Employees with Chronic Illness: Diabetes, Epilepsy

The right question for an employee with a chronic illness

When one candidate says at the pre-employment examination that they have diabetes, and another that they have taken epilepsy medication for years, the first reaction often heard in workplaces is "can this person work?". Yet for an employee with a chronic illness, the right question is different: With what measures does this job become safe for this person? Many people with chronic illnesses do the same job safely with suitable arrangements. The problem is that the decision is made by looking at the diagnosis, without examining the actual tasks of the job.

Art. 4 of Law No. 6331 requires the employer to consider fitness for work in terms of health and safety when assigning tasks. Art. 15 provides for examinations at the start of employment, on change of job, on return to work after repeated absences for health reasons when requested, and periodically. A person who will work in hazardous and very hazardous work cannot start without a report showing that they are fit for the work. For the general framework of examinations, see our article on periodic examinations and tests.

How is fitness for work assessed in chronic illness?

When fitness for work with a chronic illness is at issue, the decision is not made in a single examination but through a process in which the job and the person are examined together.

1. Set out the real tasks of the job. Using the risk assessment, write down whether the job involves work at height, driving a forklift or vehicle, working near moving machinery, lone working, night shifts, a hot environment and heavy physical effort.
2. Physician examination and history. The workplace physician assesses the course of the condition, recent attacks, medications used and their possible effects on attention or consciousness.
3. The treating physician's opinion. If necessary, with the employee's consent, information on the current situation is requested from the specialist who follows them.
4. Decision. The result can take four forms: fit; fit with specific measures; temporarily unfit; unfit for this task but fit for another.
5. Adjustment and monitoring. The measures are written down and the date of the next assessment is set.

There is also a route for objecting to reports: under the Law, objections are made to referee hospitals designated by the Ministry of Health, and their decisions are final. For where to obtain the pre-employment report, see our article on where to get a pre-employment health report.

Employees with diabetes: managing the risk of hypoglycaemia

For an employee with diabetes, the situation most relevant to workplace safety is a sudden drop in blood sugar (hypoglycaemia). It can start with sweating, trembling, absent-mindedness, blurred vision and behavioural change; if untreated, it can progress to impaired consciousness. The risk varies from person to person according to the treatment used, meal pattern and physical effort; this is why the workplace physician makes an individual assessment.

The adjustments that can be made in the workplace are often simple:

• Keeping meal and break times predictable; preventing missed meals at shift changes,
• Providing a clean, private area for blood sugar testing and insulin administration,
• Keeping a suitable disposal container for used needles and pen tips,
• Allowing the employee to carry a source of fast-acting sugar; making arrangements for this in areas where food is prohibited,
• Choosing suitable safety footwear together for foot health,
• For tasks such as work at height or driving, making additional measures or task arrangements based on the physician's assessment.

Epilepsy and workplace safety

In epilepsy and workplace safety, the decisive factors are how well seizures are controlled and during which tasks a seizure could have serious consequences. The same decision is not made for an employee who has been seizure-free for a long time and one whose seizures have not yet been brought under control.

The tasks the workplace physician will focus on in particular are: work at height and at unprotected edges, driving vehicles and forklifts, working near unguarded moving machinery, working near water or deep tanks, and lone working. Because lack of sleep can lower the seizure threshold in some people, the shift pattern is also part of the assessment; for the relationship between shifts and sleep, see our article on shift systems and fatigue management.

There is a frequently overlooked point here: collective measures such as guards on machinery and guardrails at edges are already mandatory for everyone. In a workplace with good collective protection, the additional adjustment needed for an employee with epilepsy is often small.

What first aiders need to know during a seizure: move the employee away from objects that could injure them, put something soft under their head, do not forcibly restrain their movements and do not put anything in their mouth. When the seizure ends, place them on their side, stay with them and do not leave them alone until they are fully conscious. Call 112 if the seizure is prolonged or recurs, if the employee is injured or does not regain consciousness.

Employees with heart disease

For an employee with heart disease, the assessment is made according to the type of condition and the person's exercise capacity. The headings the workplace physician will look at are heavy physical work and lifting, working in a hot environment, high work pace and work stress, night shifts and long hours. For employees with a pacemaker or implanted defibrillator, working near equipment that creates strong electromagnetic fields (for example, induction heating or some welding processes) is assessed using the device manufacturer's recommendations and the treating physician's opinion.

The table is a general framework; for each employee, the workplace physician makes the decision.

Task adjustment without discrimination

Art. 3 of Law No. 6701 on the Human Rights and Equality Institution of Türkiye prohibits discrimination on the grounds of health status and disability; Art. 6 provides that the employer may not discriminate at any stage from the job application to the end of the employment relationship. This does not prevent taking workplace safety measures; but it requires the measure to be based not on the diagnosis but on the concrete requirements of the job and the individual's situation.

In practice, observe this distinction:

• Wrong: "They have epilepsy, let's not put them in production."
• Right: "This person can work safely on guarded machines and at floor level; they will not drive a forklift and will not do a night inspection round alone."

If a permanent health condition amounts to a disability, our article on disabled employees and work adjustment also provides guidance on workplace and equipment adjustments.

Emergency preparedness: in advance and with consent

An employee with a chronic illness having an attack at work means panic for an unprepared team. Preparation is carried out with the employee's consent and by sharing only as much information as necessary:

1. Individual emergency note: Symptoms, what to do, who to call. It is prepared together with the employee; who will see it is agreed with them.
2. First aiders: Ensure that the first aiders in the section know what to do in situations such as hypoglycaemia, seizures and chest pain.
3. Supplies: The contents of the first aid cabinet are reviewed; for the contents, see our article on first aid cabinet supplies.
4. Lone working: In tasks where a risky attack is possible, lone working is prevented or regular contact is arranged.
5. Review: The assessment is renewed when treatment changes, on return from long sick leave or after an attack. For the return examination, see our article on the return-to-work examination.

In businesses in Bursa and neighbouring provinces, in our workplace physician and health surveillance services we carry out this assessment together with the tasks of the job and inform the employer only of the fitness result and the measures. Where tests are needed, we plan them with authorised laboratories and health institutions. You can use the OHS calendar tool to track periodic examination dates.

Frequently Asked Questions

Can someone with diabetes work in a job in the hazardous class?

Yes. The decision is made by the workplace physician not according to the diagnosis but according to how well the condition is controlled, the treatment used and the tasks of the job. In most cases, safe work is possible with regular breaks, a meal plan and additional measures for some tasks.

Can an employee with epilepsy drive a forklift?

This decision depends on how well seizures are controlled and on the physician's assessment. If the risk of seizures continues, tasks such as driving forklifts and vehicles, work at height and lone working are usually replaced with other tasks.

Can the employer find out about the employee's illness?

As a rule, the employer learns not the diagnosis but the workplace physician's fitness-for-work result and the measures to be taken. Health information is confidential and is special category personal data. Information shared for emergency preparedness is kept limited, with the employee's consent.

Should employees with a chronic illness be examined more often?

The periodic examination intervals in the legislation are maximum periods; the workplace physician may shorten the interval according to risk. It is appropriate to renew the assessment when treatment changes, after an attack or on return from long leave.