Health Report for Working at Height: Who and What?

What does a fit-to-work-at-height report mean?

For a person who will work on a construction site, on a roof, on scaffolding or on a machine's maintenance platform, a frequently asked question is: "Where do you get a fit-to-work-at-height report?" The first part of the answer may be surprising: there is no separate report form by this name in the legislation. The report is part of the pre-employment and periodic examination.

The legal basis is as follows:

Art. 15/2 of Law No. 6331 on Occupational Health and Safety: those who will work in jobs in the hazardous and very hazardous classes may not start work without a health report stating that they are fit for the work they will do.
Law 6331 Art. 15/3: reports are obtained from the workplace physician; less hazardous workplaces with fewer than 50 workers can also obtain them from ÇASMER (the state occupational health centres), family physicians or other public healthcare providers. Objections to reports are made to referee hospitals.
Art. 9 of the Regulation on Workplace Physicians and Other Health Personnel: the physician issues the pre-employment and periodic examination and test results, stating that the worker is fit for the work they will do, in line with the template in Annex 2.

So the phrase "fit to work at height" is the content of the fitness-for-work opinion the physician writes at the end of the examination. For this opinion to be of value, the physician needs to know that the person will work at height. A referral whose job description does not mention working at height results in a generic "fit to work" report that is of no use on site.

The definition of working at height and the technical measures are in our article on what working at height is, and the training side in our article on working at height training. This article focuses only on the health side.

What does the physician assess at a working at height examination?

The legislation gives no list of conditions for working at height; the physician considers the worker's personal characteristics, the nature of the work and the risk assessment together. Conditions physicians frequently ask about during a working at height examination, and why:

Condition	Why does it matter?	Physician's possible decision
Dizziness, balance disorder (vertigo)	A sudden loss of balance can lead to a fall	Restriction until the cause is investigated; reassessment after treatment
History of seizures (epilepsy)	Loss of consciousness and control during a seizure	Individual decision based on seizure control and treatment; specialist opinion if needed
History of fainting, arrhythmia, uncontrolled high blood pressure	Sudden loss of consciousness or feeling faint	Decision after cardiological assessment
Use of insulin or blood sugar-lowering medication	Low blood sugar can cause confusion	Decision based on disease control, conditional fitness if needed
Vision and depth perception	Steps, edges and obstacles must be seen correctly	Fit with glasses, or decision after an eye examination
Hearing	Warnings and instructions must be heard	Assessment according to hearing status on noisy sites
Musculoskeletal system	Climbing and carrying a harness and equipment require strength	Functional assessment
Medication causing drowsiness, alcohol and substance use	Impairs attention and reaction time	Change of medication or restriction
Fear of heights	Panic and freezing response	Assessment through an interview

The "possible decisions" in the table are examples. The same diagnosis can lead to different outcomes depending on the person and the type of work.

Vertigo and working at height

For a worker complaining of dizziness, the physician first tries to understand the cause. A temporary inner ear problem and recurring dizziness of unknown cause are not assessed in the same way. While the complaint persists, working at height is restricted; after treatment and follow-up, the worker is re-examined. During this period, the worker can be moved to a task at ground level.

Epilepsy and working at height

A diagnosis of epilepsy does not on its own mean an automatic "unfit" decision. The physician assesses whether seizures are under control, when the last seizure occurred, adherence to treatment and the type of work, and asks for a neurologist's opinion if needed. The decision is individual and made together with the risk assessment. A worker with uncontrolled seizures working at a height without fall protection is an unacceptable risk.

Referral for examination: what information should go to the physician?

The physician's fitness-for-work decision is only as accurate as their knowledge of what the job is. Write the following on the referral form or in the job description:

Working height and frequency: A maintenance worker who occasionally climbs a ladder to 3 metres and a tradesman working on facade scaffolding every day are not assessed in the same way.
Equipment used: Fixed platform, scaffolding, mobile platform, ladder or rope access.
PPE to be used: Carrying a full body harness, energy absorber and helmet adds physical load.
Environmental conditions: Heat, cold, wind, noise and night work.
Lone working: Will the person work at height alone, or is there someone supervising?
Rescue arrangements: How quickly a suspended worker can be rescued.

