GUIDELINES FOR REGISTRATION OF LIFTS COMPETENT PERSONS

GUIDELINES

FOR REGISTRATION OF PERSONS

WITH THE CHIEF INSPECTOR OF FACTORIES AND MACHINERY

AS LIFT'S COMPETENT PERSONS

DEPARTMENT OF OCCUPATIONAL SAFETY AND HEALTH

MINISTRY OF HUMAN RESOURCES
MALAYSIA

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 GUIDELINES FOR REGISTRATION OF LIFTS COMPETENT PERSONS

CONTENTS

1.0 General Page 3

2.0 Qualification For Registration Page 3

3.0 Application Procedure Page 6

4.0 Power of The Chief Inspector Page 6

5.0 Duties of Competent Persons Page 7

6.0 Examination Page 8

7.0 Recognition Criteria Page 9

8.0 Misconduct Page 9

Appendix 1 : Application To Be Registered As A Lifts Competent Person Page 10

Appendix 2 : Application for Renewal as A Competent Person Page 12

Appendix 3 : Declaration By a Grade I/II/III Competent Person (1/2) Page 14

Appendix 4 : Declaration By a Grade I/II/III Competent Person (2/2) Page 15

Appendix 5 : Checklist For Inspection Of Electric Elevator Page 19

Appendix 6 : JKJ 166 Page 21

Appendix 7 : JKJ 167 Page 25

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 GUIDELINES FOR REGISTRATION OF LIFTS COMPETENT PERSONS

1.0 GENERAL

1.1 The purpose of these guidelines is to lay down the procedure, stipulate the qualifications and other
conditions for the registration of persons who intend to carry out duties as a Lift's Competent Person in
pursuance to the provisions of regulation 6, regulation 30 and regulation 31, of the Factories and Machinery
(Passenger and Goods Lifts) Regulations, 1970.

1.2 In pursuance to the provisions of regulation 6, regulation 30 and regulations 31(5), 31(6), 31(7) and
31(8) of the Factories and Machinery (Passenger and Goods Lifts) Regulations, 1970, the Chief Inspector of
Factories and Machinery may exercise his rights in performing his function, exercising his power and
discharging his duties assigned to him under the Factories and Machinery Act (here-in-after referred as the
"Act") and the regulations made under the Act, not to recognize any reports, inspections or recommendations
forwarded by any person who carry out duties as a lift competent person, if the person is not registered with
the Chief Inspector.

1.3 For the purpose of these guidelines-

"Approved Firm" means a firm which has satisfied the Chief Inspector that its employs persons
suitably qualified and trained (here-in-after referred to as the lift competent person grade 1) and controls
equipment and facilities to ensure a proper standard of lift examination (inspection), service and maintenance.

"Lift Competent Person Grade I" means a person registered with the Chief Inspector to perform duties
as prescribed under regulation 6 (on behalf of the owner), regulation 30, and regulations 31(5), 31(6), 31(7)
and 31(8) of the Factories and Machinery (Passenger and Goods Lifts) Regulations, 1970.

"Lift Competent Person Grade II" means a person registered with the Chief Inspector to perform duties
as prescribed under regulation 30, regulations 31(5), 31(6), 31(7) and 31(8) of the Factories and Machinery
(Passenger and Goods Lifts) Regulations, 1970.

"Lift Competent Person Grade III" means a person registered with the Chief Inspector to perform
duties as prescribed under regulations 31(5), 31(6), 31(7) and 31(8) of the Factories and Machinery
(Passenger and Goods Lifts) Regulations, 1970.

