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Employee Passport
Health and Wellbeing
An Employee Passport is designed to support discussions around removing
any barriers and maximising the potential of each employee in the workplace.
Everyone involved in the conversation should approach it with an open mind
and willingness to consider all possible options that will ultimately deliver a
happy compromise on how business and individual needs can and will be met.
This Passport can be completed by any employee with a mental health condition which they believe
is affecting or that may impact on their work at present, or at some time in the future. It can also be
completed by anyone who has experienced mental illness previously to discuss appropriate
support to help prevent any reoccurrence of the illness.
To get started, have a meeting with your line manager and/or HR representative, record what
happens and the things you agree in the document.
Who owns this document?
_________________________________________
(Employee’s name)
Who was involved in the conversation? _________________________________________
(List all people)
Date of meeting:
_________________________________________
This document should be kept confidential once completed.
NB: This template can be freely adapted.
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Preparation guide
Health condition
 What is the nature of your health condition/disability?
 How does your health condition impact on your day to day
activities (if at all)?
 How does your health condition impact on your work (if at all)?
 How does work impact on your health condition?
 Are the impacts on your day to day or work activities constant
over time or do they fluctuate?
 Are you receiving any treatment or medication for your
condition/illness?
 Is any support currently in place?
 What additional support might be helpful?
 How can we best ensure your needs and the needs of your
team/organisation can be met?
How can we
help?
Help us help
you
 Are there early warning signs that your health is becoming
worse?
 What kind of immediate support or adjustments would be helpful
if you feel your health is becoming worse?
 Who should be contacted if you become unwell at work?
 Who else in the workplace needs to know about your condition (if
anyone)?
 If you have to go off sick how best should your Line Manager
contact you?
 Note any additional questions or other areas to consider
Additional
Questions
NB: This template can be freely adapted.
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Record of Discussion
Caring responsibilities
• Discussion notes
Health condition
• Discussion notes
How can we help?
NB: This template can be freely adapted.
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Discussion notes continued…
•
Discussion notes
•
Discussion notes
Help us help you
Additional
Information
Please keep this conversation alive and review this document regularly at least each time circumstances change and/or on an annual basis.
Many thanks to BT Group Ltd for sharing their Employee Passports as the basis for this template.
NB: This template can be freely adapted.
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Record of Discussion
Caring responsibilities
 Record actions/agreements. What? By whom? By when?
Summary of
actions/
agreements
I consent to my Line Manager* / HR* (*delete as appropriate) keeping a copy of this record:
Signed: (Employee) ____________________________________ Date: _______________
Signed: (Line Manager): _________________________________ Date: _______________
Date of review:
____________________________________
Annual review date:
____________________________________
NB: This template can be freely adapted.
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Potential adjustments
Mental wellbeing
The following are examples of the sort of factors that should be considered when determining what
adjustments might be made to the work of an individual:
NB: What adjustments are reasonable depends on the nature of the organisation and resources
available – not all organisations will be able to offer all of these possibilities.
o
Complexity

Working hours
o Hours worked per day
o Shift pattern
o Start and finish times
o Part time or flexible hours

Breaks
o Frequency
o Duration
o Time of day taken
o Location

Additional supervision
o Mentoring
o Support
o Buddying

Physical environment
o Noise
o Light
o Fresh air
o Headphones
o Partition
o Location of desk

Style of communication
o Face to face
o Telephone
o E-mail

Time for appointments
o Hospital
o Therapist
o Counselling

Change in tasks/duties
o Reduction
o Reprioritisation
o Refocusing

Work location
o Home
o Closer office

Training
o Refresher
o New skills

Equipment
o Furniture
o Hardware
o Software

Modification of processes
o Speed
NB: This template can be freely adapted.
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Whether an adjustment may be made
will depend on:
 How effective the adjustments
are likely to be
 Your particular needs, not just
the nature of the condition
alone
 The availability of financial and
other assistance
 The financial and other impacts
of adjustments on the business
and its activities
The Health and Safety impact of any
adjustments should be risk assessed.
Resources
Caring responsibilities
Internal Resources
You may wish to add contact details for any internal policies, support or guidance sources: eg Flexible
Working Policy, Equal Opportunity Policy, Stress Management Policy, Occupational Health practitioner,
Company retained OH Doctor, Health and Safety consultant, etc.
External Resources
Mindful Employer www.mindfulemployer.net
Mindout – A Line Manager’s Resource www.mindfulemployer.net
Feeling Stressed Keeping Well – A personal workbook
http://www.mindfulemployer.net/Feeling%20Stressed%20-%20Keeping%20Well.pdf
Centre for Mental Health http://www.centreformentalhealth.org.uk
Workplace interventions for people with common mental health problems
http://www.bohrf.org.uk/downloads/cmh_emp.pdf
Royal College of Psychiatrists – Work and metal health
http://www.rcpsych.ac.uk/mentalhealthinfo/workandmentalhealth.aspx
Health & Safety Executive Northern Ireland - http://www.hseni.gov.uk/
Guidance for employers on creating a working environment that encourages mental wellbeing
http://www.hseni.gov.uk/mental_wellbeing_guide_for_employers.pdf
Guidance on stress risk assessments
http://www.hseni.gov.uk/stress_management_toolkit_section_3_-_mental_wellbeing_at_work_code_of_practice.pdf
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