Employee Medical Examination Form
कर्मचारी चिकित्सा परीक्षण फॉर्म
A form for recording a pre-employment or periodic medical examination, with the findings section left for the examining practitioner.
Download Employee Medical Examination Form
What the employee medical examination form is used for
Use it to capture employee name, employee id, date of birth, gender, purpose of examination, date and related details in one standard format. Employers should state the purpose of the examination and protect the confidentiality of results.
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
- 5 labelled field groups covering Employee Name, Employee ID, Date of Birth, Gender and more.
- 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 Medical Examination Form include?
It includes Employee Name, Employee ID, Date of Birth, Gender, Purpose of Examination, Date, Findings, Opinion / Recommendations, laid out so the form can be filled by hand or typed.
Can I edit the Employee Medical Examination 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 Medical Examination 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 Medical Examination 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