A three-party discussion between the employee, employer and occupational health looks for practical work arrangements and agrees follow-up. It is not a diagnosis or a dismissal decision. This checklist prepares the company’s meeting protocol, not a named employee’s case.
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.
Protocol responsibilities
Pre-meeting questions and confidentiality
Actual notes and follow-up
Action / agenda preparation
Agenda item / purpose
Work requirements and options
Method for agreeing next actions
Owner ROLE
Method for agreeing a date
Fictitious example
A fictitious company protocol establishes which role can prioritise workload and how a review date is selected. No employee health details or identifiable case are recorded in this preparation template.
Questions about the template
How do we prepare for a work ability meeting?
Agree the objective, necessary participant roles, investigation of work options and confidentiality arrangements beforehand.
What belongs in the actual memo?
Agreed work-related actions, responsibilities and follow-up, together with basic meeting details. Diagnoses and other confidential health information do not belong in the shared memo. This template is not the actual memo.
Who joins?
The employee, employer representative and occupational health representative, plus an agreed support person. Confirm necessary roles and practical arrangements beforehand.