mail Address

Appendix A Occupational Health Department, Willow House,

Antrim Hospital, 45 Bush Road, Antrim, BT41 2RL Tel 028 9442 4401 Fax 028 9442 4402

Occupational Health Referral

Information

Management referral of staff to Occupational Health is an important step in assisting both employer and staff in reducing the impact of work on health or health on work. While the details of consultation are confidential, the manager will receive information that allows them to make decisions on the individual case. The reports are worded in terms of prognosis, disability, restricted duties and fitness.

To Manager

It is important to discuss the reasons for referral with your member of staff, to complete the referral form and forward the completed documentation to Occupational Health.

Process

Staff will be given an appointment following which a report will be sent to the referring manager.

Occasionally further information is required from the member of staff’s family doctor or consultant specialist and this may lead to a delay in the furnishing of a report. Occupational Health may need to review staff until the medical condition has resolved or become static before a definite medical opinion can be given.

Staff details Manager details

Name

(Mr/Mrs/Miss)

Name

(Mr/Mrs/Miss)

Date of birth Signature

Address

Mental Health and Disability

Planning Performance Mgt &

Support Services

Structured Referral

Current situation and member of staff’s comments at last absence meeting Date person went off duty if applicable

Please advise is employee:

Fit for full range of duties in their own post

Fit for majority of duties in their own post – please state what elements they are not fit for

Fit for other work in the Trust – Please specify.

Required duties specific to post e.g. driving, display screen work, manual handling, working with chemicals (attach job description).

Absence record including dates, and reasons if known (attach details or a printout from HRMS)

Management concerns regarding member of staff’s state of health and impact of absence/situation in the workplace

Reason for referral and specific questions to be answered

(Please include measures which have been, or could be made to facilitate early return to work)

I confirm that I have discussed the purpose and reason for this referral with the member of staff and given them a copy of the completed referral form

Name ______________________________

Signature ____________________________

Date _______________________________

Appendix B Staff in Confidence

Notification of Foreign travel for Health Care Workers

This should be completed by the member of staff and manager, and forwarded to Occupational Health, Willow House, Antrim Hospital, Bush Road, Antrim BT41 2RL

Surname First Name

Male/Female Dr, Mr, Miss,

Ms

Post Title Base/Dept

Daytime Telephone Countries to be visited

Date of Travel Expected

return to UK Date

Purpose of trip Accommodation Type

Holiday Hotel

Visiting relatives Back Pack

Working in health care Staying with relatives

Other work Hostel

Study Other

Receiving Health Care

Appendix C

Return to Work Interview

Section A - to be completed by staff during the first day of return to work following sick leave

Name:

Grade:

Department:

First day of absence:

Last day of absence:

Number of days absent:

Reason for absence:

Section B – to be completed by your manager Return to work interview

carried out by:

Held on (date):

Notes/Comments:

Signature of manager: ____________________________________ Date:

___________

Signature of member of staff: ______________________________ Date:

___________

This form should be retained by the manager, and

copied to the member of staff

Appendix C continued Conduct of Return to work interviews (attach to back of return to work interview form)

The manager should make contact with each member of staff on return from sick leave. The return to work interview should be held on the day of return or as soon as practicable. This is usually a face to face meeting, however, in exceptional circumstances, such as in the case of home care workers or staff in remote locations, managers may conduct the return to work interview by telephone. The return to work interview proforma should be completed on each occasion even if conducted over the telephone, and kept by the manager. A copy should be given to staff.

In general:

• Organise the space and timing of the meeting carefully.

• Make sure that the meeting takes place in as private a setting as possible with no interruptions and that seating arrangements have been thought through.

• Apart from return to work interviews, staff may be accompanied at meetings held under the Managing Attendance protocol by a trade union representative or work colleague.

• Recognise that such meetings can be difficult for both the manager and the member of staff and that a heated discussion is not helpful. If discussions become heated, the meeting should be adjourned for a short time.

• Managers should always remember they are not medically trained and should not attempt to explore in any depth the clinical details of an absence. They should concentrate or limit their enquiries to whether the member of staff is seeking and receiving help from their doctor and to what extent their condition affects their ability to attend regularly to carry out their duties effectively while at work.

The objectives of the return to work discussion are:

• to demonstrate interest and concern for staff.

• to make sure the member of staff has not returned to work too early for the interest of client/patient care or other health and safety risks. If a manager is concerned they should contact Occupational Health for advice.

• to identify at an early stage any underlying reasons for absence and make sure that appropriate assistance is given. Managers should immediately refer a member of staff to Occupational Health whose absence is for stress, injury at work, musculoskeletal problems, following maternity leave, where a member of staff is the victim of a violent incident at work, or when the member of staff has claimed harassment. Where cases of absence have involved drug, alcohol or substance misuse, these should be dealt with under the Workplace Drugs and Alcohol policy, in conjunction with this policy.

• to assist in the monitoring of the member of staff’s sickness record and identify at an early stage any developing patterns of sick leave.

• to advise, as appropriate, what stage of the Managing Attendance Protocol has been reached.

• to make sure that any necessary action is taken at the appropriate time and to advise the member of staff as to what action will be taken, e.g. arrangements made for referral to occupational health after 3^rd period of short-term absence.

• to update the member of staff of what has been happening during their absence from work/work commitments.

• explain to the member of staff the importance that the Trust places on good attendance.

• any faults of conduct, such as, not adhering to the notification procedure, failing to submit self/medical certificates, not attending Occupational Health appointments, can be addressed.

Appendix D

Appendix E

Record of Sickness Absence Notification (to be held by Manager)

Name:

Grade:

Department/directorate:

Contracted hours:

Absence lasting 1 – 3 calendar days Date call received Action taken in respect of illness Any work to be undertaken Name

(of manager/nominated deputy receiving call)

Signed:

Print:

Continued absence of 4 - 7 calendar day Date call received

Continued absence of 8 calendar days or more Date call received

Appendix F Absence Meeting – Checklist for Managers (to be used in conjunction with Managing Attendance protocol and flowcharts for management of short/long term absence)

Member of staff:

Member of HSC Pension scheme : Yes/No 1995 or 2008 Scheme : _____________________

Present: Manager:

Accompanied by:

Date/Time/ Venue Stage in protocol

Areas to be covered:

Pointers: Tick Notes:

Introduction Make necessary introductions

Remind employee of stage in the process

Ask employee how they are/ progress since last meeting Have up to date sickness absence information available at the meeting (if necessary sickness print can be obtained from Payroll department), review with the employee, and remind employee that due to the number of absences, length of absence to date the meeting is being held in accordance with the Trust’s

Managing Attendance protocol and confirm stage in the protocol.

Current situation

If appropriate, ask likely date of return to duty