Occupational Health · Best Practice · Pre-Construction

Occupational Health Fitness for Work Record

A formal record of occupational health referral outcomes and fitness for work decisions for safety-critical construction roles including working at height, plant operation, and confined space entry. Contains only the fitness outcome (fit / fit with adjustments / unfit) and operational restrictions, not confidential medical details. Must comply with Equality Act 2010 reasonable adjustments and UK GDPR.

Last reviewed: 29 March 2026 — This guide reflects UK law as of this date. MHSWR 1999 / COSHH 2002 remains current with no amendments enacted as of 29 March 2026. Next scheduled review: 29 March 2027.

Legal basis	Management of Health and Safety at Work Regulations 1999 (MHSWR 1999) + COSHH 2002
Status	Best Practice — strongly recommended for safety-critical roles
Safety-critical roles	Working at height, plant/machinery operation, confined space entry, lone working, crane/lifting operations
Equality Act 2010	Must not discriminate on health grounds — reasonable adjustments must be considered before any restriction or exclusion
UK GDPR	OH record contains ONLY fitness outcome and any adjustments — NOT full medical details. Health data is special category data.

1. Fitness for Work — Protecting Workers and Managing Risk Legally

Safety-critical roles in construction require workers to have the physical and mental fitness necessary to carry out the work safely, both for their own protection and for the protection of others. A plant operator who loses consciousness while operating an excavator, a scaffolder who experiences vertigo at height, or a confined space entrant who cannot self-rescue in an emergency all present risks that an occupational health fitness assessment is designed to identify and manage.

An occupational health (OH) assessment provides an evidence-based determination of whether a worker is fit for a specific role, fit with adjustments or restrictions, or unfit for that particular role. The assessment is conducted by a qualified OH professional — a registered occupational health nurse or physician — who understands both the medical factors and the occupational demands of the role being assessed.

Critically, the employer's record must contain ONLY the fitness outcome and any recommended adjustments — NOT the underlying medical details. Under UK GDPR, health data is special category data that requires additional safeguards. The OH provider retains the full clinical record; the employer receives only the fitness determination. Sharing full medical records with the employer without the worker's explicit informed consent is a data protection breach.

GDPR and medical confidentiality

The employer record must contain ONLY the fitness outcome (fit / fit with adjustments / unfit for specific role), the adjustments required, and the review date. Full medical details remain with the OH provider and must not be shared with the employer without the worker's explicit informed consent.

2. Key Components

The following table sets out the key components that an occupational health fitness for work record must address. Each element balances the employer's duty to manage safety-critical risks with the worker's rights under the Equality Act 2010 and UK GDPR.

Component	Detail
Worker name	Full name of the worker being assessed
Date of assessment	Date the occupational health assessment was conducted
Role assessed for	Specific safety-critical role — working at height, plant operation, confined space entry, lone working, crane operation, or other safety-critical function
Reason for referral	Pre-placement assessment, periodic review, return to work after illness/injury, management referral due to concerns, or change of role
OH provider	Name of the occupational health provider, clinician conducting the assessment, and their professional registration
Fitness outcome	The OH provider's determination — Fit for role / Fit with adjustments or restrictions / Temporarily unfit (with expected review date) / Unfit for this specific role
Adjustments required	Specific reasonable adjustments or restrictions recommended by the OH provider — e.g. restricted duties, modified equipment, reduced hours, supervision requirements, phased return
Review date	Date for the next OH review — periodic reviews for ongoing safety-critical roles, or follow-up date for temporary restrictions
Equality Act considered?	Confirmation that the Equality Act 2010 has been considered — reasonable adjustments explored before any restriction or exclusion from work
OH provider signature	Signature or electronic confirmation from the OH clinician who conducted the assessment
Worker acknowledged	Confirmation that the worker has been informed of the fitness outcome and any adjustments, and has had the opportunity to discuss the outcome with the OH provider
Employer record	Record retained by the employer containing ONLY the fitness outcome, adjustments, and review date — NOT the underlying medical details (UK GDPR compliance)

3. Common Mistakes

Sharing full OH medical records with the employer without consent (GDPR breach)

The OH provider's clinical record contains detailed medical information that is special category data under UK GDPR. The employer should receive ONLY the fitness outcome (fit / fit with adjustments / unfit for specific role), the recommended adjustments, and the review date. Sharing the full medical report with HR, line managers, or supervisors without the worker's explicit informed consent is a data protection breach that can result in regulatory action by the ICO, civil claims by the worker, and a fundamental breakdown of trust in the OH referral process.

Making employment decisions on health grounds without proper OH assessment (disability discrimination)

Excluding a worker from a role, restricting their duties, or terminating their employment on health grounds without a proper occupational health assessment is likely to constitute disability discrimination under the Equality Act 2010. The employer must obtain an evidence-based OH opinion, consider whether reasonable adjustments can enable the worker to perform the role safely, and only restrict or exclude as a last resort when the OH provider has determined that the worker cannot safely perform the role even with adjustments. A manager's opinion that a worker “doesn't look well enough” is not a lawful basis for an employment decision.

4. Frequently Asked Questions

Can an employer require pre-placement medical assessments?▾

Yes, but with important restrictions under the Equality Act 2010. Section 60 of the Equality Act generally prohibits asking health-related questions before a job offer has been made. This means that pre-placement occupational health assessments should follow a conditional offer of employment, not precede it. The conditional offer can be made subject to a satisfactory OH assessment, but the assessment itself must not be used as a screening tool to filter out candidates with health conditions before an offer is made. The only exceptions are where the health question is necessary to determine whether the applicant can carry out a function intrinsic to the role, to determine whether reasonable adjustments are needed for the recruitment process itself, or for monitoring diversity.

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