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Article Index
Statement of Fitness for Work (The Fit Note)
What is changing?
Fit for work? The basics
Detailed form description
Return to work tick boxes
May be fit for work?
Case Studies
Frequently Asked Questions
More information and support

Statement of Fitness for Work (The Fit Note)

Detailed form description

  1. The name of your employee.

  2. The date of the doctor’s assessment of the employee. An assessment can mean a face to face consultation, a telephone consultation or the consideration of a written report from another doctor or registered healthcare professional.

  3. The condition or conditions that affect your employee’s fitness for work.

  4. This box will be ticked when the doctor’s assessment of your employee is that they have or had a health condition that prevents them from working for the stated period of time. This is strong evidence of your employee’s fitness for work for Statutory Sick Pay purposes.

  5. This box will be ticked when the doctor’s assessment of your employee is that their condition does not necessarily stop them from returning to work. However, they may, for example, not be able to complete all of their normal duties or could benefit from amended working hours.

  6. These four tick boxes represent common ways to aid a return to work. The doctor will tick one or more of these
    options when they feel they could help your employee return to work. This list is not exhaustive and there may be other ways to help your employee return to work. Further information on each of these is included on page 11.

  7. Where the ‘may be fit for work’ box has been ticked, the doctor will add information on the functional effects of
    your employee’s condition and what could help a return to work. Where a doctor feels an assessment by an occupational health professional is required, they will state it here.

  8. Here, the doctor will state the period the advice covers for a forward period, which during the first 6 months of sickness can be up to a maximum of 3 months. Any period in day refers to calendar days not working days. In some cases your employee will be able to return, with your agreement, to work or their normal duties before the end of this
    period. If this happens they will not need to see the doctor again for another Statement.

  9. The doctor will use this section when they wish to state precise dates for the period during which the advice applies. This will be for one of three reasons:

    • the Statement covers a period based on a previous assessment during which a Statement was not issued (for example because the doctor did not have any forms with them); or

    • the Statement is for less than 14 days and the doctor does not need to see your employee again; or

    • the doctor believes it will be helpful to state a specific date for your employee to return to work as part of their recovery.

  10. The doctor will state here if they need to assess their patient’s fitness for work again at the end of the Statement period. Where the doctor does not need to see the patient again, in most cases you can expect your employee to return to work or their usual duties at the end of the
    Statement period. If the doctor needs to see the patient again and during the subsequent consultation they feel your employee is able to return to work without any functional limitations, the doctor will not issue your employee with a new Statement.

  11. The doctor will sign, date and stamp or print their address on the Statement.

© Crown Copyright 2010

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