Referral OH Consult

 

Referral for Occupational Health Consultation

 

 

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]

 

 

Referrering Manager Details


Employee Details

Information about the Employee being referred to Occupational Health


Referral

Please provide detailed information about your referral to Occupational Health and the advice you require.


Reasons for the referral

Please provide as much information as possible

Additional questions

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.

Referer's declaration



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