Medical Certificate Requirements in South Africa

These rules are in section 23 of the Basic Conditions of Employment Act (BCEA). They sit alongside the sick leave entitlement in section 22, which is covered in our guide to sick leave in South Africa. This guide covers when a certificate can be required, who can issue one, what it should contain, how far an employer can verify it, and what to do about fake notes.

When can an employer ask for a sick note?

Section 23(1) reads: an employer is not required to pay sick leave "if the employee has been absent from work for more than two consecutive days or on more than two occasions during an eight-week period and, on request by the employer, does not produce a medical certificate stating that the employee was unable to work for the duration of the employee's absence on account of sickness or injury" (BCEA s23(1)).

That gives two triggers:

1. More than two consecutive days. An absence of three or more consecutive working days.
2. More than two occasions in eight weeks. The third and any later occasion of sick leave within an eight-week period, even if each occasion is one day.

In both cases the employer must ask for the certificate. Most employers do this through a written leave or absenteeism policy, so employees know in advance when a certificate will be needed.

Section 23(1) is about pay only. An absence without a certificate is not, by that fact alone, misconduct.

Employees who live on the employer's premises. If it is not reasonably practicable for such an employee to get a certificate, the employer may not withhold pay unless it gives reasonable assistance to get one (BCEA s23(3)).

Can a policy require sick notes for single days around weekends and public holidays?

Many policies ask for a certificate for any sick day on a Monday, a Friday, or next to a public holiday, payday or annual leave. The BCEA does not provide for this. The position needs to be stated carefully:

• The duty to pay comes from the Act. Section 22(5) says the employer must pay sick leave "subject to section 23". Section 23(1) sets out the only two cases in which a missing certificate removes the duty to pay.
• Agreements cannot easily reduce sick leave. Even a bargaining council collective agreement may not reduce an employee's entitlement to sick leave under sections 22 to 24 (BCEA s49(1)(e)). An employer and employee may agree to replace or exclude a basic condition only to the extent the Act permits (s49(3)), and s23 contains no such permission.
• Our reading. A policy may ask for a certificate for a single Monday or Friday absence. But if the absence falls outside the two s23(1) triggers and the employee has statutory sick leave left, the BCEA does not let the employer withhold sick pay because no certificate was produced. Some advisers argue that a requirement agreed in the employment contract is enforceable. We have not found an appellate decision that settles the point, so treat it as unsettled.
• Leave above the minimum. Where an employer gives more paid sick leave than the BCEA requires, it can set its own certificate rules for the extra days, unless an agreement says otherwise (BCEA s19(2)).

A pattern of single-day absences next to weekends is still a fair reason to talk to the employee. Our article on Monday and Friday absenteeism patterns covers how to approach it, and a return-to-work interview is usually the first step.

Who can issue a valid medical certificate in South Africa?

Section 23(2) says the certificate must be "issued and signed by a medical practitioner or any other person who is certified to diagnose and treat patients and who is registered with a professional council established by an Act of Parliament" (BCEA s23(2)). For anyone other than a medical practitioner, both parts must be met: registration with a statutory council, and authority to diagnose and treat.

Doctors and dentists

Medical practitioners and dentists registered with the Health Professions Council of South Africa (HPCSA) qualify.

Other registered health professionals

Other practitioners registered with a statutory council, such as the HPCSA or the Allied Health Professions Council, can meet the test when the condition falls within what they are registered to diagnose and treat. A certificate for a condition outside the practitioner's scope is open to question.

Nurses and clinic sisters

Nurses are registered with the South African Nursing Council, a statutory council. The open question is whether a particular nurse is "certified to diagnose and treat patients". Some employer advisers say a clinic sister cannot issue a valid sick note. Others read s23(2) as including nurses who are authorised to diagnose and treat, such as primary health care nurses working in clinics. We have not found a court decision that settles this. If your workforce relies on public clinics, decide your position, put it in your policy and apply it consistently.

Pharmacists

Pharmacists are registered with the South African Pharmacy Council, but most are not authorised to diagnose and treat illness. A note from a pharmacist is unlikely to meet s23(2), unless the pharmacist holds a specific authorisation to diagnose and treat (for example a primary care drug therapy permit) and the condition falls within it. This point is also unsettled.

Traditional healers

The Traditional Health Practitioners Act 22 of 2007 created a statutory council for traditional health practitioners. Registration under it has not started. In a written reply to Parliament in March 2026, the Minister of Health said the Interim Traditional Health Practitioners Council was still procuring the database system needed to register practitioners (PMG, question NW800, 16 March 2026). Until traditional healers can register, their notes do not meet the "registered with a professional council" part of s23(2), and an employer is not obliged to pay statutory sick leave on the strength of one alone.

That does not mean such a note can be ignored. In Kievits Kroon Country Estate (Pty) Ltd v Mmoledi and Others [2013] ZASCA 189 (29 November 2013), an employee was dismissed after staying away to complete training as a traditional healer, having given her employer a note from her traditional healer. The Supreme Court of Appeal dismissed the employer's appeal against a finding that the dismissal was unfair. The case turned on whether her absence was justified by a sincere cultural belief and how the employer responded. It did not decide that a traditional healer's note is a medical certificate for paid sick leave under s23. The lesson for employers is to consider the note and the reasons for the absence, and to look at options such as unpaid leave or annual leave, before any disciplinary step.

