Dear Dr [Name of Doctor],
Re: [Full name of employee]
[Date of birth of employee]
[Address of employee]
I understand that you are [employee]’s GP. [Employee] has recently been off work ill and you have provided Fitness to Work Certificates from [date Certificates commenced] to [date Certificates finished] stating that he/she is absent from work due to [state reason(s) for absence].
I confirm that [employee] is employed by [Company name] as a [job title]. This position involves [brief description of work activities eg, lifting, handling, sitting/standing, shift working]. [Employee] works in a [ventilated/non ventilated warehouse/office/manufacturing unit] for periods of [number of hours] hours at a time. The environment within the [warehouse/office/manufacturing unit] is [eg, dusty] and contains particles of [list]. [Employee] is required to wear the following personal protective equipment, [list equipment] whilst carrying out his/her work.
I write to ask if you would provide a report stating when [employee] will be fit to return to work of this type and to this work environment and whether or not [he/she] will have any ongoing health issues which need to be considered.
I enclose [employee]’s authorisation to disclose medical information relating to [him/her] and you will note from this authorisation, that [employee] [does wish/not wish] to have access to the letter before it is supplied.
I understand that you may charge a reasonable fee for carrying out this work and I confirm that [Company name] would be prepared to discharge this fee provided the fee is agreed beforehand with myself.
Should there be any further information that you require then, please, do not hesitate to contact me. I look forward to hearing from you.
[name of writer]
for [name of employer]