Medical report during employment (employer’s doctor)—employee consent form

The following Employment precedent provides comprehensive and up to date legal information covering:

  • Medical report during employment (employer’s doctor)—employee consent form

Medical report during employment (employer’s doctor)—employee consent form

IP COMPLETION DAY: The Brexit transition period ended at 11pm on 31 December 2020. At this time (referred to in UK law as ‘IP completion day’), transitional arrangements ended and significant changes began to take effect across the UK’s legal regime. This document contains guidance on subjects impacted by these changes. Before continuing your research, see Practice Note: Brexit and IP completion day—implications for employment lawyers.

Date:[insert date]
Employee name:[insert name]
Employee date of birth[insert date of birth]
Employee address:[insert address]
Employer name:[insert name]

Private and confidential

To: [insert name of doctor]

I understand that you are [an occupational health professional OR doctor] [employed by OR wholly independent of] my employer.

I confirm that I am not and never have been a patient of yours or under your clinical care.

I understand that my employer wishes to obtain a medical report from you in order to:

  1. [assess my fitness for and likely return to work;

  2. establish if there is any underlying health reason for my frequent absences from work;

  3. plan the work in my department, and assess the impact of my absence from or resumption of duties on workflow and resources;

  4. assess the effect of my condition on my day-to-day activities;

  5. consider the range of reasonable adjustments my employer may need to make;

  6. consider any short-term measures my employer can put

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