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    IRATEC Medical Form

    Uploaded by

    juharie
    This document contains a pre-assessment medical form for work at height training. It lists several medical conditions that could interfere with safely completing work at height, such as heart disease, epilepsy, vertigo, and impaired limb function. The form requires the participant to confirm they do not have any conditions that would prevent them from working safely at height. A doctor must then sign off, recommending whether the participant is fit or unfit for the training.

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    IRATEC Medical Form

    Uploaded by

    juharie
    294 views1 page
    This document contains a pre-assessment medical form for work at height training. It lists several medical conditions that could interfere with safely completing work at height, such as heart disease, epilepsy, vertigo, and impaired limb function. The form requires the participant to confirm they do not have any conditions that would prevent them from working safely at height. A doctor must then sign off, recommending whether the participant is fit or unfit for the training.

    Original Description:

    for WAH Cert

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    This document contains a pre-assessment medical form for work at height training. It lists several medical conditions that could interfere with safely completing work at height, such as heart disease, epilepsy, vertigo, and impaired limb function. The form requires the participant to confirm they do not have any conditions that would prevent them from working safely at height. A doctor must then sign off, recommending whether the participant is fit or unfit for the training.

    Copyright:

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

    IRATEC Medical Form

    Uploaded by

    juharie
    This document contains a pre-assessment medical form for work at height training. It lists several medical conditions that could interfere with safely completing work at height, such as heart disease, epilepsy, vertigo, and impaired limb function. The form requires the participant to confirm they do not have any conditions that would prevent them from working safely at height. A doctor must then sign off, recommending whether the participant is fit or unfit for the training.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    of 1

    STATEMENT OF MEDICAL CONDITION TRAINING DATE:

    Pre Assessment Requirement

    It should be understood that work and Safety at height Courses of all level, involve a
    certain amount of physical and mental exertion. Certain medical conditions are a
    defined contra-indication to the safe and successful completion of work and safety at
    height course.

    Ideally candidate should be in possession of an applicable full industrial certificate.

    Principal contra-indications to working at height include the following:

    Participants Name

    IC No. / Passport No.

    Height

    Weight

    Eyesight

    Normal Abnormal Remarks


    Heart disease /
    chest pain

    High blood pressure

    Epilepsy, fits, blackout

    Fear of height / Vertigo

    Giddiness /
    difficulty with balance
    Impaired limb function

    Diabetes

    To the best of my knowledge I do not suffer from any mental or physical condition,
    including those mentioned above, which would interfere with my ability to work at
    height in a satisfactory and safe manner, or put myself or others at risk through my
    participation in work at height activities.”

    SURGERY ADDRESS DOCTOR’S NAME

    SIGNATURE & STAMP

    RECOMMENDATION : FIT / UNFIT Date :

    A-7-2, Medan Selayang 1, Medan Selayang, 68100 Batu Caves, Selangor – MALAYSIA
    Tel No : 603 – 6178 7630 / 603 – 6178 7730 Fax No : 603 – 6178 7300
    www.iratec.com.my zilla.iratec3gmail.com or norazita@iratec.com.my

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