# OCCUPATIONAL HEALTH REFERRAL
Date: 22 February 2032
Parties: Larkfield Foods Ltd, Emma Lewis and West County Occupational Health
## 1. Purpose and parties
Larkfield Foods Ltd refers Emma Lewis, a Quality Assurance Technician employed since 5 May 2026, to West County Occupational Health with her informed consent. Emma has been absent since 3 February 2032 and has provided fit notes stating that a phased return may be appropriate from 1 March. The referral seeks work-related functional advice, not a diagnosis.
## 2. Facts, scope and terms
Emma's normal work is 37.5 hours over five days at Larkfield's Gloucester site. She conducts production-floor inspections, records results on a tablet, handles samples up to 8 kilograms and occasionally works in a chilled room for up to 45 minutes. Her supervisor has not asked for her full medical records and will use only relevant advice.
## 3. Process and responsibilities
Please advise whether Emma is likely to return on or after 1 March, what hours and duties would be reasonable initially, and what restrictions or adjustments may assist. Please consider seated work, additional screen breaks, avoiding chilled-room duties for four weeks and a temporary lifting limit of 3 kilograms. Please give expected review dates and whether advice should be revisited.
## 4. Evidence, records and safeguards
The proposed plan, subject to clinical advice, is 10:00 to 14:00 on Mondays and Wednesdays from 1 March, increasing by one hour each week if tolerated, with no chilled-room work and no lifting above 3 kilograms for the first four weeks. Emma would work on records and desk-based quality checks. This is provisional, not a medical instruction or guaranteed outcome.
## 5. Review, escalation and outcome
Please comment on functional capability, likely duration and workplace adjustments, and whether Equality Act 2010 disability considerations may be relevant. Do not disclose a diagnosis to Larkfield unless Emma gives specific consent or disclosure is otherwise lawful and necessary. The report should be sent to Emma first, allowing her to understand it and exercise any applicable report-access rights before employer release.
## 6. Reservations and practical protections
Emma may withdraw consent before the assessment or decline to answer questions. Larkfield will not ask West County for unrelated history, will keep the report confidential with restricted HR access, and will consult Emma before changing duties. Attendance and capability will be managed fairly; the referral is not a disciplinary allegation and does not prejudge dismissal or ill-health capability action.
## 7. England and Wales law and completion
This completed fictional referral is dated 22 February 2032 and concerns England and Wales. West County should contact Emma at 07700 901122 and copy the report only to HR Manager Leah Green at a secure address. Larkfield will review the arrangement with Emma on 15 March and 29 March, consider alternatives and document decisions proportionately under data-protection and employment law.