Referral form: Notes for completion

Section A: It is important that the information regarding personal details is accurate and up to date, because this will form the basis of the information needed to make contact with the employee/‘patient’.

Section B: Details of the line manager will make communications between the person managing the referred person and the OH service easier.

Section C: The HR Business Partner referring the member of staff will require a report and their details are therefore required.

Section D: It is likely that more than one person will need to know the outcome of the OH consultation (although the number of people being copied into any report should be kept to an absolute minimum). A report would normally be sent to the person referring the member of staff (usually the HR Business Partner), the first line supervisor and the second line manager.

Section E: It is useful to know whether the member of staff being referred to OH is currently off work or at work. If they are off work currently, or were away from work recently, it is helpful to have an accurate history of their absenteeism, because the employee/‘patient’ is often vague about the details of their absences.

It is imperative that any member of staff being referred to the OH service is informed about their referral and they are provided with a copy of the completed referral form.

The reason for a referral is important and OH will need to know the specific reason why a member of staff needed to be referred. It is not helpful if all four questions are ticked on every referral made.

Section F: If the reason for a referral is for advice regarding fitness to work, (i.e. Q1. at Section E), the OH will need to know what work is actually being undertaken and a Job Description will need to accompany the referral form. Where no current job description exists, a brief outline of the primary tasks/duties will suffice.

If the reason for the referral is regarding sickness absence (i.e. Q2. at Section E), the OH will need to see a record of any absenteeism for the previous 2 years (or for the period of time the member of staff has been in employment if that is less than 2 years). This can be printed or hand written, but should include dates, the reasons for any absence and whether time off was self-certificated or accompanied by a doctor’s certificate.

If the reason for the referral is with regard to performance/capability (i.e. Q3. at Section E), the OH will need specific and evidenced information in that respect.

If the reason for the referral is the result of a general feeling of concern regarding a member of staff’s health or wellbeing (i.e. Q4. at Section E), the OH will need to know what those concerns are and what might have led to them.

Section G: Please explain, as concisely as possible, what it is you want to know as a result of this member of staff being seen in occupational health. If you require specific advice then you will need to ask specific questions, i.e. if you do not explain what it is you want then you are likely to be disappointed with any report that results from the consultation. Please bear in mind that any medical report regarding a member of staff can only be written and sent with that member of staffs’ consent. Please date this form.