This information determines which body systems the physician will focus on and which tests, if any, they will request. Sharing the working at height rows of the risk assessment with the physician serves the same purpose.

Which tests are requested for working at height?

There is no fixed answer in the legislation to which tests are requested for working at height. The workplace physician determines the tests according to the examination findings and the risks of the job. Examples of tests that may be considered in practice:

Vision test.
Blood pressure measurement and, if needed, electrocardiography (ECG).
Blood tests such as blood sugar and full blood count.
Hearing test for noisy work.

None of these is automatically mandatory for every worker. The physician may request an additional cardiological assessment for a worker with a history of fainting; for a young worker with no complaints, the list of tests may be shorter. We plan the necessary tests with authorised laboratories and healthcare providers.

How is a restriction in the report reflected at work?

A physician's decision of "unfit to work at height" or "fit to work under this condition" does not protect the worker if it stays only in the file. Follow these steps to reflect the restriction at work:

Make sure the employer receives the right information. Health information is confidential (Law 6331 Art. 15). The employer and the foreman are told not the diagnosis but the work-related outcome, such as "not fit to work at height for a period of 3 months".
Update the task plan. For the duration of the restriction, the worker is scheduled for work at ground level. The start and end dates of the restriction must be clear.
Enter it in the permit to work list. The person issuing working at height permits must be able to check the fitness of the workers to be named on the permit. A "personnel fit to work at height" list without diagnoses is sufficient for this.
Inform the foreman. The person assigning the crew on site must know who cannot work at height.
Set a reassessment date. For temporary restrictions, the physician sets a review date; when the date comes, the restriction is not lifted without an examination.
Do not forget subcontractor workers. The workplace physician also checks whether subcontractor workers' reports have expired (Regulation Art. 9).

Common mistakes

Not stating the job on the referral. If the physician does not know that the person will work at height, they cannot assess fitness for this work.
Seeing the report as a one-off. The pre-employment report loses its validity when the periodic examination interval expires.
Passing on restrictions verbally. A restriction that is not written and dated gets lost at shift change.
Sharing the diagnosis with everyone. What needs to be known on site is the restriction, not the diagnosis.
Overlooking the effect of night and shift work. Attention declines in a worker whose sleep pattern is disrupted; for assessing night work, see our article on night work.

In our workplace physician and health surveillance services at construction sites and industrial businesses in Bursa and the surrounding provinces, we plan the examination of personnel who will work at height together with their job description, and notify the employer of restrictions without sharing diagnoses. For other risks in construction work, see our construction sector page.

Frequently Asked Questions

Who issues the fit-to-work-at-height report?

The report is issued by the workplace physician at the end of the pre-employment or periodic examination. In less hazardous workplaces with fewer than 50 workers, ÇASMER, family physicians and other public healthcare providers can also issue the report.

How many years is a working at height report valid?

There is no separate validity period; the periodic examination interval applies. In very hazardous work the examination is carried out at least once a year, and in hazardous work at least every 3 years; the physician can shorten the period.

Can someone with epilepsy work at height?

The decision is individual. The physician assesses seizure control, adherence to treatment and the type of work, and obtains a specialist opinion if needed. With uncontrolled seizures, working at height is restricted.

Can someone who wears glasses work at height?

Wearing glasses is not a barrier on its own. The physician assesses corrected visual acuity and may write a condition such as "fit with glasses" on the report. In this case, the worker must wear their glasses at height, and the glasses must be compatible with other PPE such as a helmet and mask.

Can the physician's decision be challenged?

Yes. Under Art. 15/3 of Law No. 6331, objections to reports are made to referee hospitals designated by the Ministry of Health, and their decisions are final.