Form VIII — Health Examination (except mine employees)

Rule: Rule 5(2) · Signed by: FMO · Under: OSH & Working Conditions (Central) Rules 2026

What the form records

• Name of employee
• Gender
• Age (with DOB)
• Company
• Designation
• UAN
• Aadhaar Number (after obtaining consent)
• In-charge Employer / Executive Contacts
• Complete personal /plant Address
• Mobile /Phone
• Email
• Medical illness (Current) and under treatment & medication, If any
• Nature of Job (furnish more details, if hazardous and work-related viz. Physical, Chemical, Biological, Ergonomic etc)
• Date
• Signature of Employee
• Ht. (in cm)
• Wt. (in Kg)
• Chest measurement - On inspiration (cm)
• Chest measurement - On expiration (cm)
• Waist Circumference
• Body Mass Index
• Vision - Visual Acuity both Right & left eyes
• Vision - Colour Vision
• Blood Pressure (mm Hg)
• Complete Blood Count: (Hb, TLC, DLC, Platelets)
• Fasting Blood Sugar
• Post Prandial Blood Sugar
• SpO2
• Blood Urea
• S. Creatinine
• S. Bilirubin (Total + direct)
• SGOT
• SGPT
• Lipid profile (S. Cholesterol / Triglyceride / S.HDL)
• S. TSH
• X-ray Chest (PA view)
• ECG
• Others if any
• Final Diagnosis/ Opinion / Treatment if any, advise by qualified medical practitioner
• Does the person have seizure(s) related disorders or difficulty in working at height? If yes, specify the works to be avoided (Yes/No/NA)
• Date
• Signature of the qualified medical practitioner
• SEAL

This page opens the blank statutory form in MedFactory, ready to fill, save and print. See the Form VIII reference page for the rule and signatory detail.

MedFactory — Occupational Health Centre software for Indian factories