The Occupational Safety, Health and Working Conditions (Central) Rules, 2026
Form VIII
Official text
Open in the official PDF (pp. 256–258)
Tables and forms lose their layout when extracted; the PDF is the authoritative version.
(See rule 5(2))
HEALTH EXAMINATION photo
(Except mine employees)
PART –A (Sl.No.1-11) : To be filled by the Employee:
1. Name of employee………………………………………………2. Gender…. ….. 3. Age (with DOB)……..
4. Company…………………………………. 5.Designation……………………………….5(a). UAN:…………… 5(b) Aadhaar Number (after
obtaining consent)
6. In-charge Employer / Executive Contacts…………………………………
7. Complete personal /plant Address …………………………………
8. Mobile /Phone ……………………………………………… 9.Email…………………………………
10. Medical illness (Current) and under treatment & medication, If any………………………………
---------------------------------------------------------------------------------------------------------------------------
11. Nature of Job (furnish more details, if hazardous and work-related viz. Physical, Chemical, Biological, Ergonomic etc)
………………………………………
Date: Signature of Employee
------------------------------------------------------------------------------------------------------------------------------
PART-B:
12.Medical Test Carried out & Reports to be Attached as Annexure . Medical Officer’s interpretation/ Opinion of the Tests below (To be
indicated only if abnormal , with reference to the attached Test reports) :
a. Ht. (in cm)
b. Wt. (in Kg)
c. Chest measurement:
(i) On inspiration …………cm
(ii) On expiration ………… cm
(d) Waist Circumference
(e) Body Mass Index: ……………………
(f) Vision (Ophthalmologist tests):
i. Visual Acuity both Right & left eyes ………………………….
ii. Colour Vision………………………………………………..
(g) Blood Pressure (mm Hg)………………………………………..
(h) Complete Blood Count: (Hb, TLC, DLC, Platelets)…………………….
(i) Fasting Blood Sugar
(j) Post Prandial Blood Sugar……………….
(k) SpO ………………………..
2
(l) Blood Urea ….…………………………..
(m) S. Creatinine …………………………..
(n) S. Bilirubin (Total + direct)
(o) SGOT
(p) SGPT………………………………………………..
(q) Lipid profile (S. Cholesterol / Triglyceride / S.HDL) ……..
(r) S. TSH ………………………………..
(s) X-ray Chest (PA view) …………………………………
(t) ECG……………
(u) Others if any………………………………………….
----------------------------------------------------------------------------------------------------------------------
13.Final Diagnosis/ Opinion / Treatment if any, advise by qualified medical practitioner …………………
14. Does the person have seizure (s) related disorders or difficulty in working at height ? If yes, specify the works to be avoided: Yes/No/ NA
(Not applicable)
Date: Signature of the qualified medical practitioner
SEAL
.