Plymouth University

Human Resources

Completing the Occupational Health Referral Form – Guidance for Managers

The role of Occupational Health (OH) is to support you in effectively managing sickness absence and to look after the health and wellbeing of our employees.

The OH Referral provides an opportunity for you to seek specialist medical advice and guidance where you are concerned about the health and wellbeing of one of your team. The purpose of this guidance is to help you to provide all relevant information about the individual so that OH can provide appropriate advice.

Personal details

This information is required by OH to check the identity of the employee, and for contacting the individual to make or cancel/change appointments. Please complete this section in full and check that the information is accurate with the employee.

Employment details

OH need as much information about the employee’s job and working hours as possible to ensure that appropriate medical advice is given, on adjustments to duties for example.

Attachments

Managers must include a job description and person specification with the referral which provides OH with details of the employee’s role, and enables them to consider how the employee’s health may impact on their ability to undertake their duties.

Reason for OH referral

There are various reasons for referring an employee to OH and the OH referral form indicates the 5 main reasons with further explanation/examples below.

Advice on fitness for duty and/or need for work adjustments:

  • Role restructuring or redeployment causing the employee/employer toraise possible health concerns.
  • Work adjustments (including working hours) suggested by an employee’s generalpractitioner/consultant (including on a Statement of Fitness for Work where the adjustments are complex).
  • General concerns about health.

Sickness absence

  • Musculoskeletal sickness absence (e.g. back pain, upper limb pain)exceeding 10 days.
  • Total absence exceeding the absence alerts for prolonged orrecurrent sickness absence.

Poor performance or inefficiency/inability to fulfil contractual role

  • Reduced output or standard of performance which could reasonably be attributable to a health/wellbeing issue.
  • Inability to complete work within reasonable hours leading to increased instances of taking work home.
  • Poor attendance for non-specific illness.

Concern over mental health/stress

  • Sick note indicating stress/depression/mental health condition.
  • Employee complains of feeling stressed/you have identified possible indicators of stress.
  • Behavioural changes.
  • Suspected alcohol or drug abuse.
  • Suspected domestic violence

Consideration for dismissal

  • Prolonged sickness absence with no apparent resolution which maylead to ill health retirement or dismissal on the grounds of incapacitydue to ill health
  • Long-term incapacity to fulfil contractual role which may lead to illhealth retirement
  • Persistent intermittent short-term absences which may lead to consideration of dismissal on the grounds of capability due to inability to provide regular service

Additional space is provided for you to provide more details about the reasons for the referral and you must provide as much information as possible. If the employee has any specific requirements please include information here.

Medical advice sought

This section provides a list of standard questions (a – n) which may apply to your referral. Please consider carefully what advice you require and tick the questions that are appropriate.

You may not need to tick all the questions.

The next section enables you to let OH know what adjustments you may already have made or have planned to support the employee back to work or in the workplace. If you have not been able to consider certain adjustments please let OH know so that they can advise on alternatives where appropriate.

Management declaration and contact details

Before sending the OH referral you should have discussed it fully with the employee, and provided a copy of the referral, indicating you have done so by ticking the appropriate box in this section. If the employee is away from the workplace you may contact them at home to discuss the referral and follow up by sending both a copy of your completed referral and Occupational Health Referrals – Information for Employees.

Please include your contact details in full, and details of your Employee Relations Specialist (ERS) so they also receive a copy of any correspondence from OH, and will ensure appropriate support is provided to you.

Once completed, this form should be emailed to Occupational Health (copied to your ERS) and you must retain a copy in a secure file for your own records.

If you have any queries about the referral or completing the form please contact Occupational Health 587412 or your Employee Relations Specialist.

Important Information for Employees

You have been referred to Occupational Health so that appropriate medical advice is received and to ensure that you have access to appropriate support. However please be aware that you will be required to give consent for any medical reports to be provided to your manager.

Failure to give consent may be considered a refusal to follow a reasonable management instruction and a breach of your terms and conditions of employment and may result in action in line with the University’s Disciplinary procedure.

Occupational Health Referral Form – PLEASE COMPLETE IN FULL


Absence – Appendix 9 – OH Referral guidelines for managers and formPage 1v9. Nov. 2015