New Employee Physical Examination Form
Personal Information
Full Name
Date of Birth
Gender
Female
Male
Other
Contact Number
Address
Position/Job Title
Department
Medical History
Previous Illnesses / Surgeries / Hospitalizations
Current Medications
Allergies
Do you smoke?
Yes
No
Do you consume alcohol?
Yes
No
Vital Signs
Height (cm)
Weight (kg)
Blood Pressure (mmHg)
Pulse (bpm)
Temperature (°C)
Physical Examination
Vision
Hearing
Systemic Examination (Heart, Lungs, Abdomen, etc.)
Physician Remarks
Remarks / Recommendations
Physician Name
Examination Date
Signature