Fit Note: A Complete Guide for Employers

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The Department of Work and Pensions has revised the fit note legislation as of July 2022. It has expanded its eligibility for issuance beyond medical doctors to include nurses, OTs, pharmacists, and physiotherapists. This implies that if an employee is discussing their fitness to work with someone other than a doctor, that person may issue a fit note. Your employee needs to be seen by these doctors under NHS programs.

In April 2022, a new version of the fit note was released, which may result in noticeable changes to the fit note you receive. The healthcare provider no longer needs to sign the form physically; the issuer’s name and occupation will suffice. Your staff member may not have a hard duplicate because it was delivered to the patient digitally via SMS, e-mail, App, etc. The old form will remain in effect until the new version of the fit notes takes effect. Up until all GP IT practice systems are updated, the old fit note could be given to your employee. When we are done and the old instructions are no longer valid, we will send an announcement and a new one.

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What is a “Fit Note”?

Fit Note
Fit Note

A fit note is a document from a doctor stating that an employee is medically fit to return to work after being absent from work for seven days or more due to illness. It explains the sickness and suggests ways to return to work quickly and efficiently.

After suffering a back injury, a worker may be able to return to light tasks, but the fitness note may specify that they should not engage in any heavy lifting. A ‘Statement of Fitness for Work’ is more formally known as a ‘fit note,’ but it goes by many other names, including a physician, doctor’s, or sick note.

Considerations for Fit Notes and Gradual Return to Work

The physician’s fit-for-work note suggests a phased return to work. This could mean that a worker is required to put in temporary extra hours, perform additional responsibilities, or be given additional resources to help them do their regular job.

The fit remark may suggest modifications to the work environment, but these are not required. Employers are not obligated to make changes even though doing so is usually to both parties’ advantage.

Here are 5 things to do if your doctor has prescribed you a “fit note:”

  • Verify whether the employee’s doctor has determined that they are unfit for work or has determined that they are partially suitable for work.
  • Please inquire as to whether or not the employee is anticipated to be fit for work once the duration of their fit note has lapsed.
  • Talk to your employee about their fitness to work note and see if there are any accommodations you can make to get them back to work as soon as possible.
  • Use the fit-for-work note as proof for sick pay if the employee cannot work or if they may be able to work but you cannot agree on any adjustments.
  • If helpful, duplicate the fit note for your files (your employee should keep the original).

What sort of suggestions could you find in a Fit to work note?

Suppose the doctor thinks the worker might be able to return to work in some capacity. In that case, they can indicate as much by marking one of four checkboxes:

Gradual return to work,

Modified responsibilities

Adjusted work hours,


Workplace accommodations.

The doctor can add their thoughts on how the patient’s situation has affected their work in a separate box.

If the doctor recommended a staggered return to work, the worker would be better off returning to work gradually, part-time, and taking things easy for a while. New shifts and hours are broken down separately in their respective sections. Checking the box for modified duties implies that the employee could benefit from temporarily switching to a different job function. It includes avoiding heavy manual lifting, while checking the box for modified hours implies that the employee could benefit from temporarily changing their work schedule, such as by working staggered hours or by working part-time.

Last but not least, if the healthcare provider has checked the box for workplace adaptations, it is possible that the employee would profit from modifying some aspect of their working environment. The supply of specialized equipment, such as an ergonomic chair or keyboard, may fall under this category. It may also involve pairing an employee with an experienced colleague to act as a mentor or to provide extra supervision.

Some Important Tips:

  • To reduce costs and maximize productivity, it’s in everyone’s best interest to assist ill workers in returning to their jobs as soon as possible.
  • Disabled or ill workers may benefit from the services provided by Access to Work. The funds could be used for anything from purchasing tools to funding maintenance.
  • If an employee is deemed potentially fit for work, a fit memo can be used to discuss any necessary adjustments.
  • The physician’s fit note will not specify what adjustments need to be made, but it will guide how the employee’s health impacts their ability to do their job.
  • The doctor or nurse treating your worker will not issue a “fit note” if they believe the employee can return to work.
  • No matter how much time remains on their fit card, your employee can return to work whenever they feel ready. They need not make an appointment with their doctor first.
  • The initial sick note should be given to the employee, as it is their property. In the case of a handwritten fit note, you may wish to duplicate your files.

When Does a Sick note or Fit Note for Work Need to Be Issued?

