Referral Guidance

A good OH referral

A good occupational health referral is focused, factual, and job-related. The aim is to help OH answer specific workplace questions — not to “build a case” against the employee or provide large amounts of irrelevant history/emails/he says she says.

A strong referral usually includes these sections:

1. Employee and job details

   Basic factual information:

   1. Job title
   2. Main duties
   3. Physical or mental demands of the role
   4. Working pattern (shifts, driving, lone working, manual handling, vibration tools, respiratory sensitisers, high levels of noise etc.)
   5. Length of service if relevant and hours
   6. Any hybrid working or remote working
   7. Any recent changes to the job tasks.

   Example:
   “Customer service adviser working full-time on phones and computer systems with prolonged sitting, uses head set”

2. Reason for referral

   A concise summary of the concern:

   1. Sickness absence
   2. Reported symptoms
   3. Performance concerns linked to health NOT details of any disputes/disciplinary though remember the employee has to see the referral and agree to it.
   4. Return-to-work support
   5. Workplace adjustments already implemented and any possible options if available
   6. Safety concerns

   Good example:
   “Employee reports worsening back pain affecting prolonged sitting and attendance.” - always stipulate what the employee has stated and be clear they have stated it so we know it comes from them.

   Poor example:
   “Employee is becoming unreliable and difficult, or employee is struggling” the latter sounds like the employer is saying the employee is struggling . Be very clear who states what . He says she says emails should not be in referrals only factual information.

3. Factual absence history

   Include:

   1. Dates/frequency of absence
   2. Fit note information
   3. Patterns if genuinely relevant

   Avoid:

   1. emotional commentary
   2. assumptions about motivation

   Good:
   “12 days sickness absence over 4 months due to musculoskeletal symptoms.”

   Not:
   “Seems to take time off whenever workload increases.”

4. Current workplace impact

   This is one of the most useful parts.
   
   Explain:

   • What the contractual duties are task wise so if repetitive work, how repetitive, what type of repetition
   • what duties are affected currently
   • what the employee says they struggle with, repetitive frequency , job tasks, vibration exposure
   • what has been observed factually
   • Any relevant risk assessment

   Example:
   “Employee reports pain after 30 minutes sitting and difficulty concentrating during flare-ups.”

5. Adjustments already tried

   OH works best when management has already considered practical support.

   Include:

   • phased return
   • equipment changes
   • reduced hours
   • altered duties
   • flexible breaks
   • Stress risk assessment

   Example:
   “A standing desk and temporary reduced caseload have been trialled.”

6. Clear questions for OH

   This is the most important section.

   OH is there to answer specific management questions.

   Common useful questions:

   1. Is the employee fit for work?
   2. Are adjustments recommended?
   3. Is the condition likely covered under the Disability?
   4. Is the condition temporary or long-term?
   5. Would a phased return help?
   6. Are there restrictions managers should follow?
   7. Is further review recommended?

   Weak referrals often ask:

   “Please advise.” That usually produces vague reports.

   Lots of additional questions that actually are covered anyway in the main questions.
   Remember we do not have to tell you what the condition is if the employee will not consent, our job is to advise by answering the questions , it is our job to gather the medical history so we can do that and whilst all to often we will put in the details of the condition, we are not obliged to as our role is to advise you on what is relevant for them to do their job. Not everyone wants us to divulge all their medical details and we have to respect that.

7. Relevant supporting information only

   Potentially appropriate:

   1. risk assessments
   2. job description
   3. attendance record
   4. fit notes
   5. relevant employee correspondence but again not email disputes and he says she says, this starts to breach confidentiality and is to much information.

   Usually not appropriate:

   1. grievance bundles
   2. disciplinary gossip
   3. unrelated historic disputes
   4. character criticisms
   5. excessive email chains

   If emails are included, they should directly relate to:

   1. symptoms
   2. work impact
   3. requested support
   4. safeguarding/safety issues
8. Tone matters

   The referral should remain:

   1. neutral
   2. factual
   3. respectful
   4. evidence-based

   OH tends to work poorly when referrals sound adversarial or accusatory.

   For example:

   Better:
   “Manager seeks advice on sustainable support and fitness for duties.”

   Worse:
   “We need OH to determine whether the employee is genuinely ill.”

9. What gets the “best” OH outcome

   The best referrals:

   1. ask practical workplace questions,
   2. explain the actual role demands,
   3. focus on function not diagnosis,
   4. and avoid emotionally loaded language.

   OH is generally most useful when the employer wants:

   1. adjustments,
   2. clarity,
   3. risk management,
   4. or return-to-work planning.

   It is usually least useful when employers try to use it primarily as:

   1. a disciplinary tool,
   2. credibility test,
   3. or surveillance mechanism.

   Useful employer guidance:

   1. ACAS sickness absence and occupational health guidance
   2. HSE workplace health guidance