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  • FTW Clearance

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    Noemi Mendoza
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    This document is a fitness for work clearance for an employee. It includes the employee's name, age, department, dates and number of days absent, vital signs, results of a rapid antigen test, and clinical assessment by the company nurse. The nurse, HR specialist, and operations manager sign off on whether the employee is fit to work, unfit and sent home, or needs to be referred to the hospital.

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    FTW CLEARANCE

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    This document is a fitness for work clearance for an employee. It includes the employee's name, age, department, dates and number of days absent, vital signs, results of a rapid antigen test, and clinical assessment by the company nurse. The nurse, HR specialist, and operations manager sign off on whether the employee is fit to work, unfit and sent home, or needs to be referred to the hospital.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as xlsx, pdf, or txt
    79 views2 pages

    FTW Clearance

    Uploaded by

    Noemi Mendoza
    This document is a fitness for work clearance for an employee. It includes the employee's name, age, department, dates and number of days absent, vital signs, results of a rapid antigen test, and clinical assessment by the company nurse. The nurse, HR specialist, and operations manager sign off on whether the employee is fit to work, unfit and sent home, or needs to be referred to the hospital.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as xlsx, pdf, or txt
    of 2

    FIT TO WORK CLEARANCE

    Date:
    Name of Employee:
    Age:
    Dept. / Designation
    Chief Complaints:

    Medical Diagnosis upon check up:


    Date of Absences: # of days Absent:
    Vital signs:
    BP: SP02: Rapid Antigen Test Results:
    PR: RR:
    Clinical Assessment: Date:
    FIT TO WORK
    UNFIT / SENT HOME
    REFER TO HOSPITAL

    Checked by: Noted by: Approved by:

    Noemi M. Mendoza, RN Dennielle B. Catalan Maria Paz Melendrez


    Company Nurse HR Specialist Operations Manager
    FIT TO WORK CLEARANCE
    Date:
    Name of Employee:
    Age:
    Dept. / Designation
    Chief Complaints:

    Medical Diagnosis upon check up:


    Date of Absences: # of days Absent:
    Vital signs:
    BP: SP02: Rapid Antigen Test Results:
    PR: RR:
    Clinical Assessment: Date:
    FIT TO WORK
    UNFIT / SENT HOME
    REFER TO HOSPITAL

    Checked by: Noted by: Approved by:


    Noemi M. Mendoza, RN Dennielle B. Catalan Maria Paz Melendrez
    Company Nurse HR Specialist Operations Manager

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