A doctor’s sick or fit note is only required after an employee has been absent for seven days or more due to illness. The requirement for a doctor’s note to excuse an employee’s absence from work due to sickness is waived if the absence lasts less than seven days. The alternative is filling out a document upon their return to work. The term for this practice is self-certification. Yet, there needs to be more clarity concerning the timing and submission of fit comments.

Fit Notes for work.
Fit Notes for Work

After seven days, if a doctor believes a patient is fully recovered, they will not issue a fit certificate. After seven days of illness, an employee may visit their doctor and be told they do not need a fit note. The worker and the doctor did the correct thing, but you won’t get a fit note for the books.

It is ultimately up to your company’s policy on recording absences. For the first week of sick leave, your company’s policy could state that workers must provide medical documentation. However, in that case, it is the company’s duty to make the necessary arrangements and cover the costs.

Rules for Fit notes

A fit note is required if an employee is missing from work due to illness for more than seven days. This includes days off like weekends and holidays.

This is the legal document for a sick duty note that a primary care physician or hospital physician issues to attest to an employee’s health to return to work. If your employee’s doctor believes they are not fit for any work, or if they might be fit for some work, you’ll know from the fit note.

The date of the employee’s medical evaluation, the nature of the illness affecting their fitness for work, the duration of the prognosis, and whether or not the employee will need a new fit note when the current one expires will all be detailed in the fit note.

The proof that makes the fit note Correct

The fit note is supported by healthcare professionals and is founded on key principles established by extensive research.

People’s physical and mental well-being often improves due to doing a job that is appropriate for them.

Work can aid in recovering and maintaining health for those with a medical issue.

Most instances do not require a person to be in full health before they can return to work. What this means is different from their regular work duties.

People’s health conditions may restrict their job activities, but that doesn’t mean they can’t work.

To what end are Duty Sick notes utilised during Return to work?

The fit memo will specify whether or not the worker is fit to return to work when they can return, and what adjustments you can make to make their return easier. There could also be suggestions in the form of checkboxes showing the kinds of broad adjustments that could facilitate their return. Among these are:

  • A return to employment in which tasks or hours are gradually increased.
  • Modified responsibilities, or a shift away from their typical job responsibilities
  • The hours worked have been changed, either in terms of when they are worked or how many hours they work per week.
  • Alterations to the workplace’s structure include installing new or modified machinery or loaning assistive devices.

Doctors can elaborate on the functional impacts of the employee’s condition, such as what the employee can and cannot do at work, in the comments section of the fit-to-work note.

The fit note’s recommendations will apply to your employee, not just in their present position. This allows you a lot of leeways to talk about how to help them adjust so they can return to work.

What to do if an employee hands you a fit note?

Your worker is not fit to work if their fit note states so.

You can use this as proof in your medical leave policies (see more information about sick pay). Take a copy of the note for your files, but let the employee retain the original if they need it for insurance or another reason.

Once an employee’s fit note expires, you will know whether or not they can resume their previous duties and for how long. For more details on the fit note’s various sections, please refer to the section explaining their functions.

Maintaining contact with a worker who is gone on extended leave is recommended. The Health and Safety Executive provides advice on how to handle ill days . Your worker may be fit for work if their fit note states so.

If fit for work note states that the employee might be fit.

Line managers, H.R., union representatives, and occupational health professionals may all be included in these talks. The employee should keep the original fit note in case they need it for benefits or anything else, but you’re welcome to retain a copy for your files. It is not necessary for you to be an expert on your employee’s health situation to have these talks; instead, you should concentrate on the concrete steps to help your employee get back to work. You might find the following schedule useful as you get ready for your upcoming talks: 

  • Consider the checkboxes and the space provided for comments to learn more about the employee’s capabilities and how you can best help them.
  •  Think about how long the impact on your employee’s ability to work is anticipated to last (check Explaining the sections of fit note to see how you can do this).
  •  Consider what adjustments could be made to facilitate the employee’s return to work. 

Any agreements regarding modifications should be documented in writing for the benefit of all parties involved. Depending on the recommendations in the fit-to-work note and your talks with the employee, the adjustments may extend beyond the fit note’s expiration date. Learn how some forward-thinking companies have adjusted to help employees return to work. 

You may need to conduct a risk assessment to account for the clinical opinion in the fit note. The HSE website features helpful resources, including instructions for conducting risk evaluations. Without an agreement on modifying the fit memo, you should proceed as though it states that the employee needs to be fit for work and use it accordingly. Your worker can rest assured that they do not need a new doctor’s fit letter to verify this. Watch a real-life illustration of this phenomenon.

