fictional, and it converts the doctor into the person who created the false record. Under UU 1/1970 the employer is obliged to have workers medically examined; the examining physician's duty is to perform that examination and report fitness honestly. Signing a document that asserts an examination never performed exposes the doctor to a falsification charge and to disciplinary action before the Konsil Kedokteran Indonesia, independent of any employment consequence. There is no patient benefit and no public interest that could justify it.
What I would do. Refuse clearly and in writing; state that certificates will be issued only after examination and that the clinic can complete the 38 applicants within the two weeks if scheduled now. Put the refusal in a memo to the plant manager and the K3 committee so the instruction and my response are both documented. Where findings such as raised blood pressure, hearing loss, or a suspected occupational disease are found, record them in the medical file and issue the correct fitness decision.
Consequences to spell out. Compliance risks criminal liability, licence proceedings, invalidation of insurance and JKK claims, and personal liability if an unfit worker is later injured. Non-compliance risks an internal conflict - which is the correct risk to take. If pressure continues, I would report the K3 violation to the Disnaker and seek advice from IDI/MKEK, keeping copies of all correspondence. The audit outcome is a management responsibility; the integrity of the medical record is mine.