An occupational health referral form is how an employer asks a qualified clinician to assess whether a worker can safely perform the essential functions of their job. To complete and submit one properly, you document a job-related reason for the referral, attach the job description, write specific questions about functional capacity (not diagnosis), obtain the employee’s written consent, and send the package to the provider through a secure channel. Each of those steps carries legal weight under the Americans with Disabilities Act, so the form is both a medical request and a compliance record.
Confirm You Have Grounds to Refer
Before any form goes out, make sure the referral itself is lawful. Under the ADA, an employer can require a medical examination of a current employee only when the exam is “job-related and consistent with business necessity.”1U.S. Equal Employment Opportunity Commission. Enforcement Guidance on Disability-Related Inquiries and Medical Examinations of Employees under the ADA That standard is met when you have a reasonable belief, based on objective evidence, that the employee’s medical condition will impair their ability to perform essential functions or will pose a direct threat to safety. A hunch is not enough. The belief must rest on observable facts.
Situations that usually meet the standard include:
- An extended absence for a serious health condition where you need to understand what a realistic return looks like.
- A pattern of frequent short absences that suggests an underlying condition affecting reliability.
- A request for workplace accommodation that needs medical input to evaluate.2U.S. Department of Labor. Accommodations
- Safety-sensitive roles where medication side effects or physical limitations could endanger the employee or others.
- A return from FMLA leave, where an employer with a uniformly applied policy may require a fitness-for-duty certification before restoring the employee.3U.S. Department of Labor. elaws – Family and Medical Leave Act Advisor
Write down the objective basis in your own file before you draft the form. That internal note is what demonstrates business necessity later if the referral is challenged.
Complete the Form
The referral form is the clinician’s only window into a job they have never seen. Vague forms produce vague reports. Specificity is the single biggest lever you have over the quality of what comes back.
Employee and Job Information
Start with the basics: employee name, job title, department, manager name, and contact details for the person at your organization who will receive the report. Then attach the written job description and describe the position’s essential functions. Under the ADA, essential functions are the basic duties an employee must be able to perform with or without reasonable accommodation, and a written job description prepared before the position was advertised counts as evidence of what those functions are.4U.S. Equal Employment Opportunity Commission. The ADA: Your Responsibilities as an Employer
Go beyond the generic description where the role has specific demands. If the position requires lifting above a certain weight, standing for most of a shift, operating heavy equipment, driving, or sustained concentration under time pressure, spell that out. The clinician needs to test the employee’s capacity against the actual requirements, not a boilerplate title.
Absence and Performance History
Include attendance for at least the past twelve months: dates out, total days missed, and any pattern you have noticed. If performance concerns triggered the referral, describe them factually. Missed deadlines, error rates, specific tasks the employee has struggled with. Don’t speculate about the medical cause. The clinician’s job is to form that view; yours is to provide objective data points.
Questions Framed Around Function, Not Diagnosis
This section is where most referral forms either succeed or fail. Ask about what the employee can and cannot do, not what they have. Useful questions include:
- Can the employee perform the essential functions listed in the attached job description, with or without accommodation?
- If not, what specific limitations exist and what accommodations would address them?
- Is the employee fit to return to work, and if so, on what date and under what conditions?
- Are the current absences likely to continue at their present frequency?
- Does the employee’s condition pose a safety risk in the described role?
- Would a phased return be beneficial, and what would a reasonable schedule look like?
Avoid asking for a diagnosis. The EEOC has been clear that employers should ask about functional limitations and the need for accommodation rather than the underlying condition itself.5U.S. Equal Employment Opportunity Commission. Enforcement Guidance on Reasonable Accommodation and Undue Hardship under the ADA A clinician can tell you “this person cannot lift more than ten pounds for the next eight weeks” without ever naming the condition, and that is the level of detail you actually need to make a workplace decision.
Employee Consent
Before anything goes to the provider, obtain the employee’s written consent to share information for a workplace assessment. The authorization should be specific about what information will be shared, time-limited, and revocable in writing. Without it, the provider generally cannot send a report back, and the whole process stalls.
Walk through the consent form with the employee. Explain the purpose of the referral, what the assessment will involve, and how the results will be used. Workers who understand the process are more likely to cooperate and to give the clinician honest information, which produces a better report for everyone.
Submit the Package Securely
Send the completed form, the job description, the signed consent, and any supporting documents through a secure channel: an encrypted portal, secure email, or certified mail. Ordinary unencrypted email is not appropriate for documents containing employee health information.
Fees vary by provider, region, and complexity. There is no standard national schedule, so confirm costs before you submit. Most providers acknowledge receipt and schedule the assessment within a few business days. If you don’t hear back promptly, follow up. Delays at the intake stage extend the whole timeline.
What the Returned Report Should Contain
A well-structured report answers each of the specific questions on your form and includes recommendations on fitness for duty, accommodations, return-to-work timelines, and any follow-up evaluations needed.
What it should not contain is the employee’s full medical history or a specific diagnosis. Under the ADA, supervisors and managers may be informed about necessary work restrictions and accommodations, and first aid personnel may be told about conditions that could require emergency treatment, but that is the extent of permissible disclosure to the employer.6Office of the Law Revision Counsel. 42 USC 12112 – Discrimination If a report arrives with more clinical detail than you need, raise it with the provider and ask for a revised version. You should not be holding information you have no right to see.
If the Employee Refuses the Assessment
Pushback happens. The first response is a clear explanation: why the referral is being made, what the assessment will cover, and how the results will be used. Many refusals dissolve once the employee understands the scope is limited to job-related functional capacity rather than a deep dive into personal medical history.
If refusal persists, your options depend on the trigger. Where the referral followed the employee’s own request for accommodation, the EEOC’s position is that an individual who refuses to provide reasonable documentation of a disability and the need for accommodation “is not entitled to reasonable accommodation.”5U.S. Equal Employment Opportunity Commission. Enforcement Guidance on Reasonable Accommodation and Undue Hardship under the ADA The employer may also send the employee to a health professional of the employer’s choice if the employee’s own provider has given insufficient information.
For referrals driven by performance or safety concerns that meet the job-related and business necessity standard, an employer who has documented the objective basis is on solid ground treating refusal as a failure to cooperate with a legitimate workplace requirement. Document the refusal in writing, including what was communicated to the employee, and consult employment counsel before any adverse action.
Store the Records Correctly
Every document in this process is a medical record. The ADA requires that medical information collected through employee examinations be maintained on separate forms and in separate medical files from the general personnel file.6Office of the Law Revision Counsel. 42 USC 12112 – Discrimination Access must be limited to the narrow exceptions the statute allows.
OSHA’s standard at 29 CFR 1910.1020 requires employers to preserve employee medical records for the duration of employment plus thirty years.7eCFR. 29 CFR 1910.1020 Records of employees who worked less than one year may be offered to the employee at termination rather than retained, but for anyone with longer tenure, the thirty-year clock does not start until they leave. That obligation survives even if the employer closes its doors, so build retention into the system that creates the file, not the one that closes it.