Plant Services – Occupational Health Centre



FREE FROM INFECTION FORM

Canteen Location :
Name: Temperature SpO2
Date Age. Duration of employment
Ref. no. Sex Job Profile

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क्रमांक हां/नहीं Sr.No Yes/No Observation and remark क्रमांक / Sr.No हां/नहीं / Yes/No Observation and remark
/ Yes No
I declare that all the above statements are true and complete to the best of my knowledge.
Signature of Food Handler: Signature of Supervisor : Survellance By :


Survellance By : :

Note:
Remarks   [✓] Healthy and fit to work as food handlers [✓] Unhealthy and not fit to work as food handler [✓] Unhealthy but can return to work after

Sign of Canteen Supervisor/Admin Head : Signature of Medical Officer :


Signature of Medical Officer :
क्रमांक कृपया नीचे दिये गए प्रश्न के उत्तर हाँ या ना मे दीजिये हां/नहीं Sr.No Please answer the questions in Yes or No Yes/No Observation and remark क्रमांक / Sr.No कृपया नीचे दिये गए प्रश्न के उत्तर हाँ या ना मे दीजिये / Please answer the questions in Yes or No हां/नहीं / Yes/No Observation and remark 0) { while ($row = @mysqli_fetch_array($result)) { //echo $row ['patient_name']; } } error_log($sql); ?> / Yes No
OBSERVATION OF CONSERN CAPA COMMUNICATION NOTES

RESPONSIBILITY COMPLETION DATE STATUS AND CLOSING REMARKS
[✓] Healthy and fit to work as food handlers [✓] Unhealthy and not fit to work as food handler [✓] Unhealthy but can return to work after