SML ISUZU LIMITED

MEDICAL CERTIFICATE OF PHYSICAL FITNESS ON FIRST ENTRY IN TO SML

The Medical Officer,
Sir,
Please examine Mr. ______________________________who has been selected for appointment in our
organization.
AUTHORIZED SIGNATORY
SML ISUZU LIMITED

MEDICAL EXAMINATION REPORT

1.
2.
a)
b)
c)

(To be filed in by the Medical Officer) Date _____________________________

IDENTIFICATION: Decribe personal Marks:
On particulars by which he/she may identified
APPEARANCE:
Apparent Age?
Is his/her general appearance healthy &
Physical development normal? ____________________________________________________
Is there any defect or deformity of person
Swelling of joints, enlargement of thyroid
or lymphatic glands or any ciratrices? If so give _____________________________________

3.

MEASUREMENTS & HEIGHTS

a)
b)
c)

Chest (Over Nipples) on the compleate expiration ____________________________________

& full inspiration.
Height (without shoes) __________________________________________________________
Weight (with thin cloths)

4.

CONDITION OF CHEST

a)
b)

Is the Chest symmetrical & well formed? ___________________________________________

Do you consider the lungs to be healthy
In every respect?

5.
a)
b)

CONDITION OF HEART

c)
d)

Is the heart natural in size position & Pulse _________________________________________

Are the Sounds of the heart normal? Decribed the
Abnormalities, if any? ___________________________________________________________
(i) What is the Pulse rate? ________________________________________________________
(ii) Is it regular? Describe abnormalities. If any _____________________________________
Blood pressure (to be taken in all cases &
In supine position) ______________________________________________________________

6.

CONDITION OF EYES

a)
b)

He/ She has any disease of the eyes? ________________________________________________

If wearing glasses. State the power number _________________________________________

On the basis of the medical examination. I find that the applicant is not/ fit for the employment.
SIGNATURE OF THE MEDICAL OFFICER
WITH SEAL
Signature of the applicant made in
the presence of the medical officer.

DECLARATION BY THE CANDIDATE

I hereby declare that I have not concealead any information from the Medical officer & I do
not suffer from any decease which in any opinion should make me unfit for the job in the event of
any misrepresentation or intentional omission. I am liable termination from the service of SML Isuzu
Limited.
Date _____________

SIGNATURE OF THE CANDIDATE