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Pre Employment Medical Checkup Format

The document outlines the requirements for a pre-employment medical examination, including the need for a completed medical fitness certificate and various health reports. It specifies that expenses for the examination will be reimbursed up to a maximum limit, which should be confirmed with HR. Additionally, it includes a section for the medical official to certify the candidate's fitness for employment and a request for the candidate to disclose any significant medical history from the past three years.

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shobhashashi27
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31 views1 page

Pre Employment Medical Checkup Format

The document outlines the requirements for a pre-employment medical examination, including the need for a completed medical fitness certificate and various health reports. It specifies that expenses for the examination will be reimbursed up to a maximum limit, which should be confirmed with HR. Additionally, it includes a section for the medical official to certify the candidate's fitness for employment and a request for the candidate to disclose any significant medical history from the past three years.

Uploaded by

shobhashashi27
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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PRE – EMPLOYMENT MEDICAL EXAMINATION

Please carry with you this completed medical fitness certificate from a registered medical official/
practitioner along with the reports (X-ray, Blood, Urine etc) at the time of joining.
We would reimburse the expenses incurred on actual, subject to the maximum limit applicable at the
location you are joining. Please check with your HR contact at the site for the maximum limit that can be
reimbursed. You will have to submit bills from the place where you have got the medical examination done.

Name : _________________
Age : __________ years Sex : Male Female
S.No Investigation
General Body Health Check
Complete Blood
1
Count & ESR
General Physical
Examination (with
Basic Eye, Basic
2
Ear & Basic Dental
Check-up, Height,
Weight & BP)

3 Urine

4 X-Ray Chest

5 ABC Grouping &


Rh Typing
Diabetes Panel
Fasting Blood
1
Sugar
Cardiac Risk Profile
Cardio Vascular
1 System (ECG) &
Total Cholesterol
Any other observation by the Medical Examiner:
___________________________________________________________________________________
MEDICAL FITNESS CERTIFICATE

After examining Mr. /Ms. ________________________ I hereby certify that he/she is FIT / UNFIT for
employment.

Date : ____________________________________________ Paste the


candidates
Signature of the Medical Official: _____________________________ photograph

Name of the Medical Official: _____________________________

(Please affix a seal/stamp of the medical official / practitioner)

Please disclose history of any significant illness or treatment you have gone through in the last 3 years.
(To be filled by employee)

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