Absence, Leave and Sickness

The role of the Occupational Health Service is to provide specialist medical advice to line managers regarding a staff member's medical condition and their fitness to work, and to make recommendations with regard to adjustments, restrictions and any specific advice required by the line manager (where appropriate).

Their advice is based on factual evidence obtained from the following:

• Full background to the case e.g. absence records, job demands etc. 
• Medical assessment including physical examination where relevant.
• Workplace assessment where relevant. 
• Monitoring of the progression of a case over a period of time. 
• Reports obtained from an employee's Doctor (GP) or Specialist. 

The role of OH is not to make decisions about a staff member's continuing employment, redeployment, or future deployment. These decisions are made by management and should take into account the advice of the Occupational Health Physician, along with on other factors such as service demand, risk assessment of health and safety considerations, legal framework and financial constraints. 

Access to Occupational Health Services is through line management referral and/or Human Resources  (HR) team.  An OH referral may only be undertaken by the employee’s manager or HR. If an employee’s GP recommends referral to OH, HR should be informed so that they can make arrangements. HR should be informed of any referrals in order to monitor the service and its usage as well as provide additional advice if required.

The Occupational Health Service at City St George’s is provided by Cordell Health. As part of the integration process, Cordell Health became the Occupational Health provider for staff on the Tooting campus from 1 August 2026. Please note, any referrals from 17 July will be made to Cordell Health. Below is a range of services they provide and guidance for Managers and employees.

All staff are required to undergo occupational health clearance on employment. Please read the information below on the pre-employment medical clearance process. This process involves the: 

Completion of a Confidential Medical Questionnaire

Candidates are sent a medical questionnaire with their job offer letter. The candidate completes the medical questionnaire and returns the form directly to the Occupational Health Service. The questionnaire is seen by Occupational Health Service staff only. 

It is possible that the candidate will be asked to attend the Occupational Health Service for an assessment. This process is intended to ensure the health and safety at work of the appointed candidate within the context of the job and their health status. For some posts candidates may need to undergo health surveillance or need vaccines in order to comply with health and safety legislation. These appointments are arranged by HR but no medical information is disclosed to HR staff. 

Occupational Health may require further information from the candidate's GP or specialist to assist in the process. This can only be undertaken with the candidate's written consent. Obtaining reports can take between 4-6 weeks on average. 

Final Clearance Stage

Once all necessary assessments have been carried out OH will notify HR of the candidate's fitness to undertake the job, together with information on any restrictions that may be required. The statement of fitness does not include medical information. 

At this point the offer of employment can be confirmed (subject to any other pre-employment checks being carried out). 

The primary purpose of a management referral is to assess fitness for work in relation to any health problems the individual may have developed, making sure the individual is fit to perform the tasks involved effectively and without significant risk to their own or others’ health and safety. It is not the intention to exclude a person from their work, but to make any necessary reasonable modifications or adjustments to the job to allow the employee to work efficiently and safely. In all situations there is a legal requirement to explore and consider reasonable adjustment options if the individual has a disability within the definition of the Equality Act 2010, and it is good practice to do so in any case where appropriate.

This guidance below clarifies the roles and responsibilities of those involved when a management referral is made and clarifies the procedure to be followed. Further detailed guidance is available in City St George’s University Policy website.

Consent

It is essential that the role and responsibility of the OH service is clearly understood by those being referred. Prior to a referral to OH it is imperative that line managers have discussed the reason for the referral with their team member and that the staff member has given consent for the referral to take place. The staff member will be given a consent form by OH which explains the process, which they will need to sign before a report can be released. 

Reasons for referral

Staff members may be referred for an occupational health assessment in the following situations: 

• Long term (20 working days) or continuing sickness absence. 
• For advice on any restrictions or job modifications required either in the short term or long term. 

Or:

• Where there is not a clear indication of a likely date for return to work. 
• Persistent or recurrent short term absence amounting to more than 12 calendar days or 6 periods of sickness absence in a period of 12 months. 
• Where there is concern that the employee may have work related health problems or that existing health problems are being aggravated by the duties of the post. 
• Where health may be an underlying factor or contributory factor in performance or disciplinary issues. 
• If the employee or line manager wishes to consider re-deployment, dismissal, or retirement because of health reasons. 
• In order to identify how the organisation can help an employee manage a health problem or disability e.g. advice on working patterns, modification of equipment, provision of assistance at work. 
• When an employee is pregnant and has a specific health concern. Line managers are required to undertake a local pregnancy risk assessment for the employee. 
• When an employee discloses they have a drug or alcohol problem. 
• When health surveillance is identified as necessary as a result of a risk assessment. 

