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Occupational Health Assessment referral letter template

£ 15

Our Occupational Health Referral Letter Template facilitates seamless communication with healthcare professionals, expediting employee support and recovery.

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How long to understand and prepare this letter?
10 mins
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occupational health assessment referral letter template

What is an Occupational Health Assessment referral letter?

The Occupational Health Referral Letter Template streamlines the process of referring employees to occupational health services for assessment and support. It provides a structured format for HR or line managers to communicate relevant information about the employee's health concerns, work-related issues, or fitness for work to the occupational health provider.

Additionally, the template ensures consistency and compliance with company policies and legal requirements throughout the referral process.

The template serves as a tool to facilitate effective communication between the employer, the employee, and the occupational health provider. It helps to ensure that essential details are included in the referral letter, such as the employee's consent, relevant medical history, and specific concerns or questions to be addressed. By using this template, organisations can expedite the referral process, promote employee well-being, and facilitate appropriate interventions to support employees in managing health-related challenges at work.

Best practice timescale for this to be issued
When should this letter be issued?
As and when required (after a chemical-related incident, for example), or as part of a long term sickness absence management process
Applicable legal jurisdictions
In which jurisdictions can this letter be used?
Great Britain & NI (United Kingdom), Worldwide
United Kingdom
  • Equality Act 2010: Ensures that the referral process is fair and does not discriminate against employees based on their health condition or other protected characteristics.

  • Data Protection Act 2018 (incorporating GDPR): Mandates the handling of personal data within the referral letter in compliance with data protection principles.

  • Health and Safety at Work Act 1974: Requires employers to ensure the health, safety, and welfare of their employees, including providing access to occupational health services.

  • Acas Guidance on Health, Work, and Wellbeing: Offers best practice guidance on managing health-related issues in the workplace, including the referral process for occupational health assessments.

  • Best Practice: Clarity and Confidentiality: Ensure that the referral letter clearly outlines the reason for the assessment and maintains confidentiality of the employee's health information.

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Other territories

Refer to your local employment legislation / labor laws to support the execution of the template. Review the wording for local accuracy.

Occupational Health Assessment referral [Delete this line]

[Company name]

[Sender address]



[Recipient name]

[Recipient address]


Dear [Recipient first name],


Referral for occupational health assessment

I am writing to refer [Employee's Name], an employee of [Company Name], to you for an assessment of their health status and any potential work-related issues.

[Employee's Name] has been experiencing [brief description of health concerns or issues, if known]. Due to the nature of their role within our organisation and our commitment to ensuring the well-being and safety of all employees, we believe it is essential for them to undergo a thorough evaluation.

Please conduct a comprehensive assessment of [Employee's Name]'s health status, with a focus on any potential occupational hazards or concerns that may impact their ability to perform their job safely and effectively. Additionally, we would appreciate your insights and recommendations regarding any necessary accommodations or adjustments that may be required to support [Employee's Name] in their role.

[Employee Name] has provided written consent for us to request this assessment, whch I have enclosed.

Enclosed with this letter are relevant medical records and any additional information that may assist you in your assessment. Please see the followng details:

Employee Details

  • Employee Name:

  • Date of Birth:

  • Employee Address:

  • Employee Mobile No:

  • Employee Email:

  • Job Title:

  • Length of Service:

  • Company:

  • Company Address:

  • Referring Manager:

  • Manager contact no:

  • Manager Email:

  • HR Manager:

  • HR Contact no:

  • HR Email:

  • Who report to be sent to:

  • Date of referral:

  • PO number if required:

Job Description

Please summarise the job role, detailing main tasks, hazards, and hours of work.

Reason for Referral

Please delete those not applicable:

  • Recurrent short spells of absence causing commercial concern

  • Prolonged sickness and/or absence

  • Return to work assessment

  • Fitness for Work

  • Before Job Transfer / Modification / Promotion

  • Concerns for work performance

  • Fitness to attend disciplinary meeting

  • Suspected Alcohol or Drug Misuse

  • Other - Please give details below:

Details of Current Problem

  • Health condition / diagnosis (if known):

  • Observed impact on job role (if relevant):

  • Adjustments offered/actions taken to address problems outlined in the referral:

  • Date of current absence (if relevant):

  • Sickness record for the last 24 Months if relevant (include dates and reason for absence):

  • Performance issues (attendance, timekeeping, motivation)? If yes give details:

  • Disciplinary warnings in force in relation to performance? If yes give details:

  • Has the employee raised any concerns they have in the workplace? If yes give details:

  • Please attach GP / Specialist Reports / previous OH reports if appropriate.

