Employee Physical Examination Form

Multinational corporations may employ hundreds or thousands of people with different qualifications, skills, and experience. Recruitment can involve shortlisting, interviews, and other assessments relevant to the position. For some roles, an occupational health assessment may also be part of the process.

An employee physical examination assesses health factors relevant to a person’s work. Its purpose is to help identify whether the individual can perform the role’s duties safely and whether workplace adjustments or further assessment may be needed. Having a chronic condition or disability does not, by itself, establish that someone cannot perform a job.

A physical examination form records relevant medical history, examination findings, and the healthcare professional’s assessment. It should focus on information appropriate to the role rather than unrelated aspects of the person’s health or appearance.

The examination may take place at an occupational health clinic or another suitable healthcare facility. Tests should be selected according to the role’s requirements and the healthcare professional’s assessment. Laboratory testing is not necessarily required for every employee or position.

Where health concerns are identified, the healthcare professional can recommend follow-up care or work-related adjustments. Information shared with the employer should be limited to relevant fitness-for-work findings and recommendations, with medical records handled confidentially.

[Create a sample form below]

Components of the Form

The contents depend on the role and the purpose of the assessment. Common sections include:

1. Personal and job information: The employee’s or applicant’s name, date of birth, relevant contact details, job title, and examination date.
2. Relevant medical history: Current health concerns, medications, allergies, previous surgeries, and other information relevant to the assessment.
3. Physical examination: A healthcare professional records appropriate observations and measurements, which may include height, weight, blood pressure, pulse, temperature, and respiratory rate.
4. Role-specific assessments: Vision, hearing, mobility, or other examinations may be included when relevant to the job. These are not all laboratory tests and should be labeled separately.
5. Additional testing: Laboratory tests or drug and alcohol screening may be included where appropriate to the assessment and applicable workplace procedures. The form should identify the test and its purpose rather than assume every employee requires the same screening.
6. Vaccination history: Record vaccinations relevant to occupational exposure or workplace requirements. A vaccination record does not establish immunity to every infectious disease.
7. Assessment and recommendations: Provide space for the healthcare professional to record fitness-for-work findings, recommended adjustments, restrictions, or further review.

Importance of Using the Form

Employee physical examination forms can support occupational health management by:

• Providing a consistent record of relevant examination findings.
• Helping identify health factors that may affect the safe performance of specific duties.
• Supporting recommendations for workplace adjustments or preventive measures.
• Encouraging appropriate follow-up when a health concern is identified.
• Documenting the assessment and any planned review.

Layout of the Form

Employers and healthcare professionals can develop a form suited to the role and assessment process. Keep clinical information separate from any summary intended for the employer.

A basic sample layout is shown below:

ABC Company

Employee Physical Examination Form

Applicant’s or employee’s name: ____________________
Job title: ____________________
Date of birth: ____________________
Examination date: ____________________

Relevant medical history: ____________________
Current medications: ____________________
Allergies: ____________________

Measurements, where relevant:

Measurement	Result
Height
Weight
Blood pressure
Pulse
Respiratory rate
Temperature

Examination findings, where relevant:

Area Assessed	Findings / Comments
Vision
Hearing
Cardiovascular system
Musculoskeletal function
Mobility
Other role-specific assessments

Additional tests and relevant results: ____________________

Relevant vaccination history: ____________________

Work-related assessment and recommendations: ____________________

Further assessment or review required: ____________________

Healthcare professional’s name: ____________________
Professional designation: ____________________
Signature: ____________________
Date: ____________________