PRE-EMPLOYMENT CHECK-UP FOR "MALE CANDIDATES"

Height cms VISION (Without Glasses) NERVOUS SYSTEM

Rt Lt
Weight Kgs Distant 6/____ 6/____ Psychological make-up:
Near N/______ N/______ Acceptable Not Acceptable
Urine
Albumen Present Absent VISION (With Glasses) Higher Functions
Sugar Present Absent Rt Lt Normal Defective
Distant 6/____ 6/____
Haemoglobin Near N/______ N/______ Motor System
gms% Normal Defective
Rt Lt
CLINICAL EXAMINATION Power Sensory System
of Glasses Normal Defective
Nails of Lenses
Pink Pale Clubbed Reflexes :
Colour Vision : (with-Ishihara Chart) Superficial
Oral Hygiene Good Poor Normal Defective Planter
Deep
Speech Normal Stammer
Individual Colour Identification MUSCULO SKELETAL SYSTEM
Lymph Nodes Normal Defective Normal Defective
Not Enlarged Enlarged
GENITO-URINARY SYSTEM
Squint : Present Absent Hydrocoele Hernia
Varicocoele Phimosis
Nystagmus Present Absent Varicose Veins

ENT EXAMINATION CARDIO - VASCULAR SYSTEM SKIN

Conversational Hearing Pulse __________/min Identification Mark _______________

Normal Defective Regular irregular ______________________________

Auroscopy Peripheral Pulsations : Normal

Felt Not Felt
Nose Eczema / Extensive Acne Vulgaris /
Blood Pressure Hansen's / Melanoma/Neurodermatitis/
Throat 1st Reading __________ mm Hg Oil Acne/Psoriasis/Tylosis/Venereal
2nd Reading __________ mm Hg Warts
Thyroid Enlarged NE
Other signs: ___________________

RESPIRATORY SYSTEMS ALIMENTARY SYSTEM X-Ray Chest

Liver Not Enlarged Enlarged Normal / Shows Positive findings
Spleen Not Enlarged Enlarged
Other Signs ____________________