Nectar Lifesciences Limited, Derabassi

Appendix-01

PRE-EMPLOYMENT MEDICAL EXAMINATION

Nectar Lifesciences Ltd.
Date of Examination ________________
Name___________________________________________Sex____________Age_______Yrs.
Personal History ______________________________________________________________
Family History ________________________________________________________________
Past History __________________________________________________________________
Identification Mark: 1.__________________________ 2. ______________________________
Additional test based on Nature of Job: As per tick mark (of company’s officials) on work area
and gets additional test through qualified specialist.
1. Hazardous chemical handling area – Spiro-metry / lung function test
2. Utility / Mechanical - (Engg. dept – high noise area) - audio metry test
========================================================================
GENERAL PHYSICAL EXAMINATION
Pulse____________ per minute B.P. _____________ m. m Nutrition _______________
Height _______________ Cm Weight____________ Kg. Chest__________________
========================================================================
SYSTEMIC EXAMINATION
Eyes ___________________Color blind ness ___________ E.N.T ______________________
Skin ________________________________________________________________________
Digestive System _____________________________________________________________
Respiratory System ____________________________________________________________
Cardio – vascular system ____________________Nervous System: _____________________
(Including ECG)
Genito-Urinary System _________________________________________________________
Endocrine System ________________________Skeletal-muscular: _____________________
========================================================================
INVESTIGATIONS
Urine Examination _________Sugar _________ Albumen__________ M/E________________
Blood Examination: Group__________ HB __________ TLC ________ ESR __________
DLC: P _________ L ___________ M _______ E _______ B _________
Platelets_________________ Blood smear examination (P.B.F) _______
Random Blood Sugar___________________________________________________________
X –ray / Screening _____________________________________________________________
*Product Sensitivity test ________________________________________________________
Special Investigation ___________________________________________Remarks: Fit / Unfit

* Sensitivity test for beta-lactum antibiotics: _______________________________

SOP No.: PA-GN-002 Page 1 of 2

 Nectar Lifesciences Limited, Derabassi
Appendix-01

CERITIFICATE OF FITNESS

Serial No. _______________ Date ___________________

I hereby certify that I have personally examined ___________________________________

Son of Sh. ________________________ R/o. __________________________________and
that his age as nearly can be ascertained from my examination is _________years and that he
is in my opinion fit and free from Tuberculosis and any contagious / Infectious or skin disease.

Signature or L.T.I. of Person Employed Signature of Qualified doctor with

his/her seal (Certifying Surgeon)

Verified by Company’s Factory Medical Officer/Pharmacist

SOP No.: PA-GN-002 Page 2 of 2