Please complete this form thoroughly. Incomplete forms may result in follow-up queries and could delay the process.
Thank you.
Notes: If required, you may use our MS Word Form
You may also send your own referral documents to [email protected]
Information about the Employee being referred to Occupational Health
Please provide detailed information about your referral to Occupational Health and the advice you require.
Please provide as much information as possible
The OH report will typically include the following information:
- Type of the medical problem, including current and planned treatment, prognosis and any relationship to work.- Current fitness for work.- Anticipated return to work date if relevant.- Recommended adjustments and their timelines, e.g. phased return to work.- Prognosis and estimated risk of further absences.- Applicability of the Equality Act 2010.- Indications for a follow-up OH consultation.
I confirm that the employee is aware of this referral, understands its reasons and possible outcomes, and consents to their referral for OH consultation.
I am aware that the employee may choose to see the OH report before it is released to the referrer, ask for factual corrections of the report, provide their comments and withdraw their consent to release the OH report to the employer under the GDPR and Access to Medical Reports Act 1988.
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.
For any questions or assistance, please contact us at [email protected] or call 07383496232.
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