Classification: General Business Use

Third Party EHSS Management Attachment 9: Contractor Health Fitness Guideline

Attachment – 9b Contractor Health Fitness Referral form

Date: ………………………………………………………………. ID / Iqama No.: ……………………………………………….

Name: ……………………………………………………………. Company: ……………………………………………………….

Occupation: …………………………………………………… Age: ………………………………………………………………..

Nature of work: Administration (Office work) Operator/Technician (Field work)

To: The Medical Director of ………………………………………………… Hospital / Dispensary

Medical Investigations list for all Contractors (Office and Field work)

1.1 Complete Blood Count (CBC) 1.2 Fasting Blood Sugar (FBS)

1.3 Vision Test 1.4 Electrocardiogram (ECG) with report

1.5 Internal Medicine consultation & review

Additional Medical Investigations list for Field Workers only

1.7 Liver Function Test

1.6 Serum Creatinine
 SGPT (ALT)

1.8 TSH 1.9 Spirometry

1.10 Routine Urinalysis 1.11 Audiometric Test

The above listed medical investigations and assessment are the minimum requirement before
placement in job within SABIC to assess if the worker will be able to perform the job capably and safely,
to determine if the worker meets any established physical standards and to obtain baseline
measurements for future comparison.

Upon Completion of the medical evaluation, kindly send the medical investigation results to our
Company.

………………………………………. ……………………………………………
Signature Contractor Company Stamp