<script src="https://ajax.googleapis.com/ajax/libs/jquery/3.4.1/jquery.min.js"></script> <link rel="stylesheet" href="https://cdnjs.cloudflare.com/ajax/libs/font-awesome/4.7.0/css/font-awesome.min.css"> <head> <style> .tbl1 { border: 2px solid black; border-collapse: collapse; font-weight: 800; padding: 15px; } .tbl2 { border-collapse: collapse; font-weight: 800; padding: 15px; } </style> </head> <div id="medical_examination_form" style="display: none;"> <?php include('includes/config/config.php'); include_once("includes/functions.php"); //error_reporting(0); function getModifiedString($var) { $var = trim($var); $pos = stripos($var, ":"); $initial_str = substr($var, 0, $pos); $str = substr($var, $pos); $updated_str = "<b>" . $str . "</b>"; return $initial_str . " " . $updated_str; } $sql_form_type_data = "select a.*,b.ticket_no,b.approve_date,b.doc_attend,b.medical_attend,b.fit_unfit_status,b.doc_findings,p.* from form_data a inner join checkup_form b on a.checkup_id=b.checkup_id left join patient_master p on p.id=b.emp_id where a.checkup_id='" . $_REQUEST['checkup_id'] . "'"; error_log("query " . $sql_form_type_data); $result_form_type_data = mysqli_query($conn, $sql_form_type_data); $row_form_type_data = mysqli_fetch_assoc($result_form_type_data); @extract($row_form_type_data); ?> <div style="margin-top: 20px"> <table width="100%"> <tr> <td colspan="2" align="center" style="font-weight:900;">FORM NO- 33</td> </tr> <tr> <td colspan="2" align="center">[Prescribed under Rules 68-T and 102]</td> </tr> <tr> <td colspan="2" align="center" style="font-weight:900;">Certificate of fitness for employment in hazardous process and operations</td> </tr> <tr> <td colspan="2" align="center">(To be issued by Factory Medical Officer)</td> </tr> </table> <div style="margin-top: 20px"> <table width="100%" class="tbl3" style="border-spacing: 10px;"> <tr> <td> <?php echo getModifiedString($para_one); ?> </td> </tr> <tr> <td> <?php echo getModifiedString($para_two) ?> </td> </tr> <tr> <td> <?php echo getModifiedString($para_three) ?> </td> </tr> <tr> <td> <?php echo getModifiedString($para_four) ?> </td> </tr> <tr> <td> <?php echo getModifiedString($para_five) ?> </td> </tr> <tr> <td> <?php echo getModifiedString($para_six) ?> </td> </tr> <tr> <td> <?php echo getModifiedString($para_seven) ?> </td> </tr> <tr> <td> <?php echo getModifiedString($para_eight) ?> </td> </tr> <tr> <td> <?php if (strcmp($para_one_1, " a) Hazardous process:") == 0) { echo $row_form_type_data['hazardous_process'] == 'Y' ? " a) Hazardous process: Yes" : " a) Hazardous process: No"; } else { echo $para_one_1; } ?> </td> </tr> <tr> <td> <?php if (strcmp($para_one_2, " b) Dangerous operation:") == 0) { echo " b) Dangerous operation: " . $row_form_type_data['dangerous_process']; } else { echo $para_one_2; } ?> </td> </tr> <tr> <td style="word-wrap:normal;"> <?php echo $para_one_3 ?> </td> </tr> <tr> <td style="word-wrap:normal;"> <?php echo $para_one_4 ?> </td> </tr> <tr> <td style="word-wrap:normal;"> <?php echo $para_one_5 ?> </td> </tr> <tr> <td> <?php echo $para_one_6 ?> </td> </tr> </table> </div> <div style="margin-top: 100px"> <table width="100%" class="tbl3" style="margin-top:20px; font-size: 16px;"> <tr> <td> <img src="data:<?php echo $row_form_type_data['image_type'] ?>;base64,<?php echo base64_encode($row_form_type_data['emp_sign']) ?>" style="width: 120px; height: 40px;" /> <br> Signature or left hand thumb impression of the person examined : </td> <td align="right"> <?php $doc_emp_id = $row_form_type_data['doc_attend']; $doctor_name = getFieldfromTable('patient_name', 'patient_master', 'id', $doc_emp_id) ?> <span style="margin-left:170px"> <?php $sql_sign = "select * from employee_signature where emp_id='" . $doc_emp_id . "'"; $result_sign = mysqli_query($conn, $sql_sign); $row_sign = mysqli_fetch_assoc($result_sign); @extract($row_sign); error_log("sign query " . $sql_sign); ?> <img src="data:<?php echo $row_sign['image_type'] ?>;base64,<?php echo base64_encode($row_sign['emp_sign']) ?>" style="width: 120px; height: 40px;" /> </span> <br> Signature of the Factory Medical Officer : </td> </tr> </table> <br> <br> <table width="100%" class="tbl3"> <tr> <td width="60%" align="left"> </td> <td align="right"> <span style="margin-left:170px"> <img src="data:<?php echo $row_sign['stamp_img_type'] ?>;base64,<?php echo base64_encode($row_sign['emp_stamp']) ?>" style="width: 120px; height: 40px;" /> </span> <p>Stamp of factory Medical Officer with Name of the Factory</p> </td> </tr> </table> <!-- <br> --> <table width="100%" class="tbl3"> <tr> <td colspan="2" align="left">Date: <b><?= date_format(date_create($row_form_type_data['approval_date']), "d-m-Y") ?></b> </td> </tr> </table> <hr> <table width="100%" class="tbl3" style="page-break-after: always;"> <tr> <td align="right"></td> </tr> </table> <br> <table width="100%" border="1" cellspacing="0"> <tr> <th>I certify that I examined the person mentioned above on (date of examination) </th> <th>I examined this certificate unfit (If certificate is not extended , the period for which the worker is considered unfit for work is to be mentioned)</th> <th>Signs & symptoms observed during examination.</th> <th>Signature of the Factory medical Officer with date.</th> </tr> <tr rowspan="10"> <td height="350"><?= $row_form_type_data['fit_unfit_status'] == 'ufit' ? date_format(date_create($row_form_type_data['approval_date']), "d-m-Y") : '' ?></td> <td></td> <td><?= $row_form_type_data['fit_unfit_status'] == 'ufit' ? $row_form_type_data['doc_findings'] : '' ?></td> <?php if ($row_form_type_data['fit_unfit_status'] == 'ufit') { ?> <td><img src="data:<?php echo $row_sign['image_type'] ?>;base64,<?php echo base64_encode($row_sign['emp_sign']) ?>" style="width: 120px; height: 40px;" /></td> <?php } else { ?> <td></td> <?php } ?> </tr> </table> <div style="margin-top: 20px; font-size: 15px; text-transform:lowercase"> <div><b>Notes:</b></div> <ol> <li> If declared unfit, reference should be made immediately to the Certifying Surgeon.</li> <li>Certifying Surgeon should communicate his findings to the occupier with 30 days of the receipt of this reference.</li> </ol> </div> </div> </div> <form id="medical_examination_form_pdf" action="" method="POST"> <input type="hidden" name="htmlText" id="htmlText" /> </form> </div> <script> formSubmit(); function formSubmit() { $("#htmlText").val($("#medical_examination_form").html()); document.forms['medical_examination_form_pdf'].action = "pdf_dynamic.php"; document.forms['medical_examination_form_pdf'].method = "post"; document.forms['medical_examination_form_pdf'].submit(); } </script>