Objective: The present study aims to map the performance of the Integrated Subsystem of Health Care for Federal Public Servants (SIASS) in a large Federal Higher Education Institution, identifying the occupational health practices implemented in 2023 and the main challenges faced in managing these policies. Theoretical Framework: The theoretical framework adopted is historical, addressing the evolution of SIASS since its creation in 2009. SIASS was established to integrate occupational health actions in the federal public service, focusing on health promotion, disease prevention, and comprehensive assistance to employees. It highlighted its role in health management within federal institutions. Method: A documentary and quantitative approach was used, analyzing data extracted from the 2023 UTFPR Management Report. The analysis focused on the frequencies of benefit approvals and denials, allowing the identification of patterns and challenges in occupational health management. Results and Discussion: In 2023, SIASS at UTFPR conducted 1,539 medical evaluations, covering 42.45% of employees, with an approval rate of 91.62%. Most evaluations (57.96%) were related to health treatment leaves, followed by leaves for family health reasons (11.76%) and health treatment leaves by an official board (11.70%). The predominance of a reactive approach rather than preventive measures was identified as a critical factor. Research Implications: The research suggests strengthening prevention strategies and adjusting policies to ensure effective employee health management and aligning resources and expectations. Originality/Value: This study contributes to the literature by providing a detailed analysis of SIASS’s performance in a large federal institution, highlighting challenges, and proposing recommendations to improve occupational health management in similar contexts.