StartHealth · Template version 2026-10-27

Occupational-health contract review worksheet

Prepare the procurement decision by recording coverage, exclusions, charges and written provider responses. This is not a legally complete contract or a medical assessment.

Blank company-process preparation template, not an individual employee case form. Do not enter names, diagnoses, medication, absence history or identifiable case details. Use the employer’s approved secure process for real employee cases. This template does not store or submit information. Editorial process aid, not individual medical or legal advice; medical review pending.

Complete blank fields describing company procedures. Use the browser print dialog for A4 paper or PDF. The blank HTML also works offline.

Procurement scope

Charges and changes

Dates and decision

Action / agenda preparation

Contract questionWritten provider responseUnresolved term / extra costResponsible roleDecision status

Fictitious example

A fictitious 12-person company plans four recruits. The procurement owner requests a written headcount-change billing date and separate workplace-assessment price. Approval remains conditional until responses arrive.

Questions about the template

Is this a ready occupational-health contract?

No. It prepares procurement questions and a decision. Agree the actual contract with the provider.

Can an unresolved cost be entered as zero?

No. Obtain a written price or exclusion before approval.

Does completing it guarantee Kela reimbursement?

No. Kela decides based on eligible activity, documentation and cost ceilings.