Sick Leave in Italy: What Managers Need to Know

A US manager hears “I’m sick today” and expects a text, maybe a doctor’s note later. Italy works differently. The process is formal, it runs through the state, and managers have less room to ask questions than they might think.

This guide explains how sick notes work and where the limits are.

How the sick note works  

In Italy, the employee does not hand you a paper note. The doctor issues a medical certificate electronically. It goes straight to the national social security institute, INPS. The employee gets a protocol number for the certificate.

The employer does not receive the diagnosis. That is the key point. The certificate you can access shows that the employee is certified unfit for work and for what period. It does not show the illness.

So your role is narrow. You do not collect medical paperwork. You check that a valid certificate exists and you record the absence.

What the employee must do  

The employee still has to tell you about the absence. Do not wait for the system to do it. Most contracts and collective agreements expect the employee to notify the employer promptly, usually before the start of the working day. Many also expect the employee to share the certificate protocol number.

Your onboarding documents should say this in plain words. Name the channel (email, phone, a team chat) and the person to contact. If you leave it vague, you will end up chasing people.

How you find the certificate  

Employers can retrieve the certificate data through INPS channels, using the protocol number from the employee. Most companies with an Italian payroll provider let that provider handle it. If you work with an Employer of Record, we do this step for you and flag anything unusual.

If you manage payroll yourself, make sure someone owns this task. A missing certificate is a real issue, but you need to confirm it before you act on it.

What managers can ask  

You can ask for what the business needs to run:

• Whether the employee has notified the absence and through which channel.
• The certificate protocol number, so HR or payroll can verify it.
• Whether urgent work or handovers need coverage.
• When the certified period ends, as shown on the certificate.

You can also ask, kindly, to be told if the return date changes. Keep it short and practical.

What managers should not ask  

This is where US managers get into trouble.

• The diagnosis. Health data is among the most protected categories under European data protection rules. You do not need it and you should not request it.
• Symptoms or details. “What do you have?” is not a friendly question here. It can be treated as an intrusion.
• Proof beyond the certificate. Do not ask for extra notes, photos or lab results.
• Whether they are really sick. Doubts go to HR and, if needed, to the formal checks described below. They do not go in a chat message.
• Work while on leave. Do not ask a certified-sick employee to answer emails or join calls. It undermines the leave and creates risk for the company.

A good rule: if the answer would not change how you plan the work, do not ask.

Home visits and checks  

Italy has a system of medical control visits. The employee must be reachable at their declared address during set daily time bands. The employer can request a check, and INPS can also order one. There are rules on when an employee is exempt, for example for certain conditions or medical appointments.

If you suspect abuse, do not confront the employee. Talk to HR or your EOR first. A check is a formal step with its own procedure. An unsupported accusation can turn a small issue into a dispute.

Pay during sick leave  

Sick pay is split between the employer and the state. How much each side pays depends on the national collective agreement (CCNL) that applies to the role, and on the length of service and the type of absence. Some agreements require the employer to top up what the state pays.

This is a cost many US teams miss when they budget an Italian hire. Salary is only part of the picture. Sick pay obligations sit on top of it, and they vary by sector.

Practical steps for your team  

1. Write a short sick leave policy that reflects Italian practice, not US PTO habits.
2. Tell managers what they may and may not ask.
3. Name one person who verifies certificates and keeps the records.
4. Store absence records separately from health information. In most cases you should never hold health information at all.
5. Check your CCNL for notice rules, sick pay top-ups and any special provisions.
6. Train managers to respond with support and a handover plan, not questions.

The bottom line  

Italian sick leave is simple once you accept the structure. The doctor certifies, INPS holds the record, and the employer confirms and plans. Your job is to keep the business running and stay out of the employee’s medical life.

Want to see what an Italian hire really costs, including absence obligations? Try the cost calculator.