When an individual becomes employed in a company, his entire well-being can be affected either due to the possible stresses in the workplace or to the need for maintaining an equal work-life balance. This is the reason why companies often require their final selection of job candidates to undergo a medical and physical exam first before they will be welcomed as an employee of the company. This does not only ensure that the company is hiring capable employees but it also helps applicants know their medical state.

Generic Pre-Employment Physical Form Sample

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What Is a Pre-Employment Physical Form?

A pre-employment physical form is a document which is to be completed by medical personnel or an examiner of a company after the job application period is finalized with the list of prospective candidates. The purpose of using a pre-employment physical form is to determine the physical fitness of an applicant and to acknowledge his medical and health issues which may hinder his job performance if he will be employed. Additionally, the form will also help in determining what the company can provide in order to help the applicant throughout his employment if ever his condition can still be treated or will not be affecting his work.

Pre-Employment Physical Occupational Health Questionnaire Form

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Essential Sections of Pre-Employment Physical Forms

A basic pre-employment physical form can be made easily by any company or organization aiming to hire staff and employees for their management. However, pre-employment physical forms must be able to collect the necessary and relevant information in lieu of the employment of the applicant. Below are some of the sections which should always be included in the form regardless of the company and industry type where he will be planning to sign an employment contract:

  • Company details – Identifying who the owner of the physical form or document is important which is why it must have the name of the company along with their contact information and address. In addition, the logo of the company can also be placed in the form which will serve as the photo of the company. These pieces of information should be a part of the header which will be located at the topmost portion of the form. On the other hand, the contact details and where the form must be sent after it is completed by the medical examiner can also be indicated at the end of the form.
  • Applicant information – This is where the applicant’s general information such as his name, date of birth, address, and his contact numbers will be disclosed. However, the fields where the data of the applicant will be stated should be left blank in order to maintain the template of the form. Moreover, the applicant’s height, weight, heartbeat per minute, and pulse rate can also be included in this portion.
  • Applicant’s medical information – This section will be allotted for the observations of the medical examiner of the applicant. The applicant’s medical information should include the observations of the applicant’s skin, ears, nose, mouth, and throat, thyroid, as well as the applicant’s lungs. The state of the applicant’s nervous and skeletal system should also be described in the form to determine what irregularities the applicant has.
  • Applicant’s medical history – Aside from the observation of the medical examiner towards the physique of the applicant, the applicant’s own statements and observations to himself should also be noted in the form. These notes will be stated as part of the applicant’s medical history wherein the examiner will be able to possibly identify the cause of the applicant’s current medical condition and if ever the previously cured illness of the applicant will return which can lead to affecting the applicant’s capability to meet the company’s job standards.
  • Examiner’s validation – This would be the section where the medical examiner who conducted the test and checkup to the applicant will be able to affix his signature to validate the information disclosed in the form. Alongside the medical examiner’s signature should be his name, his title, and the date when the medical examination took place, as well as when the pre-employment physical form was completed for the applicant.

Pre-Employment Subsequent Physical Form

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Varieties of Pre-Employment Physical Forms

There are tons of different varieties of pre-employment physical forms that companies, medical organizations, and staffing agencies can use for their final selected applicants. Enlisted below are some of the varieties which are commonly used by organizations in any business industry:

Pre-Employment History and Physical Form – This variety of pre-employment physical form contain about fourteen sections to be filled out by a medical examiner or physician. The first section of the form is for the personal data of the applicant which will have the applicant’s name, ethnicity, birth information, addresses, and contact details as well as his planned or previous job title and the company that he was involved in. The second section is for identifying who the current medical provider of the applicant is while the third section of the form will be for enlisting the work history of the applicant. The succeeding sections of the form are all intended for determining the medical state of the applicant including the symptoms, vaccination history, communicable diseases, surgeries, and even the applicant’s family history to determine if the condition of the applicant is passed from one generation to another through their bloodline or genetic makeup.

Pre-Employment History and Physical Form

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In addition, the social history of the applicant including his addiction to alcohol, drugs, and his involvement in extreme physical workout sessions are also to be disclosed in the form. The reason for this is to identify whether or not the applicant’s lifestyle is the cause of his medical issues. Moreover, there is also a portion of the form which will collect the notes of the medical examiner or the practitioner who conducted the examination of the applicant along with the vital statistics, body measurements of the applicant, and the overall medical assessment based on the observations of the practitioner or examiner.

