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Please complete the form below and click submit to place your request to ��APP occupational health service. By submitting this form, you will be giving your consent to process your request.

Failure to complete this form accurately may result in a delay of processing your request.

Detail of request

I would like to request a copy of my Occupational Health Record

Please DO NOT include any Psychology Records

Please DO NOT include any Counselling Records

Personal Details:

First name(Required)

Surname(Required)

Any previous names (e.g birth name)

Date of birth(Required)

Email(Required)

Mobile / Tel(Required)

Main postal address including post code(Required)

Employment Details

Department(Required)

Please state your last/current department and work location within the organisation

Job title(Required)

Please state your last/current job title held within the organisation

How would you wish to receive the requested information?(Required)

Page last updated: 22/06/2026

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Request for occupational health records

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Detail of request

Personal Details:

Employment Details

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