Referral Form

Occupational Health referrals do not routinely require a physical examination. The occupational health assessment is based on the medical history and detailed information provided by the employee. This detailed assessment of the employee’s health status is then utilised to assess their fitness for the tasks they are expected to complete in the workplace. Telephone Assessments are a cost effective way of assessing an employees’ fitness for work or facilitate a return to work. Face to face occupational health referrals are available on request subject to availability.

  • This field is for validation purposes and should be left unchanged.

On Completion of the Form

  • Unless indicated otherwise it will be assumed by completed this referral form that you require a telephone assessment.
  • Please discuss the occupational health referral / completion of the form with the employee and advise that we will be contacting them. The referral form will be discussed with the employee once an assessment date and time has been agreed.
  • Please ensure all sections of the occupational health referral form are completed and a current contact phone number and email address for the employee are included (as this is the normal method of contact with them).
  • Once the completed occupational health referral form is received, we make will make contact with the employee to confirm a date and a time for assessment. You will be advised of the date and time of the scheduled appointment.
  • Payment of the invoice will be required before the report is released to the business.