What this is
What is a support referral record?
What is a support referral record?
It records that a worker was pointed towards employee assistance, occupational health or an external service, and who made the offer. It does not record why, what was discussed, or what came of it. The record's value is proving the offer was made, not documenting the worker's situation.
Why is it deliberately minimal?
A worker who believes asking for support creates a paper trail their manager can read will stop asking. The Record Confidentiality field states the design directly: management is told only that a referral occurred and was offered, never the reason, diagnosis or outcome, and clinical detail is held separately by occupational health.
What does Worker Consent Obtained actually cover?
Consent to notify the employer that a referral was made, nothing more. No reason, diagnosis or outcome is shared under that consent, and withdrawal is the worker's right at any point, which is why the field is scored and required rather than assumed.
Scope
When is a support referral record required?
This record proves a referral to support was made and offered. It does not assess anyone's mental health, and using it to capture the reason for a referral undermines the confidentiality the whole design depends on.
Use this template when
- A worker was pointed towards employee assistance, occupational health, or an external support service
- The referral follows a workplace incident, and may need to extend to witnesses as well as the injured worker
- The referral is self-initiated, manager-suggested, raised by a colleague, or follows an incident
- A new record is needed; each gets its own ID in the form SUP-2026-000
- A linked record needs this one to exist against it: Worker
Do not use it for
- Wellbeing Survey, which asks workers generally about workload, support and coping, not a specific individual referral.
- Psychosocial Risk Assessment, which assesses workplace factors affecting mental health as a hazard, not a single referral event.
- Workload Review, which reviews whether workload and staffing are sustainable for a team, not an individual's support pathway.
- Fitness for Duty Assessment or Impairment Concern Record, which assess capacity to work; this record signposts support and assesses nothing.
- Anything outside KnowHealth, which belongs in the workspace that owns that process
Compliance mapping
Which Privacy legislation requirements does this satisfy?
No single instrument names a 'support referral record'. The obligation comes from data protection law treating health-related information as a distinct, higher-protection category, which is why this record is built to avoid holding any.
| Clause | Requirement | Where it lands |
|---|---|---|
| UK GDPR / GDPR Art. 9 | Special category health data processed only under an applicable condition, explicit consent being the relevant one here | Header |
| UK GDPR / GDPR Art. 5(1)(c) | Personal data collected limited to what is necessary; reason, diagnosis and outcome excluded from this record by design | Header |
| UK GDPR / GDPR Art. 5(1)(c) | Data minimisation applied to free-text fields recording surrounding circumstances, not clinical detail | Context |
| UK GDPR / GDPR Art. 5(1)(f) | Personal data processed with appropriate security, including restricted access to those with a genuine need | Support offered |
| UK GDPR / GDPR Art. 5(1)(e) | Data kept no more widely than necessary, not duplicated into a general personnel file | Support offered |
| UK GDPR / GDPR Art. 7(3) | Consent capable of withdrawal at any time, with processing that depended on it stopped from that point | Follow up |
What it does not cover
- Wellbeing Survey, a general workforce instrument, not a record of one worker's referral.
- Psychosocial Risk Assessment, which assesses workplace hazards, not an individual support pathway.
- Fitness for Duty Assessment, which assesses capacity to perform a role; this record makes no assessment at all.
- Impairment Concern Record, which documents a specific capability concern, the opposite of this record's no-detail design.
- Occupational health's own clinical file, held entirely separately, referenced by this record but never merged into it.
Global
Support Referral Record requirements by country
Every major privacy regime treats health-related information as more sensitive than ordinary personal data, but the specific rule this record's design tracks most closely differs by jurisdiction.
UK GDPR and GDPR, Article 9 (special category data)
Health-related data requires explicit consent or another Article 9 condition before it can be processed at all.
Recording more than 'a referral occurred' without a separate lawful basis is itself the compliance failure, independent of any workplace outcome.