Facilitating the Return to Work of an Employee

Tick boxes

The tick boxes allow the employee’s doctor to indicate the broad adjustments that could facilitate the employee’s return to work. You’re not obligated to do this, so feel free to explore other possibilities:

  • A gradual readjustment to the workplace: 
  • the modification of their working hours, 
  • either by increasing the number of hours they put in each day or the number of hours they put in overall, 
  • By increasing the number of hours, they spend on specific tasks.
  • Modifications to the Workplace: Ongoing Developments

Comment Boxes

The space for the feedback Your doctor can provide more specific feedback on how your health will affect your ability to perform your job duties in the “comments” section. You and your employer will have more leeway to discuss strategies for facilitating your return to work because the guidance will be general and not specific to your present position. If your doctor diagnoses you with something more specific than “dry eyes,” such as “should not drive” or “should take regular breaks if using a display computer,” you will be better prepared to handle the situation at work. 

Your doctor may also use the remarks section to express concerns that work-related stress negatively impacts your health. If your doctor can, they should guide you in this area because employers often find the information here useful. Instead of just a diagnosis or list of symptoms, you should insist that your doctor include information on how your condition impacts your ability to perform your job.

Alterations that could occur:

Fortunately, you can find many resources to assist you in making positive life adjustments. The “Further support” sections can be accessed for supplementary resources and condition-specific recommendations.

Below are just a few adjustments that could be made; remember that this is not an all-inclusive list and that the most effective adjustments will be those unique to your company and the individual worker.

Some examples of reasonable accommodations include:

  • Switching to a different job or location; 
  • Modifying work equipment; 
  • Cutting back on work hours; 
  • Rearranging the office space; 
  • Bringing in a reader or interpreter; 
  • Working from home; 
  • Using voice-activated software; 
  • Pairing up with a mentor or work buddy; 
  • Working in a team rather than alone (or the other way around), and 
  • Scheduling occupational therapy.

What is the connection between medically-verified fitness notes and Statutory Sick Pay (SSP)?

When an employee is ill for four days straight, the government provides them statutory sick pay (SSP). Whether or not employees are compensated for the first three days of illness depends on the company’s strategy. However, they must get a doctor’s note after seven days of illness. The law necessitates this action.
Please keep a copy of the employee’s fit notes as proof of their illness. If an employee has been absent frequently, look at their fit notes during their annual performance review to see if there are any issues you can assist them with.

Can an employee return to work earlier than expected?

No matter how much time remains on their fit-to-work note from a doctor, your employee can return to work whenever they feel ready. They can avoid seeing their doctor again right away. It’s common for people to return to work before they fully recover, even though there are cases in which being actively engaged in one’s job can aid in both the healing process and general well-being. However, workers with chronic illnesses may be unable to return to their previous roles or schedules. It is due to restrictions imposed by their illness. To make sure that returning to work does not exacerbate their condition, it may be necessary to adjust their working circumstances and monitor those adjustments. To fulfil your legal obligations to guarantee the health and safety of the employee, you should follow the recommendations outlined in the fit note to work and conduct a risk assessment.

How Should Fitness Note Be Handled in Your Sick Leave Policy?

After seven days of continuous illness, a fit-for-work note must be required, but the rest of the strategy is up to you to decide. However, your policy’s requirements for when an employee must return to work may be more or less lenient.

You could opt for a more forgiving strategy or one that errs on caution. If this were the case, employees could be barred from returning to work before the termination date.

Employees in the United Kingdom need a sick note after seven days of continuous absence, but neither early returns nor forced stays are mandated by law or guidelines.

Normal problems faced by Employers

A fit-to-work note should be taken as evidence of an employee’s sickness note and inability to perform their job duties. However, there may be times when you have reason to believe that a worker is intentionally faking their illness.

With the employee’s permission, you should have them endure an independent medical evaluation if you doubt they can perform their duties due to an extended illness. This can then be used as evidence against the worker’s claim that they cannot perform their job and serve as the foundation for disciplinary action.

Suppose an employee has been absent from work for a short period, and you have reason to believe they have fabricated or exaggerated the severity of their sickness. In that case, you should conduct a return to work interview. You can verify their answers using their written self-certification or a fit note.

However, you must proceed with care when an employee is suspected of malingering. You should only assume the worst or make wild claims with proper evidence. An employee’s resignation and a claim for constructive dismissal could result from a breach of the implied condition of mutual trust and confidence if they are falsely accused of fraudulently taking sick leave.