"Lift Competent Person" means lift competent person grade I or grade II or grade III

2.0 QUALIFICATION FOR REGISTRATION

2.1 A person applying to be registered with the Chief Inspector as a Lift Competent Person Grade I
shall-

(a) be a Malaysian citizen;

(b) holds a qualification and experience of

i) degree in mechanical, electrical or electronic engineering or equivalent, accredited

by Malaysian Qualification Accreditation (MQA) or the Board of Engineers,
Malaysia (BEM) and with five (5) years working experience in installation,
inspection, testing, maintenance and has knowledge in designing (preparation
of first schedule) of electric passenger or goods lifts, escalators and dumbwaiters;
or
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ii) holds a diploma in mechanical, electrical or electronic engineering or equivalent,

accredited by the Malaysian Qualification Accreditation (MQA) or National
Occupational Skill Standard (NOSS) and with ten (10) years working experience in
installation, inspection, testing, maintenance and has knowledge in designing
(preparation of first schedule) of electric passenger or goods lifts, escalators and
dumbwaiters;

(c) be registered with the Board of Engineers, Malaysia (BEM), employed by an approved
firm and trained by the principal company;

(d) has passed an examination conducted by the Chief Inspector or his representatives;

(e) be medically fit;

(f) has not been-

(i) convicted of an offence under the Act or any regulations made thereunder;

(ii) convicted of an offence under the Occupational Safety and Health Act, 1994 or any
regulations made thereunder; or

(iii) convicted of an offence and sentenced to more than one year imprisonment or a
fine of more than two thousand ringgit;

(g) has fulfilled such other conditions as may be prescribed under the Act or any
regulations made there under.

2.2 A person applying to be registered with the Chief Inspector to perform duties as a lift
Competent Person Grade II shall-

(a) be a Malaysian citizen;

(b) hold a qualification and experience of

i) degree in mechanical, electrical or electronic engineering or equivalent,

accredited by the Malaysian Qualification Accreditation (MQA) the Board of
Engineers, Malaysia (BEM) and with three (3) years working experience in
installation, inspection, testing and maintenance of electric passenger or
goods lifts, escalators and dumbwaiters; or

ii) holds a diploma in mechanical, electrical or electronic engineering or

equivalent, accredited by the Malaysian Qualification Accreditation (MQA) or
National Occupational Skill Standard (NOSS) and with five (5) years working
experience in installation, inspection, testing and maintenance of electric
passenger or goods lifts, escalators and dumbwaiters; or

iii) holds a certificate in mechanical, electrical or electronic engineering or

equivalent, accredited by the Malaysian Qualification Accreditation (MQA) or
National Occupational Skill Standard (NOSS) and with ten (10) years working
experience in installing, inspecting, testing and maintaining of electric
passenger or goods lifts, escalators and dumbwaiters;
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(c) be employed by an approved firm;

(d) has passed an examination conducted by the Chief Inspector or his representatives

(e) be medically fit;

(f) has not been-

(i) convicted of an offence under the Act or any regulations made thereunder;

(ii) convicted of an offence under the Occupational Safety and Health Act, 1994 or
any regulations made thereunder; or

(iii) convicted of an offence and sentenced to more than one year imprisonment or a
fine of more than two thousand ringgit;

(g) has fulfilled such other conditions as may be prescribed under the Act or any
regulations made there under.

2.3 A person applying to be registered with the Chief Inspector to perform duties as a lift Competent
Person Grade III shall-

(a) be a Malaysian citizen;

(b) hold a qualification and experience of

(i) holds a degree in mechanical, electrical or electronic engineering or equivalent,

accredited by the Malaysian Qualification Accreditation (MQA) or the Board of
Engineers, Malaysia (BEM), and has one (1) year working experience in
maintaining, servicing and second schedule inspection of electric passenger
or goods lifts, escalators and dumbwaiters; or

(ii) holds a diploma in mechanical, electrical or electronic engineering accredited by

Malaysian Qualification Accreditation (MQA or National Occupational Skill
Standard (NOSS) and has three (3) years working experience in maintaining,
servicing and second schedule inspection of electric passenger or goods lifts,
escalators and dumbwaiters; or

(iii) holds a certificate in mechanical, electrical or electronic engineering or

equivalent, accredited by the Malaysian Qualification Accreditation (MQA) or
National Occupational Skill Standard (NOSS) and with five (5) years working
experience in maintaining, servicing and second sechedule inspection of
electric passenger or goods lifts, escalators and dumbwaiters.

