For companies with employees in Italy, occupational health surveillance is one of the key components of the Italian occupational health and safety system. It is not simply a medical check-up offered as an employee benefit. It is a legal requirement that applies when the risk assessment identifies work-related risks for which health surveillance is required by law or by the applicable occupational health and safety provisions.

Foreign companies often underestimate this area because the Italian system is highly structured. The employer must assess risks, appoint a competent occupational physician when required, ensure that workers undergo the appropriate medical examinations, manage fitness-for-work outcomes and maintain the correct documentation. These duties apply regardless of whether the parent company is based abroad, because employees working in Italy fall under Italian occupational health and safety legislation.

This article provides a practical overview of how occupational health surveillance works in Italy, when it is required and what companies should do to manage it correctly.

At a glance

What occupational health surveillance means in Italy

Under the Italian system, occupational health surveillance is the set of medical activities carried out by the occupational physician to protect the health and safety of workers in relation to the risks connected with their job duties. The legal reference is Article 41 of Legislative Decree No. 81/2008, which states that health surveillance is performed by the competent physician in the cases provided by the legislation and when requested by the worker, if the request is considered by the physician to be related to occupational risks.

This means that health surveillance is directly linked to the company’s risk assessment. It is not a generic medical screening programme. The medical protocol must be defined according to the specific risks to which workers are exposed, such as chemical agents, biological agents, noise, manual handling of loads, night work, use of display screen equipment in the cases provided by law, exposure to carcinogens or other regulated hazards.

For international companies, this distinction is important. A corporate medical policy designed at group level may be useful, but it does not replace the Italian occupational health surveillance process. The Italian system requires a physician with the qualifications set out by law, a risk-based medical protocol and fitness-for-work judgements connected with the specific role performed in Italy.

When an occupational physician must be appointed

The employer must appoint an occupational physician when health surveillance is required. Article 18 of Legislative Decree No. 81/2008 includes, among the employer’s obligations, the appointment of the competent physician for health surveillance in the cases provided by the decree.

The decision should not be made informally. It must derive from the risk assessment. If the company’s activities expose employees to risks for which health surveillance is required, the employer must appoint a qualified occupational physician and activate the relevant medical protocol.

Examples of situations that may trigger health surveillance include exposure to specific chemical or biological agents, noise or vibration above certain thresholds, manual handling of loads, night work, use of video display terminals under the conditions provided by the legislation, work at height in specific cases, exposure to carcinogenic or mutagenic substances and other occupational risks covered by Italian law. The actual obligation must always be assessed case by case through the DVR, the Italian Risk Assessment Document.

The role of the Medico Competente

The Medico Competente is the occupational physician recognised by Italian law. Article 38 of Legislative Decree No. 81/2008 defines the professional qualifications required to perform this role. Article 39 regulates how the physician may carry out the activity, for example as an employee, collaborator or external professional.

The occupational physician is not a generic company doctor. Article 25 assigns the physician several specific duties. These include collaborating with the employer and the Prevention and Protection Service in the risk assessment, planning and carrying out health surveillance through risk-based medical protocols, establishing and updating health records, providing information to workers on the meaning of health surveillance and visiting the workplace at least annually or according to a different frequency established on the basis of the risk assessment.

For business purposes, the key point is that the occupational physician is part of the prevention system. The physician should be involved early enough to support the company in identifying which workers need health surveillance, which medical examinations are necessary and how to manage fitness-for-work outcomes.

Types of medical examinations under Italian law

Article 41 of Legislative Decree No. 81/2008 identifies the main types of medical examinations that may be included in health surveillance. These include preventive medical examinations, periodic examinations, examinations requested by the worker when related to occupational risks, examinations following a change of job duties and examinations before returning to work after an absence of more than sixty continuous days for health reasons, when required to verify fitness for the task.

In specific cases provided by law, medical examinations may also be required at the end of the employment relationship or before the worker starts the job. The exact medical protocol depends on the risk profile of the activity and must be defined by the occupational physician.

For companies, the practical implication is simple: every job role should be mapped against the risks identified in the DVR. If a worker changes role, work location or exposure profile, the health surveillance protocol may need to be reviewed. This is particularly relevant for multinational organisations where job titles may be standardised globally but actual duties in Italy may differ from those described at group level.

Fitness-for-work judgements and what the employer must do

At the end of the medical examination, the occupational physician issues a fitness-for-work judgement. This may state that the worker is fit, fit with prescriptions or limitations, temporarily unfit or permanently unfit for the specific task. The judgement relates to the duties performed and to the risks connected with those duties.

The employer must take the judgement into account. Under Article 42 of Legislative Decree No. 81/2008, when the physician expresses a judgement of unfitness for a specific task, the employer must implement the measures indicated by the physician and, where possible, assign the worker to equivalent duties or, if not possible, to other duties compatible with the worker’s health condition.

