UK occupational fitness model: "may be fit for work" fit note (Med 3), reasonable adjustments under Equality Act 2010, and statutory health surveillance triggered by COSHH reg 11 plus substance-specific regulations.
The Med 3 fit note offers two options: "not fit for work" or "may be fit for work" with suggested adjustments. The latter is the UK return-to-work cornerstone: Good Work principle (Waddell) — early return with adjustments beats prolonged absence.
'May be fit for work' fit note (Med 3) is the main UK mechanism to convey suggested adjustments to employer; OH report supplements with detail (with consent).
Three operational tools — local computation, no patient data stored. Each suggests options under the physician's clinical judgement.
Capacity + work nature → fit note type, adjustments, SSP/ESA alerts.
Open Equality Act · s.20Impairment + work type → s.6 disability test + prioritised adjustments.
Open RIDDOR 2013Event/disease → reportable? + PD code, deadline, how/who reports.
OpenDisability definition (s.6)
Physical or mental impairment with SUBSTANTIAL and LONG-TERM (>=12 months expected) adverse effect on ability to carry out normal day-to-day activities
12-month long-term threshold differs from US ADA "substantially limits".
Duty to make adjustments (s.20)
Triggered when a disabled employee/applicant is placed at substantial disadvantage by: (a) provision/criterion/practice, (b) physical feature, (c) lack of auxiliary aid. Employer must take such steps as reasonable.
Employer decides "reasonableness" — OH role is to advise, not impose.
Catalogue from Acas guidance + EHRC code of practice. OH report supplements the fit note's "may be fit" suggestions with detail (with worker consent).
Self-certification first, then a qualifying HCP. The 2022 extended issuer scheme added nurses, OTs, pharmacists and physiotherapists — no longer doctor-only.
Self-certification (employee statement; SC1/SC2)
Fit note (Med 3) issued by qualifying HCP — 'not fit for work' OR 'may be fit for work' (with adjustments)
Max duration single note: Up to 3 months in first 6 months, then up to 1 year
Rate
£123.25/week OR 80% of average weekly earnings (whichever is LOWER) — Employment Rights Act 2025 introduced earnings-based calc
Duration
Up to 28 weeks per period of incapacity
Waiting days
ABOLISHED from 6 April 2026 — SSP payable from day 1 (Employment Rights Act 2025; was first 3 qualifying days unpaid before)
Lower earnings threshold
REMOVED from 6 April 2026 — more workers including part-time + lower-paid qualify
After SSP exhausted: Form SSP1 → claim 'new style' Employment and Support Allowance (ESA) from DWP
Employment Rights Act 2025 — effective 6 April 2026 — abolished the 3 waiting days + lower earnings threshold.
Occupational Health role
OH report supplements GP fit note with detailed advice on capability + adjustments (with consent shared with employer). 'Good Work' (Waddell) principle — early return with adjustments better than prolonged absence.
UK surveillance is triggered when exposure is liable to cause an identifiable disease/effect, OR by substance-specific regulations. Health records kept 40 years (COSHH reg 11).
Reg: CLAW 2002
Trigger: Significant lead exposure
Reg: CAR 2012
Trigger: Licensed/notifiable asbestos work
Reg: Control of Noise at Work Regs 2005
Trigger: Exposure at/above Upper EAV 85 dB(A)
Reg: Control of Vibration at Work Regs 2005
Trigger: Exposure at/above EAV 2.5 m/s² A(8)
Reg: COSHH reg 11
Trigger: Exposure to asthmagens
Reg: COSHH reg 11
Trigger: Skin exposure
Reg: COSHH reg 11 + EH40 BMGV
Trigger: Exposure where biomonitoring informs control
Reg: Ionising Radiations Regs 2017 (IRR17)
Trigger: Classified radiation worker
Reg: Work in Compressed Air Regs 1996 + Diving at Work Regs 1997
Trigger: Compressed air/diving work
HSE Appointed Doctor scheme
Some surveillance programmes require an HSE Appointed Doctor (not all OH physicians qualify). Lead (CLAW), asbestos (CAR), ionising radiation (IRR17), and compressed-air/diving work all require Appointed Doctor sign-off.
Under the physician's clinical judgement
Regulatory framework
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