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Please read and complete the questionnaire below :

 

The form below is for use of management or Human Resources to refer an employee for an Occupational Health assessment.​​​

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Please ensure you have gained the employee's consent to submit a referral form to Rockingham Occupational Health, specifically ensuring they are aware the data submitted includes their demographics, reasons for referral and information required from the assessment.  Any data you submit needs to comply with GDPR 2018 regulations (more information below).  If you have any queries, please email admin@RockinghamOH.co.uk.  If the employee has any queries either direct them to the links below or ask them to email admin@RockinghamOH.co.uk.

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General Data Protection Regulation (GDPR) 2018 – Any person who has health information held by Rockingham OH may apply for access to their occupational health records under the GDPR 2018 by applying in writing to Rockingham Occupational Health Limited.  For a brief summary of GDPR see the bottom of the consent form or for more detail see our Privacy Policy.

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The Access to Medical Reports Act 1988 – This Act does not apply in this situation, as the doctor who examines you is not responsible for your clinical care.  He is acting as an independent medical adviser to your current (or prospective) employer.  For more information on Access to Medical Records see the bottom of the consent form..

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This form is powered Cognito Forms to securely collect and manage your personal information in compliance with GDPR. You can learn more about how Cognito Forms protects your personal information in the Cognito Forms Privacy Policy.​​​

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