Firefighter Candidate Physical Examination Form
Candidate Information
Full Name
Date of Birth
Gender
Address
Phone Number
Email
Medical History
Condition
Yes/No
Comments
Asthma
Heart Disease
High Blood Pressure
Diabetes
Seizure Disorder
Other
Physical Examination
Height
Weight
Blood Pressure
Pulse
System
Result
Comments
Vision
Hearing
Respiratory
Cardiovascular
Musculoskeletal
Other
Physician's Comments/Recommendations
Certification
Medically Fit for Firefighting Duties
Physician Name
Physician Signature
Date