/ Date of Birth PO No. (For contract employee): Name of The Factory Name of the Employee "Name of the Agency pwy Age of the employee ‘Mentification Mark Nature of ob Date of employment Length of Service in Years General survey exe Health Height Weight 93, Blood Group 10. Eye Vision Use Glass 111. Clolour Vision Inspiration Expiration Respiration rate/min Remarks if any 13, Cardiovascular System Pulse Rate Blood Pressure Heart Sound 10 oe ae Remarks if any Aaahor Number § 302) 9 6G 59.549 oteol: FACT Employee Distinguishing Number 412. Respiratory System & Chest Measurement ‘ hodhing Form No 31-8 HEALTH RECORD (Pre-employment/ Periodical) (Prescibed under Rula 629) one: (Be 9 Ps ssa AL : ADITYA ALUMINIUM ,LAPANGA | win SCART ONAR VEMERA | Pango + BI ENGINEERING a0 2 UQ vasy malo L_-—_—— A Blah male om the dy alc 0 Good Good / Fair Foor 1G) cemimeter £3 0 Rositive / Negative sRinht. G49 Left. OLE Kilogram *Nocmal :BO em YS em gy fein aii + @&Q__ breath/minutes “19¢fgyrm ‘Si59 Budinte14, Abdomen Tenderness ve Nervous sytem oe story of Fits “ats . Yex/ No Eptespy aad pemarison aeralenadh FONDS : unortai/ Abnorm! . 16. Locomotor System™ i vormdi/ Abn orTal 17 skin Coniiton Remarks on any skin condition noticed + Notlan 4 18, Hernias 19, Hydrocele 20,Present Complain, if any 21. Summary of Findings Heart Disease Hypertension Diabetes 18 Epilepsy Poisoning Others Occupational disease, if any Recommendation, if any furture investigation: Ex fore JO 6(Rula 96) \ certify that, | have perseonally examined SiS... SHET ORB... BEELELD. S16 Dio.... PB DV. Ry ENELR, cose SIDING Al. is desirous of being employed 28... 0. Cone of ... Dept. And that as nearly as can be ascertained from my examination is\FITLUNFIT for employement at the above noted factory. 2, He/She is fit to be employed and may be employed for some other non hazardous opertaion such as... Oped Lae - 3-HET She may be produced for furture examination after a period of .LN.E- AACA. 4-Hfel She is edvised following future examination. j\)¢ f 5. 61 She is advised following furture treatment, ny The serial no. of pervious certificate is... tote & rial; Sigrture of person hat nation Signature of certifying surgeonwiae MERA SRIDHAR BEHERA Gor: og evear Father RADU BEHERA aariel, QIezIESS!, GErne!, EIS, 2861, 759205 8307 7685 2597 tiv @nigovn 047 ‘1800 300 1947