You are being referred to Healthywork Ltd, www.healthywork.org.uk an Occupational Health service. In order for us to formulate appropriate advice, we need your consent to go ahead with the assessment using relevant information from the Referrer. You will then be able to read the report following our input, before it is released, where it includes health/sensitive information.
1. Personal details
Full Name:
Home Address:
PERSONAL email address:
Mobile number:
Please tick below to consent to each of the following:
- I consent to input from Healthywork Ltd - to undertake a clinical assessment and provide appropriate advice (Clinical Consent).
Please note: by consenting to assessment, Healthywork Ltd will collect and process your personal data in order to provide this service. Please read the UK GDPR Information Notice below for full details.
- I consent to the Referrer (e.g. my employer, case manager etc) sharing any relevant work related information and health related information (as held by the Referrer) with Healthywork Ltd, as relevant to this referral.
Workplace equipment - IT and other equipment, seating etc:
- I consent to personal data information, including health information, where work related equipment is required, as relevant to the equipment being sourced, e.g. my first and second name, working postcode (not full address – may be a home worker) and my seated measurements (for work seating) will be provided to equipment suppliers to obtain suitable quotes, including delivery costs to the postcode location.
Please note: Occasionally, discussion regarding the health need has to be held with a supplier to establish the right solution.
- I consent to Healthywork Ltd taking and storing photographs and audio or video recordings, where necessary.
Please note: these will be taken using a mobile phone camera – all images are removed from the phone to more secure storage within 48 hours.
- I consent to the use of web applications to communicate with me (in addition to phone/email), including Zoom/Teams/Meet, What’s App.
- I consent for Healthywork Ltd to use specific AI tools like ChatGPT or CoPilot for research purposes (e.g., relevant health condition management, workplace reasonable adjustment and equipment information, to be included within the report).
Please note: Healthywork Ltd will never share any personal data with an AI tool that is used for training large language models (LLMs).
- I consent for Healthywork Ltd to use Heidi Health www.heidihealth.com which is an AI platform for the transcribing of meetings from audio to text. Heidi Health has been adopted by the NHS and GP clinics for the purpose of transcribing patient conversations and meetings and is secure in handling personal information. See our AI Policy: https://www.healthywork.org.uk/wp-content/uploads/2026/09/AI-Policy-Healthwork-Ltd-2026.pdf
Please note: Healthywork Ltd will not share or discuss your personal data with other professionals, one exception:
- I consent in the event of an emergency/risk to life/safeguarding situation to Healthywork Ltd sharing personal data where clinically indicated.
Please note: If Healthywork Ltd need to contact your GP (e.g. for medical documentation), you will be involved in that process and will be asked to provide further written consent at that stage.
There is no set time period until this consent ‘expires’. In general, valid consent remains until I request to withdraw consent.
Please tick to consent to each of the 8 points numbered above.
2. READ THE REPORT BEFORE RELEASE to Referrer – where medical/sensitive information is in the report
When the report includes no medical information and is workstation layout and equipment advice only, the report review process below may not be required.
Following the assessment a detailed written report will be compiled, including medical information, recommendations and workplace ‘reasonable adjustments’ (under the Equality Act 2010) for you and your employer to consider.
Also if there are any workplace issues, e.g. with tasks, work relationships etc. the Assessor will aim to detail these sensitively, in order that they can be addressed.
The report also includes information/links which may be beneficial to your Referrer/employer (e.g. reasonable adjustments) but also for you, e.g. further condition management treatment advice and self-help information.
You can ‘Read the report before release’, as the report is initially a ‘Draft’ version, for you to indicate any corrections/comments/additions ideally in writing (by email) to the Assessor (where this is difficult, a telephone call could be an option).
The report will be password protected (texted or emailed separately) as it includes confidential personal data including medical information.
The Assessor will then consider any comments you made and consider amendments to the report (there may be back and forth updated versions of the report during this report review period).
By the end of this process, you will have an electronic copy of the ‘Final’ report version which will be submitted to the Referrer/report recipient(s) on an indicated date (or extended in discussed and agreed circumstances between you and the Assessor).
