Objective To construct a scientific and systematic evaluation index system for labor literacy among medical undergraduates, to provide references for the implementation and management of labor education in medical schools, and to promote the deep integration of medical education and labor education. Methods Computerized literature retrieval was performed in China National Knowledge Infrastructure (CNKI), WanFang Data, and VIP databases, PubMed, and Web of Science, as well as relevant documents. The retrieval time frame covered from the establishment of each database to June 1, 2025. Based on Marxist labor theory, the Iceberg Model, and the Onion Model, an initial pool of indicator items was established through literature analysis. The Delphi method was employed for two rounds of expert correspondence, inviting experts to score and screen the indicators from July to August 2025. Data analysis was performed using SPSS 26.0 to assess expert engagement, authority coefficient, and the degree of opinion concentration and coordination. Results A total of 15 experts were included. Two rounds of correspondence consultation were conducted. The effective questionnaire response rates for both rounds of correspondence were 100%. The expert authority coefficients were 0.82 and 0.83, respectively. Kendall’s coefficient of concordance was significant (P<0.05), and all variation coefficients were less than 0.25, indicating converging expert opinions. The final evaluation system was composed of 4 first-level indicators, 8 second-level indicators, and 18 third-level indicators. Conclusions The evaluation index system for labor literacy among medical undergraduates combines theoretical rigor with the characteristics of medical education, providing a scientific tool for the assessment of labor literacy. Further empirical research is needed to validate its reliability and validity.