Pre-Employment Physical Fitness Report

Candidate Information

Full Name:
Date of Birth:
Position Applied For:
Date of Examination:

Vital Signs

Measurement Result Reference
Height cm
Weight kg
Blood Pressure mmHg
Pulse Rate bpm

Physical Fitness Assessment

Test Result Remarks
Cardiovascular Endurance
Muscular Strength
Muscular Endurance
Flexibility
Body Composition

General Medical Remarks

Observations:

Fitness for Duty

Medically Fit:
Medically Unfit:
Conditional Fit (with remarks):
Physician Name:
Signature:
Date: