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    Attachment 19e Contractor Health Fitness Certificate

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    l101
    In 3 sentences: This document is a contractor health fitness certificate template used by SABIC to assess and document a contractor's medical fitness for work. It includes sections to record a contractor's physical assessment results such as vital signs, physical exam findings, medical test results. The attending physician and medical director indicate their determination of whether the contractor is deemed medically fit or unfit to work, and a final fitness assignee makes the conclusive fitness determination for the SABIC site.

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    Attachment 19e Contractor Health Fitness Certificate

    Uploaded by

    l101
    32 views1 page
    In 3 sentences: This document is a contractor health fitness certificate template used by SABIC to assess and document a contractor's medical fitness for work. It includes sections to record a contractor's physical assessment results such as vital signs, physical exam findings, medical test results. The attending physician and medical director indicate their determination of whether the contractor is deemed medically fit or unfit to work, and a final fitness assignee makes the conclusive fitness determination for the SABIC site.

    Original Description:

    Petrokemya

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    In 3 sentences: This document is a contractor health fitness certificate template used by SABIC to assess and document a contractor's medical fitness for work. It includes sections to record a contractor's physical assessment results such as vital signs, physical exam findings, medical test results. The attending physician and medical director indicate their determination of whether the contractor is deemed medically fit or unfit to work, and a final fitness assignee makes the conclusive fitness determination for the SABIC site.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    32 views1 page

    Attachment 19e Contractor Health Fitness Certificate

    Uploaded by

    l101
    In 3 sentences: This document is a contractor health fitness certificate template used by SABIC to assess and document a contractor's medical fitness for work. It includes sections to record a contractor's physical assessment results such as vital signs, physical exam findings, medical test results. The attending physician and medical director indicate their determination of whether the contractor is deemed medically fit or unfit to work, and a final fitness assignee makes the conclusive fitness determination for the SABIC site.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    Classification: Internal Use

    Operation Management System SHEM No. SHEM-05.00


    THIRD PARTY EHSS MANAGEMENT Rev. # ( 00 ) Date March 2021
    Next Review Date March 2024
    Attachment 19e Contractor Health Fitness Certificate Page 1 of 1

    DATE: ………………………………

    For Medical Provider Use: Medical provider name:……………………………………….….

    Name Of Contractor: ……………………………………………….…… Hospital File No.: ……….…….


    Date of Birth: ……………………………………….Passport/Iqama No.: .…………….………………………….
    Contractor Company: ………………….………. Nationality: ………………………………………………
     Medical Examinations
    Height ………………………. Weight ……………………………………… BMI …………………………………
    Pulse …………………………. Blood Pressure ………………………….. Temperature …………………

    Physical Assessment
    Lungs & Chest Assessment Normal Abnormal Not Required
    Abdominal Examination Normal Abnormal Not Required
    Cardiovascular Assessment Normal Abnormal Not Required
    Neurological Assessment Normal Abnormal Not Required
    Medical Investigation Assessment
    CBC Normal Abnormal Not Required
    RBS Normal Abnormal Not Required
    Creatinine Normal Abnormal Not Required
    Urine Analysis Normal Abnormal Not Required
    SGPT (ALT) Normal Abnormal Not Required
    ECG Assessment Normal Abnormal Not Required
    Chest X-Ray Normal Abnormal Not Required
    Audiometry Normal Abnormal Not Required
    Spirometry Normal
    Abnormal Not Required Vision Normal
    Abnormal Not Required

    Remarks………………………………………...............................................................................................
    Initial Medical Fitness
    FIT UNFIT

    …………………………………… ………………………………… ………………………………….


    Attending Physician Medical Director Medical Provider Stamp
    For SABIC Site Use: SABIC Site Name: ……………………………………………………..

    Final Medical Fitness FIT


    UNFIT

    …………………………… …………………………………..
    …………………………………..
    Final Fitness Assignee Badge Number Site Stamp

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