Do you confirm that the reason for this referral has been fully explained to the applicant and that the applicant agrees with the referral to UKIM Occupational Health & Wellbeing and understands that an occupational health advice will be available to you, the employer, with their consent advising you about how you might be able to help him/her from a work perspective taking into account the applicant’s current health problems/symptoms/underlying condition(s)

Do you confirm that the Applicant consents to UKIM Occupational Health & Wellbeing retaining relevant personal and health information as required in order to process this referral and that they understand their rights under the Data Protection Act (further information can be found at WWW.ico.org.uk) *