While health screening is voluntary, health surveillance is not and is usually a condition of employment in a given role. The ethical issues in ongoing health surveillance include those considered at pre-placement but the impact on the worker of the OH practitioner’s decision is usually greater. Denying someone an opportunity to work is a major decision but taking their livelihood away is even more significant. Decisions must be based on sound evidence which should be confirmed if there is material doubt. Professional judgement must be objective and must not be swayed unduly by emotion, but compassion should be shown in communicating adverse results to the worker. Matters requiring medical intervention should be referred on appropriately and agreement should be sought from the worker to communicate the employment outcome (but not the health issues) to the employer. If the worker refuses consent for the outcome to be communicated, the OH practitioner must consider whether a public interest disclosure is indicated or whether it will suffice to advise the employer that health surveillance could not be completed because of withdrawal of consent.