Where there is no engagement/communication about the report from you: despite attempts to contact you (via email, text, call etc), the ‘Draft’ report will be converted to ‘Final’ report, to be submitted on the deadline date agreed (unless an extension submission date has been agreed with you).
Prior to actual submission by email to the Referrer, it will be re-emailed along with a text message to you, with a short period of time to respond (minimum 2 hours) so there is still another opportunity for you to communicate and review this report version).
If you have visual/health needs impacted by screen use, do not have an electronic device or have a device on which it is difficult to read a long report, e.g. small mobile phone screen access only, or do not use email, the Draft report can be sent by an alternative method (posted to you or the report can be emailed to another person you choose. The password to open the report will only be sent to you, unless you choose another recipient).
Please discuss any specific alternative requirements with the Assessor at the assessment.
I wish to ‘read the report before release’ to the Referrer so have provided my PERSONAL email address and my mobile number in Section 1 above.
Date this form is completed:
Please sign at the end of the document, thank you.
UK GDPR - Information Notice to Individual Clients from 25.05.2018
Privacy Information
Healthywork Ltd is committed to ensuring that your privacy is protected. Should we ask you to provide certain information by which you can be identified when working with Healthywork Ltd, you can be assured that it will only be used in accordance with this privacy statement.
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Name and contact details of the Data Champion
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Alison Biggs - Director
T: 07958 502363
E: alison@healthywork.org.uk
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Data Processors
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Any Associate professional conducting input for Healthywork Ltd
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Why we collect and process your data
We collect your personal data because we have a contract in place with you to provide our services to you and we require your personal data in order to provide this service. There is a Recognised legitimate interest, a new ground for lawful processing allows processing necessary for purposes like national security, public safety or emergency response. We also have a legal obligation to keep clinical records. We ask for your consent to process your data in certain ways, e.g. sharing it with others, taking your photograph.
How and what information is collected about you
We may collect the following information by email, telephone call, by post, questionnaires / forms, or in-person:
- Name and Date of Birth
- Contact details (phone, email, address)
- Family members / Support Staff names and contact details
- Personal health and lifestyle information, including reports and letters from healthcare professionals.
- Referral information and assessment/input outcomes
What we do with the information we gather and what it is used for
- Professional record keeping of client information.
- Recording the initial assessment/provision of services.
- Sharing your information with relevant parties when necessary (with your permission)
Controlling your personal information
- We will not distribute, sell or lease your personal information to third parties unless we have your explicit permission or are required by law to do so.
- If you believe that any information we are holding on you is incorrect or incomplete, please email or write to us as soon as possible at the address below. We will promptly correct any information found to be incorrect.
How you can access your information
You may request details of personal information which we hold about you under the UK GDPR. If you would like a copy of the information held on you, please write to Alison Biggs at Healthywork Ltd, PO Box 545, Abbots Langley, Hertfordshire, WD5 5AN. There is no longer a charge for this service.
How long we keep your information for
The Regulation does not set out any specific minimum or maximum periods for retaining personal data. Instead, it says that:
Personal data processed for any purpose or purposes shall not be kept for longer than is necessary for that purpose or those purposes.
Healthywork Ltd will retain personal data for 7 years for adults and 7 years following their 18th birthday for children, unless upon review it is deemed necessary to retain it for a longer period.
Data Transfer outside the European Union
In some instances, it may be necessary for us to transfer your data outside of the European Union, or to countries not approved by the ICO. Where this is the case, we will seek further consent from you to do this. In all instances, we will take all steps necessary to safeguard your information and ensure that your data protection rights are maintained.
Security
We are committed to ensuring that your information is secure. In order to prevent unauthorised access or disclosure, we have put in place highly secure electronic systems and managerial procedures to safeguard and secure the information we collect.
Right to Complain
If you have a concern about our information practices, you have the right to complain. You can do so by contacting the Information Commissioner’s Office on 0303 123 1113 or by visiting www.ico.org.uk
If you wish to withdraw consent or request a transfer or erasure of your data, please email alison@healthywork.org.uk.
