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Pay as you go

Health Referral

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Complete below & submit

Human Resources Contact Details

Staff Member Details

Is Staff Member at work?
Yes
No

Job Details

  • Summary of role

  • Impact of absence

  • Particular aspects of the role staff member must be able to do

Reason for Referral

State if health problem is affecting performance, fitness & attendance or if there are any current performance issues/processes underway

Sickness Absence Record

State the reason, duration and frequency of absence for the last 12 months including current absence if off sick

Adjustments/Support

Outline any adjustments/support which have already been made and also what adjustments cannot be accommodated and reason

What questions do you want answered?

i.e. would you like to know about

Fitness for role?
Does the staff member have a disability or mobility issue?
Yes
No

I confirm that this referral has been discussed with the staff member. He/she/they are aware of the reason(s) for the referral and agrees to attend an appointment. (Please note OH cannot see the staff member unless they have been advised of the reason for the referral).

If you need to discuss this referral in further detail please contat the Occupational Health service on:

Tel: 01227 286288 | Email: payg@ohworks.co.uk

Our Responsiveness

Where we are able to contact the staff member by telephone we will aim to offer an appointment within 5 working days. If we are required to contact them by post an appointment is likely to be 5-10 working days as we need to allow the post to reach them. Please therefore provide the staff member's phone details wherever possible.


We aim to provide a written report with 48 hours of the appointment.

OHW Occupational Health & Wellbeing Services - Canterbury

31 Saint George's Place

Canterbury

CT1 1UT

Get in Touch
Email our 'Support Relations' Team

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