Synopsis
Assess how health affects function, use the fit note lawfully and constructively, support safe work participation and recognise when occupational or safeguarding action is needed.
- A fit note records a clinical assessment of how a health condition affects fitness for work; it is not a declaration that a diagnosis automatically prevents all work.
- Employees can self-certify sickness absence for the first seven calendar days, including weekends and bank holidays; statutory fit-note evidence may be requested after that period.
- Doctors, registered nurses, occupational therapists, pharmacists and physiotherapists may certify fit notes when they are assessing the patient within their scope and the note is clinically appropriate.
Reasoning priorities
Establish how the condition and treatment affect work capability.
Record severity, trajectory, cognition, mobility, stamina, reliability and safety rather than deriving incapacity from a diagnostic label.
Worked reasoning
A 39-year-old, absent for nine days, can type and walk normally but cannot repeatedly lift above shoulder height; the employer has office tasks.
- Assess injury severity, treatment, analgesic effects, sleep, transport and actual duties; exclude neurological deficit or another clinical reason for urgent review.
- Reason from function: unrestricted warehouse lifting is currently unsafe, but desk work and ground-level light duties may be feasible; discuss the patient’s goals and expected recovery.
- Issue “may be fit for work taking account of the following advice”, describing temporary avoidance of overhead and heavy repetitive lifting, with amended duties and movement breaks for a defined review period.
- Verify that the patient understands the employer decides feasibility, that the note counts as not fit if adjustments cannot be arranged, and arrange review for worsening pain, weakness or failure to improve.