Please complete this form to refer an Employee for HAVS Tier 4 under the Control of Vibration at Work Regulations 2005
The referring manager or HR advisor information
Information about the worker being referred to Occupational Health
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.
Pre-paid clients: I confirm that I have read and agree to the terms and conditions as per the Booking and the Privacy and Data Protection Policies (www.workableoh.uk/policies)orContractual clients: This booking is made subject to the current OH Agreement in place.
For any questions or assistance, please contact us at [email protected] or call 07383496232.
I confirm that the employee is aware of this referral and the appointment date and time. They understand the reasons for the referral, the potential outcomes, and have provided written consent for the OH assessment.
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