Recognizing Impairment and Determining Fitness for Work

The review finds that work is a critical determinant of health and well-being. An employee’s fitness for work should be assessed through a biopsychosocial approach, meaning that it should consider workers’ abilities, health, and job demands. Work ability is dynamic, often shaped by illness, injury, and even workplace conditions. Standard functional assessments are often too biomedical, which overlook environmental and occupational factors and may not represent the holistic abilities of an employee. Risk, capacity, and tolerance are especially important in safety-sensitive roles, while workplace accommodations such as modified duties and flexible schedules are vital to sustaining participation and productivity.

• Fitness for work is determined by a worker’s ability to perform job tasks safely, with attention to both risk to self and others.
• Work ability is often dynamic and should balance individual capabilities with occupational demands. Ensuring employees have work that is appropriate to their current abilities is vital for health promotion, injury prevention, and vocational rehabilitation.
• Functional assessments should move beyond biomedical models and include environmental and task demands, providing objective evidence to inform work accommodations.
• Risk, capacity, and tolerance are interconnected factors in assessing fitness for work, especially in safety-sensitive and decision-critical jobs where impairment can have severe consequences.
• Comprehensive, biopsychosocial evaluations and workplace accommodations play a crucial role in maintaining employment and enhancing workforce well-being for individuals with temporary or permanent impairments.