An important challenge facing the quality of practice in occupational medicine is a limited evidence-base, but equally important is the need to translate good evidence into high quality practice. Audit has an important role to play in addressing the determinants of variations in practice. Furthermore where the evidence is good enough to permit the development of valid practice guidelines, audit may help in improving education and standards of practice. External audit may have a role to play in ensuring conformity with service-level agreements and especially in addressing issues of quality which some management systems may fail to address. As more literature is published reviewing and achieving a consensus on the evidence-base for the practice of occupational medicine, and as more experience in audit is described, it can make an important contribution to quality in occupational medicine.