In brief
A fitness-for-work report ends with the result "fit", "fit with restrictions (conditionally fit)" or "unfit", and this decision is made not about the worker's general health but for the specific job they will do. With a restricted report, the job, task or shift is adapted to the restriction; with an unfit result, the worker is not employed in that job. Appeals against the report are made to referee hospitals designated by the Ministry of Health, and the decision is final.
What does a fitness-for-work report say?
At the end of a pre-employment or periodic examination, the workplace physician makes a decision: can this worker do this job from a health point of view? The answer is usually "fit". But sometimes the report comes back with the result "fit with restrictions" or "unfit for work". An unfit for work report does not mean the worker is unfit for every job; it is a decision made for the specific job and conditions the physician has assessed.
This distinction matters. The same worker may be found unfit for a maintenance task involving work at height, but completely fit for an assembly task at ground level. This article explains what the employer, the physician and the worker should do when a restricted or unfit result comes out, the route for a second opinion and an appeal, and how restrictions are carried over into shift and duty plans.
The basis is Art. 15 of Law No. 6331 on Occupational Health and Safety: examinations are carried out on recruitment, on a change of job, on return to work when requested, and periodically; persons who will work in jobs in the hazardous and very hazardous classes cannot start work without a health report stating that they are fit for the work they will do (Art. 15/2). For where reports are obtained, see our article on the pre-employment health report.
Three results, three different paths
| Result | Meaning | What the employer does |
|---|---|---|
| Fit | The worker can do the assessed job from a health point of view | Enters the date of the next periodic examination in the calendar |
| Fit with restrictions (conditionally fit) | The job can be done if the stated restrictions are observed | Carries the restrictions over into the duty, equipment and shift plan |
| Unfit | The worker cannot do this job under these conditions | Does not employ the worker in that job and considers another role |
The value of a restricted report depends on how clearly the restriction is written. "Should not do heavy work" is not a restriction but an interpretation. A restriction that can be applied to the work answers three questions: What can they not do? For how long? When will it be reassessed? For example: "Should not manually lift loads over 15 kg; for 3 months; follow-up examination February 2027."
Restricted fitness-for-work report: typical restrictions
The examples below show how restrictions commonly seen on site are reflected in the plan. The medical reason for a restriction is confidential; the employer and supervisor know only the restriction itself.
| Restriction | Effect on the duty and shift plan |
|---|---|
| Cannot work at height | Removed from platform, ladder and roof work; a name check is made on the work at height permit form |
| Cannot work night shifts | Put on a fixed day shift in the shift rota |
| Cannot lift loads above a certain weight | Removed from tasks involving manual handling, or a lifting aid is provided |
| Should not work in noisy areas | Moved from high-noise sections to a low-noise station |
| Should not be exposed to substances irritating the respiratory tract | Assigned outside paint, dust or solvent areas |
| Cannot operate construction plant, forklifts or vehicles | Removed from the operator authorisation list and the key list |
| Should not work alone | Not given single-person shifts or tasks at remote locations |
| Should not work at moving machinery | Not assigned to machines with guards open or to maintenance |
For what the physician assesses in people who will work at height, see our article on the health report for work at height, and for reading results in noise exposure, our article on audiometry results.
Adapting the job: step by step
When a restricted report arrives, the aim is not to remove the worker from work but to fit the work to the restriction. Art. 9 of the Regulation on the Duties, Powers, Responsibilities and Training of Workplace Physicians and Other Health Personnel gives the physician the duty of examining and issuing reports in order to place workers such as groups requiring special policies and those with chronic illnesses in suitable work; in a return-to-work examination, it is also the physician's duty to submit to the employer for approval the assignment of a role suited to their health condition for those found unsuitable to continue in their old role. To put this recommendation into practice:
- Have the restriction written functionally. Ask the physician for a clear restriction text that answers the three questions above.
- Analyse the task. The OHS specialist and section supervisor identify which steps of the worker's current task conflict with the restriction.
- Adapt the work first. A lifting aid, a height-adjustable bench, job rotation or giving one step of the task to another worker is often enough.
- Change the role or shift if necessary. If adaptation is not possible, another role or shift compatible with the restriction is considered. On a change of job, an examination is carried out for the new role under Art. 15 of Law No. 6331.
