English version - Fit for Work Europe

Japanese employers must operate on the principle of ‘health consideration’, which requires that
employers must assess health and safety for each worker, as it is deemed impossible to fully
avoid risk conditions within the work environment. As a result of such assessment occupational
physicians are required to issue ‘fit notes’ to formalize their awareness of the risk associated
with a certain job, and to provide recommendations for the worker to minimise the impact of
work on health.
Tanaka, Hoshuyama, Takahashi, Ito and Okubo (1998) conducted a survey of occupational
health physicians to evaluate the current situation and the application of systems for return to
work and fitness for work in Japanese companies. Tanaka et al. found that most companies
carried out assessments of return to work, and involved occupational health professionals
and other related staff in the assessment process. In the majority of cases, the occupational
physicians were in charge of the decision-making process on return to work and were
authorized to make the final decision. In the companies with 3,000 or more employees, the
cases of longer-term sick leave were assessed in a more comprehensive process than those
of shorter-term sick leave. In the study 119 companies (88 per cent) conducted on additional
health examination to assess the employee’s fitness for work. Sixty-four companies (47 per
cent) had standardised criteria on fitness for work. 118 companies (83 per cent) had job training
systems for employees’ return to work, and they mainly introduced restricting one’s job and/or
reducing one’s work-load. It was suggested that complete systems for return to work and fitness
for work were more available among companies with 3,000 or more employees than among
companies with 2,999 or fewer employees.
While the existence of the provision for fitness assessments is commendable, there is no official
structure of the ‘fit note’. The University of Occupational and Environmental Health’s Department
of Preventive Medicine and Community Health has identified22 the following types of the ‘fit
notes’ issued by the occupational physicians:
• Type 1: Work potentially affect worker’s health;
• Type 2: Risk management and prevention of accident relating to disease;
• Type 3: Referral;
• Type 4: Communication to the head of department/supervisor;
• Type 5: Fit for work with appropriate adjustments of work environment and/or/
conditions.
22 Information provided by an in-country expert
MSDs and employers
Fit For Work? Musculoskeletal Disorders and the Japanese Labour Market 53