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Pre Employment Physical Form 01-21-11 - Best Choice Home ... 2026

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The document is a pre-employment physical form that collects personal and medical information from an individual, including height, weight, blood pressure, immunization records, and past medical history. It includes sections for tuberculosis screening and a certification by a medical practitioner regarding the individual's employability status. The form requires the practitioner's signature and stamp to be valid.

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Click ‘Get Form’ to open it in the editor.
Begin by entering your personal information at the top of the form, including your name, address, and telephone number. Select your gender and provide your date of birth.
In the medical practitioner section, input your height, weight, blood pressure (BP), and temperature/pulse/respiratory rate (T.P.R).
Complete the immunizations and lab tests section by marking positive or negative for each test. Fill in the dates as required.
For past medical history and tuberculosis screening, answer all questions honestly by checking 'YES' or 'NO'.
Finally, ensure that a medical practitioner reviews and signs the form. They must include their stamp with contact details.

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What do they check for in a pre-employment physical?

The exam typically includes questions about your health and lifestyle, measurements of vital signs, physical tests, vision and hearing checks, and potential drug screening.

How do you fail pre-employment physical?

What Would Cause An Employee to Fail a Pre-Employment Physical? Inability to repeatedly lift more than a set weight. Inability to perform the tasks of the job. Inability to stand or sit for a protracted period. Having a chronic communicable disease such as tuberculosis. Failing a pre-employment drug and alcohol test.

What would make you not pass a physical exam?

Uncontrolled Medical Conditions These include high blood pressure, heart disease, diabetes, or respiratory issues. If these conditions are currently being managed under a doctors care, be sure to provide documentation of your treatment and medications.

How to pass a pre-employment physical?

How Can Your Employee Prepare for Their Pre-Employment Physical? Get a Good Nights Sleep. Employees should make sure they get a good nights sleep the night before their pre-employment physicals. Eat a Healthy Breakfast. Wear Comfortable Clothing. Gather Paperwork. Make a List. Bring Aids. Bring ID.

What would cause you to fail a pre-employment physical?

Common Reasons You Might Fail a Pre-Employment Physical Uncontrolled Health Conditions: Certain medical issues, if not managed, could make the job unsafe for you or others. Vision or Hearing Difficulties: Some roles require clear vision or hearing for safety.

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