(c) be employed by an approved firm;

(d) has passed an examination conducted by the Chief Inspector or his representatives

(e) be medically fit;

(f) has not been-

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(i) convicted of an offence under the Act or any regulations made thereunder;

(ii) convicted of an offence under the Occupational Safety and Health Act, 1994 or
any regulations made thereunder; or

(iii) convicted of an offence and sentenced to more than one year imprisonment or a
fine of more than two thousand ringgit;

(g) has fulfilled such other conditions as may be prescribed under the Act or any
regulations made there under.

2.4 A person who already poses the competency under the existing system may apply to be
registered with the Chief Inspector as Competent Person Grade I or equivalent Grade and may be
undergone and passed an interview conducted by the Chief Inspector or his representatives.

3.0 APPLICATION PROCEDURE

3.1 An application to be registered with the Chief Inspector must be forwarded by the approved firm
and has to be certified by its existing Lift Competent Person (if any), and must be made and completed
in the form set out in Appendix I and shall be accompanied with the relevant information,
documentation and declarations required under Clause 2.0 above.

3.2 Registration is valid for a period of three (3) years from the date of registration or as specified
by Chief Inspector, unless it is canceled by the Chief Inspector as stipulated in Clause 4.2.

3.3 Application for renewal of registration must be made by using the form as set out in Appendix
2.

3.4 A competent person who has ceased to work with an approved firm and intends to work with
another firm, has to reapply by using the form as set out in Appendix I and has to sit for another
examination to re-register him as a competent person.

4.0 POWER OF THE CHIEF INSPECTOR

4.1 Refusal to register. The Chief Inspector may refuse to register any application made if he is
satisfied that the applicant does not meet the requirements as outlined in Clause 2 or failed an
examination as prescribed under Clause 6.

4.2 Refusal to renew registration and cancellation of registration. The Chief Inspector may
refuse to renew or canceled at any time, registration of any competent person if he:-

(a) has ceased to work with the approved firm;

(b) has declared by Medical Officer or Occupational Health Doctor as medically unfit;

(c) has not meet any requirements set by the Chief Inspector;

(d) has failed to perform his duties as outlined in Clause 5; or

(e) has committed any of the misconduct as outlined in Clause 8.

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4.3 The Chief Inspector may call the lift competent person for an interview upon the renewal of
the competency.

5.0 DUTIES OF LIFT COMPETENT PERSONS

5.1 The Lift Competent Person Grade I shall:-

(a) be a representative of the lift owner to prepare, sign and submit to the Chief Inspector,
the First Schedule as required by regulation 6 (a) of the Factories and Machinery
(Electrical Passenger and Goods Lift) Regulations, 1970;

(b) fulfill all of the duties as prescribed under regulations 30, 31(5), 31(6), 31(7) and 31(8)
of the Factories and Machinery (Electric Passenger and Goods Lifts) Regulations, 1970;

(c) to carry out at least thirty (30) first or regular inspection per year by using the JKJ 166
for first inspection and checklist for inspection of electric and hydraulic elevator for
regular inspection in order to fulfill the requirement for renewal;

(d) to ensure the safety and health of employees of the approved firm and other people
during the installation, testing and first inspection and regular inspection of the lifts
under his care being taken care of;

(e) notify the Chief Inspector of any accident or incident involving the lift under his care;

(f) provide technical accident report and remedial action;

(g) supervise Lift Competent Person Grade II and Grade III; and

(h) submit declaration as set out in appendix 3 and 4, and an organisation chart to indicate
the line functions and territorial responsibilities of the competent persons in relationship
to the firm's Chief Executive officer, Managing Director or General Manager of the lift
firm.

