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Occupational Health Assessment Employee Consent form template

£ 15

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

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occupational health assessment employee consent form template

What is an Occupational Health Assessment Employee Consent form?

The Occupational Health Assessment Employee Consent form serves as formal authorization from an employee to undergo occupational health assessments. It outlines the employee's agreement to participate in the assessment process, including medical examinations, tests, and consultations, to evaluate their fitness for work or specific job-related tasks.

Additionally, the form seeks the employee's consent to disclose relevant medical information to the occupational health provider for assessment purposes.

The form ensures compliance with data protection regulations by obtaining explicit consent from the employee for the collection, processing, and sharing of their health information for occupational health purposes only. By obtaining informed consent, the employer demonstrates respect for the employee's autonomy and privacy while facilitating access to necessary health assessments to support their well-being and safety in the workplace.

Best practice timescale for this to be issued
When should this form be issued?
Prior to referring the employee to an Occupational Health service
Issued by who, to whom
Who should issue this form, and to whom?
The Employee to the Employer (you)
Applicable legal jurisdictions
In which jurisdictions can this form be used?
Great Britain & NI (United Kingdom), Worldwide
United Kingdom
  • Data Protection Act 2018 (incorporating GDPR): Mandates that employee consent forms comply with data protection regulations, ensuring the lawful processing of personal data.

  • Equality Act 2010: Ensures that the assessment process is fair and non-discriminatory, respecting the rights of employees with protected characteristics.

  • Health and Safety at Work Act 1974: Requires employers to ensure the health, safety, and welfare of their employees, including facilitating occupational health assessments where necessary.

  • Access to Medical Reports Act 1988: Regulates the obtaining and handling of medical reports, including consent requirements and the rights of employees to access and challenge the reports.

  • Best Practice: Informed Consent: Ensure that the consent form provides clear information about the purpose, nature, and implications of the assessment, allowing employees to make informed decisions about their participation.

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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 Employee Consent

I, [Employee's Name], hereby provide my consent to [Company Name] to refer me to Occupational Health for an assessment of my health status and any potential work-related issues. I understand and agree to the following terms and conditions:

  1. Purpose of Referral: I understand that the purpose of this referral is to assess my health status and any potential work-related issues that may impact my ability to perform my job safely and effectively.

  2. Confidentiality: I understand that all information gathered during the occupational health assessment will be kept confidential and will only be shared with relevant personnel involved in my employment and occupational health management.

  3. Access to Information: I consent to the sharing of relevant medical information and records between [Company Name] and the Occupational Health Department to facilitate the assessment process.

  4. Awareness: I confirm that I am fully aware of the referral to the Occupational Health Department and the questions that may be asked during the assessment process.

  5. Sharing of Assessment Report: I understand that the completed referral form and assessment report will be shared with me by [Company Name] following the assessment. I [would | would not] like to see the report prior to [Company name].

  6. Voluntary Participation: I understand that my participation in the occupational health assessment is voluntary, and I have the right to withdraw my consent at any time.

  7. Contact Information: I agree to provide accurate contact information to facilitate communication between [Company Name] and the Occupational Health Department regarding the assessment process.

By signing below, I acknowledge that I have read and understood the terms and conditions outlined in this consent form, and I voluntarily consent to the referral to the Occupational Health Department for assessment.

Signature: _________________________ Date: _______________

Print Name: _________________________

Please retain a copy of this consent form for your records.

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Version: [1.0]

Issue date: [date]

What communication / process sequence is this part of?

This step
Occupational Health Assessment Employee Consent form template
Next step
Occupational Health Assessment referral letter template

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

How might this be used in practice?

Scenario: Occupational Health Assessment Employee Consent Form for Long-Term Sick Employee at HealthCare Limited

HealthCare Limited, a healthcare provider, is dedicated to supporting the health and well-being of its employees, including those on long-term sick leave. In line with this commitment, the company implements an Occupational Health Assessment Employee Consent Form to ensure proper assessment and support for employees returning to work after an extended absence.


Jane, an employee at HealthCare Limited, has been on long-term sick leave due to a serious illness. As part of her return-to-work plan, the company schedules an occupational health assessment to evaluate Jane's fitness for work and identify any support or accommodations she may need upon her return.


  1. Sensitive Approach: The HR department approaches Jane with empathy and sensitivity, explaining the purpose and benefits of the occupational health assessment. They assure her that the assessment aims to support her successful return to work and address any health-related concerns.

  2. Clear Communication: The HR representative provides Jane with clear and concise information about the consent form, explaining its purpose, the types of assessments involved, and the confidentiality of her health information. They address any questions or concerns Jane may have to ensure she fully understands the process.

  3. Informed Consent: Jane willingly provides her consent to undergo the occupational health assessment, understanding its importance in facilitating her return to work and ensuring her health and safety in the workplace. She signs the consent form, indicating her agreement to participate in the assessment process.


  1. Assessment Coordination: The HR department liaises with the occupational health provider to schedule Jane's assessment at a convenient time. They ensure that the assessment is conducted by qualified healthcare professionals experienced in dealing with long-term sick employees.

  2. Assessment Outcome Review: Following the assessment, the HR representative meets with Jane to discuss the assessment outcomes and recommendations. They provide support and guidance to address any concerns raised during the assessment and collaborate with Jane to develop a tailored return-to-work plan.

  3. Accommodation Implementation: If the assessment identifies any specific accommodations or support measures needed for Jane's return to work, the HR department ensures their prompt implementation. This may include adjustments to her work environment, modified duties, or access to additional support services.

  4. Ongoing Support: HealthCare Limited continues to offer ongoing support to Jane as she transitions back to work. The HR department remains accessible to address any further concerns or adjustments needed to support Jane's health and well-being in the workplace.

Why buy our Occupational Health Assessment Employee Consent form 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
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