A fit note, officially the Statement of Fitness for Work, is the medical evidence an employee in Great Britain gives their employer after more than 7 days off sick in a row, counting weekends and bank holidays. It says the employee is either not fit for work or may be fit for work with changes, and it can be issued by a doctor, nurse, pharmacist, occupational therapist or physiotherapist.
Most people still call it a sick note, but the name changed for a reason: the form is built to get people back to work, not just to sign them off. If you run a small team, knowing what it does and doesn't require of you saves a lot of awkward conversations.
When a fit note is needed
| Length of sickness absence | What the employee gives you |
|---|---|
| 7 days or less, in a row | Self-certification: confirmation they were off sick, in the way you've agreed, such as a form or email |
| More than 7 days in a row | A fit note, or other acceptable medical evidence |
| Off after a hospital stay | Possibly a Med10 form covering the inpatient dates, alongside a fit note |
The 7 days are calendar days and include non-working days such as weekends and bank holidays. So someone off sick from a Friday to the following Friday, 8 days in a row, needs a fit note even though they missed only 6 working days. Fit notes are free if the employee has been ill for more than 7 days when they ask for one; a healthcare professional might charge for one covering 7 days or less.
Who can issue one
Since 2022, fit notes can be certified by doctors, nurses, occupational therapists, pharmacists and physiotherapists, but only those with the training to assess fitness for work. The healthcare professional must carry out an assessment first, which can be face to face, by video or phone, or by reviewing a written report from another healthcare professional.
Physiotherapists and occupational therapists may issue either a fit note or an AHP Health and Work Report. The guidance says employers can accept other medical evidence too, such as a private medical certificate.
Digital fit notes: no ink signature needed
This trips up a lot of managers. The newer fit note replaced the signature in ink with the issuer's name and profession, so employees can receive it digitally, and they may never have a paper copy. A valid fit note must include the issuer's name, profession and the address of the practice. Digital and printed versions carry a barcode you can scan to check it. You may still see the older form, signed in ink, now and again. Take a copy for your records; the employee keeps the original because they may need it for benefits.
Not fit for work vs may be fit for work
| What the fit note says | What it means for you |
|---|---|
| Not fit for work | Treat it as evidence for your sick pay procedures for the period it covers |
| May be fit for work | The employee could work with support; discuss changes with them |
A may be fit note can tick one or more boxes for the kind of changes that might help:
- A phased return to work: a gradual increase in duties or hours
- Altered hours: changes to the times or length of work
- Amended duties: changing duties to take account of a condition
- Workplace adaptations: changing aspects of the workplace, including working from home
Here's the part most employers don't realise: the advice is about the employee's fitness for work in general, not their current job, which gives you room to offer different duties for a while. It's also advice, not an instruction. If you can't make the changes, you can use the same fit note as evidence for sick pay, and the employee doesn't need a new or revised one.
Coming back early, and the myth of being signed back
There's no option on a fit note to sign someone back to work, and if a healthcare professional thinks a person is fit, they simply won't issue one. Your employee can return at any time, even before the fit note runs out, without going back to their healthcare professional first. When the fit note expires, they should return, or get a new one.
What to do when a fit note lands on your desk
- Check it shows the issuer's name, profession and practice address, and note the dates it covers.
- Take a copy, digital or paper, and give the original back.
- If it says may be fit, arrange a conversation with the employee about the suggested changes.
- Carry out a risk assessment if needed: if it says avoid lifting, giving them manual handling work makes you liable.
- Write down anything you agree, and how long it lasts; changes usually run at least until the fit note expires.
- Agree a keeping in touch plan, and consider occupational health if the condition is linked to the work.
If you don't have in-house HR, outsourced HR support for small businesses can help with tricky cases, and it's worth knowing the quiet signs of anxiety at work before absence turns long term.
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My verdict
Treat the fit note as the start of a conversation, not a closed door. The two rules I'd pin on every manager's wall: the 7-day count includes weekends, and a may be fit note means talk, not wait. Small, temporary changes often get someone back sooner, and nobody needs to be signed back to work.
Related: the iot page.
Frequently asked questions
When do I need a fit note?
After more than 7 days off sick in a row, counting weekends and bank holidays. For 7 days or less, employees self-certify.
Who can issue a fit note?
Doctors, nurses, occupational therapists, pharmacists and physiotherapists with the right training, after an assessment.
Does a fit note need a signature?
Not any more. The current form shows the issuer's name and profession instead, so it can be sent digitally.
What does may be fit for work mean?
The employee could work with support, such as a phased return, altered hours, amended duties or workplace adaptations.
Can an employee return before their fit note ends?
Yes, at any time, without going back to their healthcare professional. There's no option to be signed back to work.
Does the employer keep the fit note?
The employer can take a copy; the employee should keep the original.
