Railway transport workers, ensuring the safety of the operation of railway transport infrastructure, loading and unloading activities, passenger transportation, cargo baggage, are exposed to various industrial risk factors in the course of their professional activities, which determines the specifics of the organization of medical care in the sectoral healthcare system. The safety of railway transportation depends, among other things, on the health status of railway transport workers. The medical examination of Russian Railways employees, being a priority area of industry medicine, makes it possible to increase the period of active work and preserve the labor potential of railway workers, prevent and timely identify diseases of various types and the main risk factors for their development, and also determines the conditions for the development of a system of measures to reduce the risks associated with the health of Russian Railways employees. The purpose of this study was to assess the indicators of medical examination of employees of JSC «Russian Railways» on the Trans-Baikal Railway for the period from 2018 to 2022. According to the results of the study, a high indicator of the completeness of coverage of railway transport workers with medical examinations was established, which reflects the availability of primary health care and should lead to an increase in the detection of chronic non-communicable diseases and occupational pathology. However, the frequency of detection of diseases during medical examination and the indicator of timely registration of employees of JSC «Russian Railways» on dispensary registration tend to decrease. To improve the effectiveness of medical examinations and follow-up, programs have been introduced to combat cardiovascular and endocrine diseases. Based on the results of the medical examination, the health group of employees is determined, which doctors focus on when planning further tactics of medical supervision and developing a system of preventive measures. Employees of the I and III categories of work, as the most difficult, mainly have II and III health groups characterized by either the presence of risk factors or the presence of a chronic non-communicable disease, and requiring the establishment of dispensary supervision, as well as the provision of specialized medical care, including high-tech. The study of the indicators of medical examination of employees of JSC «Russian Railways» on the Trans-Baikal Railway for the period from 2018 to 2022. It allowed us to evaluate the results obtained and identify application points for the development of new structural and organizational measures, in particular, within the framework of the introduction of a three-level system of medical care, the formation of competence centers at the first level of its provision.