1.Staff physical examination form Date of birth Native place Gende Male r and female Department in charge Career experience And years of service Medical history Blood type Item Color _No_Panchromatic blindnes Blindness_Red Green s Blindness_Red Blindness_Green Blindness time Height cm Weight kg Chest cm Blood pressure mmHg regard Left (after correction ) Power Right (after correction ) hear Left / / / / / / / / / Power right regard Left Power right hold Left Power right eye ear nose Tooth Thyroid Lymph gland Liver Heart Respirator Circulator Tendon reflex skin Nutrition Judge physician Date of inspection blood Hb%gm RBC liquid WBC VDRL Date of inspection urine liquid Pre category 1seco 2seco 3seco 4seco 5secon 6secon Preventi nd nd nd nd d d on hepatitis meet B species hcv Date Special records Physician&apo s;s Signature

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