CORPORATE MEDICAL CELL

MEDICAL EXAMINATION OF CONTRACT WORKER IN CLIMS DURING INDUCTION/OVERHAULING

PHOTOGRAPH
S.NO.
PASTE HERE

ATTESTED BY EIC

DEMOGRAPHICS

NAME AGE&SEX AADHAR NO. ADDRESS MOBILE NO. DATE OF

EXAMINATION

CONTRACTOR/AGENCY WITH NTPC CLIMS ID/GATE PASS ID NTPC EIC

PO NO.

SIGNATURE OF CONTRACTOR SIGNATURE OF EIC

HISTORY/SELF DECLARATION – YES/NO

DIABETES VERTIGO
HYPERTENSION HEIGHT PHOBIA
EPILEPSY SKIN DISEASES
ASTHMA/LUNG DISORDER ALCOHOL INTAKE

MENTAL ILLNESS TOBACCO CHEWING

CANCER PILES/FISSURE/HERNIA/HYDROCOELE
HEARING PROBLEM ANY CHRONIC ILLNESS
ANY DEFORMITY ANY PAST ACCIDENT/ANY PAST SURGERY
HISTORY OF MEDICINES BEING TAKEN

SIGNATURE OF CONTRACT WORKER

GENERAL EXAMINATION

HEIGHT WEIGHT BP BMI CHEST CHEST (EXPIRATION) PULSE/SPO2/TEMP

(INSPIRATION)

PALLOR ICTERUS CLUBBING BUILT TONGUE TEETH ANY OTHER FINDING

SYSTEMIC EXAMINATION

CARDIOVASCULAR SYSTEM RESPIRATORY SYSTEM

CNS ANY OTHER FINDINGS

1
 CORPORATE MEDICAL CELL
MEDICAL EXAMINATION OF CONTRACT WORKER IN CLIMS DURING INDUCTION/OVERHAULING

VISION

PARAMETER VALUES/RESULTS/INTERPRETATION

RIGHT EYE LEFT EYE

WITH GLASS WITHOUT GLASS WITH GLASS WITHOUT
GLASS
DISTANT VISION

NEAR VISION

COLOUR VISION

ANY EYE RELATED DISORDER

FOR FEMALE WORKERS

LAST MENSTRUAL PERIOD MENSTRUAL CYCLE – PREGNANCY DURATION (IF

REGULAR/IRREGULAR PRESENT) -

INVESTIAGTIONS

CBC RANDOM URINE R&M BLOOD GROUP

BLOOD SUGAR

ECG CHEST X-RAY HEIGHT PASS TEST

ANY OTHER SPECIFIC TEST WHICH IS DEEMED NECESSARY ACCORDING TO EXPOSURE HISTORY/JOB PROFILE

OPINION – MEDICALLY FIT

UNFIT
TEMPORARILY UNFIT
CONDITIONALLY FIT
REMARKS (IF ANY) –

SIGNATURE OF PERSON EXAMINED SIGNATURE OF DOCTOR

2
 CORPORATE MEDICAL CELL
ANNUAL MEDICAL EXAMINATION OF CONTRACT WORKER IN CLIMS

PHOTOGRAPH
S.NO.
PASTE HERE

ATTESTED BY EIC

DEMOGRAPHICS

NAME AGE&SEX AADHAR NO. ADDRESS MOBILE NO. DATE OF

EXAMINATION

CONTRACTOR/AGENCY WITH NTPC CLIMS ID/GATE PASS ID NTPC EIC

PO NO.

SIGNATURE OF CONTRACTOR SIGNATURE OF EIC

HISTORY/SELF DECLARATION – YES/NO

DIABETES VERTIGO
HYPERTENSION HEIGHT PHOBIA
EPILEPSY SKIN DISEASES
ASTHMA/LUNG DISORDER ALCOHOL INTAKE

MENTAL ILLNESS TOBACCO CHEWING

CANCER PILES/FISSURE/HERNIA/HYDROCOELE
HEARING PROBLEM ANY CHRONIC ILLNESS
ANY DEFORMITY ANY PAST ACCIDENT/ANY PAST SURGERY
HISTORY OF MEDICINES BEING TAKEN

SIGNATURE OF CONTRACT WORKER

GENERAL EXAMINATION

HEIGHT WEIGHT BP BMI CHEST CHEST (EXPIRATION) PULSE/SPO2/TEMP

(INSPIRATION)

PALLOR ICTERUS CLUBBING BUILT TONGUE TEETH ANY OTHER FINDING

SYSTEMIC EXAMINATION

CARDIOVASCULAR SYSTEM RESPIRATORY SYSTEM

CNS ANY OTHER FINDINGS

1
 CORPORATE MEDICAL CELL
ANNUAL MEDICAL EXAMINATION OF CONTRACT WORKER IN CLIMS

VISION

PARAMETER VALUES/RESULTS/INTERPRETATION

RIGHT EYE LEFT EYE

WITH GLASS WITHOUT GLASS WITH GLASS WITHOUT
GLASS
DISTANT VISION

NEAR VISION

COLOUR VISION

ANY EYE RELATED DISORDER

FOR FEMALE WORKERS

LAST MENSTRUAL PERIOD MENSTRUAL CYCLE – PREGNANCY DURATION (IF

REGULAR/IRREGULAR PRESENT) -

INVESTIAGTIONS

CBC (OR TLC DLC HB) RANDOM URINE R&M SGOT, SGPT,
BLOOD SUGAR S. CREATININE

ECG CHEST X-RAY HEIGHT PASS TEST

ANY OTHER SPECIFIC TEST WHICH IS DEEMED NECESSARY ACCORDING TO EXPOSURE HISTORY/JOB PROFILE

REMARKS (IF ANY) –

SIGNATURE OF PERSON EXAMINED SIGNATURE OF DOCTOR