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    Safty

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    Anonymous ABLtDDvKui
    This document contains a medical examination report form for employees working in mines. It includes: 1) Identification information for the employee and whether it is an initial or periodic exam. 2) Findings from the medical exam, including vital signs, vision, hearing, respiratory, circulatory, abdominal, nervous, locomotor, and skin assessments. 3) Details on urine analysis, chest x-rays, other tests, and any specialist opinions. 4) Space for the examining authority's signature, date, and designation. The purpose is to document the medical fitness of mine employees and identify any issues requiring follow up or restrictions on work duties.

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    Safty

    Uploaded by

    Anonymous ABLtDDvKui
    126 views3 pages
    This document contains a medical examination report form for employees working in mines. It includes: 1) Identification information for the employee and whether it is an initial or periodic exam. 2) Findings from the medical exam, including vital signs, vision, hearing, respiratory, circulatory, abdominal, nervous, locomotor, and skin assessments. 3) Details on urine analysis, chest x-rays, other tests, and any specialist opinions. 4) Space for the examining authority's signature, date, and designation. The purpose is to document the medical fitness of mine employees and identify any issues requiring follow up or restrictions on work duties.

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    This document contains a medical examination report form for employees working in mines. It includes: 1) Identification information for the employee and whether it is an initial or periodic exam. 2) Findings from the medical exam, including vital signs, vision, hearing, respiratory, circulatory, abdominal, nervous, locomotor, and skin assessments. 3) Details on urine analysis, chest x-rays, other tests, and any specialist opinions. 4) Space for the examining authority's signature, date, and designation. The purpose is to document the medical fitness of mine employees and identify any issues requiring follow up or restrictions on work duties.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    126 views3 pages

    Safty

    Uploaded by

    Anonymous ABLtDDvKui
    This document contains a medical examination report form for employees working in mines. It includes: 1) Identification information for the employee and whether it is an initial or periodic exam. 2) Findings from the medical exam, including vital signs, vision, hearing, respiratory, circulatory, abdominal, nervous, locomotor, and skin assessments. 3) Details on urine analysis, chest x-rays, other tests, and any specialist opinions. 4) Space for the examining authority's signature, date, and designation. The purpose is to document the medical fitness of mine employees and identify any issues requiring follow up or restrictions on work duties.

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    FORM-O

    (See rule 29F(2) and 29L)


    Report of Medical examination under rule 29B
    (To be issued in triplicate)**
    Certificate No:………………..

    Certificate that shri/shrimathi……………………………………………………………………………………… employed as

    …………………………………………. In megha engineering & infrastructures Limited. Form B No. :………………..

    Has been examined for an INITIAL/PERIODICAL medical examination. HE/SHE* appears to be ………...

    …………………. Years of age

    The findings of the examining authority are given in the attached sheet.

    It is considered that shri/shrimathi*……………………………………………………………………………………………….

    (a) Is medically fit for any employment in mines


    (b) Is suffering from………………………….. and is medically unfit for
    (i) Any employment in mines: or
    (ii) Any employment below ground: or
    (iii) Any employment or work
    (c) Is suffering from …………………………. Is should get this disability *cured/controlled and should
    be again examined within a period of ………………………..months.He/she will appear for re-
    examination with the results of test of ………………………….. and the opinion of
    …………………………………… specialist from ………………………….. He/she may be permitted /not*
    permitted to carry on his /her duties during this period

    Place: signature of the examination authority

    Date Name and designation in blocks letters


    FORM-O

    Report of the examination Authority

    (To be filled in for every medical examination whether initial or periodical re-examination or after
    cure/control of disability)
    Annexture to certificate no…………………………… as a result of medical examination on ……………………
    Identification mark………………………………………
    (1) General development-good/Fair/Poor
    (2) Height……………..cms
    (3) Weight……………………kg
    (4) Eyes:
    (i) visual acuity-Distant vision (with or without glasses)
    (ii) Any organic disease of eyes
    (iii) Night blindness
    (iv) Colour blindness
    (v) Squint(to be tested in special cases)
    (5) Ears:
    (i) Hearing right ear……………………….Left ear…………………..
    (ii) Any organic disease
    (6) Respiratory system :
    (i) Chest measurement:
    After full inspiration …………………….. cms
    After full expiration……………………….cms
    (7) Circulatory system
    Blood pressure
    Pulse
    (8) Abdomen
    Tenderness
    Liver
    Spleen
    Tumour
    (9) Nervous system
    History of fits or epilepsy
    Paralysis
    Mental Health
    (10) Locomotor system
    (11)Skin
    (12)Hernia
    (13)Hydrocele
    (14)Any other abnormality
    (15)Urine:
    Reaction
    Albumin
    Sugur
    (16)Skiagram of chest
    (17)Any other test considered necessary by the examination Authority
    (18)Any opinion of specialist considered necessary

    Place:
    Date : signature of the examining auth
    Report of Medical examination as per the recommendations of
    National safety conferences in mines
    (To be used in continuation with Form O)

    Certificate No :

    Name :

    Identification :

    1. Cardiological Assessment

    Ausculation S1
    S2
    Additional Sound
    Electrocardiographic(12 leads) findings: Normal/Abnormal

    Enclosed ECG

    2. Neurological Assessment

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