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The Allied Health Professions Advisory Fitness for Work Report and how to complete it

Allied Health Professional (AHP) Health and Work Report

4. Example condition: Back pain

Fiona Hardwick is a construction health & safety adviser. She has been referred to a rehabilitation programme for Low Back Pain by her GP. This is a six week programme on Wednesdays 1.30 – 4.00 starting on 14th August. Her lumbar spine is stiff, spinal extensors are weak and core stability limited. Her symptoms are worse in the morning. After 10 weeks off sick she has returned on reduced hours (11.00 - 4.00 Mon-Fri) and adjusted duties. She has been avoiding sitting on low surfaces and site activities involving e.g. standing, bending, squatting, in case they aggravate her pain. She is avoiding using the pool cars as their seats are low and is also avoiding lengthy meetings.

You feel she should start to increase her hours by 30 minutes per week, gradually starting earlier in the day to return to full hours by September. She could also start to return to site visits by accompanying other colleagues to help build her confidence, aiming for a full return by the end of October if not before. She should start to use the pool cars for 10 minutes at a time and be encouraged to take changes of position and or breaks in meetings. Although she may experience future flare ups from time to time, she should be able to remain at work with temporary minor adjustments. She requires no further investigations.

Would you like to have a go? - Please fill in the AHP Report.

Click on the Example information button button to get some help

Allied Health Professions
Advisory Fitness for Work Report

1 Patient's name: Fiona Hardwick
Date of birth: 19/07/1972

I advise that:


2 This form has been completed by a:
Physiotherapist / Occupational Therapist / Podiatrist / Other

Practitioner's name: Your Name
HCPC registration number: OT XXXXX
Organisation/Service: Name of your service / department / unit
Contact details (email/ tel no.): Your contact info
A follow up review / required* has been made for *delete as appropriate
5 With your employer's agreement you may benefit from these or more options:
Examples of phased returns
Workplace assessments
6 Patient-reported work-relevant difficulty, recommendations and goals:
Difficulty Functional limitations Recommendations / goals Examples of workplace adaptations Impact of ongoing clinical management
8 Additional information is provided on 0 accompanying sheets
9 Signature: Your signature

AHPs: please follow the guidance held on the website of your professional body when filling out this form and always attach the information sheet for employees, employers and doctors. Employees, employers and doctors: please read information attached or log on to:

This report does not replace the Statement of Fitness for Work (fit note) for benefits purposes.

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