Physical Exam Form For Work Template for Indonesia

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Key Requirements PROMPT example:

Physical Exam Form For Work

"I need a Physical Exam Form For Work that complies with Indonesian regulations for our mining operation in East Kalimantan, with specific focus on respiratory health assessments and exposure to mining conditions - this will be used for our annual employee health checks scheduled for March 2025."

Document background

The Physical Exam Form For Work is a crucial document required under Indonesian labor law for both pre-employment and periodic medical examinations. It is designed to comply with Minister of Manpower Regulation No. 2 of 1980, Law No. 13 of 2003 on Manpower, and related occupational health regulations. The form is used during initial employment, for periodic health assessments, and when employees change positions or return to work after extended illness. It includes comprehensive health evaluations, specific job-related medical assessments, and professional medical opinions regarding fitness for work. This document plays a vital role in maintaining workplace safety, ensuring employee health, and meeting legal compliance requirements in Indonesia's employment sector.

Suggested Sections

1. Personal Information: Employee's basic details including name, date of birth, gender, employee ID, position/role, and department

2. Employment Details: Information about current position, duration of employment, specific job duties, and workplace exposure risks

3. Medical History: Past medical conditions, surgeries, medications, family history, and work-related health issues

4. Physical Examination Results: Comprehensive physical examination findings including vital signs, height, weight, BMI, and general physical condition

5. Vision and Hearing Assessment: Results of vision and hearing tests, including color vision if job-relevant

6. Cardiovascular Evaluation: Heart examination results, blood pressure, pulse rate, and related findings

7. Respiratory Assessment: Lung examination results, breathing capacity tests, and related findings

8. Musculoskeletal Evaluation: Assessment of physical mobility, strength, and job-relevant physical capabilities

9. Laboratory Results: Basic required laboratory test results including blood work, urinalysis, and other standard tests

10. Medical Professional's Certification: Official determination of fitness for work, including any restrictions or recommendations

Optional Sections

1. Specific Job-Related Tests: Additional tests required for specific job roles (e.g., height work, confined spaces, heavy machinery operation)

2. Psychological Assessment: Mental health evaluation for positions requiring high stress tolerance or specific mental capabilities

3. Drug Screening Results: If required by company policy or for specific positions

4. Infectious Disease Screening: Additional screening for workers in healthcare or food service industries

5. Environmental Exposure Assessment: Specific tests related to workplace environmental hazards

6. Previous Workplace Injury Assessment: Detailed evaluation of any previous workplace injuries and current status

Suggested Schedules

1. Schedule A - Laboratory Test Requirements: Detailed list of required laboratory tests based on job category and risk level

2. Schedule B - Physical Capability Requirements: Specific physical requirements and assessment criteria for different job categories

3. Schedule C - Medical History Questionnaire: Detailed self-reported medical history form to be completed by employee

4. Appendix 1 - Workplace Risk Assessment: Assessment of specific workplace hazards and required medical evaluations

5. Appendix 2 - Medical Standards Reference: Reference guide for medical professionals on pass/fail criteria for different job categories

6. Appendix 3 - Follow-up Procedures: Guidelines for follow-up examinations and periodic health monitoring requirements

Authors

Alex Denne

Head of Growth (Open Source Law) @ Genie AI | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

alex.den.21@genieai.co

Relevant legal definitions

Clauses

Relevant Industries

Manufacturing

Construction

Mining

Healthcare

Oil and Gas

Transportation

Agriculture

Food Processing

Chemical Industry

Pharmaceuticals

Maritime

Aviation

Heavy Industry

Automotive

Energy

Telecommunications Infrastructure

Relevant Teams

Human Resources

Occupational Health and Safety

Medical Services

Compliance

Risk Management

Operations

Production

Quality Assurance

Facilities Management

Employee Relations

Relevant Roles

Occupational Health Physician

Human Resources Manager

Health and Safety Officer

Factory Worker

Construction Worker

Mining Engineer

Healthcare Worker

Laboratory Technician

Industrial Machine Operator

Warehouse Staff

Commercial Driver

Maritime Worker

Chemical Plant Operator

Food Production Worker

Oil Rig Worker

Aviation Personnel

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Authors

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