07795 214 663

Fitness for Work Assessment

Aka: “Case Management”, “Management Referral” or “Sickness Absence Referral”

Fitness for Work Assessment

1. Fitness for Work Assessment.  Key Features


We assess your employee’s fitness for work, answer your questions and make recommendations in carefully structured, plain English, actionable reports.


We help prevent scenarios where a trail of GP fit notes with no strategy for resolution, concludes with the worst possible outcomes; continued poor performance, absence management and lost wages.


You initiate the referral using our standard referral form.  We guide you through the end to end process.


Each unique and often complex assessment is managed through consistent and repeatable steps, ensuring compliance with legislation, medical codes of conduct and your company’s policies.


Diligently conducted, either remotely or physically present, by experienced and qualified Occupational Health Specialist Practitioners.

2. Fitness for Work Assessment. Step by Step Guide

Click on a step below to view more detail.

Refer your employee for a Fitness for Work Assessment when you are concerned that they have a long-term health condition (has lasted, or is likely to last, >4 weeks).  Typical situations can include:

  • New Starter Pre-Placement Health Screening identifies a health condition likely to require job adjustments.
  • Long-term or repeated short-term sickness absence.
  • Performance issues which may be related to the health condition.
  • Your employee informs you of their intent to return to work after a long-term absence and you need guidance on their fitness for work and reasonable adjustments.
  • Your employee has raised a concern that work may have caused, or has aggravated, their health condition.
  • You need an independent assessment of whether your sickness absent employee is fit to attend check-in meetings or an internal procedural meeting.

Where your employee is already sickness absent:

  • Refer for a Fitness for Work Assessment as soon as you become aware or concerned that sickness absence is expected to continue beyond 4 weeks1, initiating a process of support and advice to prevent your employee from becoming detached from work and the case drifting further away from the best possible conclusion.
  • Where your employee has already been sickness absent for more than 4 weeks with:
    • No indication of a return to work within the next 4 weeks, then you might refer for a Fitness for Work Assessment to better understand their likelihood of returning to work.
    • An indication of a possible return to work within the next 4 weeks, then you might refer to understand their likelihood of returning to work and what adjustments and support they might need upon their return.

If you have any questions about Fitness for Work Assessments then contact Work Wellness by completing an Enquiry Form or by phoning us on 07795 214 663.  Without obligation, we can help:

  • Test your reasons for considering a Fitness for Work Assessment and the likely value you will receive.
  • Understand your intentions towards your employee and gain an insight into your workplace, your culture, the nature of your employee’s work and any health and safety risks to help ensure the assessment report is as actionable as possible.
  • Advise whether the Fitness for Work Assessment needs to be conducted physically present rather than remotely via video conference or telephone. 
  • Advise whether the Fitness for Work Assessment should be conducted by an occupational health physician in those rare cases where:
    • Your legal counsel requires it or 
    • Assessment is required for ill-health retirement under an occupational pension scheme.

To initiate a referral for a Fitness for Work Assessment, we provide you with 3 documents, each carefully designed to make the referral as straightforward as possible:

1. Occupational Health Assessment, Management Referral Form.

For you to complete and return to us.  The referral form:

  • Is structured to help you detail; the requirements of the job, your reasons for believing health conditions may be affecting performance in the job and any adjustments and support you have provided so far.
  • Guides you through an assessment question checklist from which you can tick the questions you would like Work Wellness to answer.  You also have the opportunity to pose additional questions.
  • Gives you the opportunity to request additional comprehensive work risk assessments if you have a particular concern that work may have caused or is aggravating your employee’s health condition.

The completed management referral form includes the completed form itself together with any other documents which accompany it such as; a job description, sickness absence history,  fit notes, minutes of return to work, welfare or other meetings, record of adjustments already implemented, etc.

Referral decision tree

2. Occupational Health Assessment, Employee Consent Form.

For you to ask your employee to sign and then return to us together with the completed referral form.  The form is carefully designed to obtain all necessary consents at this stage in the process.  When obtaining your employee’s consent to the referral you should:

  • Explain the reason for referral and the process, for example:
    • “I have recently become concerned about your performance at work. And I want to refer you for an occupational health assessment to explore whether or not you might have a health condition which could be the cause of this and, if so, what can be done about it.”
    • “We are aware that you have a health condition, and we want to make sure we are providing sufficient support for you.”
    • “Your absence level is higher than average and we would to refer you for an occupational health assessment for advice on whether or not anything more can be done to help with your health.”
  • Allow your employee to see the completed occupational health assessment referral form.

3. Occupational Health Assessment. Employee Guide.

For you to give to your employee.  Whilst written primarily for the benefit of your employee, the guide will also be a useful resource for you to draw upon to explain the process to your employee when obtaining their consent to the referral.

Returning the referral forms in good time is crucial to the quality of the assessment.

