Management Referral Form

This form is an example form of what can be completed when submitting a management referral to Occupational Health. This form will be used as the basis of the discussion between the Occupational Health Clinician and the individual employee, therefore please ensure all relevant sections of this form are completed as fully and accurately as possible. We expect all referrals to be submitted through our secure online portal but the attached can be used for internal purposes prior to submission onto the portal.