An occupational health referral is a formal request for an independent medical assessment of an employee’s fitness for work, typically made when an absence is prolonged, the cause is unclear, or adjustments are needed to support a return. Occupational health (OH) referrals are one of the most underused tools in UK HR practice — many managers avoid them because they are unsure when to refer, what to ask, or how to interpret the report that comes back.

This guide explains when an OH referral is appropriate, provides a referral template you can adapt, and covers the consent and data protection requirements that govern the process.

Key takeaways

  • An OH referral is appropriate when an absence exceeds 2-4 weeks, when the employee has a long-term health condition, or when you need expert advice on adjustments.
  • The referral must be made with the employee’s informed consent — you cannot refer someone without their knowledge.
  • The referral questions should focus on fitness for work and recommended adjustments, not diagnoses.
  • The OH report is confidential medical information — it should be shared only with those who have a legitimate need to know.
  • OH recommendations are advisory, not binding — the employer must consider them but is not obligated to follow every recommendation.

When to refer to occupational health

Mandatory referral triggers

Refer to OH when:

  • The absence exceeds 4 consecutive weeks (recommended by ACAS)
  • The employee has a recurring pattern of short-term absence that cannot be explained by standard RTW interviews
  • The employee has disclosed a long-term health condition that may require reasonable adjustments
  • The employee is returning from maternity, paternity, or adoption leave and there are health concerns
  • There is a health and safety risk to the employee or colleagues
  • The employer is considering disciplinary or capability action and needs medical evidence

Optional referral triggers

Consider referring when:

  • The employee requests it
  • The manager has concerns about the employee’s wellbeing that are beyond their competence
  • The absence relates to mental health and the manager needs guidance on support
  • The employee is returning to a physically demanding role after illness or injury

The referral template

Employee details

  • Employee name:
  • Job title:
  • Department:
  • Line manager:
  • Date of referral:

Absence details

  • Date of first absence:
  • Current status (absent / returned with adjustments / returned without adjustments)
  • Total days absent to date:
  • Reason for absence (as shared by employee — do not include unsubstantiated diagnoses)
  • Previous absences (pattern and frequency):

Referral questions

The OH report is only as useful as the questions you ask. Use these standard questions as a starting point:

  1. Is the employee currently fit for work? If not, when is a realistic expected date of return?
  2. What is the likely duration of the current absence?
  3. Are there any recommended adjustments that would support the employee’s return? (e.g., modified duties, reduced hours, phased return, ergonomic equipment, remote working)
  4. Are there any workplace factors contributing to the employee’s absence? (e.g., workload, relationships, environment)
  5. Is the employee fit to carry out the essential functions of their role? If not, what are the specific limitations?
  6. Are there any ongoing health conditions that may require long-term adjustments?
  7. Would a referral to a specialist service (e.g., physiotherapy, counselling) be beneficial?
  8. Is the employee willing to participate in a return-to-work plan?

I confirm that I have explained the purpose of this referral to the employee and obtained their informed consent. The employee understands that:

  • An occupational health professional will assess their fitness for work
  • The referral will include information about their absence and any relevant medical history they choose to share
  • The resulting report will be shared with [HR / line manager / both]
  • The employee may decline the referral at any time

Employee consent obtained: Yes / No Date consent obtained: Referred by: Date of referral:

Using the OH report

Receiving the report

The OH report is typically returned within 5-10 working days. It will contain:

  • The OH professional’s assessment of the employee’s fitness for work
  • Recommendations for adjustments or modified duties
  • An expected return date (if the employee is currently absent)
  • Any workplace factors contributing to the absence

Sharing the report

The report is confidential medical information. Share it only with:

  • HR — who need the full picture to manage the absence
  • The line manager — who needs to implement adjustments (but only the fitness-for-work and adjustment recommendations, not the full medical history)
  • Senior management — only if a capability or redeployment decision is being considered

Do not share the report with colleagues, team members, or anyone without a legitimate need to know.

Acting on recommendations

OH recommendations are advisory. The employer must:

  1. Consider every recommendation seriously
  2. Implement reasonable adjustments where possible
  3. Explain to the employee if a recommendation cannot be implemented (and why)
  4. Document the decision-making process

Failing to act on OH recommendations, particularly for disabled employees, may constitute a failure to make reasonable adjustments under the Equality Act 2010.

An OH referral requires the employee’s informed consent. The employee must know:

  • What information will be shared with the OH professional
  • Who will receive the report
  • That they can decline the referral

If the employee declines to consent, the employer may still be able to make a referral if:

  • There is a legitimate business interest in assessing fitness for work
  • The referral is necessary for the employer to comply with health and safety obligations
  • The employer has no less intrusive means of obtaining the required information

However, referring an employee against their wishes is a significant step and should only be taken after legal advice.

Putting it into practice

Five checks to ensure your OH referrals are effective:

  1. The referral is made at the right time (absence exceeding 2-4 weeks, or when adjustments are needed).
  2. The employee has given informed consent and understands the process.
  3. The referral questions focus on fitness for work and adjustments, not diagnoses.
  4. The OH report is shared only with those who have a legitimate need to know.
  5. OH recommendations are considered, acted on, and documented.
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Leave Balance tracks absence durations and flags when an occupational health referral threshold is reached — so OH referrals happen proactively, not after months of unmanaged absence.

Frequently asked questions

How long does an occupational health referral take?

Typically 5-10 working days from the date of referral to the receipt of the report. Some OH providers offer faster turnaround for urgent cases. The referral process itself (obtaining consent, completing the form) should be completed within 2-3 days.

Generally, no — you need the employee’s informed consent. However, if there is a legitimate business need and the employee’s refusal places health and safety at risk, the employer may proceed after taking legal advice. Refusing a referral is unusual and may indicate broader issues.

What is the difference between occupational health and a GP referral?

Occupational health is a specialist service that assesses fitness for work and recommends workplace adjustments. A GP referral is a medical consultation for diagnosis and treatment. OH focuses on the workplace; the GP focuses on the condition.

How much does an occupational health referral cost?

Costs vary by provider and the complexity of the referral. A standard referral typically costs £200-£500. For complex cases requiring specialist assessment, costs may be higher. Many organisations use an occupational health service on a retainer basis.

What if the OH report recommends adjustments I cannot afford?

You must consider every recommendation and explain to the employee if an adjustment cannot be implemented. “Too expensive” is a valid reason only if the cost is genuinely disproportionate to the benefit. For disabled employees, the duty to make reasonable adjustments may require investment that goes beyond what you would spend on a non-disabled employee.

This article is general information, not legal advice. Consult qualified employment counsel for jurisdiction-specific guidance.