Standard Pre-Employment Medical Report

PERSONAL DETAILS
Candidate Name: Medical Provider Details: REDIMED
Date of Birth:
Date of examination:
Project:
Position applied for: Functional Classification:

ASSESSMENT RESULTS
Screening Completed Met Requirement
Medical Questionnaire and Examination Yes No
Functional Assessment Yes No
Level Demonstrated: Sedentary / Light Medium Heavy

Drug and Alcohol Screen Yes No

Hearing Test Yes No
Spirometry Yes No

RISKS IDENTIFIED
Please indicate if any of the following were identified in the medical or functional assessment:
BMI above 35 / weight above 120kg / unable to complete step test? Yes No
Current medical conditions? Yes No
Previous or current work-related injuries or illnesses? Yes No
Examiner Comments on risks and potential controls to manage:

RISK RATING (Please Circle)

GREEN The candidate is currently fit for the proposed position
(Fit and Low Risk)
Review by Health and Rehabilitation Team required? Yes No
AMBER Medical or functional issues have been identified that place the candidate at
(Fit Conditional or Medium increased risk to perform the proposed role. The identified risks may be able to be
Risk) controlled with restrictions / modifications.
GP follow up or further investigation required Yes No
RED The Candidate is not currently fit to perform the inherent requirements of the
(Unfit or High Risk) proposed role and pose significant risk for new injury or sustaining an aggravation
to an existing injury. The risk is not likely to be managed with a Health
Management Plan.
Doctor: Signature: Date:

BMS-FRM-1194 Rev 4
Discipline: Human Resources Page 1 of 14
Division: Engineering Construction; Maintenance and Industrial Services Last printed: 04/05/2023