Pre-Employment Job Placement Medical Questionnaire Form – Compared to the aforementioned pre-employment physical form, this document variety is intended to be completed by the employee before he will be assigned to another job placement or role. In the form, the employee will have to disclose not only his name but also the name of the family doctor who has examined him before. Then, the employee will have to answer the medical questionnaire section of the form wherein he will be asked about his reactions to certain medications, allergies, his lifestyle then and in the present, the symptoms that he is experiencing, as well as whether the types of treatments that he needed to undergo before such as radiation treatments.

Pre-Employment Job Placement Medical Questionnaire Form

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Pre-Employment Physical Ability Test Form – There are specific jobs which require the physical attentiveness and strength of an applicant which is why companies who hire employees for these types of jobs conduct several physical ability tests. In order to be accepted in the company, an applicant should be able to pass every test since one failure can cause disqualification of the applicant’s application for the job. For this, a pre-employment physical ability test form or booklet will be provided to the applicant which will be handed over to the doctor who will facilitate the physical fitness test.

Pre-Employment Physical Ability Test Form

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A set of guidelines and instructions to be followed by the applicant for him to pass the test will also be included in the form along with the list of preparations that the applicant should be able to keep in mind throughout the period of the test. If the applicant passed the test, the doctor should indicate whether or not the applicant was able to perform each test safely and without any issues or medical concerns arising.

Pre-Employment Physical Authorization and Consent Form – This form is not only for noting the job applicant’s medical health information but it also gathers the authorization and the granted legal consent of the applicant in taking the test. The applicant will have to agree and sign the drug, alcohol, and nicotine testing acknowledgment section of the form which is essential for indicating that the applicant approves in submitting his specimen for the test. The list of prohibited drugs and special risk positions are included in the form in order to inform the applicant and the medical examiner about what the details and the regulations mandated by the company regarding the prohibition of drugs and alcohol.

Pre-Employment Physical Authorization and Consent Form

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Also in the form is a medical history questionnaire which contains a set of questions to be answered by the applicant with a simple yes or no. Then, the applicant should affix his signature on the allotted areas for granting consent that the company will be able to obtain and use the results of his medical exam or testing. In addition, a respiratory history questionnaire section, social security number collection disclosure, a release of information statement, an application statement, and a status affidavit are also enclosed with the form.

Pre-Employment Physical Clearance Form – There are only three sections in this form variety. The first is the employee information section which will have the name of the employee, his job title, work-site location, and his signature. The second is the medical evaluation section which will indicate whether or not the employee or applicant is cleared for employment and if there are a few medical concerns resulting to the need for another round of tests to determine the applicant’s eligibility. Lastly, the medical information section will be for the final decision of the medical provider or examiner and his name, signature, and date of when he signed the form.

Pre-Employment Physical Clearance Form

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Pre-Employment Physical Exam Form – This is the most basic form which is used generally by medical providers and employment companies or organizations since it caters all the important data to be used in selecting the right employee for the job vacancy of the company. In the form, the recent injuries of the applicant, the current medication that he is taking, medical aids or equipment that he is using to perform daily, and his previous work restrictions will be disclosed in the first section. Then, the details of his medical state and health will be indicated in the succeeding portions of the form along with an explanation of the medical examiner to be stated in the last part of the form.

Pre-Employment Physical Exam Form

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Pre-Employment Physical Exam Request Form – This is the type of form to be used before an applicant or an employee will be appointed to a physical examination. With a pre-employment physical exam request form, the applicant will be able to present and inform a physician about the varieties of exams which are required by the employer. Some of the information to be stated in the form includes the applicant’s appointment date and time, the contact and location of the physician’s office, the applicant’s job classification, the exam type, and the vaccination information of the applicant.

Pre-Employment Physical Exam Request Form

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Pre-Employment Physical Information Form – This form contains identical sections to the aforementioned request form, however, it differs in its layout and the additional details which are included in the form. Since this is an information form, the applicant will undergo an intake procedure where the physician will be filling out a type of medical intake form. Then, the applicant must sign the patient consent and acknowledgment form before he can proceed to take the physical test or exam.

Pre-Employment Physical Information Form

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Regardless of the variety of pre-employment physical form, the objective of the company should be not to discriminate applicants rather lend a hand whenever it is possible and inform their applicants about underlying medical issues which were not yet addressed. Moreover, applicants should also be ready to disclose confidential information to their physician in order to achieve a better and in-depth diagnosis of his medical and physical state. And due to the confidentiality of the information stated in the form, the company who will be receiving the results of the applicant’s exam should be kept with the applicant’s data and must only be used if there is a necessity to do so, and if the applicant gave a consent to reuse and review his information.

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