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Fitness Certification ( Other than Riggers )

Date of Check up:-

Candidate Name ………………………………………………………………………………... Age …………………………..

Company Name …………………………………………………………………………………….

Nature of Job ……………………………………………………………………………………….

Physical Assessment Investigation:

1. Height 1. BP

2. Weight 2. Diabetic

3. Vision Test

4. Hearing Test

5. Breathing Test

6. Limb Mobility

Medically fit/unfit for the Job

Signature / name of Doctor

Doctor’s Registration number Hospital / Clinic Stamp

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