Medical Screening Form for Construction Sector. Required to be filled in by the HSE officer or the personnel himself upon mobilization at critical and high-profile sites. The form shall be accompanied by the Doctor's certificate as well.

1. SKC ENGINEERS AND CONTRACTORS PRIVATE LIMITED
E M P L O Y E E M E D I C A L S C R E E N I N G F O R M
Personal Contact Details
Full Name CNIC or Passport No
Contact No Email ID
Home Address Current Address
Date of Birth D D M M Y Y Y Y Height Weight [kg]
Gender Marital Status No. of Children
Emergency Contact Details
Emergency Contact 1 Emergency Contact 2
Name Name
Contact No Contact No
Medical History
Have you ever suffered from Y/N Details if answered Yes Have you ever suffered from Y/N Details if answered Yes
Asthma Heart Disease
High Blood Pressure Low Blood Pressure
Diabetes Epilepsy
Airborne Disease Shortness of Breath
Frequent Colds Contagious Disease
High Cholesterol Headaches & Migranes
Other None
Have you ever undergone
any major surgery
Do you have any Allergies
Declaration
I certify that the information I have provided is true and complete to the best of my knowledge. I am aware that this self
declaration statement is subject to review and verification and if such information has been falsified Imay be terminated
from employment
Signature Date