Background: Audit is an important facet of clinical governance and good occupational health practice. There are well-established clinical guidelines for the management of low back pain. Occupational Health Guidelines for the Management of Low Back Pain at Work were launched by the Faculty of Occupational Medicine in March 2000, based on an extensive, systematic review of the scientific literature predominantly from occupational settings or concerning occupational outcomes. Aim: To determine whether documented National Health Service occupational health assessment of low back pain in the North West region of England conforms to the published guidelines. Methods: A retrospective audit of case notes was conducted. Six performance indicators were derived from the Occupational Health Guidelines for the Management of Low Back Pain at Work in order to evaluate the performance by occupational physicians. Two hundred and seventy-seven case notes were identified from eight different occupational health departments. Results: Low rates of compliance with national standards were observed for recording of some performance indicators, notably for the assessment and documentation of 'red' and 'yellow flags'. Our findings suggest that the quality of documentation of key information in the notes leaves significant room for improvement. Conclusions: For future audits, we recommend having two external auditors and seek to demonstrate a high degree of agreement between observers by conducting a reproducibility exercise. Future Faculty guidelines should emphasize documentation of the assessment and perhaps consider assessment tools to improve documentation. © The Author 2008. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved.