Managing Worker Fitness for Duty in Safety-Sensitive Positions

Picture this: A fatigued worker climbs into the cab of a logging truck after a string of long shifts. Another worker, distracted by financial stress at home, prepares to operate heavy machinery on a construction site. In both cases, the individuals are technically present and performing their jobs, but their ability to work safely is compromised.

This is the heart of fitness for duty: ensuring workers are in the psychological, physical, and emotional state needed to perform safely and effectively. Specifically, fitness for duty refers to an individual’s physical and mental capacity to safely carry out a task at a given time. Some factors that can compromise fitness include fatigue, illness, drug use, overconfidence, personal issues, and distractions [1]. 

In safety-sensitive positions, where the consequences of a split-second lapse can be severe, fitness for duty is not a “nice-to-have” – it’s essential for protecting workers, teams, and organizations.

The Importance of Worker Fitness

One in four employed Canadians report experiencing consistent burnout in the workplace [2]. Crucially, across industries (such as forestry, construction, healthcare, mining, energy, and transportation), research consistently shows that workers experiencing stress, fatigue, or burnout are significantly more likely to be involved in incidents, even when their technical skills remain intact. 

For instance, prolonged wakefulness (17–21 hours) impairs reaction times to levels comparable to legal alcohol limits [3, 4]. In healthcare settings, nurse presenteeism – working while experiencing health problems such as depression or pain – has been linked to increased patient falls, more medication errors, and lower quality-of-care ratings, underscoring the real safety risks associated with impaired fitness for duty [5].

The stakes are clearly uniquely high in industries where lives and livelihoods depend on worker readiness; worker fitness can have far-reaching and serious impacts including:

• Human costs – lapses in judgment can result in serious injury, fatality, or long-term disability.

• Financial costs – absenteeism, presenteeism, turnover, and claims drive significant expenses. 

• Legal responsibilities – Employers are required to take “reasonably practicable” steps to ensure worker safety. Failing to address fitness for duty can expose organizations to liability.

Shifting from “Impairment” to “Fitness for Duty”

Traditionally, employers have focused on “impairment” which is often narrowly interpreted as substance use. But this approach is limited: it is subjective, legally complex, and fails to capture broader risks.

Today, leading organizations are instead adopting a fitness-for-duty framework as it is proactive, holistic, and prevention-oriented. Rather than focusing on detecting single risk factors, it integrates the multiple dimensions of worker well-being that influence safety and performance. This shift acknowledges that mental health, fatigue, chronic illness, stress, etc. can be just as compromising as alcohol or drug impairment.

• Impairment asks: “Is this worker under the influence right now?”

• Fitness for duty asks: “Is this worker in the right state – physically, mentally, emotionally – to do their job safely today?”

Dimensions of Worker Fitness for Duty

A strong Fitness for Duty system addresses all elements that influence safety and performance including:

1. Psychological health: stress, anxiety, depression, burnout.

   • Workers with moderate to high psychological distress are more likely to be involved in accidents and report more workplace failures and fewer successes than their lower-distress peers [6].

2. Physical health: chronic conditions, pain, injuries, sleep disorders.

   • In Canada, workers with diabetes are more likely to experience work-loss days and self-reported work injuries compared to non-diabetic peers [7].

3. Emotional well-being: resilience, mood regulation, ability to cope with workplace pressures.

   • Poor mental health costs Canadian employers more than $20 billion annually in lost labour via absenteeism and presenteeism [8].  

4. Fatigue and sleep: insufficient rest, long shifts, irregular schedules. 

   • Working 12-hour shifts increases injury risk by 37%, and night shifts raise risk by 30% compared to daytime [9].

5. Substance use: alcohol, cannabis, prescription and non-prescription drugs.

   • Substance use remains a leading factor in preventable workplace incidents and, for people working in safety-sensitive positions, risks for using substances may be higher due to stress, variable shift work, decreased help-seeking behaviours, or managing pain and injuries [10,11].

Strategies for Managing Worker Fitness for Duty

Creating a safer, healthier workplace is an ongoing process. However, organizations can start small, focus on factors that are most achievable, and build momentum. Each step forward can make a real difference while also respecting cost, resources, and readiness for change. Below are some practical strategies to consider and adapt to your organization’s needs:

1.    Policies & Protocols

•  Define safety-sensitive roles and set clear expectations.

• Consult the Canadian Model for Providing a Safe Workplace – A best practice guide from the Construction Owners Association of Alberta and Energy Safety Canada. 

•  Balance safety obligations with privacy and human rights. Consult with a legal expert or Human Resources specialist prior to implementing or changing any policies as legal expectations can be complex and hard to navigate. 

• Emphasize supportive approaches rather than punitive ones. 

2.    Education & Awareness

• Train leaders and workers to recognize signs of fatigue, mental distress, or impairment.

• Normalize and encourage self-care, open disclosure, and respectful communication.

• Leverage regular safety touchpoints, like staff meetings and toolbox talks, to foster ongoing dialogue on fitness for duty. 

3.    Wellness & Prevention Programs

• Implement fatigue management strategies, including shift design, rest policies, and napping options.

• Offer mental health education and support tools, such as wellness talks and workshops, resilience training, and stress management resources.

• Focusing on psychological wellness allows organizations to intervene early, before it translates into performance risks.

•  Promote physical health through screenings, ergonomic initiatives, regular movement incentives, as well as injury and illness support. 

•  Enable confidential reporting mechanisms to reduce stigma. 

• Consider developing an anonymous reporting hotline or online form for reporting. 

