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Yorkshire Ambulance Service: Ergonomic assessment referral

The following form is for managers looking to refer a member of staff for an ergonomic assessment as part of the  Occupational Health Physiotherapy Service for employees of the Yorkshire Ambulance Service. 

Once we have received the referral, a therapist will be in contact to arrange a time to complete the assessment. 

Your details

Address

Nature of referral

Nature of instruction
Has a self assessment and internal DSE been carried out?

If a self assessment and internal DSE has not been completed, please undertake prior to making a referral to Ascenti. 

Patient details

Shift pattern
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Once we have received the referral, a therapist will be in contact to arrange a time to complete the assessment. 

If you would like to speak to somebody regarding this referral, please call 0330 678 0850.