PERFORMA FOR MEDICAL FITNESS CERTIFICATE FOR FOOD HANDLERS (FOR THE YEAR

PERFORMA FOR MEDICAL FITNESS CERTIFICATE FOR FOOD HANDLERS (FOR THE YEAR - 2019-20)
(See Para No. 10.1.2, Part-II, Schedule - 4 of FSS Regulation, 2011)
It is certified that Shri/Smt./Miss*
employed with M/s JUBILANT FOODWORKS PVT. LTD. coming in direct contact with food items has been carefully examined* by me on date
MonthDayYear
Date
*Medical Examination to be conducted :
Physical Examination
Diagnosis
Eye Test
Diagnosis

Eye InfectionOther
Skin Examination
Diagnosis

Fungal infectionBacterial skin infectionSkin lesionsOther
Hepatitis B Vaccine (Dose Zero)
Reason for not administer

H/o FeverRecently hospitalisedOn antibioticsPregnantAllergic to the vaccineAlready receivedOther
Already received

DayMonthYear
Date
Compliance with schedule of Vaccine to be inoculated against enteric group of diseases (Typhoid Vaccine)
Reason for not administer

H/o FeverRecently hospitalisedOn antibioticsPregnantAllergic to the vaccineAlready receivedOther
Already received*

DayMonthYear
Date
Any test required to confirm any communicable or infectious disease which the person suspected to be suffering from on clinical examination
Reason
Additional Recommendations :
Result*

FitNot Fit
If Not Fit
User ID
Session ID
Form Category ID
Doctor ID
Should be Empty:

PERFORMA FOR MEDICAL FITNESS CERTIFICATE FOR FOOD HANDLERS (FOR THE YEAR - 2019-20)