Americans with Disabilities Act, 42 U.S.C. §12112(d)
Employee medical information must be kept confidential and stored in files separate from the general personnel file.
No Record Kept In Personnel File mirrors a specific statutory filing requirement here, not just good practice this record happens to follow.
Privacy Act 1988 (Cth), Australian Privacy Principles 3 and 6
Health information is 'sensitive information', requiring consent to collect and a stricter permitted-use test than ordinary personal information.
The same minimisation logic applies through a different statute, with collection itself, not only later use, requiring consent.
How to complete it
How to complete a support referral record, step by step
The fields are short and mostly yes or no. The judgement calls below are about restraint: what not to write, more than what to tick.
Factors Identified and any other free text should describe whether work was a factor, not what was actually discussed. Thoroughness in this field is not the goal; restraint is.
Consent obtained to notify the employer a referral was made does not extend to a broader disclosure later, however reasonable that later disclosure might seem in the moment.
Others Affected By Same Event is a judgement call about who witnessed a serious incident, not only who was hurt by it. Extending the offer to witnesses is a deliberate decision, not an afterthought.
This has to be checked, not asserted. A copy sitting in a manager's own folder or an HR case system still counts as a record kept, whatever this field says.
What auditors find
Most common support referral record findings
These recur because the fields most likely to leak detail are free text or informal conversation, neither of which this record can enforce restraint on by itself.
| Finding | Clause | What fixes it |
|---|---|---|
| Reason for referral or diagnostic detail recorded in Factors Identified or elsewhere on the form. | UK GDPR / GDPR Art. 5(1)(c) | Strip free text to whether work was a factor; remove any clinical detail. |
| Referral discussed with the worker's manager beyond the fact that a referral was made. | UK GDPR / GDPR Art. 9 | Confirm the referrer communicated only the fact of referral, never detail, outside occupational health. |
| A copy of the record retained in the general personnel file. | UK GDPR / GDPR Art. 5(1)(e) | Store separately, restricted to occupational health and HR on a need-to-know basis. |
| Consent obtained once and treated as covering ongoing check-ins indefinitely, without honouring withdrawal. | UK GDPR / GDPR Art. 7(3) | Reconfirm Worker Sets The Terms Of Contact at each check-in, and stop on withdrawal. |
| Consent To Any Sharing Obtained marked Yes without recording what was shared or with whom. | UK GDPR / GDPR Art. 5(1)(b) | Log the specific onward disclosure and its purpose, not a blanket yes. |
| Witnesses to a serious incident not offered support because only the injured worker's referral was logged. | Health and Safety at Work etc. Act 1974, s.2 | Assess and offer support to those affected by the same event, not only the person named on the record. |
Case in point
Case in point: the note that outlived the referral
A manager referred a worker to the employee assistance programme after a difficult period, obtained verbal consent to tell HR a referral had been made, and added a short note to the worker's personnel file so 'nothing would be missed at appraisal time'. The note named the specific personal circumstance the worker had disclosed in confidence.
Eighteen months later, an unrelated manager conducting a routine personnel file review read the note while checking something else entirely, and mentioned it in a team conversation assuming it was common knowledge. The worker's complaint that followed was not about the referral, which had been offered appropriately, but about a diagnosis-adjacent detail that should never have existed anywhere accessible outside occupational health.
The template
The template, field by field
The form exactly as it installs. Every field, option, score and conditional rule is editable, and the links to other templates come with it.
4 sections
- Reference
- HLT-026
- Archetype
- Record
- Record ID
- SUP-2026-000
- Scoring
- Not scored
- Direction
- n/a
- Singleton
- No
- Basis
- Privacy legislation
- Links
- Links Worker
- Tags
- Wellbeing, Support
- Sections
- 4
- Fields
- 41
- Follow up fields
- 5
- Repeating sections
- 0
- Links out
- 3
Header
15 fieldsReferral ID*
Auto sequence. Format SUP-2026-000.