This is one of the most delicate aspects for foreign companies. The employer does not receive the worker’s diagnosis, but must manage the operational impact of the judgement. For example, if a worker is fit with limitations for manual handling, the company must organise the work so that those limitations are respected. Ignoring a limitation may create significant liability in the event of injury or occupational disease.

Health data, confidentiality and documentation

Health surveillance involves sensitive health information. In Italy, the medical records are managed by the occupational physician according to the rules of professional secrecy and data protection. The employer should not receive clinical details or diagnoses. The employer receives the fitness-for-work judgement necessary to organise work safely.

The occupational physician establishes, updates and keeps the health and risk record for each worker subject to health surveillance. Article 25 also requires the physician to provide workers with information on the meaning of the medical surveillance to which they are subject and, where relevant, on the need for further checks after exposure to risks with long-term effects.

Another important obligation concerns the transmission of aggregated health and risk data. Article 40 provides for the communication of aggregate data from health surveillance through the relevant model, commonly known as Allegato 3B, using the INAIL online service. This is managed by the occupational physician, but companies should ensure that the process is correctly coordinated and that the necessary information is available.

Practical workflow for foreign companies operating in Italy

A company operating in Italy should manage occupational health surveillance through a structured workflow:

• prepare or update the DVR, identifying risks for each role and work activity;
• verify whether the identified risks require health surveillance under Italian law;
• appoint a qualified Medico Competente when required;
• share the risk assessment information with the occupational physician;
• define the medical protocol for the relevant workers and job duties;
• schedule preventive, periodic and other required medical examinations;
• manage fitness-for-work judgements and any limitations or prescriptions;
• keep evidence that the process has been implemented correctly;
• review the protocol when roles, risks, work organisation or legal requirements change.

Common mistakes made by foreign companies

Assuming that a corporate medical check-up is enough: A wellness programme or group medical policy does not replace Italian occupational health surveillance if Italian law requires a risk-based protocol managed by a Medico Competente.

Appointing the physician too late: The occupational physician should be involved when the risk assessment shows that health surveillance is required. Late appointment can create gaps in compliance and delay the start of work activities.

Confusing HR medical information with occupational health surveillance: Fitness-for-work judgements must be managed within the Italian health and safety framework. HR should not request or store medical diagnoses that are not necessary for work organisation.

Failing to update the protocol after organisational changes: A change in role, exposure, work location, equipment or schedule may affect the health surveillance requirements.

Ignoring limitations in the fitness judgement: If the occupational physician issues prescriptions or limitations, the employer must organise the work accordingly.

How Frareg can support companies

For English-speaking companies operating in Italy, occupational health surveillance is often one of the areas where legal, medical and organisational requirements overlap. Frareg can support companies in understanding whether health surveillance is required, coordinating the occupational physician, integrating the process with the DVR and managing the operational documentation required by Italian law.

This approach helps companies align corporate policies with Italian legal requirements, avoid fragmented processes and provide clear evidence of compliance during audits, inspections or internal reviews.

FAQ

Is occupational health surveillance mandatory for every company in Italy?

No. It is mandatory when the risk assessment identifies risks for which Italian law requires health surveillance, or in other cases provided by the applicable legislation.

Does every company need to appoint a Medico Competente?

No. The appointment is required when health surveillance is necessary. The decision must be based on the risk assessment and the applicable legal requirements.

Can a foreign company use its own corporate doctor instead?

Not as a substitute for the Italian role, unless the doctor meets the legal requirements to act as Medico Competente in Italy. The Italian system requires a qualified occupational physician under Legislative Decree No. 81/2008.

What is the connection between the DVR and health surveillance?

The DVR identifies occupational risks. If those risks trigger health surveillance obligations, the company must appoint the occupational physician and implement the appropriate medical protocol.

What does the employer receive after a medical examination?

The employer receives the fitness-for-work judgement. The employer should not receive the worker’s diagnosis or unnecessary clinical information.

What happens if the worker is fit with limitations?

The employer must respect the limitations and organise the work accordingly. If needed, the worker should be assigned to tasks compatible with the medical judgement.

Are remote or office workers subject to health surveillance?

They may be, depending on the risks identified. For example, display screen equipment work may trigger specific requirements in the cases provided by the legislation.

Who keeps the medical records?

The health and risk records are managed by the occupational physician according to the applicable legal and confidentiality requirements.

Does health surveillance replace safety training?

No. Health surveillance and safety training are separate obligations. They must both be managed when applicable.

Should the occupational physician participate in the risk assessment?

Yes. Article 25 of Legislative Decree No. 81/2008 requires the occupational physician to collaborate with the employer and the Prevention and Protection Service in the risk assessment, for the aspects within the physician’s competence.