Fit Notes: What UK Employers Need to Know

The fit note, formally the Statement of Fitness for Work or Med 3, records how an employee's health condition affects what they can do at work (DWP fit note guidance for employers). It is evidence for Statutory Sick Pay and for your own sick pay rules.

This guide covers England, Scotland and Wales, where Statutory Sick Pay law applies (Social Security Contributions and Benefits Act 1992, Part XI). For Northern Ireland, see nidirect.

Self-certification: the first 7 days

Employees can self-certify for the first 7 calendar days of a sickness absence, which includes weekends and bank holidays (DWP guidance, 2.2). For SSP, an employee cannot be required to provide medical information for the first 7 days of a spell of incapacity (Statutory Sick Pay (Medical Evidence) Regulations 1985, reg 2(2)).

When the employee returns, you can ask them to confirm they were off sick. You and the employee agree how, for example on a form or by email (GOV.UK, taking sick leave). For SSP you may accept self-certification verbally or by letter, on the government's form SC2, or on your own similar form (GOV.UK, employee fitness to work).

If your policy asks for medical evidence in the first 7 days, the healthcare professional may charge a fee, and DWP guidance says the employer should cover that cost (DWP guidance, 2.2). A fit note is free once the employee has been ill for more than 7 days (GOV.UK).

When a fit note is needed

An employee must give you a fit note if they have been ill for more than 7 days in a row and have taken sick leave. The 7 days include non-working days such as weekends and bank holidays (GOV.UK). For SSP, you can only ask for a fit note once the employee has been off for more than 7 days in a row (GOV.UK, SSP notice and fit notes).

Fit notes are only for medical problems. A healthcare professional should not issue one for a problem that is not making the person ill (DWP guidance, further information).

How long a fit note can last

The length depends on the healthcare professional's judgement. In the first six months of a condition a fit note can only be issued for up to three months at a time (DWP guidance, 2.3; 1985 Regulations, Schedule 1, rule 12). After hospital treatment you may also receive a Med 10, which gives the dates the employee was an inpatient. It must be signed by a healthcare professional and cover no more than 26 weeks (DWP guidance, 2.6).

Who can issue a fit note

A fit note can be issued by (GOV.UK):

• a GP or hospital doctor;
• a registered nurse;
• an occupational therapist;
• a pharmacist; or
• a physiotherapist.

Nurses, occupational therapists, pharmacists and physiotherapists were added in 2022 (DWP guidance, 1.2). Only those with the training to assess fitness for work issue them, and community or high-street pharmacists do not have access to the Med 3 form. The healthcare professional must assess the employee first, face to face, by video or phone, or from a written report by another healthcare professional (DWP guidance).

Other evidence you can accept

If you agree, an employee can give you another form of evidence instead of a fit note, such as an Allied Health Professional (AHP) Health and Work Report or a private medical certificate (DWP guidance, 2.4; GOV.UK). You do not then need to ask for a fit note as well.

"Not fit for work" and "may be fit for work"

The healthcare professional decides between two statements (DWP guidance, 3):

• Not fit for work. The note says how long the employee will not be fit for work. Treat it as evidence for your sick pay procedures.
• May be fit for work. The employee could work with some support. The note can tick one or more of: a phased return to work, altered hours, amended duties and workplace adaptations, and can add comments. The advice is about fitness for work in general, not only the current job.

"May be fit for work" is advice. You do not have to agree to the changes, but DWP recommends you consider them and discuss them with the employee. If you cannot agree on changes, the employee must be treated as not fit for work, and the same fit note is evidence for sick pay. They do not need a new one (GOV.UK; DWP guidance, 3.8).

There is no "fit for work" note. An employee who is fit for work is not given a fit note, and an employee can return before their fit note ends without going back to the healthcare professional (DWP guidance, 2.1, 4.3 and FAQs).

What the employer can do

• Talk to the employee about changes that would help them stay in or return to work, and record what you agree (DWP guidance, 3.4 and 3.7).
• Assess risk. You may need a risk assessment to follow the advice; for example, if the note says to avoid lifting and you give the employee manual handling, you are liable (DWP guidance, 3.5).
• Consider the Equality Act. Think about reasonable adjustments. People with HIV, cancer or multiple sclerosis are disabled under the Equality Act from the day of diagnosis (DWP guidance, 3.6). Our employment law guide covers disability-related absence.
• Ask for more information. Ask the employee first. You can write to the healthcare professional, but you may have to pay, and you must have the employee's permission to ask for a report about their health (DWP guidance, 2.7 and FAQs).
• Ask for a further assessment. If you think an employee assessed as not fit could do some work, you may ask them to undergo a further assessment. You cannot require medical evidence beyond a fit note (DWP guidance, FAQs).

A return-to-work interview is a good place to go through the fit note advice and agree any phased return.

Digital fit notes and checking a note

Since April 2022 a fit note can be handwritten, printed, or sent to the employee digitally. It must include the issuer's name, profession and the address of their practice. A note sent digitally or printed from a healthcare IT system has a barcode you can scan. Older notes signed in ink are still valid (DWP guidance, 1.1, 2.5 and FAQs).

A fit note must be signed or carry the name of the healthcare professional who issued it. If it has neither, do not accept it, as it may not be genuine (DWP guidance, FAQs). You can take a copy; the employee keeps the original (GOV.UK).

Keep the information confidential and available only to people who need it, such as HR. Tell the employee how it will be stored and for how long (DWP guidance, 2.8).

Fit notes and Statutory Sick Pay

• You cannot withhold SSP because a fit note arrives late (GOV.UK, SSP notice and fit notes).
• A "not fit for work" note is evidence you can accept for SSP (DWP guidance, FAQs).
• If a note says "may be fit for work" but you agree the employee should stay off, they can still receive sick pay, because you treat the note as if it said not fit for work (DWP guidance, FAQs).
• If you decide to stop paying SSP, explain why. The employee is entitled to a written statement and can ask HMRC for a formal decision (DWP guidance, FAQs).

Fit notes in Appsentia

Appsentia works from leave types and dates. It does not store diagnoses or medical certificates, so keep fit notes in your HR records.

Sources

1. Department for Work and Pensions, Getting the most out of the fit note: guidance for employers and line managers, updated 6 October 2023.
2. GOV.UK, Taking sick leave.
3. GOV.UK, Statutory Sick Pay employer guide: notice and fit notes.
4. GOV.UK, Statutory Sick Pay: employee fitness to work.
5. GOV.UK, Ask your employer for Statutory Sick Pay (form SC2).
6. The Statutory Sick Pay (Medical Evidence) Regulations 1985, regulation 2 and Schedule 1, legislation.gov.uk.

Sources checked on 11 November 2026. This page is general information, not legal or medical advice.