5.2 The Lift Competent Person Grade II shall:-

(a) fulfill all of the duties as prescribed under regulations 30, 31(5), 31(6), 31(7) and 31(8)
of the Factories and Machinery (Electric Passenger and Goods Lifts) Regulations, 1970;

(b) be under the supervision of a Competent Person Grade I;

(c) to carry out at least sixty (60) first or regular inspection per year by using the JKJ 166
for first inspection and checklist for inspection of electric and hydraulic elevator for
regular inspection in order to fulfill the requirement for renewal;

(d) to ensure the safety and health of employees of the approved firm and other people
during the installation, testing and first inspection and regular inspection of the lifts
under his care being taken care of;

(e) supervise Lift Competent Person Grade III; and

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(f) notify the Chief Inspector or Lift Competent Person Grade I of any accident or incident
involving the lift under his care.

5.3 The Lift Competent Person Grade III shall:-

(a) fulfill all of the duties as prescribed under regulations 31(5), 31(6), 31(7) and 31(8) of
the Factories and Machinery (Electric Passenger and Goods Lifts) Regulations, 1970;

(b) be under the direct supervision of a Lift Competent Person Grade I or Grade II;

(c) to carry out at least ninety (90) Second Schedule inspection per year in order to fulfill
the requirement of renewal the competency

(d) to ensure the safety and health of employees of the approved firm and other people
during the monthly and Second Schedule inspection of the lifts under his care being
taken care of; and

(e) notify the Chief Inspector or the Lift Competent Person Grade I of any accident or
incident involving the lift under his care.

5.4 Any Lift Competent Person who fails to carry out the duties as prescribed under Clauses 5.1,
5.2 or 5.3. respectively shall be considered has committed a misconduct.

6.0 EXAMINATION

6.1 An examination or a technical presentation shall be conducted for a candidate who intends to
be a Lift Competent Person Grade I, to determine his knowledge and experiences. Such oral
examination shall include -

(a) Part I - To determine the experience and knowledge of candidates pertaining to the
designs and preparation of lift's first schedule;

(b) Part 11 - To determine the experience and knowledge of candidates pertaining to the
installation, testing and statutory inspection of new lifts and regular inspection; and

(c) Part III - To determine the experience and knowledge of candidates pertaining to the
maintenance, servicing and second schedule inspection of lifts; and

(d) Part IV - To determine the experience and knowledge of candidates pertaining to code
of practice and relevant regulations.

6.2 An examination shall be conducted for a candidate who intends to be a Lift Competent Person
Grade II, to determine his knowledge and experiences. Such oral examination shall include Part II,
Part III and Part IV as outlined in Clause 6. 1.

6.3 An examination shall be conducted for a candidate who intends to be a Competent Person
Grade III, to determine his knowledge and experiences. Such written examination shall include Part
III and Part IV as outlined in Clause 6. 1.

6.4 An interview and a technical presentation may be conducted for a candidate who already poses
the competency under the existing system who intends to be a Lift Competent Person Grade I or
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equivalent Grade , to determine his knowledge and experiences related to the latest requirement on
technical and legislation.

6.5 A technical presentation by lift competent person grade I and II and an interview may be
conducted for a lift competent person who applies to renew his/her competency , to verify that he/she
has carried his duty as lift competent person as stipulated in the Act and the Guideline.

7. RECOGNITION CRITERIA

7.1 Recognition to a candidate who meets the requirements as set out in Clause 2.1 and passed an
examination as prescribed under Clause 6.1, shall be granted a certificate and registered as a Lift
Competent Person Grade I.

7.2 A candidate who meets the requirements as set out in Clause 2.2 and passed an examination as
prescribed in under Clause 6.2, shall be granted a certificate and registered as a Lift Competent Person
Grade II.

7.3 Recognition to a candidate who meets the requirements as set out in Clause 2.3 and passed an
examination as prescribed under Clause 6.3, shall be granted a certificate and registered as a
Competent Person Grade III.

7.4 Recognition to a candidate who meets the requirements as set out in Clause 2.4 and passed an
interview as prescribed under Clause 6.4, shall be granted a certificate and registered as a Lift
Competent Person Grade I.