1. Written referral with consent

All referrals to the Occupational Health (OH) Service must be in writing using the Management Referral Request form (see forms section below). Line managers should discuss the need for an OH referral with their local HR team via hrhelp@sgul.ac.uk.

The quality and clarity of advice provided by the Occupational Health service depends largely upon the background, detail, and specific questions provided by line managers and HR for each referral. 

When the Management Referral Request form is completed please send it to your local HR Adviser who will complete the HR section of the form and send it to OH. 

2. Specific questions

Referrals should specify: 

1. The main concerns and the reason for the referral (see section 2 of the form - Reason for Referral) 
2. Specific questions which line managers may wish to ask include: 
   1. "Is there any underlying medical condition to account for the sickness absence, behaviour, performance etc?" 
   2. "Is it possible to predict a likely date for a return to work?" If a date has been set beyond which continuing absence cannot be accommodated 
   3. "Will the staff member be fit to return to work by (date)?" 
   4. "Are any restrictions required?" 
   5. "Is there any medical reason why the staff member cannot undertake the duties of the post regularly and efficiently in future?" 
   6. "Is there a need to seek alternative employment?" 
   7. "Is there any additional help or support which can be recommended?" 

3. Background information

In order for the Occupational Physician to provide a full opinion to line managers, they should be fully informed of the background to each case including the: 

• precise nature of the duties and responsibilities of the post including details of any hazards (e.g. copies of risk assessments) and a job description. 
• relevant employment details, length of service, nature of working environment, together with any capability, disciplinary or industrial injury issues if relevant to the referral. 
• details of the sickness absence. Of particular importance is a summary of the duration and reasons for the sickness absence so that the Occupational Physician can discuss this with the staff member. Line managers are encouraged to ensure that medical certificates are sent to HR promptly and that sickness absence records are kept up to date. 

NB: If termination of employment / medical ill health retirement is being considered as a possible action this must be made clear in the referral so that a firm prognosis can be provided. 

4. OH appointments

Following receipt of a management referral form an appointment will be arranged by OH for the staff member to be assessed by an Occupational Health Physician or Occupational Health Nurse. 
An appointment will be offered routinely within 2 weeks of the date of receipt of a referral. In exceptional circumstances e.g. very severe or terminal illness it may not be necessary for the staff member to see the Occupational Health Physician and recommendations may be made on the basis of medical reports received from doctors responsible for the staff member's medical care.

5. Informal Discussion and Advice 

HR Advisers/Managers/ Business Partners are encouraged to discuss difficult or complicated referrals with the Occupational Health Physician or Occupational Health Advisor on an informal basis, so that they can establish how the OH service can help in a particular case. 

The Occupational Health Physician's report

Following the assessment the Occupational Health Physician/Advisor will provide a written report detailing their opinion and recommendations as appropriate. This may include: 

• An opinion about fitness to work. 
• A prediction about the likelihood of a return to work. 
• An opinion about whether work factors or hazards have contributed to ill-health or sickness absence and how these could be modified. 
• Recommendations about restrictions or modifications which could be made in job content or working arrangements. 
• Advice about fitness for alternative duties. 
• Suggestions regarding help or support which the University and /or other agencies could offer. 
• Advice about the necessity of further assessment or monitoring. An opinion about whether or not previous sickness absence was genuine will not be provided as it is impossible to ascertain this retrospectively. 

Where relevant the Occupational Health Physician will make reference to the Equality Act, RIDDOR (Reporting of Injuries, Diseases and Dangerous Occurrences Regulations) or other relevant legislation. 
Detailed clinical information will not be included in the report and specific diagnoses may be withheld. A full report may not be available after one consultation and where the occupational health assessment process is likely to be prolonged, an indication of the likely time scales and any delays will be given in so far as is possible. 

A copy of the written report will be provided to the staff member in accordance with current recommendations on good practice for Occupational Health Physicians. 

• Management Referral Request Form (Word).

Once the form is completed please send it to the local team hrhelp@sgul.ac.uk who will complete the HR section of the form and send it to OH. 

The Employee Consent for an Occupational Health Report Form is provided to the staff member being referred by the Occupational Health Physician or Occupational Health Nurse, who will ask them to read and sign it. 

For further information on management referrals please see: 

• Manager's Guide - Case Management Referrals (PDF)
• Employee's Guide to Occupational Health referrals (PDF).

Please also see below for Health Surveillance Forms:

• Research Passport Health Questionnaire (Word)
• Health Surveillance and Monitoring policy (Word).