Annual Health Check Up

Annual Health Check Up

Employee Name:	Age:	Sex:
D.O.J:	Designation:
D.O.B:	Department:

A. Examinations
Heights:		Weight :		Blood Pressure:
Eye 1.     Distant Vision: 2.     Vision with Glasses 3.     Color Vision 4.     Any Other
ENT 1.     Oral Cavity 2.     Nose 3.     Throat 4.     Larynx
B. Investigations
1	Blood Group
2	Blood Sugar
3	HB
4	ECG (above 40 years)
5	X-Ray Chest
6	HIV (if required)
7	HBsAg (if required)
8	HCV(if required)

Any Comments:

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ENT Consultant Sign            EYE Consultant Sign             Physician Sign