4.11 Management Referral Form

This form is to be completed by the employer or manager.

REQUIREMENTS / MAIN FEATURES OF THE JOB

KNOWN HAZARDS

Please upload a copy (in PDD, JPG, DOCX, DOC format) of the last two years sickness absence records with diagnosis or copies of med 3 (GP sick notes)
 
Fields with a red star are required

IMPORTANT NOTICE: AUSSIE FLU ON INCREASE. PROTECT EMPLOYEES WITH FLU VACCINE (only £7+VAT each while stocks last).

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