Health Examination (Except mine employees)

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......... 4. Company........................................ 5. Designation.................................... 5(a). UAN:............... 5(b) Aadhaar Number (after obtaining consent) 6. In-charge Employer / Executive Contacts. ............................................. 7. Complete personal /plant Address............................................. 8. Mobile /Phone................

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....ttached Test reports) : a. Ht. (in cm) b. Wt. (in Kg) c. Chest measurement: (i) On inspiration ......... cm (ii) On expiration .......... cm (d) Waist Circumference (e) Body Mass Index:................................. (f) Vision (Ophthalmologist tests): :................................. i. Visual Acuity both Right &....

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.... Cholesterol / Triglyceride / S.HDL) :................................. (r) S. TSH:................................. (s) X-ray Chest (PA view) :................................. (t) ECG. :................................. (u) Others if any. :................................. -------------------------------------------------------------------------------------....