Pre-Course Physical Examination Check List

Pre-Course Physical Examination Check List
Personal Information
Student Name

First NameLast Name
Student ID
Qualification Code
Qualification Name
Contact Number
Email Address
example@example.com
General Health Assessment
1. Do you have any chronic medica conditions? (e.g., asthma, diabetes, epilespy)
If YES, please specify
2. Are you currently on any medication?
If YES, Please specify
3. Have you had any recent surgeries or hospitalizations?
If YES, Please specify
4. Do you have any allergies? (e.g., food, medication, latex)
If YES, Please specify
5. Are you fine to lift any heavy object (up to 5-7 kgs)?
If No, Please specify
6. Do you have any conditions that affect your ability to handle power tools, lift heavy materials, or work in dusty environments?
If YES, Please specify
7. Are you comfortable working at heights or in confined spaces?
If NO, Please specify
Declaration
I hereby declare that the information provided above are accurate to the best of my knowledge. I understand that any false information may affect my eligibility to participate in the workshop activities. I will notify to the college as well as my trainer in case if my health situation changes in future.
Signature
Date

DayMonthYear
Date
Should be Empty:

Personal Information