Occupational Health Referral Form

An educational library of workplace documents — purpose, who completes them, when they are used, typical fields, common mistakes and how they connect. Linked to workplace safety, workplace training, occupations, industries and employment documents. Informational only — template examples, not legal advice or official documents; employers remain responsible and using a document does not guarantee compliance.

What an occupational health referral form is

An occupational health referral form is the document an employer uses to ask an occupational health professional to assess and advise on a worker’s health in relation to their job — for example after a long absence, where surveillance is needed or where a concern about fitness for a task arises. It frames the question for the professional and supports a fair, consistent process.

This page is an educational overview with a simplified example. It is not an official template, not jurisdiction-specific and not legal advice, and it does not provide a medical opinion.

Purpose

• Ask an occupational health professional a clear question.
• Provide relevant context about the role and its demands.
• Support decisions about fitness, adjustments or surveillance.
• Document that advice was sought and on what basis.

Who completes it

• Usually a manager or HR, often with the worker’s knowledge and consent.
• The occupational health professional provides the advice separately.
• The employer decides when a referral is appropriate.
• Confidential health information is handled carefully and separately.

When it is used

• When advice is needed on fitness for a role or task.
• On return from a significant or prolonged absence.
• Where health surveillance or an adjustment may be needed.
• When a concern about health and work arises.

Typical fields

• Worker and role, with the key demands of the job.
• The specific question or concern for the professional.
• Relevant context, kept proportionate and necessary.
• Confirmation of consent where required.
• Referrer details and date.
• Example fields only — adapt to your process and data-protection duties.

Common mistakes

• Asking a vague question, so the advice is not useful.
• Including more health detail than is necessary.
• Referring without the worker’s knowledge where consent is expected.
• Not acting on the advice that comes back.

Document workflow

An occupational health referral often follows a fit for work declaration, a return-to-work conversation or a surveillance trigger, and it leads to advice that may feed a health surveillance record or workplace adjustments. It is used carefully, with attention to consent and data protection, and the outcome is acted on within the employer’s process.

See the related documents below for what is commonly completed before, alongside and after an occupational health referral form.

Retention (high level)

Referral forms and any advice are generally kept for a period set by the employer, in line with their obligations and strict data-protection duties, with clinical detail held confidentially. Specific retention periods vary by jurisdiction.

This page does not state a required period — confirm retention with the applicable law and the official authority.

Completing and sharing as a PDF

Referral forms are commonly completed and shared as PDFs through secure channels and kept separately from general records. Exporting to PDF supports documentation; it does not make the form official or guarantee compliance.

Employer checklist

• Ask a clear, specific question and provide the role demands.
• Keep health information proportionate and necessary.
• Address consent where it is expected.
• Act on the advice and protect the personal data involved.

Worker notes

• Understand why a referral is being made and what it covers.
• Provide relevant information so the advice is meaningful.
• Know how your health data is handled and protected.

Country considerations

Rules on occupational health, consent and health data vary significantly by country, and the official authority differs. This page is general and high-level — it is not a statement of any country’s law and not legal advice.

Always confirm the current requirements with the official authority for your country and a qualified professional.

Who is responsible

The employer is responsible for making appropriate referrals, acting on advice and protecting health data — and for compliance. This page is an educational overview with a template example; it does not provide a medical opinion, does not make a workplace compliant and does not transfer responsibility.