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    Medical Check Up Format For Contract Workers

    Uploaded by

    Sathish Kumar
    This document contains forms for the medical examination of contract workers during induction/overhauling at NTPC power plants. The forms collect demographic information, medical history, examination findings, test results, and the examining doctor's opinion on fitness for work. Sections include physical measurements, systemic examination of body systems, vision testing, additional tests if needed, and signatures of the worker and doctor.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Medical Check Up Format For Contract Workers

    Uploaded by

    Sathish Kumar
    622 views4 pages
    This document contains forms for the medical examination of contract workers during induction/overhauling at NTPC power plants. The forms collect demographic information, medical history, examination findings, test results, and the examining doctor's opinion on fitness for work. Sections include physical measurements, systemic examination of body systems, vision testing, additional tests if needed, and signatures of the worker and doctor.

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    Medical Check Up Format for Contract Workers

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    This document contains forms for the medical examination of contract workers during induction/overhauling at NTPC power plants. The forms collect demographic information, medical history, examination findings, test results, and the examining doctor's opinion on fitness for work. Sections include physical measurements, systemic examination of body systems, vision testing, additional tests if needed, and signatures of the worker and doctor.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    622 views4 pages

    Medical Check Up Format For Contract Workers

    Uploaded by

    Sathish Kumar
    This document contains forms for the medical examination of contract workers during induction/overhauling at NTPC power plants. The forms collect demographic information, medical history, examination findings, test results, and the examining doctor's opinion on fitness for work. Sections include physical measurements, systemic examination of body systems, vision testing, additional tests if needed, and signatures of the worker and doctor.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 4

    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

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