Remember that being absent from work for a valid reason is not considered misconduct. It must be handled as a capability problem. Even though you have the right to terminate an employee on long-term sick leave if they cannot perform their work, you must demonstrate why reasonable accommodations could not have prevented the employee’s dismissal. A discrimination or unfair termination claim could follow from failing to do so.

Does my worker need a doctor’s letter to prove they’re Fit to work?

No. The fit-to-work note does not include a provision for approving the individual’s return to employment. A doctor’s note stating that an employee is healthy enough to return to work will not be given.

If your worker has yet to return to work after the expiration of their fit notice, they should do so.

There are specific processes in place to vet potential employees for select positions. If this is relevant to your company, someone in workplace health or legal should be able to tell you.

A private agreement with a doctor should be made if your company has a policy that mandates workers’ documentation of their fitness for work. Once a doctor has cleared an employee to return to work, they cannot issue another “fit note” to keep the worker out of the office. At the same time, the employee undergoes further medical testing at your request.


Can anyone in the medical field give a fit note?

Healthcare providers (H.C.P.s) are only authorised to issue medical necessity letters. According to the law, these professionals include nurses, OTs, PTs, pharmacists, and M.D.s. Professionals in these fields may only issue “fit notes” if they have received the appropriate training. They get the expertise to determine whether or not an individual can perform their job duties physically and mentally.

Can an employer override a doctor’s sick note UK?

In its most recent set of regulations, the government has indicated that businesses can disregard a physician’s letter if they deem it unnecessary. The employer is not required to follow the recommendations made in the fit memo.

Can a community, private, or high-street pharmacy issue a fit certificate to an employee?


Community pharmacies do not offer fit-for-work notes as part of their NHS services. They do not have access to the official ‘Med3’ form, the technical term for the fit note given free of charge under NHS provision.

The new policy is meant to affect pharmacists and those in a position to evaluate patients’ job capacity.

Does a fit note impact sick pay?

The fit note can support your sick pay policies. Employees can still collect disability pay even if their fit notes indicate they may be able to return to work.

You should consider the employee’s cash situation if they return to work on reduced hours. In such situations, it is up to the employer’s discretion to either pay sick leave for the missed shifts or continue regular pay as usual.

Do workers need a doctor’s letter to prove they’re healthy enough to return to work?

After receiving a fit letter, employees can return to work without further documentation. After the allotted time on an employee’s fit note has passed, they are responsible for returning to work or obtaining a new one.

There are specific processes in place to vet potential employees for select positions. Your HR, OH, or legal team will know if your business is affected.

A private agreement with a doctor or an occupational health expert should be made if your company has a policy. The policy mandates employees that provide medical documentation of their fitness for work. Once a doctor has cleared to fit to work, they cannot issue another “fit note” to keep the worker away. And the employee undergoes further medical testing at your request.

Does A fit note require a signature?

The doctor’s signature is required on the fitness report. The letter must be signed regardless of whether it was written by hand or printed.

When is a fit letter required?

An employee is not required to provide you with a fit note for 7 days of absence from work. If they have been out ill for more than seven days, the law requires them to return to work. Employees who have been out sick for less than a week should be able to self-certify their absence. And its causes upon their return to work. They could self-certify their absence using a pro forma. They also provide a written report of what happened during their absence. A government document SC2 statement of illness could also be filled out. Doctors cannot give excuse notes in the first seven days of illness. For the first week of leave, you must provide and pay for any medical documentation that may be required.

What does the new fit note for Employers?

As of April 2022, there will be multiple options for providing your employee with a fit-to-work note. The only difference is that the new fit note can be digitally authorised rather than printed. It can be signed so that the name of the healthcare expert who issued it is included. Your staff member may not have a hard duplicate because it was delivered digitally to the patient. While the new fit note template is being rolled out, your employee may be given the old version. And it is still legitimate once a doctor signs.

How to calculate sick days?

To determine how many days you’ve been unwell, add up every day you haven’t gone to work due to illness.

What if a fit note indicates an employee’s job may affect their health?

You need to consider this and keep your legal obligations in health and safety. A workplace health evaluation of the worker is another option to consider. You’ll get an unbiased opinion on the employee’s ability to perform their job. Also suggest reasonable accommodations tailored to their position and health.

What if a fit note suggests that an employer should seek occupational health advice?

It depends on the employer whether or not to act on this advice. And in some instances, a solution can be found without needing additional expertise. An occupational health specialist should be evaluated for complex or possibly work-related conditions. If you require additional assistance setting up a workplace health referral, the AHRC staff is here to help.

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Robert Windham
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VisaHelpUK - UK Immigration and Visa Application Advice Service
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