| 1Rx |
MEDICAL ASSESSMENT & FOLLOW-UP ADVICE
Food Handler Medical Fitness Programme · this document is NOT a fitness certificate
|
| Assessment ID | — |
| Employee | — |
| Date & time of assessment | — |
| Video record | — |
—
No certificate has been issued for this assessment
Basis for the decision
—
Clinical concern, tests and referral
| Clinical concern | — |
| Test(s) advised | — |
| Referral | — |
Food-handling restriction
—
Reassessment
| Reassess by | — |
| Conditions for reconsideration | — |
Instruction to the employee
Submit the required evidence through the follow-up link sent to you. A reassessment is
raised as a new fitness request and is linked to this assessment; this outcome and its
records are preserved.
Examining doctor
| Name | — |
| Registration No. | — |
| Digitally signed | — |