Occupational Health Examination

#Occupational Health Examination 1. GENERAL OBSERVATIONS Height (cm): Weight (kg: BMI: (-) Deformities (-) Scars 2. VISION Acuity: Distance right: 6/ Distance left: 6/ Near right: N Near left: N Colour Vision (Ishihara) number of incorrect responses: Visual Fields (confrontation) Abnormal < 45 degrees (-) Right (-) Left 3. EARS AND COMMUNICATION External canals: Right: (-) Dermatitis; (-) Fungal infection; (-) Narrowed; (-) Occluded; (-) Excess wax. Left: (-) Dermatitis; (-) Fungal infection; (-) Narrowed; (-) Occluded; (-) Excess wax. Tympanic membranes: Right: (-) Wet perforation; (-) Dry perforation; (-) Otitis media; (-) Effusion; (-) Not visible. Left: (-) Wet perforation; (-) Dry perforation; (-) Otitis media; (-) Effusion; (-) Not visible. (-) Speech abnormality (-) Hearing abnormality (whisper test) 4. URINALYSIS (- TRace + ++ +++) Glucose: - Protein: - Blood: - WBCs: - Bilirubin: - 5. CARDIOVASCULAR SYSTEM Pulse (bpm): BP: BP (if repeated): Abnormalities: (-) Cardiac rhythm (-) Heart sounds (-) Murmurs (-) Peripheral pulses (-) Peripheral veins ECG (if required): Comments: 6. RESPIRATORY SYSTEM (abnormalities) (-) Trachea (-) Chest expansion (abnormal < 5cm) (-) Air entry (-) Breath sounds (-) Added sounds -> (-) Widespread crackles; (-) Basal crackles; (-) Wheeze; (-) Rub. (-) Facial abnormality (able to make facial seal using negative pressure PPE, if applicable) Comments: 7. ABDOMEN AND GASTROINTESTINAL SYSTEM (abnormalities) (-) Scars (-) Hernia (inguinal, femoral, umbilical, incisional, etc.) (-) Organomegaly (-) Renal bruits Comments: 8. SKIN (abnormalities) (-) Dermatitis/eczema (-) Psoriasis (-) Skin cancer/solar damage (-) State of hands and feet Comments: 9. NERVOUS SYSTEM (abnormalities) (-) Muscle tone (-) Motor power (-) Muscle wasting / asymmetry (-) Tremor (-) Gait (-) Coordination (-) Fine motor movements (-) Lower limb reflexes (-) Tinel / Phalen signs – Right (-) Tinel / Phalen signs – Left (-) Any other CNS, spinal or peripheral nerve problem? Comments: 10. MENTAL STATE (abnormalities) (-) Affect (-) Evidence of thought disorder (-) Any other mental state observations of note Comments: 11. MUSCULOSKELETAL SYSTEM (abnormalities) (-) Joint deformities (-) Arthritis Neck: (-) Contours (-) Curves (-) Posture (-) Deformity (-) Muscle spasm (-) Flexion (-) Extension (-) Right lateral flexion (-) Left lateral flexion (-) Right rotation (-) Left rotation Back: (-) Contours (-) Curves (-) Posture (-) Deformity (-) Muscle spasm (-) Flexion (-) Extension (-) Right lateral flexion (-) Left lateral flexion (-) Right rotation (-) Left rotation Joint movements: (-) Right shoulder (-) Left shoulder (-) Right elbow (-) Left elbow (-) Right wrist (-) Left wrist (-) Right hip (-) Left hip (-) Right knee (-) Left knee (-) Right ankle (-) Left ankle (-) Right SLR (-) Left SLR Comments: 12. FUNCTIONAL TESTS (abnormalities) (-) Right grip strength (-) Left grip strength (-) Right empty can test (-) Left empty can test (-) Heel-toe walk (-) Duck walk (half-squat) (-) Heel walk Comments: 13. INVESTIGATIONS (only if required or indicated) Chest x-ray: Blood tests: Glucose (mmol/L): Total cholesterol (mmol/L): HDL Cholesterol (mmol/L): LDL Cholesterol (mol/L): Triglycerides (mmol/L): Cardiovascular risk score (% risk in next 5 years): 14. ASSESSMENT Relevant to the inherent requirements of the job, is there a medical condition that is likely to: (-) affect or limit efficient performance (-) affect or limit safe performance (-) be aggravated by performing the inherent requirements Comments (including reasonable adjustment):

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