🪞 Transparent pricing model     

👥 In-person and 💬 Digital services

🏛️ All prices are subject to VAT

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🤔 If you are not sure: 📱 Call the accountable manager responsible for the employee's health and wellbeing or 📧 email: enquiries@workabilitysolutions.co.uk
This helps us to monitor your industry health and safety trends and tailor our services to your needs.
These details are mandatory fields on our OH portal.
🔚 If you are filling this form, but are NOT the accountable manager, please add your name to the Additional Notes at the end of this form.
📥 Use an email account that can be accessed by people responsible for ensuring the Health, Safety and Wellbeing of Employees.
Enter the name of the Accountable Manager, who is responsible for managing your Employee's Health, Safety and Wellbeing.
📥 Use an email account that can be accessed by people responsible for invoicing and remittence.
Urgent reasons for referral include: Health and/or Safety concerns not addressed in a Fit Note | Unexplained symptoms or behaviour that appear to be worse during or after work. ❗NB Only complete this section if you have an urgent referral.
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Please enter ALL the employee information as it needs to be displayed on the report. This is required to set up their SECURE employee assessment portal.
Please enter ALL the employee information as it needs to be displayed on the report. This is required to set up their SECURE employee assessment portal.
Please enter ALL the employee information as it needs to be displayed on the report. This is required to set up their SECURE employee assessment portal.
Please enter ALL the employee information as it needs to be displayed on the report. This is required to set up their SECURE employee assessment portal.
Please enter ALL the employee information as it needs to be displayed on the report. This is required to set up their SECURE employee assessment portal.
Please enter ALL the employee information as it needs to be displayed on the report. This is required to set up their SECURE employee assessment portal.
Please enter ALL the employee information as it needs to be displayed on the report. This is required to set up their SECURE employee assessment portal.
Please enter ALL the employee information as it needs to be displayed on the report. This is required to set up their SECURE employee assessment portal.
Please enter ALL the employee information as it needs to be displayed on the report. This is required to set up their SECURE employee assessment portal.
Please enter ALL the employee information as it needs to be displayed on the report. This is required to set up their SECURE employee assessment portal.
Please enter ALL the employee information as it needs to be displayed on the report. This is required to set up their SECURE employee assessment portal.
Please enter ALL the employee information as it needs to be displayed on the report. This is required to set up their SECURE employee assessment portal.
Please enter ALL the employee information as it needs to be displayed on the report. This is required to set up their SECURE employee assessment portal.
Please enter ALL the employee information as it needs to be displayed on the report. This is required to set up their SECURE employee assessment portal.
Please enter ALL the employee information as it needs to be displayed on the report. This is required to set up their SECURE employee assessment portal.
Please enter ALL the employee information as it needs to be displayed on the report. This is required to set up their SECURE employee assessment portal.
Please enter ALL the employee information as it needs to be displayed on the report. This is required to set up their SECURE employee assessment portal.
Please enter ALL the employee information as it needs to be displayed on the report. This is required to set up their SECURE employee assessment portal.
Please enter ALL the employee information as it needs to be displayed on the report. This is required to set up their SECURE employee assessment portal.
Please enter ALL the employee information as it needs to be displayed on the report. This is required to set up their SECURE employee assessment portal.
Please enter ALL the employee information as it needs to be displayed on the report. This is required to set up their SECURE employee assessment portal.
Please enter ALL the employee information as it needs to be displayed on the report. This is required to set up their SECURE employee assessment portal.
Please enter ALL the employee information as it needs to be displayed on the report. This is required to set up their SECURE employee assessment portal.
Please enter ALL the employee information as it needs to be displayed on the report. This is required to set up their SECURE employee assessment portal.
Please enter ALL the employee information as it needs to be displayed on the report. This is required to set up their SECURE employee assessment portal.
Please enter ALL the employee information as it needs to be displayed on the report. This is required to set up their SECURE employee assessment portal.
Please enter ALL the employee information as it needs to be displayed on the report. This is required to set up their SECURE employee assessment portal.
Please enter ALL the employee information as it needs to be displayed on the report. This is required to set up their SECURE employee assessment portal.
Please enter ALL the employee information as it needs to be displayed on the report. This is required to set up their SECURE employee assessment portal.