8. MISCONDUCT

8.1 For the purpose of these guidelines, misconduct means:

(a) failure to carry-out the duties as prescribed under Clause 5;

(b) delegates the duties to another person who is not registered with the Chief inspector;

(c) failure to advice the occupier or owner of any defect in the lifts which is likely to cause
danger to life or property while such lift is under his direct control;

(d) causing damage to the lifts or injury to any person by careless operation of the lifts or by
neglect of routine instructions, or by neglect to use the safety appliances provided or by
any negligent act or omission; or

8.2 Any lift competent person who being found to be guilty of misconduct, his/her competency
shall be terminated immediately.

8.3 Any lift competent person Grade I who being found to be negligent that caused an accident or
dangerous occurrence of the lifts under his care, he or she shall be charged under the relevant Act or
Regulations.

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Appendix 1
JABATAN KESELAMATAN DAN KESIHATAN PEKERJAAN
(KEMENTERIAN SUMBER MANUSIA)
APPLICATION TO BE REGISTERED AS A LIFT COMPETENT PERSON I/II/III

A. PARTICULARS OF THE CANDIDATE

(To be filled by the Applicant)

1. PERSONAL PARTICULARS

1.1 Name of Candidate (in block letters) 1.2 Date of Birth

1.3 Sex 1.4 Identity Card Number*

Male/Female .

1.5 Place of Birth 1.6 Citizenship

1.7 Approved Lift Firm Name & Registration No 1.8 Job Designations:

...

1.9 Office Address 1.10 Tel. No. (Office)

.. 1.11 Tel. No. (Home)

1.12 E-mail address

...............
2. QUALIFICATION

2.1 Professional education* Year Qualification

Name of Institution/ From to Obtained
University

. .

. . .
2.2 Technical training

. .

Date: . ..
Signature of Applicant
Note: (*) Please enclosed certified copies of relevant document and latest medical examination report.
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B. EXPERIENCE OF THE CANDIDATE (To be filled by the existing CP Lift Grade I if any)

1. TRAINING YES/NO DURATION

(a) Design

(b) Manufacturing

(c) Code of Practice

(d) Testing/Commissioning

(e) Installation

(f) Maintenance

(g) Others (please specify)

2. FIELD EXPERIENCE YES/NO NO. OF MONTHS (ACCUMULATE)

(a) Design

(b) Manufacturing

(c) Preparation of 1st Schedule

(d) Installation

(e) Testing/Commissioning/1st Inspection

(f) Maintenance/Monthly Inspection

(g) Annual/Regular Inspection

(h) 2nd Schedule Inspection

(i) Total number of years experiences in lift industry

C. DECLARATION BY THE CP Lift Grade I

I hereby:-
i. certify that the above particulars are true and correct to the best of my knowledge; and
ii. declare that all of the conditions as set out in paragraph 2 have been fulfilled.

Date: . ..
Signature
( Name of CP Lift Grade I )
CP Lift Grade I No : .

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Appendix 2

JABATAN KESELAMATAN DAN KESIHATAN PEKERJAAN, MALAYSIA

Application for Renewal as a Competent Person Grade I/II/III

A. PARTICULARS OF APPLICANT

File No: .....................................

Registration No: ......................

Expiry Date: .................................

1. I .............................................................. N.R.I.C. No. ........................................

a competent/assistant-competent person employed by ........................................ would like to
apply for renewal of registration as a Competent Person Grade I/II/III/** for the next three (3)
years.

2. Enclosed herewith please find document* to support my application for the purpose.

Date: .......................................... ........................................

(Signature of Applicant)

B. JKKP STATE OFFICE COMMENT

Mr . ................................ ................. N.R.I.C. No . ................................................

who is registered as a Competent Person Grade I/II/III/**, has successfully fulfill duties as
prescribed under Clause 5 of these guidelines.

I have no objection for the Department to renew his registration as a competent person (design
and/or construction, installation tests and/or maintenance) for the next three (3) years.

