HAVS T4 Referral

 

HAVS Tier 4 Referral Form

 

Please complete this form to refer an Employee for HAVS Tier 4 under the Control of Vibration at Work Regulations 2005

 

Referrer's Information

The referring manager or HR advisor information


Employee Information

Information about the worker being referred to Occupational Health

 


Information for the employee

Please forward the following information to the employee:

1. Please bring photographs of finger blanching, if applicable.

2. The medical will take approximately 50 minutes. The doctor will take your medical history and examine your neck, arms and hands.

3. Please see the Bristol and Chepstow clinic information on www.workableoh.uk/contact/

⚠️ Please do not attend if you have a new cough, fever or high blood pressure.

Referrer declaration