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Certifications for fitness for duty and return to work programs are an integral part of every medical practitioner’ duties. Fitness for duty decisions have a direct impact on employee availability and productivity in the workplace. Increasing trends of sickness absenteeism, presenteeism and declining organisational wellness indices have become a common trend as a result of subjective and unsound fitness for duty and return to work evaluations. The increasing use of dysfunctional and out-dated principles of light duty, indefinite sick leave and unqualified medical retirement among others that are desynchronized with occupational risk exposure profiles and person job specifications requires urgent redress.Fitness for duty decisions must take into account work processes, inherent job demands and attendant occupational risk profiles. These must be based on functional terms clarifying the restrictions and limitations in the face of workplace occupational exposures and job demands. The new approach of ‘fit’ notes versus sick leave notes has brought a new dimension in the return to work principles. The use of person job specifications, hazard identification and risk assessment methods and task analysis leads to an improvement of informed decision making for medical practitioners. Fitness for duty evaluations play a pivotal role in ensuring appropriate job placements and injury prevention. It is vital that medical practitioners apply the fundamental principles in assessing return to work and fitness for duty.