Physical fitness is important especially in job positions where extreme activities are done every single day to meet work demands and client needs. This is why employers conduct pre-employment physical tests and examinations for their candidates to filter those who do not fit the physical requirements for a job.

Pre-Employment Physical Form Sample

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What Is a Pre-Employment Physical Form?

A pre-employment physical form is a document provided by companies and physicians to job application in order to identify medical and health conditions which should be acknowledged due to employment needs and restrictions. In addition, there are also some sections or portions of a pre-employment physical form which are intended to be filled out by the applicant’s physician since the data to be disclosed are only determined by the physician such as the applicant’s vital signs and drug screen results. Another section of the form which is only to be completed by the physician is the section where the employment decision or clearance will be stated. This is where the physician can indicate whether or not the applicant is suitable for the job position or if there are any restrictions due to the applicant’s condition and illness.

Pre-Employment Physical Health Questionnaire Form

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What’s In a Pre-Employment Physical Form?

Pre-employment physical forms are also considered as a type of medical form, however, it is to be submitted to an employer after it is completed. Some of the contents of pre-employment physical forms are as follows:

  • Patient or applicant information: In a pre-employment physical form, the job applicant is referred to as the patient of the physician and must disclose his basic data in the patient or applicant information section. This is where the applicant’s name will be stated along with his date of birth, gender, marital status, address, contact numbers, and language preference.
  • Systems review section: The applicant is the one who will fill out this section which is for identifying the current medical and health state of the applicant. Some of the factors to be reviewed by the applicant includes his observations about his weight, sinus problems, allergies, his memory condition, and mental health state.
  • Medical questionnaire: Questions about the types of vaccine shots that the applicant have acquired along with the applicant’s lifestyle habits such as smoking, drinking alcohol, and using illicit drugs are some of the items which should be answered by the applicant.
  • Applicant’s medical history: The medical history to be disclosed in a pre-employment physical form should focus on the medications and the treatments that the applicant have obtained or is required to undergo. Aside from the medication list, details about the effect of the applicant’s work due to his condition also have to be stated as well as the applicant’s conditions which require special medical care to be provided by his employer.
  • Physical examination report: This section of the form is to be filled out by the administering physician. The entries to be disclosed in the physical examination report includes the applicant’s basic information, the physician’s findings of the applicant’s health, the applicant’s ability to lift materials, the physician’s assessment, and the medical clearance of the physician in lieu of the examination’s findings.

In addition, a signature block for the physician must also be in the form which must have an area for the physician’s name, signature, the date when the form was completed, and the name of the person who referred the applicant to him.

Varieties of Blank Pre-Employment Physical Forms

Pre-Employment History and Physical Form – This form variety not only gathers the medical information of an applicant but also his histories. In the first page of the form, the applicant’s personal data, current medical provider, prior employment history, symptoms and communicable diseases review will be disclosed. And in the succeeding pages, on the other hand, collects the past and current medical conditions of the applicant, as well as his family and social histories, his occupational assessment, and physical examination results.

Pre-Employment History and Physical Form

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Pre-Employment Physical Consent Form – The main purpose of a pre-employment physical consent form is to document the authorized consent of the applicant regarding the pre-employment physical procedure of the company or his employer before he will be hired. In addition, the form also includes obtaining the applicant’s consent about the drug screening which requires confidential information to be disclosed to the physician and to the employer. Moreover, the penalty or the effects of a positive drug test is also indicated in the form which is the disqualification of the applicant’s job application.

Pre-Employment Physical Consent Form

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Pre-Employment Physical Exam Request Form – The user of this form variety is the document-preparer of the company whose role is to provide copies of the filled out form to the applicant or the job candidate, the medical practitioner or authorized physician of the company, and the company’s human resource personnel. In the form, the document-preparer should state the name of the candidate along with the appointment date and time for the physical examination, the location of the physician’s office, and the job classification of the candidate. The type of examination that the candidate should be taking and the range of vaccination information to be provided by the physician will also have to be included in the form to inform the physician.

Pre-Employment Physical Exam Request Form

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Pre-Employment Physical Fitness Consent Form – Some job positions require individuals to be physically ready even during the application period such as positions in the police and security department of a State or company. For this, a pre-employment physical fitness consent form will have to be filled out by the physician who is administering the assessment process of the applicants. The form will indicate the affirmation of the physician regarding his findings of the applicant as well as the release consent of the applicant towards the organization if ever he had acquired injuries as a result of the physical fitness test.

Pre-Employment Physical Fitness Consent Form

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With the right variety of pre-employment physical form, an organization, company, or an employer will be able to protect themselves from any lawsuits and claims, as well as from dealing with financial loss and issues due to poor employee retention. Nevertheless, after an applicant is hired, the company must still conduct annual physical exams to ensure that the health of the applicant who had become an employee is still eligible for the job.

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