PRE-EMPLOYMENT MEDICAL EVALUATION
Applicant Details:
Full Name: [Your Name] | Position Applied For: |
Date of Birth: | Contact Number: |
Address: | Email Address: |
Medical Evaluation Criteria:
To ensure the health and safety of all employees, Human Resources conducts a pre-employment medical evaluation. This evaluation assesses an individual's fitness for the position they have applied for.
General Health Assessment:
Criteria | Observations | Remarks |
Height | 6 feet 1 inch | Normal |
Weight | | |
Blood Pressure | | |
Vision | | |
Hearing | | |
Laboratory Tests:
Test | Result | Remarks |
Blood Sugar Level | | |
Cholesterol Level | | |
Complete Blood Count | | |
Musculoskeletal Evaluation
Criteria | Observations | Remarks |
Range of Motion | | |
Strength | | |
Flexibility | | |
Additional Tests/Notes:
No respiratory or cardiovascular concerns noted.
Based on the medical evaluation conducted, the applicant is medically fit and is cleared for the position of IT Specialist at Human Resources.
Signature of Medical Examiner:
Medical Practitioner
License Number:
[Month Day, Year]
Acknowledgment by Applicant:
I, [Your Name], acknowledge that the above information is accurate to the best of my knowledge. I have not withheld any medical information related to my health status.
Signature:
[Your Name]
[Month Day, Year]
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