The record's own ID. Other templates point at this value.
Status*
Drives who this goes to next.
- Planned2 pts
- In progress2 pts
- Complete3 pts
- Deferred0 pts
- Open0 pts
- Closed3 pts
- Overdue0 pts
Date and Time*
Completed By*
Site*
Site ID*
Format SITE-000.
Links to FDN-001 Site ID
Worker*
Person ID*
Format PER-0000.
Links to FDN-003 Person ID
Record Confidentiality
Referral details stay with occupational health and the referrer. Management is told only that a referral was made and offered, never the reason, diagnosis or outcome. Restrict access to this template accordingly.
Clinical Detail Held Separately*
- Yes3 pts
- No0 pts
Access Restricted To Occupational Health*
- Yes3 pts
- Partly1 pt
- No0 pts
Worker Consent Obtained*
Consent to notify the employer that a referral was made. No reason, diagnosis or outcome is shared. Withdrawal is the worker's right.
- Yes3 pts
- No0 pts
Signpost, Do Not Diagnose
A manager's job is to notice, ask, listen and point toward help. It is not to assess mental health or offer treatment, and attempting to usually makes things worse.
Referral Type*
Self referral, manager suggested, colleague concern, or following an incident.
Urgency*
Context
5 fieldsWork Related Factors Present*
Where work is a factor, the work needs changing as well as the person being supported.
- No3 pts
- Partly1 pt
- Yes0 pts
Factors Identified
Following A Workplace Incident*
Case ID
Thread key
Others Affected By Same Event
After a serious incident, everybody who witnessed it needs the offer, not just the injured person.
- No3 pts
- Yes1 pt
Support offered
9 fieldsSupport Options Explained*
- Yes3 pts
- Partly1 pt
- No0 pts
Employee Assistance Offered*
- Yes3 pts
- Not available1 pt
- No0 pts
Occupational Health Offered*
- Yes3 pts
- No0 pts
External Services Signposted*
- Yes3 pts
- No0 pts
Time Off Or Adjustment Offered*
- Yes3 pts
- No0 pts
Worker Chose*
Confidentiality Explained*
- Yes3 pts
- No0 pts
Consent To Any Sharing Obtained*
- Yes3 pts
- Not needed3 pts
- No0 pts
No Record Kept In Personnel File*
- Correct, none kept3 pts
- Record was kept0 pts
Follow up
12 fieldsCheck In Agreed*
- Yes3 pts
- Declined by worker2 pts
- No0 pts
Check In Date
Worker Sets The Terms Of Contact*
- Yes3 pts
- No0 pts
Workplace Adjustment Made
- Yes3 pts
- Not needed3 pts
- No0 pts
Adjustment Detail
Psychosocial Assessment Review Triggered*
- Yes3 pts
- Not needed3 pts
- No0 pts
Action Required*
Raise the action record, then enter its reference here.
- No2 pts
- Yes0 pts
Priority
- High0 pts
- Medium1 pt
- Low3 pts
CAPA ID
Format CAPA-2026-00000.
Links to FDN-014 CAPA ID
Action Owner
Referrer*
Signature*
HLT-026 · record IDs look like SUP-2026-000 · Links Worker
Open in KnowellaRun it with agents
From a document you fill in to a programme that runs itself
The record is short by design. What slips is restraint, not completion: a free-text field capturing more than it should, or a copy quietly surviving in the wrong file.
Holds the referral record against the worker link, and flags a record with clinical detail in a free-text field before it is filed.
Tracks the consent and access-restriction fields against applicable privacy legislation, and flags where a broader disclosure has occurred without matching consent.
Tracks whether managers have completed training on signposting without diagnosing, the distinction this record's design depends on.
Watches for a record with no independent verification that No Record Kept In Personnel File is actually true, and raises it before it is assumed.
This template lives in KnowHealth — employee wellbeing. Exposure monitoring, health surveillance, case management and return to work.
