Management Referral

An Occupational Health Referral (or OH referral) is a medical assessment of an employee conducted by a healthcare professional, to help determine any issues the employee faces. This assessment assesses an employee’s physical and mental health where applicable and provides their employer with recommendations. It also gives the employer instructions on what they can do to ensure a safe and healthy working environment for that employee.

As standard, our management referral reports will always cover the following where applicable:

Is the employee fit for normal hours and duties required by the post? If not, please comment on their likely future fitness for their normal or alternative work?
When will they be able to return to work/return to normal hours/duties?
Is there an underlying medical condition affecting their ability to work?
How does this condition affect the employee at present?
Are they having appropriate treatment, will it aid their recovery and if so when?
Is this employee likely to be able to provide regular and effective service in the future?
In your view, is the employee likely to be covered under the disability provision of the Equality Act 2010?
Advice with regards to possible adjustment(s) and support with the employer could consider?

Employee details

Please provide details about employee

Date of referral*

Type of Referral*

Personal details

Employee name*

Date of birth*

Contact details

Home address*

Post code*

Mobile phone number*

Email address*

Injury / illness

Current injury(s) / Illness(s)

Date of current injury(s) / illness(s)*

Employee consent confirmation

Please confirm that you have discussed the contents of the referral with the employee and they have consented to be contacted by Innovate on that basis. It is important that the full reason for the referral is explained to the employee prior to submission. Innovate Healthcare are unable to proceed without confirmation that you have completed these steps.

Work details

Please provide details about work

Work details

Currently signed off work

Job details

Job title

Job description

Employee’s duties or job demands

Work details

Work address

Referrer details

Please provide your details

Personal details

Referrer name*

Mobile phone number*

Email address*

Company details

Company name*

Referrer position*

Company Number*

VAT Registration*

Company Address*

Finance Contact Email*

Finance Contact number*

As standard, our management referral reports will always cover the following where applicable:

Employee details

Personal details

Contact details

Injury / illness

Employee consent confirmation

Work details

Job details

Work details

Reason for the referral

Additional information

Questions

Referrer details

Personal details

Company details