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    Form No. 31AhEALTH

    Uploaded by

    Prasanta Patnaik
    This document contains a health record form used for pre-employment or periodic employee checkups. It collects information such as the employee and factory name, age, identification details, job role, medical history, physical measurements, examination of body systems, any present complaints, summary of findings of conditions like heart disease or tuberculosis, and recommendations for further investigation if needed. The medical officer and employee must sign upon completion of the health evaluation documented in the form.

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    Form No. 31AhEALTH

    Uploaded by

    Prasanta Patnaik
    3K views2 pages
    This document contains a health record form used for pre-employment or periodic employee checkups. It collects information such as the employee and factory name, age, identification details, job role, medical history, physical measurements, examination of body systems, any present complaints, summary of findings of conditions like heart disease or tuberculosis, and recommendations for further investigation if needed. The medical officer and employee must sign upon completion of the health evaluation documented in the form.

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    This document contains a health record form used for pre-employment or periodic employee checkups. It collects information such as the employee and factory name, age, identification details, job role, medical history, physical measurements, examination of body systems, any present complaints, summary of findings of conditions like heart disease or tuberculosis, and recommendations for further investigation if needed. The medical officer and employee must sign upon completion of the health evaluation documented in the form.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    3K views2 pages

    Form No. 31AhEALTH

    Uploaded by

    Prasanta Patnaik
    This document contains a health record form used for pre-employment or periodic employee checkups. It collects information such as the employee and factory name, age, identification details, job role, medical history, physical measurements, examination of body systems, any present complaints, summary of findings of conditions like heart disease or tuberculosis, and recommendations for further investigation if needed. The medical officer and employee must sign upon completion of the health evaluation documented in the form.

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    © All Rights Reserved
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    FORM No.

    31 - A
    HEALTH RECORD
    (Pre-employment / Periodical)
    [Prescribed under Rule - 62 - I ]

    1. Name of the factory :

    2. Name of the employee :

    3. Employee distinguishing number :

    4. Age of the employee :


    Identification Mark
    nature of job

    5. Date of 1st employment :

    6. Length of service in years :

    7. General Survey :
    Health : Good / Fair / Poor
    Height : cms.
    Weight : Kg.

    8. Blood Group :

    9. Eye Vision : Normal / Abnormal


    Use of glass - Yes / No

    10. Hearing : Normal / Abnormal

    11. Respiratory System : Chest measurement


    Inspiration
    Expiration
    Respiration rate / min.
    Remarks if any

    12. Cardiovascular systems :


    Pulse rate
    B. P.
    Heart Sound, remarks if any
    13. Abdomen Tenderness : Yes / No.

    14. Nervous System : History of Fits - Yes / No


    Epilepsy - Yes / No
    Remarks on
    Mental health -

    15. Locometer System : Normal / Abnormal

    16. Skin Condition : Normal / Abnormal

    17. Hernia : Present / Absent

    18. Hydrocele : Present / Absent

    19. Present complain if any :

    20. Summary of findings :


    Heart disease
    Hypertension
    Diabetes
    T. B.
    Epilepsy
    Poisoning
    Others
    Occupational diseases, if any

    21. Recommendation, if any for any


    further investingation :

    Signature of the employee Signature of the Medical officer

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