ACCESS CONTROLLER (SECURITY & HO ACCESS CONTROL)

MEDICAL CERTIFICATE AS PROOF THAT APPLICANT MAY DO STRENUOUS EXERCISE TO ACCOMPANY VACANCY APPLICATION Advertised post applying for (applicant to complete): ………………………………………………………………………… (Tip: Applicant to attach relevant vacancy advert to this form when visiting Medical Practitioner) Name of person examined: ……………………………………………………………………………………………………… Identity number of person examined: ……………………………………………………………………………………… I hereby certify that I have examined the abovementioned person on …………………………….. (date). From the information related to the health declared by the person and my clinical examination/diagnostic tests, I certify that this person is FIT NOT FIT FIT WITH THE FOLLOWING RESTRICTIONS …………………………………………………………………… to do strenuous exercise required in the mentioned post. Comments by Medical Practitioner: …………………………………………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………………………………………… Date: …………………………………………………… Medical Practitioner’s initials & surname: ……………………………………………. Medical Practitioner’s signature: ………………………………………………………….. Practice Number: …………………………………………………………………………………. Practice stamp must be included to confirm authenticity