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OCCUPATIONAL HEALTH REFERRAL Employees full name: Employees address: Date of birth: Home Phone Mobile Phone Work location: Job / Job Title Work Demands×Hours per day e.g.: Lifting, Bending, Standing,
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How to fill out occupational health referralindd
Who needs occupational health referralindd?
01
Employees who have been injured or become ill on the job and require medical attention.
02
Employees who need a physical examination or assessment for work-related purposes, such as for specific job requirements or clearances.
03
Employees who have been identified as requiring occupational health services by their employer or a healthcare professional.
How to fill out occupational health referralindd:
01
Start by providing your personal information, such as your full name, date of birth, and contact information.
02
Indicate the reason for the referral, whether it is due to a work-related injury or illness or for a specific assessment or examination.
03
Include any relevant details about the incident or condition that led to the referral, such as the date of the incident, description of the injuries or symptoms, and any treatments or medications already received.
04
If the referral is for a specific assessment or examination, specify the type of assessment needed and any supporting information or documentation required.
05
Sign and date the referral form to confirm that the information provided is accurate and complete.
06
Submit the referral form to the appropriate party, such as your supervisor, human resources department, or occupational health clinic, depending on your workplace's procedures.
Remember to follow any additional instructions or requirements provided by your employer or the healthcare provider handling your referral.
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