The referral forms must be returned to Work Wellness at least 5 working days prior to the appointment, to allow sufficient time to:

  • Agree the calendar appointment with your employee.
  • Request and receive relevant documentation from your employee.
  • Research and prepare for the appointment.

Now that all relevant information is presented to us on the referral form, we will pause briefly to:

  • Assess whether we can add value to the case.  In a minority of cases, typically with ‘late referrals’ where you have been actively managing the case for months, we may not be able to identify / recommend any adjustments or assistance over and above what you have already implemented.  In such cases we would explain our reasoning to you and let you decide whether to proceed with the assessment.  You may still decide to proceed for example, because we provide independent medical validation, having followed occupational health ‘best practice’ processes, of your management of the case.
  • Re-confirm whether the assessment can be conducted remotely or physically present.

Arranging the assessment consultation:

  • We can arrange the consultation appointment directly with your employee including; providing candidate appointment slots, agreeing the slot most convenient to them, issuing the calendar invite and receiving the invite acceptance.
  • Alternatively, you may choose to arrange the consultation appointment between Work Wellness and your employee, in which case we will offer you 3 candidate appointment slots to agree with your employee.  You may choose this option:
    • In order to retain overall control over the process (e.g., to minimise the risk of ’employee did not attend’).
    • For the first one or two referrals until you are comfortable with the process.

Relevant documentation:

Whoever arranges the appointment should also request that your employee sends relevant documentation to Work Wellness, to be with us at least 1 working day prior to the appointment.  Relevant documentation can include:

  • A written chronology of any health conditions relevant to the assessment such as; date of incident (if any), date of onset of symptoms, date of diagnosis, date of commencement of treatment, dates of any significant changes to treatment and / or symptoms, etc.
  • Copies of any letters / reports they have from their GP and treating specialists about their health condition(s) such as; referrals and appointments for medical investigation, diagnoses, description of symptoms, recommended or prescribed treatments and prognoses for recovery.

We will prepare in advance of the consultation by:

  • Reading through the information you have provided in the referral form.
  • Reading through information such as GP / specialist letters and reports provided by your employee.
  • Researching unfamiliar terms, health conditions and treatments described in the referral form or information provided by your employee.
  • Prepare a starting set of questions ready explore with your employee in order to elicit the information required to answer the questions you have asked of us.

During the consultation we will seek to elicit accurate disclosure of relevant information from your employee by:

  • Building trust and rapport, establishing a safe space, where your employee can disclose the facts of their health condition and treatment and discuss how it affects their work and attendance.
  • Listening without judgement.  Acknowledging your employee’s feelings whilst being impartial and objective.
  • Reading the tone and body language as well as the words, listening for their spoken and unspoken reasons for attendance or performance which might include work, lifestyle and family related issues.
  • Asking progressively more closed questions where we believe it is necessary to establish the facts. 

Where appropriate we may:

  • Explore what your employee is already doing to alleviate their symptoms and improve their health.  Where appropriate we might recommend what more they could do.
  • Discuss with your employee whether they are accessing the health care they need.

We will make an informed assessment based upon the information we have gathered up to this point.  Health issues can affect different employees in different ways, a medical condition can completely defeat one person resulting in long-term absence, whilst another might try and work through it resulting in presenteeism, errors and safety issues.  Our Fitness for Work Assessment will consider the state of mind of your employee as much as their state of health.

After the Fitness for Work Assessment you will receive a report containing:

  • Answers to the questions which you ticked on the occupational health assessment referral form.
  • The practitioner’s assessment of:
    • The degree to which any health conditions affect your employee’s capability to perform in their job.
    • Risks to their mental or physical health arising from the job they do, the equipment they use and their working environment, including whether or not these risks caused or are aggravating their health condition.
    • Risks their mental or physical health pose to other colleagues, customers or to the general public.
    • The likelihood or ‘prognosis’ for recovery where this can be supported with medical evidence such as a diagnosis and the effectiveness of any treatment strategy in place.
    • Your employee’s current fitness for work; whether they are unfit, fit or likely to be fit with adjustments.
  • The practitioner’s recommendations for:
    • Adjustments; to the job they do, the equipment they use, their working environment or to processes and procedures.
    • Other forms of support and treatment to aid your employee’s rehabilitation such as physiotherapy or cognitive behavioural therapy.
    • The timing and pace of a phased return to work where your employee is sickness absent.
    • A follow-up review, e.g., towards the end of the planned phased return to work period.

The Fitness for Work Assessment report will more than likely contain sensitive information so we follow General Medical Council guidelines to ensure confidentiality.  Further details of these guidelines can be found at the end of this link: Processing Employee Health Information

The Fitness for Work Assessment report should be a valuable source of information to help you decide how to manage your employee, their performance and the risks to their health and safety.   Further guidance can be found at the end of this link: Using Your Occupational Health Report.

