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Physical Exam Form For Work for Belgium

Physical Exam Form For Work Template for Belgium

This document is a standardized medical examination form used in Belgian workplaces to assess an individual's fitness for work, complying with Belgian labor law and occupational health regulations. It serves as an official record of an employee's or candidate's physical health assessment, incorporating both general health evaluation and specific job-related health requirements. The form includes comprehensive medical examination results while adhering to GDPR and Belgian privacy laws regarding medical data protection. It is designed to meet the requirements of the Belgian Code on Well-being at Work and related occupational health legislation.

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What is a Physical Exam Form For Work?

The Physical Exam Form For Work is a critical document required under Belgian workplace health and safety regulations, specifically mandated by the Code on Well-being at Work (2017). This form is used during pre-employment screenings, periodic health assessments, and return-to-work evaluations. It contains sections for recording medical history, physical examination findings, job-specific health requirements, and fitness-for-work conclusions. The document must comply with both occupational health requirements and GDPR privacy regulations, ensuring proper handling of sensitive medical information. It serves as a legal record of an employee's occupational health assessment and is particularly important for positions involving physical demands, safety-critical roles, or exposure to workplace health risks.

What sections should be included in a Physical Exam Form For Work?

1. Employee Information: Basic identification details including name, date of birth, national registration number, and contact information

2. Employer Details: Company name, department, job title/function, and work location

3. Type of Examination: Specification of examination type (pre-employment, periodic, return-to-work, etc.)

4. Job Description and Risk Factors: Brief description of job duties and associated health risks

5. Medical History: Previous medical conditions, surgeries, current medications, and family history

6. Physical Examination Results: Standard physical examination findings including vital signs, height, weight, vision, hearing

7. Job-Specific Health Requirements: Assessment of specific health requirements related to job function

8. Medical Professional's Conclusion: Final assessment and fitness-for-work determination

9. Privacy Statement and Consent: GDPR-compliant privacy notice and consent for medical data processing

10. Certification: Signatures of examining physician and date of examination

What sections are optional to include in a Physical Exam Form For Work?

1. Specific Risk Assessments: Additional assessments for specific workplace risks (e.g., working at heights, exposure to chemicals)

2. Vaccination Status: Required for healthcare workers or positions with biological risk exposure

3. Drug and Alcohol Screening: When required by specific company policies or safety-sensitive positions

4. Ergonomic Assessment: For positions involving physical labor or specific ergonomic concerns

5. Mental Health Assessment: For high-stress positions or when specifically required

6. Follow-up Requirements: Specific instructions for future examinations or monitoring

What schedules should be included in a Physical Exam Form For Work?

1. Medical Test Results: Detailed results of any required medical tests (blood work, hearing tests, etc.)

2. Risk Factor Checklist: Detailed checklist of job-specific health risks and exposure factors

3. Functional Capacity Evaluation: Detailed assessment of physical capabilities relative to job requirements

4. Medical Restrictions Form: Detailed list of any work restrictions or accommodations if applicable

5. Employee Health History Questionnaire: Detailed self-reported health history form completed by employee

Authors

Alex Denne

Head of Growth (Open Source Law) @ Ƶ | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

Jurisdiction

Belgium

Publisher

Ƶ

Document Type

Employment Form

Cost

Free to use
Relevant legal definitions

























Clauses




















Relevant Industries

Manufacturing

Construction

Healthcare

Transportation

Mining

Chemical Industry

Food Processing

Logistics

Agriculture

Education

Information Technology

Retail

Hospitality

Energy

Pharmaceutical

Relevant Teams

Human Resources

Occupational Health Services

Health and Safety

Legal and Compliance

Risk Management

Medical Administration

Employee Relations

Recruitment

Privacy and Data Protection

Relevant Roles

Human Resources Manager

Occupational Health Physician

Safety Coordinator

Risk Prevention Advisor

Compliance Officer

Medical Administrative Assistant

HR Business Partner

Occupational Health Nurse

Employee Relations Manager

Health and Safety Manager

Privacy Officer

Recruitment Manager

Industries








Teams

Employer, Employee, Start Date, Job Title, Department, Location, Probationary Period, Notice Period, Salary, Overtime, Vacation Pay, Statutory Holidays, Benefits, Bonus, Expenses, Working Hours, Rest Breaks,  Leaves of Absence, Confidentiality, Intellectual Property, Non-Solicitation, Non-Competition, Code of Conduct, Termination,  Severance Pay, Governing Law, Entire Agreemen

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