Occupational Medicine Fitness-for-Duty Evaluation Referral Form

Streamline Workplace Health Assessments with a Professional Fitness-for-Duty Referral Form

Managing fitness-for-duty evaluations for safety-sensitive positions requires clear documentation, seamless provider communication, and compliance-ready records. This Occupational Medicine Fitness-for-Duty Evaluation Referral Form is designed specifically for occupational health clinics, HR departments, and healthcare providers who coordinate workplace health assessments.

Whether you're referring an employee for medical clearance after an injury, requesting accommodation assessments, or fulfilling employer-mandated health screenings, this template captures all the critical information evaluators need—job demands, safety concerns, medical history context, and specific evaluation requests—in one organized, professional format.

Built for Occupational Health Workflows

This form helps occupational medicine providers, HR teams, and safety managers coordinate evaluations efficiently. It includes fields for employee information, job classification, specific physical demands, reason for referral, medical history summary, and detailed evaluation requests. The structured format ensures evaluators receive complete context for accurate fitness determinations while maintaining OSHA and workplace safety compliance documentation standards.

How Paperform Enhances Your Referral Process

With Paperform, you can customize this template to match your clinic branding, add conditional logic to show relevant fields based on referral type, and integrate directly with your practice management system or HR platform. Use Stepper to automate follow-up workflows—send confirmation emails to referring providers, notify evaluators of new referrals, update employee records, and trigger reminder sequences for pending clearances.

The intuitive form editor lets your administrative team update job classifications, add new accommodation categories, or modify evaluation criteria without technical support. Since fitness-for-duty documentation often requires provider signatures, you can seamlessly connect this form to Papersign to collect secure eSignatures on clearance letters and accommodation recommendations.

Trusted by Healthcare and HR Professionals

Occupational health providers, corporate wellness teams, and HR departments trust Paperform for professional, compliant forms that protect both employees and organizations. With SOC 2 Type II compliance, encrypted data handling, and robust access controls, your sensitive health information stays secure while remaining accessible to authorized team members.

Get started with this fitness-for-duty referral template today and create a faster, more reliable evaluation process that keeps your workplace safe and compliant.