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A high percentage of potential employees are passed fit for work despite undergoing pre-placement health assessments. Few studies have evaluated the cost effectiveness of such assessments. The aim of this study was to audit the outcome of National Health Service (NHS) pre-placement health assessments and estimate the manpower costs of undertaking them at an NHS Trust.An audit of the outcome of NHS pre-placement assessments at an NHS Trust between 1 April 2005 and 31 March 2006 was undertaken using an electronic database. The cost of undertaking the assessments was also calculated based on manpower hours spent per year.A total of 2973 pre-placement assessments were undertaken during the 12-month period. Of the employees, 98.5% were passed fit without comment, 1.5% were passed ‘fit with comments’ on the fit slip and no potential employee was found unfit for NHS work. Ten diagnostic categories contributed to a fit with comments result. The manpower cost to this trust per year to process the 2973 NHS assessments was estimated to be approximately £13 502.Given the annual financial costs incurred and the high percentage of employees passed fit for work, alternative pre-placement health assessment methods could be considered. The method should ensure, however, that the ability to detect a wide range of medical conditions at the pre-placement stage still exists.