Is a clinic sick note valid for work?

Most South Africans who fall ill do not see a private GP. They queue at a public clinic or community health centre, where they are usually seen by a nurse. So it matters a great deal whether the note they come back with is accepted at work. Some employers reject anything that is not from a doctor; others accept any piece of paper with a stamp. Neither approach is what the law says. This guide explains who may issue a valid sick note under the Basic Conditions of Employment Act 75 of 1997, the BCEA, where clinic nurses and traditional healers fit, what the note must say, and when an employer is entitled to reject one.

This guide is part of our Leave in South Africa: every type of leave and your rights, which links every guide on the topic.

First, remember when a note is needed at all. Under section 23(1), your employer may refuse to pay sick leave only if you were absent for more than two consecutive days, or on more than two occasions in eight weeks, and did not produce a certificate when asked. Our guide to the rules for sick leave covers those triggers and the three-year cycle.

The legal test in section 23(2)

The certificate must be issued and signed by a medical practitioner, or by any other person who is certified to diagnose and treat patients and who is registered with a professional council established by an Act of Parliament.

That gives two questions for anyone who is not a doctor:

1. Is this person certified to diagnose and treat patients, not merely to assist or refer?
2. Are they registered with a council created by legislation, such as the Health Professions Council of South Africa, the South African Nursing Council or the Allied Health Professions Council?

The test is about the person, not the building. A note from a doctor at a public clinic is exactly as valid as one from a private practice. Doctors, dentists and psychologists registered with the Health Professions Council meet the test within their field. So, generally, do chiropractors and homeopaths, who register with the Allied Health Professions Council. The UIF's own regulations accept illness certificates from a medical practitioner, chiropractor or homeopath.

Clinic nurses

Nurses are registered with the South African Nursing Council under the Nursing Act 33 of 2005, so the registration half of the test is met. The harder half is whether a particular nurse is certified to diagnose and treat.

According to commentary on the Nursing Council's position, a professional nurse who holds an additional qualification in clinical nursing science, health assessment, treatment and care, often called a primary health care or clinical nurse practitioner qualification, is regarded as competent to assess, diagnose, treat and issue sick notes. A nurse without that qualification should issue only a certificate of attendance. The same commentary says the Nursing Council recommends that a nurse book a patient off for no more than two days and refer them to a doctor if they have not recovered. We could not obtain the Council's own document, so treat those details as reported guidance rather than settled law.

In practice, nurses who see and treat patients at public clinics are commonly primary health care trained. A clinic note signed by such a nurse, showing the nurse's name and Nursing Council registration number and stating that you were unfit for work on given dates, is likely to satisfy section 23(2). An employer that rejects it simply because it did not come from a doctor is on weak ground.

A certificate of attendance is not a sick note

Section 23(1) requires a certificate stating that you were unable to work for the duration of your absence because of sickness or injury. Many clinics hand out a slip that only records that you attended on a particular date, sometimes with the times you arrived and left. That proves where you were. It does not say you were too ill to work.

An attendance slip may help to explain a morning lost in a clinic queue, and many employers accept it for that purpose as a matter of policy. But where a certificate is legally required, an attendance slip will not oblige the employer to pay sick leave for the days you stayed home afterwards. If you are given one, ask whether the nurse or doctor can issue a proper certificate, or whether you should see someone who can.

Traditional healers

The Traditional Health Practitioners Act 22 of 2007 provides for a council and a register of traditional health practitioners. If that system were fully operating, a registered practitioner who diagnoses and treats would arguably meet section 23(2). Recent commentary, from September 2026, reports that registration is still not fully operational, so employers cannot verify practitioners through a working national register. The result is that a note from an unregistered traditional healer will generally not, on its own, secure paid sick leave under the BCEA.

That is not the end of the matter. In Kievits Kroon Country Estate (Pty) Ltd v Mmoledi and Others [2013] ZASCA 189, a chef asked for unpaid leave to complete her training as a traditional healer, supported by her healer's letters. The employer refused, she went anyway, and she was dismissed. The CCMA, the Labour Court, the Labour Appeal Court and finally the Supreme Court of Appeal all left in place the finding that the dismissal was unfair. The case did not decide that a healer's note is a medical certificate; she was not claiming sick pay. What it shows is that an employer cannot treat a sincerely held cultural belief, and the documents that go with it, as worthless or dishonest without considering them.

So an employer may lawfully decline to pay statutory sick leave on an unregistered healer's note, but it should consider the absence fairly: as unpaid leave, annual leave by agreement, or a cultural accommodation. Some collective agreements and company policies expressly recognise traditional healers, and where they do, that more generous rule applies.

What a valid note should contain

Beyond the BCEA's two requirements, the Health Professions Council's ethical rules for practitioners set out what a certificate should show. Employers commonly look for the same things:

• the practitioner's name, practice address and registration number;
• your name;
• the date and time of the consultation;
• whether the practitioner examined you or is relying on what you told them;
• whether you are totally unable to work or fit for lighter duties;
• the exact dates you are booked off;
• the practitioner's signature and the date the certificate was issued.

Your diagnosis does not have to appear. The practitioner may describe the illness only with your consent, and "medical condition" is enough. Your employer may verify that the practitioner exists, is registered and issued the note, but it is not entitled to demand your diagnosis or clinical records.

When an employer can reject a note

An employer may treat a sick note as insufficient, and refuse to pay sick leave for the days concerned, where:

• it was not issued by someone who meets the section 23(2) test, such as a nurse without the qualification to diagnose, or an unregistered healer;
• it does not state that you were unable to work, as with an attendance slip;
• it does not cover all the days you were absent, for example a two-day note for a four-day absence;
• the practitioner cannot be traced or is not registered;
• it shows signs of alteration, such as changed dates or mismatched names.

An employer may not reject a valid note because it comes from a public clinic, because it is from a qualified nurse rather than a doctor, or because the diagnosis is missing. And where neither section 23 trigger applies, it cannot refuse to pay for the lack of a note at all.

Rejecting a note normally means the days are unpaid. It does not justify dismissal on its own. A forged or bought certificate is different: it is dishonesty, and employers regularly dismiss for it after a fair hearing. Our guide to disciplinary hearings explains that process, and our guide on being dismissed for being off sick covers long or repeated absence.

Worked example

This example is illustrative. Zanele is a cashier earning R7 800 a month. She was off sick on two separate days in September. In October, still within eight weeks, she wakes with severe gastroenteritis and goes to her local clinic, where a professional nurse examines her and books her off for Monday and Tuesday. Because this is her third absence in eight weeks, her employer asks for a certificate. She hands in the clinic note. Her manager rejects it: "We only accept doctors' notes."

The note shows the nurse's name and Nursing Council number, the date and time of the consultation, and states that Zanele was unfit for work on both days. If the nurse holds the primary health care qualification, the note meets section 23(2), and the employer must pay the two days from Zanele's sick leave balance.

Change the facts: the clinic gave Zanele only a slip saying she attended from 07:30 to 12:00 on Monday. That does not say she was unable to work, so her employer may lawfully refuse to pay sick leave for those two days, although it might accept the slip for the Monday morning as a matter of policy.

What to do

1. Before you leave the clinic, check the note: your name, the practitioner's name and registration number, the dates booked off, and the words that you were unfit for work.
2. If you are given an attendance slip and will be off for more than two days, ask for a proper certificate or a referral.
3. Hand in the note promptly and keep a photo or copy.
4. If a valid note is rejected, reply in writing, explaining who signed it and their registration, and ask the employer to state its reason.
5. If pay is still withheld, approach a labour inspector at the Department of Employment and Labour, or the CCMA if you earn below the earnings threshold.