France operates a mandatory occupational health system unlike anything most foreign employers have encountered. Known as médecine du travail, it is entirely preventive, entirely employer-funded, and entirely non-negotiable from the moment you hire your first employee in France, regardless of your corporate structure in the country.
This guide explains how the system works, what appointments are required, what they cost, and what happens when obligations are not met.
What is "médecine du travail"?
Médecine du travail is France's occupational health and prevention system, governed by the French Labour Code (Code du travail) and significantly reformed by the loi santé au travail of 2 August 2021, which came into force in March 2022. The system's purpose is prevention, not treatment. Occupational physicians do not prescribe medication, diagnose illness, or act as general practitioners. Their role is strictly to assess whether an employee's working conditions are compatible with their health, and to advise both employer and employee on risk reduction.
The SPST: France's occupational health and prevention services
Every employer in France must affiliate its employees with a Service de Prévention et de Santé au Travail (SPST), an approved occupational health and prevention service. Most SPSTs are inter-company (interentreprises), meaning they serve multiple employers across a sector or geographical area. A small number of large companies run their own internal SPST.
The SPST employs the occupational physician but also a multidisciplinary team: prevention technicians, nurses, social workers, and ergonomics specialists. Employers pay a membership fee and a per-capita contribution for each employee registered.
Who is responsible: the employer, always
Under the French Labour Code, occupational health compliance is the employer's responsibility, not the employee's. If a mandatory visit does not take place, because the employer failed to schedule it, failed to register with a SPST, or failed to inform the employee, the liability sits entirely with the employer. This principle has direct consequences in the event of a workplace accident or an employee's work-related illness.
Registering with an occupational health centre
When to register (from the first hire)
Registration with a SPST must happen from the moment you hire your first employee in France. There is no grace period. The affiliation must be in place before the employee starts work for certain high-risk roles (see SIR below), and within the first three months for all other employees.
If you are setting up a French entity and preparing your first recruitment, registering with a SPST should sit on your checklist alongside payroll setup and employment contract drafting. Our guide to new starter onboarding in France covers this pre-hire checklist in full.
How to find the right SPST for your company
The competent SPST is determined by the geographical location of the workplace, not the employer's registered office. You can find the relevant SPST through the DDETS (Direction Départementale de l'Emploi, du Travail et des Solidarités) for your department, or via the national SPSTI directory.
Once affiliated, the SPST allocates you to an occupational physician and schedules the first visits. Administrative management, scheduling, tracking visit dates, keeping records, falls to the employer.
Remote employees: which centre applies
For employees who work entirely from home (télétravail), the competent SPST is determined by the employee's place of residence, not the employer's address. This matters for foreign companies who hire French remote workers without a French office: you must identify and register with the SPST covering each employee's home département. If your workforce is geographically dispersed, this can mean affiliations with multiple SPSTs.
Types of mandatory occupational health appointments
The loi santé au travail restructured the visit framework. The following table summarises all mandatory appointment types currently in force:
The VIP (visite d'information et de prévention) is the baseline visit for all new hires. It can be conducted by an occupational nurse rather than a physician, and, following post-COVID regulatory changes, teleconsultation is permitted for certain visits. The SIR (suivi individuel renforcé) applies to employees exposed to occupational risk factors as defined by the DUERP (document unique d'évaluation des risques professionnels): asbestos, ionising radiation, hyperbaric work, night shifts, and others listed in the Labour Code.
Source: code.travail.gouv.fr
For employees who join your French payroll in roles with no specific risk exposure, the VIP within three months of start is the only immediate obligation. Subsequent renewal visits are scheduled by the SPST.
The occupational physician's role
Prevention first, treatment never
The occupational physician's legal mandate is exclusively preventive. They visit workplaces to assess risk factors, review the DUERP alongside the employer and the CSE (Comité Social et Économique, the employee representation body established under French employment law), and monitor collective and individual health over time. They do not provide treatment and cannot be substituted for a general practitioner.
Following a visit, the physician issues a fitness for work statement (avis d'aptitude). In most cases this is simply a confirmation that the employee is fit for their role. Where concerns exist, the physician may issue a restricted aptitude notice or, in serious cases, an unfitness notice (inaptitude), which triggers a legally regulated dismissal process and cannot be ignored by the employer.
What the physician can and cannot tell your employer
Medical confidentiality applies strictly. The occupational physician cannot share an employee's medical records or diagnosis with the employer. The only information communicated is the fitness statement: fit, fit with restrictions, or unfit. The physician may recommend workplace adaptations, ergonomic adjustments, modified hours, redeployment, but cannot disclose the underlying health reason.
Costs and practical management
Who pays (always the employer)
The employer bears all costs associated with occupational health compliance, including:
- SPST affiliation fee: a one-off or annual membership charge, variable by SPST
- Per-capita contribution: since 1 January 2023, SPSTs invoice employers on a per-employee basis (introduced by the 2021 loi santé au travail, Art. L.4622-6), replacing the former flat-rate model
- Employee time: visits take place during working hours and are treated as paid working time, the employer cannot deduct them from the employee's leave balance or pay
Actual contribution amounts vary by SPST and sector. Some industry-wide collective agreements (conventions collectives) specify a contribution ceiling. As an indicative reference, inter-company SPSTs typically charge between €80 and €150 per employee per year, though this range can be higher in specialised sectors.
Outsourcing occupational health compliance in France
For foreign companies without an HR function in France, tracking visit deadlines, managing SPST affiliations, and maintaining records for each employee is operationally demanding. Many choose to delegate this to a local HR partner who takes on SPST registration, visit scheduling and recordkeeping, removing the administrative burden from the foreign company entirely. This is covered in detail in our guide to HR and payroll compliance in France.
What happens if you do not comply
Non-compliance with occupational health obligations does not go unnoticed. Labour inspectors (inspecteurs du travail) can verify SPST affiliation and visit records during a standard inspection. In the event of a workplace accident or an employee developing an occupational illness, the absence of mandatory visits significantly weakens the employer's position.
French courts can reclassify a workplace accident as an inexcusable fault (faute inexcusable) if the employer failed to take measures they knew, or should have known, were necessary to prevent the risk. Occupational health obligations exist precisely to document that the employer was aware of, and actively monitoring, health and safety conditions. The absence of a VIP or a return-to-work visit is a concrete failure of that duty, with real legal consequences in litigation.
The CSE, where one exists, also has a right of access to occupational health data at a collective level and can formally question the employer on the state of SPST compliance.
