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sA-9663 (01/201 s)

MSP-95-7' Attachment #1

EXAMINATION Gl7.O25' Attachment #l


SAUDI ARAMCO/CONTRACTOR MEDICAL
FOR HEAVY EQUIPMENT OPERATORS
Photo
PHYSICIAN'S EXAMI NATON FORM*
'(uPoN COMPI ETING F

EMPLOYEE *Ott iur-ur= uu,*t)


SAUDIGOVERNMENT ID #
OR IQAMA #

DATE
COMPANY NAME
(PLEASE PRINT)

e seParatelY' with or
without the use ol eyeglasses or contact lenses'
F*ition and visual fields should be normal'

3- Diplopia is UNACCEPTABLE'

isPeech communication
with or without a hearing aid.

suooeru INCAPACITY
NACCEPTABLE.
- the 5 years'
ih6 in"tuo"s, but is not limited to, a history of seizures atter
mellitus'
vestiUular disorders, heart disease, and diabetes

OGdrrnent ot musculo'skeletal capacities'

z- CoonOinution and progressive or disabling


neurological disease'

I t'rirtoty of psychiatric illness or emotional instabil'ttY'

and its side effects.

FITTOWORK?

REMARKS:

DATE rvrv / oo / vyyy

:=::
ffi
::

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