5.    Leadership & Culture

• Model healthy behaviours at the leadership level. This includes ensuring that leaders regularly and visibly take breaks and opportunities to connect with peers and recharge. 

• Reinforce that programs exist to protect workers, not punish them.

• Prioritize trust and psychological safety as non-negotiable cultural foundations. 

6.    Technology & Innovation

• Apply screening tools such as self-checklists and fatigue self-assessments.

• Use wearables to monitor sleep, alertness, and fatigue risk.

• Integrate data systems to link test results, incident reports, and wellness metrics.

• Explore emerging solutions like Neurapulse™ (Shift OHS Inc.), which provide real-time assessments of attention, reaction time, and decision-making – helping identify cognitive risks before they cause incidents (Impirica, n.d.).

• Ensure technology is applied ethically, with strict privacy safeguards and transparency about data use.

The Path Ahead

Implementing a fitness-for-duty system is not without challenges. Organizations must navigate issues such as privacy and confidentiality, fairness in assessments, and building trust so workers see these programs as supportive rather than punitive. Resource demands are also real. But with thoughtful planning, programs can be both practical and credible.

What is clear, is that managing fitness for duty in safety-sensitive roles is no longer optional. It is an essential part of building safe, productive, and resilient workplaces. By adopting a holistic and proactive framework, employers can:

• Prevent incidents before they occur.

• Protect workers’ health and dignity.

• Strengthen culture, trust, and retention.

• Demonstrate legal due diligence.

Next steps for organizations:

1. Review existing policies and practices through a fitness-for-duty lens.

2. Engage key stakeholders across HR, safety, operations, and wellness to build alignment.

3. Act by piloting integrated approaches, training leaders, and measuring progress with clear metrics.

Investing in a fitness-for-duty system not only protects your people but also strengthens culture, trust, and performance. To learn more about building an approach tailored to your organization, connect with WellIntel or Shift OHS: 

• WellIntel is an evidence-based wellness solutions company that equips individuals and organizations with science-backed information and actionable strategies to enhance mental health and well-being. Through expert-led talks, workshops, and research & assessment services, WellIntel helps organizations create healthier, more resilient workplaces while empowering individuals to take an autonomous, proactive role in their mental health and wellness. Visit the website or get in touch at info@wellinteltalks.com.

• Shift OHS is your end-to-end partner in occupational health and safety, helping organizations in high-risk industries move beyond compliance to build proactive, performance-driven cultures. From cognitive fitness assessments and drug & alcohol testing to tailored policy development, supervisor training and 24/7 support, Shift OHS integrates human behaviour, leadership accountability and advanced tools so safety lives on the floor — not just in the manual. Whether you’re in oil & gas, transportation, construction or manufacturing, their team of medical, legal and industry experts delivers flexible solutions that reflect how you work and where you operate. Visit the website or reach out at info@shiftOHS.com.
  

Written by:
WellIntel & Shift OHS Executive Teams

References:

[1] Kim, Y., Park, J., & Jung, W. (2017). A quantitative measure of fitness for duty and work processes for human reliability analysis. Reliability Engineering & System Safety, 167, 539–548. https://doi.org/10.1016/j.ress.2017.07.012

[2] Mental Health Research Canada. (n.d.). Workplace mental health. https://www.mhrc.ca/workplace-mental-health

[3] Canadian Centre for Occupational Health and Safety. (CCOHS; n.d.). Fatigue. In OSH Answers Fact Sheets. Retrieved October 3, 2025, from https://www.ccohs.ca/oshanswers/psychosocial/fatigue.html

[4] Arnedt, J. T., Owens, J., Crouch, M., Stahl, J., & Carskadon, M. A. (2005). Neurobehavioral performance of residents after heavy night call vs after alcohol ingestion. JAMA, 294(9), 1025–1033. https://doi.org/10.1001/jama.294.9.1025

[5] Letvak, S. A., Ruhm, C. J., & Gupta, S. N. (2012). Nurses’ presenteeism and its effects on self-reported quality of care and costs. American Journal of Nursing, 112(2), 30–38. https://doi.org/10.1097/01.NAJ.0000411176.15696.f9

[6] Hilton, M. F., & Whiteford, H. A. (2010). Associations between psychological distress, workplace accidents, workplace failures and workplace successes. International Archives of Occupational and Environmental Health, 83(8), 923–933. 

[7] Li, J., & Nowrouzi-Kia, B. (2017). Diabetic status and its association with work-related injuries in Canada. International Journal of Occupational and Environmental Medicine, 8(2), 104–112. https://doi.org/10.15171/ijoem.2017.1074

[8] Conference Board of Canada. (2015). Mental health issues in the labour force: Reducing the economic impact on Canada. Ottawa, ON: Conference Board of Canada.

[9] Dembe, A. E., Erickson, J. B., Delbos, R. G., & Banks, S. M. (2005). The impact of overtime and long work hours on occupational injuries and illnesses: New evidence from the United States. Occupational and Environmental Medicine, 62(9), 588–597. https://doi.org/10.1136/oem.2004.016667

[10] Canadian Apprenticeship Forum. (2023). Understanding substance use among apprentices in the skilled trades. Ottawa. https://cupe.on.ca/wpcontent/uploads/2024/01/Understanding-Substance-Use-Among-Apprentices-in-the-SkilledTrades.pdf 

[11] Public Health Ontario. (2022). Construction workers disproportionately impacted by opioid related deaths, report find (news release). Accessed October 20, 2025: https://www.publichealthontario.ca/en/About/News/2022/Construction-workers-opioidrelated-deaths