The practitioner:

  • Will usually make themselves available for a 5-15 minute telephone call to clarify information in the assessment report which might appear ambiguous or difficult to understand (e.g., a medical condition which has not been adequately explained).
  • Is obliged to remain impartial and transparent at all times with both employers and employees.  If you ask the practitioner “off the record” for their opinion, advice and guidance about a particular case then they will politely refuse but offer to contribute “on the record” at a Case Conference.  Further explanation can be found in our Client Meetings Policy.

Please note:

  • An occupational health assessment is informed by; information you provide on the referral form, letters and reports from your employee’s GP / specialist, the consultation with your employee and if necessary, reports specifically commissioned by the OH practitioner from your employee’s GP/specialist.  The OH practitioner also applies their own medical knowledge.
  • The OH practitioner will not diagnose a health condition, instead their report may recommend that your employee seeks a diagnosis by a qualified and certified specialist, e.g., a radiologist who can diagnose a prolapsed disc, a psychologist could can diagnose a mental health disorder such as bi-polar, etc.

The Fitness for Work Assessment report will include a recommendation for a follow-up review when it also includes any of the following recommendations:

  • That a medical report is requested from your employee’s GP or treating specialist.  We will request the follow-up appointment after we have received the report.
  • That your employee should be referred to a specialist to investigate / examine a relevant health issue.   We will request the follow-up appointment after we have received the results of the investigation.
  • A period of temporary adjustments or a phased return to work.  We will recommend that the follow-up appointment is arranged towards the end of the adjustment period.

The purpose of this review is to:

  • Confirm the effectiveness of the adjustments and sign-off your employee to return back to normal duties.
  • Recommend more permanent adjustments to enable your employee to perform over the long-term.

Whether to accept a recommendation and proceed with a review is your decision.

We operate a process of formally closing each case and archiving all relevant documentation.  There are a number of good reasons for doing this, including:

  • Compliance with data retention regulations.
  • Whether and when occupational health involvement in a case has ended can be pertinent for employment tribunals.

The case close date is set as the later of:

  • Release date of the report if:
    • No follow-up review recommended.
    • Follow-up review recommended but recommendation not accepted by you.
  • Release date of follow-up review report.

3. Fitness for Work Assessment.  Step by Step Average Timeline

Day -5
Identify referral reason
Step 1: You decide to refer

Refer for a Fitness for Work Assessment as soon as you identify a reason.

Day 0
Gather information
Step 2: You make the referral

Allow 5 days to make the referral for a Fitness for Work Assessment.  The actual timescale will depend upon how quickly you can:

  • Collate and capture the information necessary to complete the referral form.
  • Obtain your employee's consent to the referral.
Day 8
Arrange appointment
Step 3: Arrange the consultation
  • Within 2 working days of referral we will be in contact to arrange the Fitness for Work Assessment consultation.  We can utilise the time prior to the to obtain GP or treating specialist letters / reports from your employee. 
  • We are very flexible:
    • We can confirm the appointment slot in advance of receiving the referral forms, but we must receive the forms at least 5 working days prior to the appointment to allow time to:
      • Agree the calendar appointment with your employee.
      • Request and receive relevant documentation from your employee.
      • Research and prepare for the consultation.
    • In the rare instances that your referral is urgent, e.g., your employee suddenly notifies their intention to return to work "on Monday" and you are unsure if they are ready or whether they might require adjustments, then we will endeavour to re-arrange our calendar if we have your assurances that the process can be successfully compressed.
Day 13
Release report
Step 5: Work Wellness report back to you
  • Within 3 working days of the consultation we aim to provide your employee with advance sight of the assessment report.
  • We allow them 2 working days to respond with requests for corrections and / or deletion of any confidential information which they do not wish to be disclosed to you.
  • If they have not responded within 2 working days we issue a reminder and allow a further working day.  If we have still not received a response then we release the report to you.
  • If your employee requests changes to the report then we aim to release the report to you within a further 3 working days.  It is usually much sooner but there are instances when changes are only agreed after some discussion.

4. Fitness for Work Assessment.  Why Invest

Complete Solution 3dRestore.  The costs of getting it wrong:

  • The average UK employee takes 4.4 sickness absence days per annum, costing £975 in lost productivity, temp cover and management time.  The cost of presenteeism is estimated at 1.5x the cost of absenteeism.
  • In 2020, a claim of £4.7m was awarded to an employee partly because their employer, the Royal Bank of Scotland, had not referred them for an occupational health assessment to identify possible job adjustments.

Restore.  The benefits of getting it right:

  • Case studies have found that consistent and early referral for Fitness for Work Assessments more than halves sickness absence rates and durations with one company study reporting £760k savings in the first year.
  • A 2016 study found a positive effect amongst 46% of Cardiff City Council employees who were referred for a Fitness for Work Assessment which recommended workplace cognitive behavioural therapy (CBT).
  1. Workplace health: long-term sickness absence and capability to work. Early Intervention.  NICE guideline [NG146].  20 November 2019.[]