Confirmation of Employee Awareness

Please confirm the employee has been given a copy of this referral: [Yes/No]

Questions for the OH Professional

Please delete those not applicable:

  1. Is there a health condition present and is it likely to be permanent, fluctuating or resolvable?

  2. Are there any work-related aspects to the health problem?

  3. Is the employee fit to undertake normal duties of their current role?

  4. When is a return to work likely?

  5. Are there any suggested adjustments or supportive measures to help the employee?

  6. In your medical opinion, is the employee likely to be classed as disabled under the Equality Act 2010?

  7. Is the employee fit to attend a disciplinary/sickness meeting? (please delete as appropriate)

  8. Is a further OH review recommended?

  9. Additional Questions:

Thank you for your attention to this matter. If you require any further information or assistance, please do not hesitate to contact me at [Your Contact Information].

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Yours [faithfully | sincerely],



[Sender name]

[Sender job title]

[Sender telephone]
[Sender email]

What communication / process sequence is this part of?

Previous step
Occupational Health Assessment Employee Consent form template

Our Occupational Health Assessment Employee Consent form template streamlines the process, ensuring employee compliance and facilitating efficient health evaluations.

This step
Occupational Health Assessment referral letter template

How might this be used in practice?

Scenario: Occupational Health Assessment Referral

ABC Limited, a UK-based company, is committed to ensuring the health and well-being of its employees. HR Manager Sarah oversees the process of referring employees for Occupational Health Assessments when necessary.

Identification of Concern

Sarah becomes aware of an employee, John, who has been experiencing health issues that may impact his ability to perform his job safely and effectively. These issues include frequent back pain and discomfort while carrying out physical tasks in the workplace.

Initial Assessment

Sarah conducts an initial assessment of John's situation, including reviewing any relevant medical documentation and discussing his concerns with him. Based on this assessment, Sarah determines that a referral to an Occupational Health Assessment is necessary to further evaluate John's health and identify any adjustments or accommodations that may be required to support him in the workplace.

Referral Process

Sarah initiates the referral process by contacting the company's designated Occupational Health provider and providing them with relevant information about John's case. She follows the call up with a referral request letter. This includes details of his job role, the nature of his health issues, any previous medical assessments or treatments, and any specific concerns raised by John or his manager.

Appointment Scheduling

Once the referral is made, Sarah works with the Occupational Health provider to schedule an assessment appointment for John at the earliest convenience. She ensures that John is provided with clear instructions regarding the date, time, and location of the appointment, as well as any documentation or information he may need to bring with him.

Assessment Outcome

Following the Occupational Health Assessment, the provider evaluates John's health condition and provides a detailed report outlining their findings and recommendations. This report may include guidance on adjustments to his job role or working environment, recommendations for medical treatment or rehabilitation, and advice on managing his health condition effectively.

Implementing Recommendations

Sarah reviews the Occupational Health Assessment report and collaborates with John, his manager, and any other relevant stakeholders to implement the recommendations provided by the Occupational Health provider. This may involve making reasonable adjustments to John's job role or working conditions, providing additional support or training, or exploring other forms of assistance to help him manage his health condition effectively while remaining productive in the workplace.

Follow-up and Support

Sarah maintains regular communication with John to monitor his progress following the Occupational Health Assessment and to ensure that the recommended adjustments or accommodations are effective in supporting his health and well-being in the workplace. She remains available to provide ongoing support and assistance as needed, liaising with the Occupational Health provider and other stakeholders as required to address any further concerns or issues that may arise.

Why buy our Occupational Health Assessment referral letter template?

  • It's easily editable and implementable, saving you time and money
  • It's designed by CIPD accedited Chartered HR practitioners with operational experience in this area
  • You will maintain compliance with ACAS guidelines, legislation, and industry best practices
What other advantages does buying from offer?
  • Email notifications for any updates made to this template or its accompanying materials
  • 12 months of unrestricted access without any additional costs (any update in that period is free to you)
  • A 25% discount on all library, toolkit, and template purchases/renewals

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