Violence Risk and Fitness for Duty Are Not the Same Question

Stephan M. Carlson, MD, MBA, FAPA · Employment and Fitness

A fitness-for-duty referral and a violence risk referral feel adjacent, so they are routinely collapsed into one report. They are not the same question, and an opinion that answers both at once usually answers neither well. Two questions that travel together but diverge Fitness for duty asks a present-capacity question: can this employee, right now, perform the essential functions of a defined job, with or without reasonable accommodation, without posing a direct threat? Violence risk asks a probabilistic question: over some future window, what is the likelihood this person engages in harmful conduct, and what conditions raise or lower it? One is anchored to a specific job and a specific mom

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