Date:................................................. ..
Director,
Department of Occupational
Safety and Health . .................

Document includes latest inspection report, medical examination report and any other
document deems appropriate.

* Proof of minimum number of inspection per year

** Please delete those which is not applicable
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BORANG PEMERIKSAAN LIF

No Pendaftaran
OYK

JENIS PEMERIKSAAN JENIS JENTERA

Nama
Tarikh NO. Tanda
BIL LOKASI LIF Pemeriksa
Pemeriksaan PMA Tangan
Pertama Ulangan Travelator Eskalator Dumwaiter JKKP

Penumpang Barang OKU

1

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

Total Unit
Pemeriksaan

Total Keseluruhan Unit Pemeriksaan :

-----------------------------------------------
Tanda Tangan Orang Yang
Kompeten Lif

Nama :
Cop Pengesahan

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Appendix 3

JABATAN KESELAMATAN DAN KESIRATAN PEKERJAAN, MALAYSIA

Declaration By a Grade I/II/III Competent Person

Name: ..................................................... N.R.I.C. No . ..................................................

Name and Address of Approved Firm:
...............................................................................................................................................................................
...............................................................................................................................................................................
...............................................................................................................................................................................
..........................................................................................................................................................................

I hereby declare the followings is under my supervision:-

1. Number of new lift/escalator/dumbwaiter installed: ......................................

2. Number of lift/escalator/dumbwaiter maintained: .........................................
3. Name or brand of lift/escalator/dumbwaiter maintained other than the brand of lift/escalator/dumbwaiter
approved:

PMA Location Lift Brand Lift/Escalator/Dumbwaiter

Date: .............................................. ...............................................

(Signature of a competent person)

In the presence of the Approved Lift Firm's C.E.O/M.D./G.M:

Date: .............................. ..........................................................

(Signature of C.E.O/M.D./G.M.)

.....................................................
Company's Official Stamp

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Appendix 4

PERMOHONAN SEBAGAI ORANG BERKOMPETEN LIF

A. JENIS PERMOHONAN : BARU / LANJUTAN GRED:

B. BUTIRBUTIR PEMOHON

1. No. K.P./Passport/
Polis/Tentera

2. Nama

3. Alamat

4. Poskod 5. Bandar

6. Negeri

7. Jantina (L/P) 8. Tarikh lahir

C. KELAYAKAN BIL INSTITUT BIDANG TARAF TAHUN

AKEDEMIK/LATIHAN

Ruang untuk permohonan Baharui Kompetensi

Tarikh Luput Kompetensi

D. PENGAKUAN

Saya mengakui bahawa semua maklumat yang diberikan adalah benar.

Tarikh : . ....
Tandatangan Pemohon

Nama : ...

No. K.P. ..

E. MAKLUMAT PEGAWAI PERUBATAN YANG BIASA MERAWAT:

(Sebutkan nama dan alamat Pegawai Perubatan yang biasa merawat anda)

Nama Pegawai Perubatan :

Alamat :

SALINAN ASAL HENDAKLAH DIKEMUKAKAN KEPADA KETUA PENGARAH JKKP

SALINAN PENDUA HENDAKLAH DISIMPAN OLEH PEGAWAI PERUBATAN YANG MEMBUAT
PEMERIKISAAN

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-2-
F. PEMERIKSAAN PERUBATAN
(UNTUK DIPENUHI OLEH PENGAMAL PERUBATAN)

BAHAGIAN I
No. Pendaftaran Pemohon di klinik : Tarikh Pendaftaran :

Keadaan Umum :

Berat : ..kg. Ketinggian : sm

Pemeriksaan air kencing untuk albumin dan gula (Jika positif siasat selanjutnya)

Tekanan darak: Sistolik : . Diastolik :

Kejituan penglihatan mengikut Carta Snellen (Dalam meter)

Tanpa kacamata min. 6/60 Kanan : .. Kiri : ..

