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    Alimul Ehsan
    6 views1 page
    This document appears to be a screening or registration form for factory workers in India. It contains the following information: 1. Sections for the worker to provide personal details like name, address and consent to the screening. 2. A medical examination section that lists 11 potential symptoms of drug or alcohol addiction and checks if the worker shows any of these symptoms. 3. A concluding section stating that based on the screening, a determination will be made on whether the person is fit for work or not due to drug abuse issues.

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    This document appears to be a screening or registration form for factory workers in India. It contains the following information: 1. Sections for the worker to provide personal details like name, address and consent to the screening. 2. A medical examination section that lists 11 potential symptoms of drug or alcohol addiction and checks if the worker shows any of these symptoms. 3. A concluding section stating that based on the screening, a determination will be made on whether the person is fit for work or not due to drug abuse issues.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    6 views1 page

    Drug

    Uploaded by

    Alimul Ehsan
    This document appears to be a screening or registration form for factory workers in India. It contains the following information: 1. Sections for the worker to provide personal details like name, address and consent to the screening. 2. A medical examination section that lists 11 potential symptoms of drug or alcohol addiction and checks if the worker shows any of these symptoms. 3. A concluding section stating that based on the screening, a determination will be made on whether the person is fit for work or not due to drug abuse issues.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
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    CONSENT. OF FACTORY WORKER

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    if any body is addicted to drug or alcoho&then the following symptoms are shown.
    1. Sleep disturbances: Yes [-_-l Nof--l
    2. Abnonnal sensitivity to noise: Yes [-_l No [---l
    3, Nervous physical activity, like scratching: Yes f--l No[--l
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    4. Irritabilifi dizziness or confusion: Yes [--l No [---l
    ). .Uxrreme anorexla: Yes [--l No [---l
    6. Tremors or'even conydlsions: Yes [--l No[---l
    7. Tachycardia: Yes T--l No[---l
    8. Braclycardia: [--l
    Yes No[---l
    Y. tiypertenslon: Yesl I Nol-_-l
    1.0. Fresence of inhaling paraptrernalia, razor blades, mirrors, and skaws. Yes [*-l [.--lNo
    11. Fliysicr,,l effeeis, sueh. as lirrer, kidne-y and lung damage/problem: Yes [_-l No [_-l

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