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[Folder Structure Level 0]

Effective Date: [DD Month YYYY] Version: [##] Page: 1 of 1


FORM Security Classification: Restricted
Reference Document No. [XXX-XXX-XXX-XXX-XXX-YYYY-###-Document Title]
Document No. [XXX-XXX-XXX-XXX-XXX-YYYY-###-Document Title]

MEDICAL CHECK-UP REQUIREMENTS


FOR BUSSINESS PARTNERS

PRE-EMPLOYMENT & ANNUAL


MCU MATRIX

NO REQUIRED EXAMINATION
1 Medical History / Health Assessments
Complete Physical Examination, also include :
• Waist Circumference examination
2
• Hernia Examination
• Visual Acuity Test ( Visus ) & Color Blind Test
3 Chest X-ray
4 Electrocardiogram ( ECG 12 leads resting )
5 Complete Blood Routine ( Diff Count & MCV,MCHC, MCH )
6 Fasting Blood Glucose
7 Liver Function ( SGOT & SGPT )
8 Renal Function ( Ureum, Creatinine, Urid Acid )
9 Lipid Profile ( Cholesterol Total, Triglycerides, HDL, LDL )
10 Urine Routine

Date , 23 November 2021


Digitally signed by Bambang
Setiawan
DN: cn=Bambang Setiawan,
o=Donggi Senoro LNG,
ou=QHSE,
email=bambang.setiawan@dsl
ng.com, c=ID
Date: 2021.11.23 09:57:30
+08'00'
Dr.Bambang Setiawan / Dr.Boy Hidayat
Chief Medical Officer

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