Request Letter for Medical Examination Template

Request For Medical Examination for Persistent And Prolonged Sickness


The Request for Medical Examination Letter is sent by the employer to the employee in cases of prolonged or persistent absence. This letter includes the 'fit note' requirements.

The Sickness and Absence Policy provides for the Company to be sympathetic to cases of genuine illness or incapacity, and states that prolonged or persistent absence may be investigated.

It further states that where there is concern for an employee’s health and his/her ability to carry out their work, the Company reserves the right to seek medical opinion(s) by asking the employee to agree to undergo an independent medical examination and/or obtain a report from the employee’s own doctor.

Refusal by the employee to agree to an independent medical examination and/or releasing a report from the employee’s own doctor may lead to the commencement of the Company's Disciplinary Procedures and Policy.

However, prior to any letter being sent to the employee the employer should thoroughly investigate the reasons for the absence and consult with the employee in this regard. A first meeting should involve a recorded discussion of the problem e.g. backache, headache, migraine. Medical advice should be recommended and where appropriate, a period of time for improvement should be allowed. If problems persist, you should consider whether the employee has taken all available help, seek permission to approach his GP and/or obtain the agreement of the employee for an independent medical examination.

A record of the Absence Self Certificate form(s) and Absence Return to Work form(s) should be kept and analysed to establish the history and patten of absences.

This Request for Medical Examination Letter template is in open format. Either enter the requisite details in the highlighted fields or adjust the wording to suit your purposes.