Meet KnowHealth→Glossary
Support Referral Record definitions and key terms
- Special category data
- A GDPR classification for data including health information, requiring an additional lawful condition, such as explicit consent, beyond the general basis for processing personal data.
- Data minimisation
- The principle that personal data collected should be limited to what is necessary for the stated purpose, applied here by design, not left to the completer's discretion.
- Signposting
- Pointing someone towards a source of help without assessing, diagnosing or treating them, the limit of what a manager's role in this record covers.
- Employee assistance programme
- A confidential support service, often provided by an external third party, offering counselling and advice separate from the employer's own management chain.
- Consent withdrawal
- The worker's right to revoke previously given consent at any time, after which processing that depended on that consent must stop.
FAQ
Frequently asked questions about support referral record
What does this record not capture, and why?+
It does not capture the reason for referral, any diagnosis, or the outcome of support accessed. Recording any of these would defeat the confidentiality that makes workers willing to ask for help in the first place.
Who can see this record?+
Access is restricted to occupational health, with the referrer and the worker themselves. Management sees only that a referral was made and offered, never the surrounding detail.
Can the worker withdraw consent after agreeing to it?+
Yes, at any point, and Worker Sets The Terms Of Contact exists precisely to keep checking this rather than assuming an initial yes holds indefinitely.
What if the referral follows an incident that affected several people?+
Others Affected By Same Event should be assessed honestly. A serious incident's support offer should extend to witnesses, not stop at whoever was named as injured.
Does a copy belong in the personnel file?+
No. No Record Kept In Personnel File scores 'correct, none kept' as the passing answer; a copy filed there, however well-intentioned, is the failure this field is built to catch.
What's the difference between this and a Psychosocial Risk Assessment?+
The risk assessment looks at workplace factors, demand, control, support, as a hazard to manage across a team. This record documents a single referral for one worker, and assesses nothing about the workplace itself.
Keep going
Related templates and programmes
Industries this is written for
Programmes this belongs to
Used together in Wellbeing and Mental Health
Wellbeing Survey
Asks workers about workload, support, stress and how they are coping
Psychosocial Risk Assessment
Assesses workplace factors that affect mental health, including demand, control, support and change
Workload Review
Reviews whether workload, hours and staffing are sustainable for a team
Wellbeing Program Plan
Sets out what wellbeing support is available and how people access it
Fitness for Duty Assessment
Assesses whether a worker is currently able to perform their role safely
Impairment Concern Record
Records a documented concern that a worker may be impaired and unable to work safely
More in Wellbeing
Wellbeing Survey
Asks workers about workload, support, stress and how they are coping
Psychosocial Risk Assessment
Assesses workplace factors that affect mental health, including demand, control, support and change
Workload Review
Reviews whether workload, hours and staffing are sustainable for a team
Wellbeing Program Plan
Sets out what wellbeing support is available and how people access it
Written and reviewed by
Siddarth Singh
Founder & Chief Executive Officer, Knowella
Certified Safety Professional and industrial and systems engineer with more than a decade inside food supply chain, freight and manufacturing operations. This page was written against the current text of the standards it cites, not against secondary summaries of them.
- Certified Safety Professional (CSP), Board of Certified Safety Professionals
- MBA, University of Chicago Booth School of Business
- MS and BS, The Ohio State University, Industrial and Systems Engineering
- Six Sigma Black Belt
Sources and last review. Reviewed 16 August 2026 against:
- UK GDPR and Data Protection Act 2018, Article 9 (special category data)
- UK GDPR, Article 5(1) (principles: minimisation, storage limitation, integrity and confidentiality)
- Americans with Disabilities Act, 42 U.S.C. §12112(d) (confidentiality of employee medical information)
- Privacy Act 1988 (Cth), Australian Privacy Principles 3 and 6
This page is general guidance, not legal advice. Confirm requirements with your jurisdiction’s regulator.