PRE-EMPLOYMENT MEDICAL EXAMINATION REPORT

A. BASIC DATA:

1. Name
2. Selected for the position of
a) Date of Birth
b) Identification marks

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3 Unit & Location

4 Date of Joining
B. CLINICAL EXAMINATION

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1. a) Height
b) Weight

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2. Chest measurements
a) Normal
b) Expanded

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3. Abdomen measurements

4. Blood Pressure

5. Skin

6. Ear, Nose & Throat

7. Vision

8. Respiratory system

9. Circulatory system

10. Nervous system

11. Gastro-intestinal system

12. Genito-urinary system

13. Serious illness or operation

in the past

14. Colour Blindness

C. REMARKS ON PATHOLOGICAL TESTS

1. Chest X-ray

2. ECG

3. Complete blood count

4. Urine routine

5. Serum colesterol & blood urea

6. Fasting and post prandial blood sugar

7. Blood group

D. FAMILY HISTORY

1. Father

2. Mother

3. Siblings

E. CONCLUSION

1. Any further investigation required

2. Any precautions suggested

F. CERTIFICATION:

Certified that the above named recruit does not appear to be suffering from any disease
communicable or otherwise, constitutional weakness or bodily infirmity except
__________________________________.
I do not consider this as disqualification for employment in the Company.

Date
Place

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Signature of the Medical Adviser

Seal of the Medical Hospital