Scribd Logo
Upload

Welcome to Scribd!

  • 47 views

    Employee Medical Examination Form

    Uploaded by

    sojeck
    The document is an employee medical examination form that collects an employee's personal and medical history information. It includes sections on the employee's name, date of birth, height, weight, smoking and drinking habits, past medical history of diseases, general examination of hearing, eyesight, blood pressure, heart, lungs, extremities, spine, blood and urine tests, family medical history, and any other physical abnormalities. The examining doctor provides their name, signature and location on the form.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content

    You might also like

    Employee Medical Examination Form

    Uploaded by

    sojeck
    47 views1 page
    The document is an employee medical examination form that collects an employee's personal and medical history information. It includes sections on the employee's name, date of birth, height, weight, smoking and drinking habits, past medical history of diseases, general examination of hearing, eyesight, blood pressure, heart, lungs, extremities, spine, blood and urine tests, family medical history, and any other physical abnormalities. The examining doctor provides their name, signature and location on the form.

    Original Description:

    pf

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Report this Document
    The document is an employee medical examination form that collects an employee's personal and medical history information. It includes sections on the employee's name, date of birth, height, weight, smoking and drinking habits, past medical history of diseases, general examination of hearing, eyesight, blood pressure, heart, lungs, extremities, spine, blood and urine tests, family medical history, and any other physical abnormalities. The examining doctor provides their name, signature and location on the form.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    47 views1 page

    Employee Medical Examination Form

    Uploaded by

    sojeck
    The document is an employee medical examination form that collects an employee's personal and medical history information. It includes sections on the employee's name, date of birth, height, weight, smoking and drinking habits, past medical history of diseases, general examination of hearing, eyesight, blood pressure, heart, lungs, extremities, spine, blood and urine tests, family medical history, and any other physical abnormalities. The examining doctor provides their name, signature and location on the form.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    of 1

    EMPLOYEE MEDICAL EXAMINATION FORM

    ___________ Project Site


    Name :______________________________________________
    Date: _____________
    Employment No:_____________________
    Contractors Name: __________________________
    Department / Trade :_________________
    Date of Birth:_______________ Height :______ meters
    Weight:_________ kgs
    Personnel History: Single / Married

    Smoking : Y / N

    Alcohol : Y / N

    Taking any medicines regularly : Y / N


    Past Medical History any Major Disease / Disorder
    Yes No
    Diabetes
    Muscular
    Mental Disorder
    Arthritis
    Kidney

    Hearing :

    Yes No

    Liver
    Lung ( Asthma / Tuberculosis)
    Cardiovascular
    Central Nervous System
    Any other serious disease

    Right Ear :

    GENERAL EXAMINATION
    Left Ear:

    Eye Test :
    Right Eye:
    If corrective lens worn :
    With Lens :
    Thorax:
    Pulse:
    Blood pressure:
    Systolic:
    Extremities:
    Upper
    Heart:
    Lung Function Test:
    Chest X-Ray:
    Blood Test:
    Group:
    HIV:

    Left Eye :
    Right Eye:

    Urine Test:
    Family History:

    Specific Gravity:
    Heart Attack: Y / N

    Less Hearing - Audiometery


    Color
    Vision:
    Left Eye:

    Diastolic:
    Lower
    Electrocardiograph:

    Spine

    Hemoglobin:
    Cholesterol:

    CBC:
    Sugar:

    ALB:

    Sugar:
    Diabetes : Y / N

    Any other Physical Abnormalities:


    General Comments:

    Name of Examining Doctor

    Signature

    Location

    You might also like