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Italian legislation on prevention in occupational hygiene and safety, which is based largely on European Union Directives, requires health surveillance when risk assessment has identified a risk for workers' health. Health surveillance must be carried out by the occupational physician and concludes with the issue of a fitness for work certificate for the specific job. The guidelines produced by the "Italian Society of Occupational Medicine and Industrial Hygiene" (SIMLII), through the "Consortium for Accreditation and Updating in Occupational Medicine" founded by the "S. Maugeri Foundation of Pavia", Italy, focus firstly on the definition of judgment of fitness for a specific job. They outline the theoretical basis of the medico-legal terminology for fitness for work, which is founded on the concepts of suitability, fitness, capacity, ability, representing successive degrees of qualification and specific potential that the worker may attain during accomplishment of the tasks involved in the job. To assess fitness for a specific job, the occupational physician must consider whether the worker possesses the psycho-physical requisites normally needed to do the job, not the top levels of such requisites. The intrinsic characteristics of any judgment of fitness for work, namely its individual, probabilistic and time-dependent nature, are illustrated. The operative methodological model for making a judgment must include: assessment of the job and work environment, assessment of the worker through health surveillance, comparison and correlation of the two terms of the equation: human subject-work environment, the judgment thus made and the choice of any necessary measures and/or intervention. The methods for conducting the assessment process culminating in a judgement are presented, as stipulated in the pertinent legislation, and include the following conclusions: fitness, partial or total unfitness, temporary unfitness, fitness provided suitable prescriptions are observed,fitness provided some conditions are met. These definitions are analyzed in greater depth, especially the possible confusion between partial unfitness and fitness provided suitable prescriptions are observed. The employer or worker may lodge an appeal with the local health service inspection service against certain judgments of unfitness for work. Finally, as health surveillance is governed by different legal norms, the contents of which appear to be to some extent contradictory, even though aimed at safeguarding the dignity and freedom of the worker, the reasons why the occupational physician should take into account diseases apart from those of the organs exposed to specific risk are discussed. These should be borne in mind when issuing the specific fitness for work certificate at the end of preventive and periodical medical examinations.