Should the Nanny Do a Health Check Before Starting?

There are three layers of health screening in Shanghai household-employment practice:

• Standard 健康证 — the food-handler health certificate. Required by mainland law for anyone handling food in a workplace setting (including household nannies who cook). Tests: hepatitis A, hepatitis E, typhoid, dysentery, basic TB screening. Issued by local district health centers. Valid 1 year. Cost ¥ 100–300.
• Extended pre-employment screening — adds hepatitis B (HBsAg), hepatitis C antibody, full chest X-ray for active TB, sometimes HIV with consent. Recommended for live-in and newborn-care placements. Cost ¥ 300–500 on top of the 健康证.
• Vaccination status review — confirming the candidate's vaccinations (hepatitis B series, MMR, varicella, COVID booster history). Not a test; a document review. Most Chinese adults have hepatitis B vaccination from childhood; MMR and varicella vary.

Almost every Shanghai placement agency will have arranged a 健康证 before introducing the candidate. Many also do the extended screening as part of their internal vetting. Ask to see the certificate at signing; don't accept verbal confirmation.

For yuesao specifically, the screening is more elaborate — the agency typically commissions a full pre-placement medical including breast-feeding-support training certifications, recent infectious-disease screening, and sometimes a 7-day pre-placement quarantine for higher-tier yuesao.

Screening structure:

Who pays:

• For the basic 健康证: the candidate or the agency, typically already done.
• For extended screening: family pays, usually ¥ 300–500 reimbursed against the candidate's receipt.
• For yuesao full medical: family pays as part of the placement fee.

Turnaround:

• 健康证: 3–5 working days from blood draw to certificate.
• Extended screening: 5–7 working days for full results.
• Plan accordingly — book screening at least 2 weeks before the planned start date.

• Assuming the agency has done the full screening when only the 健康证 has been done. Ask specifically what was tested. The 健康证 doesn't include hepatitis B or comprehensive TB screening.
• Skipping the check because the candidate "looks fine." Doesn't work. Hepatitis B and TB can be carried asymptomatically for years.
• Doing the check after the start date. Should be completed before start. If the family is in a hurry, run a 2-week probation while the check is processing — but written, not informal.
• Not reviewing vaccination status. Particularly for live-in placements with infants, the nanny's vaccination status (especially MMR, varicella, and COVID) matters for the children.
• Demanding tests beyond the medical-appropriate set. Pregnancy testing without medical justification is overreach. Specific genetic screening is overreach.
• Forgetting to renew annually. 健康证 is 1-year validity. For long placements, renew at the anniversary.

• Ask the agency what screening has been done. Get specifics, not "she's healthy."
• Request the certificate copy. Photograph of the 健康证 is sufficient.
• For live-in or newborn-care placements: add hepatitis B (HBsAg), hepatitis C antibody, and chest X-ray to the screening. Reimburse the candidate against receipt; usually ¥ 300–500 total.
• Review vaccination history. Ask casually at interview; note for the record. Most Chinese adults have hepatitis B from childhood; MMR and varicella vary by birth cohort.
• For yuesao: confirm with the agency that a full pre-placement medical has been done. If not, commission one — ¥ 500–1,500, depending on agency.
• Diary the renewal. 健康证 is 1-year validity. Annual renewal is the candidate's responsibility but the family is the one keeping track of the calendar.
• Handle results sensitively. Positive results (e.g., hepatitis B carrier) deserve a conversation, not an automatic rejection. Most carriers can work in childcare with reasonable precautions. Consult a pediatrician for guidance.

• A candidate who refuses the health check. Pass. Universal practice; refusal signals something.
• An agency that won't share certificate copies. Pass; or insist before signing.
• A certificate dated more than 1 year ago. Re-do.
• An agency commissioning tests beyond medical-appropriate set (e.g., pregnancy testing without consent). Decline.
• A candidate with a positive hepatitis B carrier result and no medical-clearance conversation. Don't auto-reject; consult a pediatrician. Many carriers work safely in childcare with standard precautions.
• Family pushing tests the candidate hasn't consented to. Consent matters. HIV in particular requires explicit consent.