Abstract When advising a syncope patient about resumption of driving, flying or vocational activities, physicians must consider relevant laws and regulations, the etiology of the syncope, and the risk of recurrence and the impact of recurrence on the safety of the patient and others. Guidelines from professional cardiology societies may aid the physician. In the United States, private driving is regulated by individual states and their laws show significant variance. Commercial driving and flying are regulated at the federal level. These regulations tend to be more uniform, but are significantly stricter due to the potential risk to the public posed by commercial drivers or pilots with syncope. For many diagnoses, both regulations and professional society recommendations incorporate an observation period following the index syncopal event. This is due to the natural history of syncope recurrence and to allow time to monitor the response to treatment.