PERFORMA FOR MEDICAL FITNESS CERTIFICATE
For food handlers · For the year 2026
Issued under Para 10.1.2, Part II, Schedule 4 of the FSS (Licensing & Registration of
Food Businesses) Regulations, 2011
| Certificate ID — | Consultation ID — |
| Employee ID — | Date & time of examination — IST |
It is certified that Shri/Smt./Miss —, employed with
M/s. — (store —), —,
coming in direct contact with food items, has been
carefully examined by me on —.
The examination included:
| • | Physical examination (general and physical assessment) |
| • | Eye examination |
| • | Skin, hands and nails examination |
| • | Compliance with the applicable schedule of vaccination against the enteric group of diseases |
| • | Additional investigation(s), where clinically indicated |
Based on the history provided, records reviewed, examination and available clinical
findings, the above-named person is found free from any evident infectious or
communicable disease relevant to food handling and is declared:
FIT FOR FOOD-HANDLING DUTIES
Based on the history provided, records reviewed, examination and available clinical
findings, the above-named person is declared:
—
| Clinical concern | — |
| Tests advised | — |
| Referral | — |
| Restriction | — |
| Reassess by | — |
| Conditions for reconsideration | — |
| Certificate valid until: — | Annual renewal, or earlier review if illness develops |
Employee obligation: The employee must immediately report fever, jaundice,
diarrhoea, vomiting, sore throat with fever, persistent cough, infected skin lesions,
boils, open wounds, or discharge from the eyes, ears or nose to the employer, and must not
undertake food-handling work until medically reviewed.
Examining registered medical practitioner
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—
Reg. No. —
—
—
Digitally signed · —
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cert=— consult=—
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tamper-evident | immutable | audited |