# Occupational-health contract review worksheet

StartHealth · Template version 2026-10-27

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.

## Procurement scope

- Company / unit: ____________________
- Company version and date: ____________________
- Decision owner ROLE: ____________________
- Description of work and working locations: ____________________
- Coverage: employees and entrepreneurs separately: ____________________
- Preventive service scope: ____________________
- Optional medical-care scope: ____________________
- Excluded services and usage limits: ____________________

## Charges and changes

- Unit prices and separately charged items: ____________________
- Recurring fees and billing period: ____________________
- Setup and workplace-assessment charges: ____________________
- Device charges and ownership if applicable: ____________________
- Headcount-change channel and responsible role: ____________________
- Effective billing date for headcount changes: ____________________
- Price-change terms: ____________________

## Dates and decision

- Starting date to agree: ____________________
- Ending date / fixed term: ____________________
- Notice terms and end-date calculation: ____________________
- Confirmation of old/new provider transition: ____________________
- Decision status: open / conditional / approved / rejected: ____________________
- Next decision checkpoint: ____________________

## Action / agenda preparation

| Contract question | Written provider response | Unresolved term / extra cost | Responsible role | Decision 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.

### 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.

## Source and scope

Original editorial template, not a reproduction of a TTL form. Source checked 2026-10-27.

- TTL: https://www.ttl.fi/teemat/tyoterveyshuolto/miten-hankin-tyoterveyspalvelut
- StartHealth: https://starthealth.fi/en/guides/occupational-health-contract-finland