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    FSSAI Vaccination Form - Tybar 2.5ml

    Uploaded by

    anandsiv
    This document contains a medical fitness certificate for food handlers employed by Rebel Foods. It certifies that an individual named has been examined and found free of infectious diseases, making them fit to work with food. The examination included a complete blood count, urine test, and confirmation of vaccinations against enteric diseases. A vaccination consent form is also included, documenting an employee's typhoid vaccination details and declaration that their health information is accurate.

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    FSSAI Vaccination Form - Tybar 2.5ml

    Uploaded by

    anandsiv
    188 views2 pages
    This document contains a medical fitness certificate for food handlers employed by Rebel Foods. It certifies that an individual named has been examined and found free of infectious diseases, making them fit to work with food. The examination included a complete blood count, urine test, and confirmation of vaccinations against enteric diseases. A vaccination consent form is also included, documenting an employee's typhoid vaccination details and declaration that their health information is accurate.

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    This document contains a medical fitness certificate for food handlers employed by Rebel Foods. It certifies that an individual named has been examined and found free of infectious diseases, making them fit to work with food. The examination included a complete blood count, urine test, and confirmation of vaccinations against enteric diseases. A vaccination consent form is also included, documenting an employee's typhoid vaccination details and declaration that their health information is accurate.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    188 views2 pages

    FSSAI Vaccination Form - Tybar 2.5ml

    Uploaded by

    anandsiv
    This document contains a medical fitness certificate for food handlers employed by Rebel Foods. It certifies that an individual named has been examined and found free of infectious diseases, making them fit to work with food. The examination included a complete blood count, urine test, and confirmation of vaccinations against enteric diseases. A vaccination consent form is also included, documenting an employee's typhoid vaccination details and declaration that their health information is accurate.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 2

    PERFORMA FOR MEDICAL FITNESS CERTIFICATE FOR FOOD HANDLERS

    (FOR THE YEAR 2020)


    (See Para No. 10.1.2, Part- II, Schedule - 4 of FSS Regulation, 2011)

    It is certified that Shri/Smt./Miss.................................................................... employed with


    M/s Rebel Foods., coming in direct contact with food items has been carefully examined by me on date
    _____ Based on the medical examination conducted, he/she is found free from any infectious or
    communicable diseases and the person is fit to work in the above mentioned food establishment.

    Name and Signature with Seal of Registered


    Medical Practitioner / Civil Surgeon

    *Medical Examination to be conducted:


    1. Complete Blood Count
    2. Urine Routine
    3. Compliance with schedule of Vaccine to be inoculated against enteric group of diseases
    4. Any test required to confirm any communicable or infectious disease which the person suspected to be
    suffering from on clinical examination.

    Name and Signature with Seal


    of Registered Medical Practitioner
    Vaccination Consent Form

    Name: Date:

    Age/Sex:
    _____________________________________________________________________________

    Tick the correct answer:


    YES NO
    Did you ever had a serious allergic reaction to any previous vaccination?
    Do you suffer from any disease that affect the immune system?
    Do you currently have fever/high body temperature?

    Vaccination : Typhoid
    Past History
    Vaccination Brand Name
    Batch No.
    Manufacturing Date
    Expiry Date
    Vaccination Sticker

    Declaration: I hereby state that the above statements are true to the best of my knowledge.

    Name & Signature (Employee) Doctor’s Name & Signature

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