How does an OH Practitioner assess fitness for work?
When an employee is unwell, recovering from an injury, or struggling with health issues, HR often faces the tricky question: “Are they fit to work – and if so, how?”
That’s where Occupational Health Advisors (OHAs) step in. Our role isn’t to judge or label someone as “sick” or “well,” but to give an objective, professional opinion on what the employee can do safely, and what support or adjustments might help to enable them to work.
The Fitness-for-Work Process
Here’s how we typically approach an assessment:
1. Referral and background context
HR or the line manager completes a referral form to give background information to explain why the assessment is needed. This could be due to frequent short-term absences, a long-term absence, a new diagnosis, or an understanding if they are fit to perform a safety-critical role. We review the referral form and job role information to understand what the organisation’s concerns are, what behaviours or difficulties they are observing in the workplace, and what information they are seeking from the referral. The referral form is the organisation’s chance to put their perspective forward so that the OHA can have a balanced view of what is happening in the workplace, as the individual and employer may have differing views, for example, the employee may feel their health condition is not affecting their performance, however, the employer may have noticed that their output has significantly reduced, or work is no longer being performed to the standard expected. This additional information helps us assess the impact of someone’s condition on work from a more balanced perspective.
2. OH consultation
The OH Advisor will assess the individual face-to face, by video or telephone. A full medical history will be taken. This will include discussing the main condition(s) associated with the reason for the referral and relevant past medical history. A full understanding of the condition, symptoms, how the symptoms impact on normal functioning at home and work, any treatment, effectiveness of treatment and future treatment options planned will be discussed. We also discuss any medication, side effects, gain an understanding of their family/home situation and any significant stressors or significant life events, and possible non-health related barriers to returning to work or full performance.
The OH Advisor will also discuss their current role. This will include their working pattern and hours including shift patterns, and their main tasks. This is to understand the physical and mental demands placed on them at work. Types of demands include lone working, heavy lifting, working at heights, long working hours, working with vulnerable people, fast paced role, managing a team, target driven role, and intense periods of high concentration. We would also ask if there are any aspects of their job they can’t do due to their health condition, any concerns they have about any aspect of their role, and any significant work stressors.
The individual would also be offered the opportunity to provide any other information they felt was relevant. With consent, the OH Advisor may also request medical reports from the GP or specialist. This is usually recommended if the medical history or treatment plan is unclear, if the individual is not recovering within the timeframes expected, or if there may be a potential ill-health dismissal so that we can ensure that we are providing OH advice based on the most up-to-date clinical information from the individual’s treating clinician.
3. Assessment of fitness to work
Understanding an individual’s symptoms and the impact of those symptoms on normal daily activities is key to assessing fitness to work. The focus is not simply on the diagnosis, but on how the person’s symptoms actually affect day-to-day function. When assessing symptoms, we need to understand what the symptom is, when it started, any obvious triggers or aggravating factors, how frequently the symptom occurs, how severe it is, how long it lasts and what makes it better. We look at whether the individual can carry out essential daily activities such as walking, sitting, standing, concentrating, or sleeping, and then consider how these abilities translate into the specific demands of their job. For example, back pain might mean someone can walk short distances but struggles with prolonged standing or heavy lifting; anxiety may allow them to manage at home but significantly affect concentration or tolerance of busy environments. By exploring severity, frequency, and variability of symptoms, alongside treatment progress and prognosis, we build a picture of what the individual can do reliably and safely, what tasks may be limited, and whether adjustments could bridge the gap. As stated above, we would also take into account the observations made by the employer to help understand functional ability at work. We would also take into account the employee’s perspective about their capacity and symptoms and any concerns they have about returning. Part of our role is often to address misconceptions and break down barriers to reassure the individual that returning to work in a supported way is unlikely to make their condition worse and can be a helpful part of their recovery. Our functional approach to assessing fitness for work ensures that our medical opinion is practical, evidence-based, and gives managers clear guidance they can use in planning work and support.
4. OH report – Professional opinion
Based on our assessment, the OH Advisor would then provide an OH report detailing the impact of the health condition on the individual and work and our opinion on current fitness for work, likely future impact (e.g. are they likely to be able to sustain reliable attendance and performance in the future), timeframes for recovery, and any adjustments or support that could facilitate a return to work or support them at work (e.g. phased hours, modified duties, equipment). The report should give you enough information to fully understand how the condition impacts the person at work, if there is likely to be any improvement or deterioration of the condition over time and timescales for this, and what actions both the employer and employee can take to minimise any impact on work and to facilitate the individual to work to the best of their ability despite their health condition. Having enough relevant information in the report can help HR and Line managers make business decision with confidence.
Fitness-for-work assessments help transform uncertainty into clarity. For employees, they provide reassurance that their health is being taken seriously. For HR and managers, they offer a clear, evidence-based pathway to safe, informed business decisions.