Request for occupational health records

Please complete the form below and click submit to place your request to Newcastle 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)

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Detail of request

Personal Details:

Employment Details