Occupational health checks and references: the order of checks
Health questions wait until after the offer. References can start the moment you have consent. Here is how the two fit together.
What is an occupational health check?
An occupational health check, which NHS Employers calls a work health assessment, is a confidential review by an occupational health professional of whether someone can do a role safely, with any reasonable adjustments. In healthcare it usually covers immunisations too. It takes place after a conditional offer, because the Equality Act limits health questions before an offer. RefAssure does not do OH checks; it handles the references.
What happens in a work health assessment?
Work health assessment is one of the six NHS employment check standards published by NHS Employers. The guidance applies to employees, temporary and agency workers, students, trainees and volunteers starting a new NHS role or moving to a significantly different one.
Who carries it out
Occupational health practitioners, or other suitably trained professionals depending on local protocol, review the information the candidate provides. Complex cases go to the occupational health service. For agency workers, NHS Employers notes the assessment may be done by a SEQOHS accredited provider. The recruiting manager makes the final appointment decision, taking OH advice into account.
What it covers
- Fitness for the role: whether the person can carry out the duties, and what reasonable adjustments might help.
- Immunisations: healthcare employers must make sure staff do not pose an infection risk to patients, following the UK Health Security Agency Green Book.
- Exposure prone procedures: roles involving EPPs need extra screening for blood-borne viruses.
Confidentiality
Health information should be held separately by occupational health, not on the personnel file. The manager receives a fitness outcome and any recommended adjustments, not the medical detail, unless the individual agrees.
Care providers have a parallel duty. Regulation 19 expects CQC registered providers to be satisfied that staff are able, after reasonable adjustments, to do the work. See CQC Regulation 19.
Where occupational health sits in the order of checks.
Interview and selection
No health or sickness absence questions yet, apart from the narrow exceptions such as adjustments for the interview.
Conditional offer
Make it clear in writing that the offer depends on satisfactory pre-employment checks, including occupational health.
Checks run together
References, identity, right to work, DBS, registration and the work health assessment can all run in parallel.
Confirm and start
Once every check is satisfactory, confirm the start date. References that started early keep the timeline short.
Keep health out of early references.
Section 60 of the Equality Act covers questions asked by or on behalf of an employer, which is generally taken to include questions put to referees.
Leave out sickness questions pre-offer
Many employers drop sickness absence and health questions from references sent before an offer. Ask about health through OH instead.
Ask about conduct and capability
Dates, role, performance, conduct, disciplinary action and safeguarding concerns are the substance of a reference.
Store health separately
If health information arrives in a reference by mistake, pass it to OH and keep it off the personnel file.
One reference template, no health questions.
Build your template once with the questions your organisation expects, so every reference asks the same thing.
- Short text, paragraph, yes/no, 1 to 10 rating, date and date range questions
- Up to 25 questions per template, up to 10 templates per account
- Upload your current PDF or Word form and it becomes a template in about 20 seconds
- Referees chased with 5 emails and up to 2 texts over 12 days
Occupational health check questions
More in the full FAQs.
Is an occupational health check a medical?
Not usually. Most start with a confidential health questionnaire reviewed by an OH professional. A consultation or examination follows if the role or the answers need it.
Can an employer ask health questions before a job offer?
Generally no. Section 60 of the Equality Act 2010 restricts health and disability questions before an offer, with narrow exceptions such as interview adjustments or checking someone can do a function intrinsic to the job. Take HR advice if you are unsure.
What is a work health assessment?
It is the NHS Employers name for the occupational health check. It is one of the six NHS employment check standards, alongside identity, right to work, registration, criminal record checks and references. See NHS pre-employment checks.
Can an offer be withdrawn after an occupational health check?
An offer is normally conditional on satisfactory checks. If the outcome relates to a disability, you must consider reasonable adjustments first, or you risk discrimination. Take HR or legal advice before withdrawing.
Who sees the occupational health report?
The detail stays with occupational health. The manager normally receives a fit or not fit outcome with recommended adjustments. Further detail needs the individual's consent.
Does RefAssure do occupational health checks?
No. RefAssure collects references and employment history, with consent, chasing and a signed PDF. Use an occupational health provider for the work health assessment. See how RefAssure works.
Related guides
Start references while OH does its part.
Your first reference is free. Then from 80p, no monthly fee.