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Confined Space Fitness Certificate

This health fitness certificate determines if a person is fit to work in confined spaces. It contains the name, date of birth, and employer of the person examined. The attending physician, Joy M. Endaya, examined the person and any related health information, clinical tests, and declared on the medical examination form if the person is fit or not fit for working in confined spaces.

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Keith Shearer
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2K views1 page

Confined Space Fitness Certificate

This health fitness certificate determines if a person is fit to work in confined spaces. It contains the name, date of birth, and employer of the person examined. The attending physician, Joy M. Endaya, examined the person and any related health information, clinical tests, and declared on the medical examination form if the person is fit or not fit for working in confined spaces.

Uploaded by

Keith Shearer
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
  • Health Fitness Certificate Form: This form certifies the health fitness of an individual for the purpose of working in a confined space, including fields for personal and medical details.

Health Fitness Certificate

for the purpose of permission to work in Confined Space

Name of Person examined:


Date of Birth:

Name and Address of Employer:

I hereby certify that I have examined the abovenamed person on

from the information related to health being declared by the person, my clinical

examination and diagnostic test recorded on medical examination form, I certify that

this worker is for working in confined space.


FIT
NOT FIT

JOY M. ENDAYA,
License No. 268949
MD
Date Attending Physician

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