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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

6. Example condition: Fractured right humerus

Jenny Kowalski is full-time receptionist. She travels to work by two buses. She has a history of anxiety. She has fractured her right humerus and is being treated with a sling and home exercises.

She is right handed. Her GP has signed her as ‘not fit’ for work. Her fit note expires on 14th February but she is making a good recovery apart from some reduction in shoulder adduction and abduction, and repetitive movements are still uncomfortable.

She is keen to return to work, but anxious and concerned about frequent use of the mouse, and telephone, travelling in the rush hour, and standing for long periods at the reception desk as her shoulder muscles tire after 20 minutes. You think she may be able to return to work now if she

  1. works from 9.30am to 3.30pm initially to avoid the rush hour to regain her confidence
  2. builds in additional breaks of 15 minutes at three points during the working day to allow a change of position and carry out some simple exercises
  3. and is temporarily provided with a stool to perch on.

She should be able to return to full hours and duties within four weeks, but it would be helpful if her progress is monitored and progressed by her line manager. You have given her an open appointment until the end of September and agree to send a copy of the report to her GP.

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

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Allied Health Professions
Advisory Fitness for Work Report

1 Patient's name: Jenny Kowalski
Date of birth: 19/07/1994

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
4 AHP Advisory Fitness for Work Report issued for period from to
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 Examples of workplace adaptations

7 Comments Other helpful information or actions

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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