The questions that I should like answered are, for example:
I confirm that I have discussed with the employee the reason for this referral and he or she fully understands and agrees to attend the Occupational Health Department.
To be completed by the Manager/Human Resources Manager (Referrer)
For confidentiality purposes please complete the required information asked in this box:
Incomplete information may cause a delay in receipt of the report. Thank you for your co-operation.