Wednesday, May 29, 2013

physical fitness certificate

Joined a company that wanted me to go to a registered medical practitioner and get a fit to work note from the Doctor. They did  not have a template so I decided to upload this one, that I got on the recommendation of the doctor I went to, from a stationary store.

If I had this text/image would have printed it out and gone straight to him.

Edited the grammar from original. Ready to print : PDF and source open office format

Edited text:

PHYSICAL FITNESS CERTIFICATE


1. I, do hereby certify that I have examined                                                  candidate for

and that I cannot detect that he/she has any disease,constitutional affection or bodily infirmity except  ___

I do not consider this as disqualification for employment in office of 

2. I'm also satisfied (after personal examination) that he/she was vaccinated/re-vaccinated within a week prior to the date of this examination

3.     is age is according to his/her own statement year and by appearance about ..  years.


4. Height

5. Weight 

6. Chest measurement on (full inspiration  )

7. Vision
a) Right Eye
b) Left Eye ..:

Wears spectacles Yes/no


City / Place :
Date :

Image:




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