A fitness-for-work certificate is a statement that employees are in good enough health to cope with the increased risk of ill-health or injury that the work entails. As an employer, you must ensure that your employees have a fitness-for-work certificate if you are going to employ them in

• work with certain allergenic chemical substances
• work with fibrosis-inducing dusts such as asbestos, certain inorganic fibres and silica
• work with certain metals such as lead, cadmium and mercury
• physically demanding work such as climbing with a large difference in level, smoke and chemical diving and diving work.

The assessment is carried out in the context of a medical surveillance by a specialist doctor. If the doctor considers that the employee's health is sufficiently good, they may issue a certificate of fitness for the job.

The specific expertise that the doctor must have, can be found in the appendices to the Swedish Work Environment Authority's provisions and general guidelines (AFS 2023:15) on occupational medical surveillance

A foreign fitness-for-work certificate must be equivalent to a Swedish one

If an employee has a foreign fitness-for-work certificate, you as an employer must ensure that this certificate is equivalent to a fitness-for-work certificate issued in Sweden, before you can assign the employee to the job in question.

This means that the medical examination, on which the foreign fitness-for-work certificate is based, must fulfil all the requirements of the Swedish provisions. This may, for example, concern the information that must be included in the certificate, the content of a medical examination and the doctor's competence.

The Swedish Work Environment Authority does not assess the validity of the certificate until it becomes relevant in a permit or inspection case. The assessment is then based on the employer's report. The report must contain documentation showing that the medical examination fulfils Swedish requirements. The documentation must be in writing and in Swedish.

A worker can always decline to take part in a medical surveillance – all medical surveillance and health examinations are voluntary. However, as an employee, you should bear in mind that a medical surveillance is part of the process of protecting yourself and others from ill health, injury or illness.

If an employee declines a medical surveillance linked to an assessment for a fitness-for-work certificate, a fitness-for-work certificate cannot be issued. In such cases, the employer may not assign the employee to work requiring such a certificate.

The employer pays for medical surveillance

Medical surveillance and health examinations carried out by the employer in accordance with the Swedish Work Environment Authority's provisions, must not entail any costs for the employee. This is governed by the EU Framework Directive on Occupational Safety and Health and also follows from the preparatory work for the Swedish Working Environment Act.

The EU Framework Directive on Occupational Safety and Health includes a general provision that measures relating to safety, hygiene and health at work must under no circumstances entail any cost to employees (Article 6.5 of Directive 89/391/EEC).

The preparatory work for the Work Environment Act states that the costs of measures to improve the work environment shall be part of companies' production costs (Proposition 1976/77:149, p.192).

The employer is responsible for the risks that may be the reason for a medical surveillance

As an employer, you are responsible for reducing the risks that may be the reason for a medical surveillance, just as you are responsible for the whole work environment. You must be familiar with the Swedish Work Environment Act and other work environment regulations.

Get a better work environment by working systematically

As an employer, you need to work systematically with the work environment to improve it. Our provisions for systematic work environment management apply to all employers – regardless of the activities or the risks that you and your employees could be exposed to.

Employees and safety representatives are important for a good work environment

Employees and safety representatives have an important role in work environment management. As an employer, you must give all employees the opportunity to participate in work environment management. For example, you can let employees suggest measures or provide feedback on measures that you have implemented.

Employees' participation in work environment management

As an employee, you must participate in work environment management and participate in implementing the measures needed to achieve a good work environment. You must follow the employer's instructions. You must also report to your employer or your safety representative if the work involves immediate and serious danger to life or health.