- Put the decision in writing and inform the worker. It is written which tasks will temporarily not be done, who will follow up and the follow-up date.
- Enter the follow-up date in the calendar. Time-limited restrictions are reassessed by the physician at the end of the period; it is wrong both for a restriction to continue being applied after the period has expired and for it to lapse by itself.
Where a permanent disability is involved, our article on fitness for work and job adaptation for disabled workers gives guidance on adapting the job. For assessing a worker returning from long sick leave, see our article on the return-to-work examination.
Second opinion and fitness-for-work appeals
A restricted or unfit result may be disputed by the worker or the employer. The internal route is tried first:
- Additional tests and specialist opinion: Before making a decision, the physician may ask for an opinion from the relevant specialty; the worker may also submit reports from the physician treating them. New information can change the decision.
- Reassessment: For conditions that may improve with treatment (for example blood pressure or blood sugar brought under control), a re-examination is planned after a set period.
If these routes do not produce a result, there is a formal appeal route. Under Art. 15/3 of Law No. 6331, appeals against reports are made to referee hospitals designated by the Ministry of Health, and the decisions given are final. Until the appeal is concluded, duty planning is based on the result and restrictions in the current report.
Carrying restrictions over into shift and duty plans
A restriction in a report only works when it reaches the person doing the planning. A practical arrangement is set up as follows:
- Restriction list: The workplace physician or nurse keeps a list that contains no diagnoses: worker's name, section, restriction, start and end dates, follow-up date. This list is separate from the health file.
- Need to know: The list is shared only with the supervisor planning shifts and the relevant foreman. For the confidentiality of health information, see our article on workers' health information and KVKK (the Personal Data Protection Law).
- Links to systems: The shift rota, the forklift and crane operator authorisation list, and the work at height and hot work permit forms are compared with the restriction list.
- Night shift: For the rules on restrictions relating to night work, see our article on night work.
- Notification of changes: When a restriction is lifted or changed, the list is updated the same day and the relevant supervisor is informed.
- Calendar: Follow-up examinations and the end of time-limited restrictions are entered in the OHS calendar tool.
For example, in a three-shift automotive supply industry plant, removing an operator with a night work restriction from the shift rotation also affects the rotation of the other operators on the same line. The restriction list should therefore be checked before the shift plan is prepared.
If the report says unfit for work
An unfit result has different implications in a pre-employment examination and in a periodic examination. On recruitment, the candidate is not started in the assessed position; if there is another position in the same workplace suited to their health condition, a separate assessment can be made for that position. In a periodic examination, the worker is not employed in their current job and the job adaptation steps are applied.
The reason for an unfit result may be a work-related health problem. If the physician suspects an occupational disease, under Art. 11/5 of the Physician Regulation they refer the case to health service providers authorised by SGK. If a worker has been diagnosed or provisionally diagnosed with an occupational disease, the examinations of other workers working in the same environment are also repeated (Physician Regulation, Art. 9). For the process, see our article what is an occupational disease.
At workplaces in Bursa and the surrounding provinces, as part of our workplace physician service we write restrictions in a form that can be applied to the work, track follow-up dates in the health surveillance plan and plan tests with authorised health institutions.
Frequently Asked Questions
What happens to a worker who receives an unfit for work report?
They are not employed in that job under those conditions. The employer assesses whether there is another role compatible with the restriction; if a change of role is needed, an examination is carried out for the new role and the change is notified to the worker in writing.
Can a restricted fitness-for-work report be appealed?
Yes. Under Art. 15/3 of Law No. 6331, appeals against reports are made to referee hospitals designated by the Ministry of Health, and the decision given is final. While the appeal is ongoing, planning is based on the current report.
Who should know the restrictions in a conditionally fit report?
The medical reason for the restriction is confidential. The supervisor planning the worker's duties and shifts and the relevant foreman know only the restriction itself and its duration.
What happens when the restriction period ends?
The physician reassesses the worker and decides whether to lift, continue or change the restriction. A restriction is not considered lifted by itself without the physician's decision.
A physician assigned for the time your hazard class requires: pre-employment and periodic examinations, fitness-for-work reports and health surveillance.
Bursa SİSTEMER OSGB Technical Team — written from the field experience of our OHS specialists and workplace physicians. Legal information is valid as of the publication/update date; contact us for an assessment specific to your business.