BACKGROUND: Maintaining one’s current job is important for patients. Few studies have investigated the presence of support systems in small- and medium-sized companies to help balance the therapeutic needs and occupational roles of workers in Japan. 
 
 AIMS: To understand whether small- and medium-sized companies in Japan have established workplace policies to help employees with chronic disease balance medical treatment and professional life.
 
 METHODS: We surveyed a sample of small- and medium-sized companies in Japan identified from a large database of corporate credit and marketing research companies between February and March 2017. A questionnaire addressed workplace policies that supported employees’ medical treatments and professional lives, such as flexible work arrangements and the preparation of manuals and forms to facilitate communication with treating physicians. 
 
 RESULTS: Of the 4158 companies initially contacted, 1140 companies (27%) responded to the survey. Of the valid respondents, 21% of the workplaces reported having established sufficient office rules to address employee’s necessary medical needs. Approximately half of the workplaces (53%) shared that they had a system in place to provide temporary medical leave for employees with chronic diseases. Few (12%) workplaces had established a process for having a trial return to work after a period of absence due to a medical condition. 
 
 CONCLUSIONS: Currently, a minority of small- and medium-sized companies in Japan have established workplace policies to address the medical needs of employees with chronic diseases.