What must a valid medical certificate contain?

The HPCSA's ethical rules (rule 16) set the minimum content of a medical certificate issued by its practitioners. According to the HPCSA's guidance, the certificate must include (HPCSA guidance on medical certificates, March 2026):

• The practitioner's name, address and qualifications.
• The patient's name, and employment number where applicable.
• The date and time of the examination.
• Whether the certificate is based on the practitioner's own observation during an examination, or on information received from the patient on acceptable medical grounds.
• A description of the illness in plain language, only with the patient's informed consent. Without consent, the practitioner states that in their opinion the patient is unfit for work.
• Whether the patient is totally unfit for duty or able to do less strenuous work.
• The exact period of recommended sick leave.
• The date the certificate was issued.
• The practitioner's initials and surname in block letters, and the HPCSA registration number.

The BCEA requires the certificate to be signed by the practitioner (s23(2)). Beyond that, it only requires that the certificate states the employee was unable to work for the duration of the absence on account of sickness or injury (s23(1)). Check that the dates on the certificate cover the whole absence. A certificate issued after the absence, based only on what the employee reported, should say so.

The HPCSA rules bind practitioners, not employees. A certificate that leaves out an item is not automatically fake. The usual step is to ask the employee for a corrected certificate before treating the leave as unpaid.

Can an employer verify a medical certificate?

Yes, within limits. An employer may:

• Check that the practitioner is registered, using the HPCSA's public register (or the register of the relevant council).
• Contact the practice to confirm that the certificate was issued by that practitioner, the date of the consultation and the period the employee was booked off.

An employer may not obtain the diagnosis or other health details without the employee's consent:

• Under the National Health Act 61 of 2003, information about a patient's health status and treatment is confidential and may be disclosed only with the patient's written consent, a court order or law, or where non-disclosure would seriously threaten public health (National Health Act s14). The HPCSA's rules impose the same duty on practitioners.
• Under the Protection of Personal Information Act 4 of 2013 (POPIA), health information is special personal information (POPIA s26). An employer may process it where necessary to implement laws or collective agreements that create rights dependent on the employee's health, such as sick leave, or to support workers in connection with sickness or work incapacity (POPIA s32(1)(f)). It must treat the information as confidential (s32(2) and (3)).

In practice: tell employees in your policy that certificates may be verified, limit verification to authenticity, keep certificates in a restricted file and do not record diagnoses in general HR or line-manager systems.

Fake or bought sick notes

Bought and forged sick notes exist. In 2017, a seller in Khayelitsha told GroundUp he sold medical certificates for R150, copying real certificates with real doctors' names and addresses (GroundUp, 2017). Submitting a certificate the employee knows to be false is dishonesty and can justify dismissal after a fair process. It may also be the crime of fraud.

The employer must prove what the employee knew. In Woolworths (Pty) Ltd v CCMA and Others (JA90/2022) [2024] ZALAC 29 (13 June 2024), Woolworths dismissed an employee for submitting irregular medical certificates from a doctor it suspected. The Labour Appeal Court dismissed Woolworths' appeal because there was no evidence that the employee knowingly obtained an irregular certificate, tampered with it, or misled the doctor. Suspicion about a practitioner is not enough. The court said that an employer that suspects it is dealing with a bogus doctor should investigate, and warn employees against using that doctor if the suspicion is well founded.

Signs that justify a closer look:

• Altered dates, or dates that do not cover the absence.
• A practitioner name or registration number that does not match the HPCSA register.
• A practice that cannot confirm it issued the certificate.
• The same unusual practitioner on certificates from several employees.

Investigate, put the specific allegation to the employee, and give them a chance to respond before deciding anything. Our guides on sick leave abuse and absenteeism warning letters cover the process, and our labour law and absenteeism overview covers misconduct and incapacity.

Where Appsentia fits

Appsentia does not handle medical certificates or diagnoses. It works from leave records uploaded from Excel or CSV, or synced from PaySpace. It shows how often and when each employee is off sick, including sick days on Mondays and Fridays, around public holidays and paydays, and next to other leave, with a risk score from 0 to 100. That helps HR see where a conversation is due. A pattern does not, on its own, show misuse. See what Appsentia analyses.

Sources

1. Basic Conditions of Employment Act 75 of 1997 (as amended), gov.za: sections 19, 22, 23 and 49.
2. HPCSA, HPCSA guidance on medical certificates, 9 March 2026.
3. Parliamentary Monitoring Group, Question NW800 to the Minister of Health, 16 March 2026.
4. Kievits Kroon Country Estate (Pty) Ltd v Mmoledi and Others (875/12) [2013] ZASCA 189, 2014 (1) SA 585 (SCA).
5. Woolworths (Pty) Ltd v CCMA and Others (JA90/2022) [2024] ZALAC 29, as reported by BusinessTech, 28 July 2024.
6. GroundUp, Selling fake medical certificates is "big business" in Cape Town, 2017.
7. National Health Act 61 of 2003, s14.
8. Protection of Personal Information Act 4 of 2013, s26 and s32.

This page is general information, not legal advice. Check the current Act, the HPCSA rules, and any sectoral determination or bargaining council agreement that covers your employees, before acting on a specific case.