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

Major repair work on M5 Oldbury Viaduct, between jcts 1 & 2. If visiting us, please allow extra journey time.

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