Fitness-to-work is an assessment of whether a worker’s health lets them do a specific job safely, without danger to their own health or that of others. The result is a conclusion about the worker and the job; ILO guidance says it should contain no information of a medical nature. The International Labour Organization’s Occupational Health Services Recommendation (No. 171) lists such health assessments before assignment to tasks that may involve a danger to the worker or others, at periodic intervals during hazardous exposure, and on resuming work after a prolonged absence for health reasons.
What the rules and guidance say
Great Britain. HSE says health and safety law requires employers to make sure workers “are medically fit to carry out their work safely”, including “ensuring workers are medically fit to undertake the role required”, and notes that an industry may produce its own standards. For offshore oil and gas, a core setting for energy operators, HSE lists “ensuring initial and continued fitness to perform a job safely” as part of occupational health.
United States. Under the Americans with Disabilities Act (ADA), EEOC enforcement guidance (issued in 2000) separates three stages:
- Before a job offer: no disability-related inquiries or medical exams, even job-related ones.
- After a conditional offer: medical exams are allowed whether or not they relate to the job, as long as they are given to “all entering employees in the same job category.”
- During employment: exams must be “job-related and consistent with business necessity”, which generally means the employer has a reasonable belief, based on objective evidence, that a medical condition will impair essential job functions or that the worker will pose a direct threat.
Exams required by other federal laws, including the Occupational Safety and Health Act, are also permitted (see medical surveillance).
Outcomes and confidentiality
ILO Recommendation No. 171 (paragraph 16) describes the outcome of a prescribed exam for work involving a particular hazard:
- The physician should communicate conclusions in writing to both the worker and the employer.
- The conclusions “should contain no information of a medical nature.”
- They may indicate fitness for the proposed assignment, or specify the jobs and working conditions that are medically contra-indicated, temporarily or permanently.
Where a worker’s continued employment in a job is contra-indicated, the occupational health service should help find alternative employment in the undertaking or another appropriate solution (paragraph 17). The Recommendation also calls for provisions to protect workers’ privacy and to ensure health surveillance is not used for discriminatory purposes.
In the US, the EEOC says the ADA requires medical details obtained from inquiries or exams to be treated as a confidential medical record, shared only in limited circumstances with supervisors, managers, first aid and safety personnel, and government officials investigating ADA compliance. For how health files differ from HR files, see employee health records vs personnel files.
A fitness-to-work outcome can also come out of health surveillance or a return-to-work assessment.
In MyC’s fitness-to-work software, the outcome is shared with HR, health and safety teams and managers, while the medical basis stays confidential.
Related terms
- Return-to-work assessment: A return-to-work assessment reviews whether and how a worker can come back after sickness absence or injury, and which adjustments or phased return they need.
- Health surveillance: Health surveillance is a program of repeated health assessments for workers still exposed to a hazard after controls, to identify ill health caused by work.
- Medical surveillance: Medical surveillance is the program of medical exams and tests that specific OSHA standards require employers to offer workers exposed to certain hazards.
- Employee medical record: Employee medical record, under OSHA 29 CFR 1910.1020, means a record of an employee's health status made or kept by a physician, nurse or health care staff.