Human resources

Management referral to occupational health

Managers wishing to refer an employee to the occupational health unit must complete a management referral form (word) which captures all the information required for us to process an accurate and efficient referral.

Tab through the fields to complete electronically and ‘save as’ to own file under preferred name. This can then be emailed directly to and copied to the employee and HR Advisor.

The Occupational Health Unit (OHU)
Carmelita House, 4th Floor, 21-22 The Mall, Ealing W5 2PJ.

Old versions of the form will not be accepted and will be returned to you, together with the new form which you will need to complete again and return.

Please read the referrals to referrals to ccupational health guidance (pdf) and occupational health procedure (pdf) before completing this form.

Please remember to mark the email as 'confidential'.


  • It is your responsibility to ensure that the manager's referral form is fully completed and sent to relevant personnel
  • The form has a pre-set number of options for you to choose from, please ensure that you select all the relevant boxes
  • Save the form as you complete it and keep a spare copy on a separate disk or PC, in case of possible corruption or system failure

Useful documents

Ill-health retirement - guidance (pdf)
Where an employee becomes permanently unfit for their substantive post they may be eligible for ill health retirement.

Phased return to work - guidance (pdf)
The purpose of a phased return to work is to rehabilitate an employee to their full duties and gradually build back up to undertaking their normal working hours within the earliest agreed timescale.

Reasonable adjustment - guidance (pdf)
In some circumstances adjustments are recommended to the workplace, duties or hours to enable an employee to continue in their post wherever possible.

Short-term sickness absence - guidance (pdf)
In cases where the employee meets one of the specified trigger points the manager must review the individuals attendance and consider whether action is required.

Please note: All correspondence, including emails, will be placed in the employee's occupational health file. Access to this information is available to the employee on request.

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Last updated: 29 Jan 2024