This form should be completed by the designated health practitioner and

This form should be completed by the designated

This preview shows page 49 - 51 out of 90 pages.

This form should be completed by the designated health practitioner and submittedto the Director within 21 days and a copy sent to the employer.Name of workplace…………………………………………….…………………………Workplace registration No.……………………………….………………………………Location ……………………………………………………………………………………Tel………………………………………………………..…………………………………………………………………………………………………………………………………Address…………………………………………………………………………………….Fax………………………………………………………………………..Email……………………………………………………………………………………………..………………….Type of risk to health………………………………………………………………………Number of workers exposed…………………………………………………….…………RESULTS OF EXAMINATIONS Number of employees examined...…….…………………………………………………Number of employees with abnormal results…………………………………………… Occupational diseases…………………………………………………………Non-occupational disease(s) …………………………………………………Number of employees recommended for re-deployment………………………………….I certify that the information given above is correct. Particulars of all workers with abnormalresults including those recommended for re-deployment are attached.49
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Name of Designated Health Practitioner…………………………………………………...Approved Registration No…………………………………………………………………. Address………………………………….. ………………………………………………... Physical address of office…………………………………….. Tel………………………Fax…………………………………………………………………………………………E-mail..…………………………………………………………………………………… Signature……………………………………………………………………..……………Date……………………………………………………………………………..…………Certificate of RedeploymentTo be used for redeployment of over exposed employeesCertificate of Redeployment (Third Schedule) to be filled out in triplicate by the Doctor within 7days and copies issued to:--Director DOSHS- Employer- EmployeeTHIRD SCHEDULE RULE (6)CERTIFICATE OF RE- DEPLOYMENT
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  • Fall '18
  • ........., Occupational safety and health, Safety and Health Committee, Directorate of Occupational Health and Safety Services, Occupational Health and Safety Officer, Director of Occupational Health and Safety Services

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