Dengan Kecamata min. 6/12 Kanan : .. Kiri : ..

*Untuk mereka yang memakai kacamata. Perlu dinyatakan pada lesen.

JAWAPAN

Sila tandakan X dalam ruang yang bersesuaian Ya atau Tidak

Bil Perihal Ya Tidak Catatan

1 Ada kecacatan dalam penglihatan (Carta istihara)
2 Ada kecacatan dalam penglihatan lapangan (field vision)
3 Ada bukti kecacatan sistem saraf
4 Ada bukti-bukti penyakit psikiatrik (psychiatric)
5 Adakah pemohon menunjukkan tanda-tanda peminum arak dan
Penyalahgunaan dadah
6 Ada ketidaksempurnaan dari/atau kecacatan fizikal
7 Ada bukti kelainan sistem kardiovaskular
8 Adakah pemohon mempunyai tekanan darah tinggi yang tidak
terkawal
9 Adakah pemohon mengidap penyakit kencing manis yang tidak
dikawal dengan sempurna
10 Ada kecacatan pendengaran
11 Ada bukti kelainan sistem respiraton
12 Siasatan lanjut yang dijalankan dan keputusannya:
a): ..
b): ..
c): ..
13 Pandangan-pandangan lain oleh pengamal perubatan:



Catatan: Kelewatan boleh berlaku kerana diperlukan siasatan lanjut.

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BAHAGIAN II

Sila jawab soalan-soalan berikut berhubung dengan sejarah kesihatan anda. Tanda X dalam kotak ruangan yang
sesuai Ya atau Tidak. Jika Ya jelaskan dalam ruang catitan.

Adakah anda mempunyai sejarah atau sedang mengalami penyakit berikut

Bil Perihal Ya Tidak Catatan

*1 Masalah mata
- Katarak
- Pandangan monocular
- Lain-lain yang menyebabkan halangan pandangan
*2 Tidak dapat mengenaipasti warna-warna asas (primer)
[merah, hijau, kuning (amper)]
3 Sukar melihat dalam gelap
*4 Apa-apa jenis sawan atau kekejangan
5 Kecederaan berat dikepala
*6 Serangan pening atau pening
7 Sakit kepala yang berat atau migrane
8 Pembedahan otak yang major
*9 Stroke (dengan kecacatan residual}
*10 Kencing manis dalam rawatan insulin
*11 Penyakit mental
*12 Penyalahgunaan arak dalam masa 5 tahun yang lalu
*13 Penyalahgunaan dadah dalam masa 5 tahun yang lalu
14 Kecacatan tulang belakang
*15 Ketidaksempurnaan atau kecacatan anggota
- pergerakan sendi yang terhad
- kecacatan anggota yang berat
- amputation yang berat
16 Penyakit jantung / tekanan darah tiggi / debaran jantung
17 Sesak nafas / muntah darah / batu kronik
*18 Pekak
- pekak tuli
*19 Penyakit buah pinggang yang kronik
20 Apa-apa rawatan yang berulang
21 Apa-apa penyakit atua kecederaan yang tidak dinyatakan di atas

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BAHAGIAN III

KEPUTUSAN PEMERIKSAAN PERUBATAN

Saya sahkan bahawa saya pada hari ini telah memeriksa pemohon
No. Kad Pengenalan .. Jawapan kepada soalan-soalan di atas adalah
benar
Setakat yang saya ketahui dan percaya. Daripada pemerhatian dan pemeriksaan perubatan, saya dapati
pemohon dari segi fixikal dan mental adalah:

SIHAT (MEDICALLY FIT) / TIDAK SIHAT (MEDICALLY UNFIT)

Tandatangan pengamal perubatan : ..

Nama dan kelayakan pengamal perubatan : No. Pendaftaran MMC:

Alamat : .. No. Pendaftaran Klinik:

Tarikh :

UNTUK KEGUNAAN JKKP

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Appendix 5

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Appendix 6

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Appendix 7

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