Employee Health Declaration Form
कर्मचारी स्वास्थ्य घोषणा फॉर्म
A self-declaration form where an employee states health information the employer is permitted to ask for, such as symptoms or exposure.
Download Employee Health Declaration Form
What the employee health declaration form is used for
Use it to capture employee name, employee id, department, date, additional information (optional) in one standard format. Answer truthfully and keep the form confidential; it is a self-declaration, not a medical assessment.
Who should use it
- Employees and students who need to apply for health-related leave
- HR and school offices who record such leave
- Qualified medical practitioners completing their own sections
Key features
- 3 labelled field groups covering Employee Name, Employee ID, Department, Date and more.
- Signature lines for the people who complete or approve it.
- Checklist boxes you can tick by hand.
- Pre-written wording with blanks, available in both English and Hindi.
- Clean A4 portrait layout designed to print on a standard office printer.
- Contains a medical-use disclaimer and blank sections for any medical details.
Frequently asked questions
What details does the Employee Health Declaration Form include?
It includes Employee Name, Employee ID, Department, Date, Additional information (optional), laid out so the form can be filled by hand or typed.
Can I edit the Employee Health Declaration Form before printing?
Yes. Download the Word (.docx) version, add your name, logo or extra fields and then print or save it as PDF. The PDF is best when you only need to print and write by hand.
Is the Employee Health Declaration Form available in Hindi?
Yes. Both an English and a Hindi version are provided in PDF, DOCX format where listed on this page.
Is the Employee Health Declaration Form an official medical document?
No. It is a general template for drafting or record-keeping. It does not certify that anyone is ill or fit, and any medical statement, signature, registration number and stamp must come from a qualified, authorised medical practitioner. Always give truthful information.
Last updated: 11 October 2026