A manager asks for a fit note on an employee’s second day of absence. An employee returns after three weeks with a note saying they ‘may be fit for work’. A safety-critical role raises concerns that neither document answers. Knowing when are fit notes required is only the starting point. Occupational Health practitioners need to understand what a fit note can establish, what it cannot establish, and when a more focused fitness-for-work assessment is needed.
In most UK workplaces, an employee can self-certify sickness absence for the first seven calendar days. A fit note may be requested if the employee is off sick for more than seven calendar days, including weekends, bank holidays and days they were not due to work.
This is commonly called the seven-day rule. If someone’s absence lasts seven calendar days or fewer, their employer should not ask them to obtain a fit note. A workplace self-certification process is normally sufficient. Once the absence goes beyond seven days, the employer may ask for medical evidence. A fit note is the usual form of evidence and may support Statutory Sick Pay (SSP) processes.
The key word is ‘may’. A fit note is not automatically generated on day eight, and not every employee will need one unless the employer requests evidence. Equally, a fit note does not determine whether someone qualifies for SSP. Eligibility for SSP depends on separate employment and earnings criteria.
For Occupational Health practice, this distinction matters. Do not treat the presence of a fit note as proof that an employee is entitled to a particular payment, or its absence as proof that an absence is not genuine. The document has a more limited clinical and administrative purpose.
The seven-day period is consecutive. A part-time employee who is absent from Thursday to the following Thursday has been absent for more than seven calendar days, even if they were only scheduled to work on some of those days.
This is an area where managers often make avoidable errors. Counting shifts or contracted working days instead of calendar days can lead to an inappropriate request for evidence. Clear absence policies and manager training reduce that risk.
A fit note is a Statement of Fitness for Work. It is issued by an authorised healthcare professional who has assessed the patient’s health condition and considers that a period away from work, or changes to work, may be clinically appropriate.
It contains one of two broad opinions: the person is ‘not fit for work’, or they ‘may be fit for work taking account of the following advice’. The latter can include suggestions such as a phased return, altered hours, amended duties or workplace adaptations.
The wording is deliberately advisory. A fit note is not a detailed risk assessment, a legal direction to the employer, or a comprehensive account of functional capacity. It will rarely answer the specific questions that matter in a complex workplace decision, such as whether a forklift driver can safely work night shifts while taking sedating medication, or whether a nurse can undertake restricted clinical duties during rehabilitation.
A clinician can usually issue a fit note without a face-to-face consultation where this is clinically appropriate. It may be issued digitally, and it may be provided by a doctor, registered nurse, occupational therapist, physiotherapist or pharmacist involved in the person’s care. The format is less important than the clinical judgement behind it.
When a fit note says an employee may be fit for work, the employer and employee should consider whether the suggested adjustments are practical and safe. They are not obliged to implement every recommendation if it cannot reasonably be accommodated.
If the workplace cannot support the proposed changes, the employee is treated as not fit for work for the period covered by the note. They do not need to obtain another fit note simply because the employer cannot offer the adjustments.
Conversely, a person may return before the end date on a ‘not fit for work’ note if they feel able to do so and the employer agrees. There is no formal ‘fit to return’ certificate required from a GP. This is often misunderstood and can create unnecessary barriers to a timely, supported return.
Fit notes are useful for ordinary sickness absence administration. They are less useful where the decision turns on particular job demands, safety risks or the feasibility of adjustments. This is where Occupational Health adds practical value.
Consider an employee returning after depression-related absence. The fit note may recommend altered hours and reduced workload. An Occupational Health assessment can explore the functional issues behind that advice: sleep pattern, concentration, medication effects, travel demands, exposure to distressing work, management support and the likely pace of a sustainable return.
The same applies to musculoskeletal conditions. ‘Light duties’ is not a defined clinical restriction. For one worker, it may mean avoiding manual handling above a specified weight. For another, it may involve reduced ladder use, regular movement breaks or temporary limits on repetitive upper-limb work. A useful report translates broad medical advice into clear workplace options without disclosing unnecessary diagnostic detail.
Safety-critical roles need particular care. A fit note cannot substitute for a role-specific assessment where impaired alertness, reduced mobility, seizures, medication side effects, visual limitations or psychological symptoms could affect the employee, colleagues or the public. The proportionate approach depends on the role, the hazard and the available controls.
Employers are entitled to manage attendance and seek enough information to make reasonable work decisions. They are not entitled to an employee’s full medical history. A fit note may include a diagnosis, but Occupational Health communications should remain focused on functional restrictions, prognosis where clinically supportable, and recommendations relevant to the job.
An employee’s consent is central when Occupational Health seeks a medical report from a GP or treating specialist. This is different from receiving a fit note supplied by the employee. Practitioners should explain why further information is needed, what questions will be asked and how the report may influence workplace decisions.
This approach supports trust and better-quality information. It also prevents the common mistake of asking a GP to decide whether a person is ‘fit for their role’ without providing meaningful information about the role itself.
A fit note can alert an employer to a health issue, but it does not decide whether the Equality Act 2010 applies. A person may be disabled under the Act even if they have no fit note, and a person with a fit note may not meet the legal definition of disability.
Where there is a potential long-term and substantial effect on normal day-to-day activities, the employer should consider reasonable adjustments. Occupational Health can help by assessing likely functional impact, identifying barriers within the role and suggesting adjustments that are specific enough to test in practice.
Adjustments should not be confused with indefinite removal of essential duties. Sometimes a temporary adjustment, graded exposure to demands or redeployment discussion is appropriate. Sometimes the residual risk cannot be controlled in the current role. Defensible decision-making means recording the evidence considered, the options explored and the reason for the outcome.
When reviewing a fit note, start with the absence timeline. Has the employee been absent for more than seven consecutive calendar days, and has the employer actually requested medical evidence? Then move quickly beyond the certificate. Clarify the employee’s account of their symptoms and treatment, the functional impact, the essential demands of the role, relevant hazards and the adjustments already attempted.
A high-quality assessment does not simply repeat ‘may be fit’ or ‘not fit’. It gives the employer a workable plan. That may include a phased return with review points, temporary limits on a defined task, changes to working time, referral for workplace equipment, or a clear rationale for why return should be delayed.
For learners developing confidence in this area, the most valuable habit is to separate three questions: is medical evidence needed for absence administration; what does the available clinical evidence say; and what is safe, reasonable and workable in this specific job? A fit note may inform all three, but it rarely resolves them alone.
Used well, fit notes can open a constructive conversation about work and recovery. The Occupational Health professional’s role is to turn that broad clinical advice into proportionate, person-centred workplace decisions that support both health and safe work participation.
