As of January 1, 2026, the NSW coal industry officially transitioned from Order 43 to the new Order 45 health assessment framework. This update represents the most significant shift in mining health surveillance in years, moving away from a one-size-fits-all approach toward a more unified, risk-based system.

For businesses and operators, this change isn’t just a paperwork update; it alters how you recruit, how you monitor your workforce, and how you manage health compliance. But we are here to help with a clear outline of what has changed and what that means to your business and your employees.

 

What Has Changed Under Order 45?

The move to Order 45 introduces a number of fundamental shifts in how health assessments are conducted and reported, including:

  • Unified Health Assessment: The distinction between “pre-placement” and “periodic” medicals has been replaced by a single, standardised Order 45 Health Assessment. While unified, the process is categorised into three specific options – Health Assessment, Health Assessment Review and Retirement Health Assessment.
  • Risk Categorisation: Employers must now assign every worker a risk category based on their role. This is a mandatory requirement on the Role Requirement Form; without it, an assessment cannot be submitted. Categories of A, B or C are defined as:
    • Category A (Safety Critical): Roles where sudden incapacity could cause a serious incident affecting others.
    • Category B (Safety Sensitive): Roles where sudden incapacity affects only the worker themselves.
    • Category C (Non-safety Sensitive): Roles where incapacity is unlikely to lead to a serious incident.
  • Enhanced Chest Imaging Standards: To improve early detection of dust-related diseases, ILO-standard chest X-rays are now mandatory and must undergo dual-reading by qualified B-readers.
  • Respirator Fit Testing is Now Optional: While respirator fit testing was mandatory under Order 43, it is now at the employer’s discretion under Order 45. However, businesses must still comply with broader WHS regulations regarding respiratory protection. Note: WHA Order 45 medicals will continue to include respirator fit testing unless specified at the time of booking.
  • Formalised Retirement Assessments: Exit/Retirement medicals are now a formal requirement and can only be conducted by Coal Services Health clinics. External medical providers are no longer eligible to perform these specific assessments.

 

How Does it Impact Businesses?

The transition to Order 45 places more emphasis on the employer’s role in defining the risk profile of their workforce.

  1. Administrative Responsibility

Businesses must review all their current position descriptions and assign the appropriate risk categories (A, B, or C). This categorisation directly identifies the scope of the medical assessment conducted by the medical practitioner.

  1. Recruitment and “Portability”

Under Order 45, the health assessment certificate is portable. It no longer lists a specific employer’s name. This means a new hire can use a valid Order 45 assessment completed within the last 3 years, provided it was assessed against a risk category equal to or higher than their new role.

  1. Mandatory Medical Reviews

If a medical condition is identified that may impact safety, a Health Assessment Review is now mandatory. Employers are responsible for facilitating these reviews, including provisions for time and payment when investigations relate to airborne contaminants, hazardous chemicals or occupational noise exposure.

 

How Does it Impact Employees?

For workers, the new system offers more consistency but does require a higher level of personal health reporting.

  • Portability Benefits: Employees moving between sites or employers can often avoid additional medical assessments if their Order 45 assessment is current (within 3 years) and is of the same or higher category.
  • Strict Validity Rules: Any new employee starting a role after January 1, 2026, must have a completed Order 45 assessment. Existing Order 43 medicals are only valid if the worker stays with their current employer.
  • Clinical Rigor: With mandatory dual-read X-rays and breath analysis testing, employees should expect a more rigorous and standardised clinical experience.

 

Transitional Roadmap

Requirement Under Order 43 Under Order 45 (Current)
Medical Type Separate Pre-placement & Periodic Single Unified Assessment
Risk Focus Location-based Task & Exposure-based (Risk Categories)
X-Ray Reading Single-read often standard Mandatory Dual-read by B-readers
Fit Testing Mandatory Optional (Employer’s discretion)
Validity Often tied to employer 3 years (Portable across industry)

 

To remain compliant, your immediate actions should include updating your Role Requirement Forms to include the new risk categories and ensuring that any new hires since January 1, 2026 have been booked for an Order 45 assessment rather than the old Order 43 format.

Coal Services have put together a comprehensive FAQ document to help business and employees navigate this transition. Check it out to find the answers to any other questions you may have – Coal Services FAQ

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