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To prevent work-related ill-health, selection of workers for mandatory occupational health surveillance should be based on the actual risk of work-related disease.(i) To determine the proportion of sick-listed workers with self-reported work-related health problems not under mandatory occupational health surveillance. (ii) To determine whether self-reported work-related sickness absences occur more frequently among workers under mandatory occupational health surveillance or among workers not under mandatory surveillance.Questionnaire-based descriptive study. The setting was the work inability assessment consultation of social insurance physicians in Belgium. Patients’ inclusion criteria were employee, age 18–50 and 1–12 months of sickness absence. Workers with pregnancy-related sicknesses were excluded. We cross-tabulated the questionnaire results, noting (i) the workers’ perception of the work relatedness of their sickness absence and (ii) workers’ knowledge of the occupational physician, which was assumed to reflect workers who had undergone mandatory occupational health surveillance.There were 1564 participants. Thirty-seven per cent of workers with self-reported work-related sickness absences were not under mandatory occupational health surveillance. Work-related sickness absences occurred as frequently among workers under mandatory occupational surveillance as among those not under mandatory occupational health surveillance (34 and 35%, respectively; P=0.80).To prevent work-related illnesses and sickness absences, a revision of the mandatory occupational health surveillance system is indicated.