Occupational health exam
General measurements
Weight (cm):
Height (cm):
Body mass index (BMI):
Waist circumference (cm):
Waist-to-height ratio (WHR):
Blood pressure (mmHg):
Pulse (bpm):
Pulse regularity:
Vision
Distance vision
Uncorrected:
- Right eye: 6/
- Left eye: 6/
- Both eyes: 6/
Corrected:
- Right eye: 6/
- Left eye: 6/
- Both eyes: 6/
Near vision
Uncorrected:
- Right eye:
- Left eye:
- Both eyes:
Corrected:
- Right eye:
- Left eye
- Both eyes:
Field vision
Confrontation test:
- Right eye:
- Left eye:
Colour vision
Ishihara colour vision blindness test:
Depth perceptionTitmus stereo test:
Without corrections (SC):
- Seconds of arc, Titmus Fly:
- No stereo vision:
With corrections (CC):
- Seconds of arc, Titmus Fly):
- No stereo vision:
Hearing
Whisper test:
- Right ear:
- Left ear:
Audiometry:
- Right ear:
- Left ear:
General exam
Eyes/pupils:
- Right eye:
- Left eye:
Ear inspection:
- Right ear:
- Left ear:
Nose:
Throat:
Teeth:
Heart auscultation:
Varicose veins:
Lung auscultation:
Abdomen:
Hernial orifices:
Skin:
- Scars:
Appearance:Behaviour:
Other:
Functional capacity evaluation
Gait:
Brisk walking:
- Pulse (bpm):
- Heart rate (bpm):
-- Baseline:
-- End of test:
- Dyspnoea (Borg scale):
-- Baseline:
-- End of test:
- Fatigue (Borg scale):
-- Baseline:
-- End of test:
- SpO2s (%):
-- Baseline:
-- End of test:
- Stopped or paused before 6 minutes?
-- No:
-- Yes, reason:
- Total distance walked in 6 minutes (metres):
- Predicted distance (metres):
- Percent predicted (%):
- VO₂ max (ml/kg/min):
Squatting (6 x):
Mobility
Ability to don and remove survival suit and to enter/exit a helicopter:
Neck:
Extension (normal 60°):
Flexion (normal 50°):
Rotation (normal 80°):
- To the right:
- To the left:
Lateral bending (normal 45°):
- To the right:
- To the left:
Back:
Straight leg raise (SLR):
Flexibility test (3 x):
Extension (normal 25°):
Flexion (normal 90°):
Lateral flexion (normal 25°):
- To the right:
- To the left:
Rotation (normal 30°):
- To the right:
- To the left:
Shoulders:
Abduction (normal 150°):
- Right:
- Left:Adduction (normal 30°):
- Right:
- Left:
Retroversion (normal 50°):
- Right:
- Left:
Forward elevation (normal 150°):
- Right:
- Left:
Elbows:
Extension (normal 0°):
- Right:
- Left:
Flexion (normal 150°):
- Right:
- Left:
Forearms:
Pronation (normal 80°):
- Right:
- Left:
Supination (normal 80°):
- Right:
- Left:
Wrists:
Extension (normal 60°):
- Right:
- Left:
Flexion (normal 60°):
- Right:
- Left:
Radial deviation (normal 20°):
- Right:
- Left:
Ulnar deviation (normal 20°):
- Right:
- Left:
Thumbs:
Flexion in MP joint (normal 60°):
- Right:
- Left:
Flexion in IP joint (normal 80°):
- Right:
- Left:
Hips:
Backward extension (normal 100°):
- Right:
- Left:
Flexion (knee flexed) (normal 100°):
- Right:
- Left:
Adduction (normal 20°):
- Right:
- Left:
Abduction (normal 40°):
- Right:
- Left:
Knees:
Flexion (normal 150°):
- Right:
- Left:
Ankles:
Inversion (normal 30°):- Right:
- Left:
Eversion (normal 20°):
- Right:
- Left:
Dorsiflexion (normal 20°):
- Right:
- Left:
Plantarflexion (normal 40°):
- Right:
- Left:
Strength
Grip strength:
- Right hand:
- Left hand:
Elbow flexion:
- Right: /5
- Left: /5
Shoulder girdle:
- Resisted external rotation:
-- Right: /5
-- Left: /5
- Deltoid strength test:- Anterior head:
-- Right: /5
-- Left: /5
- Lateral head:
-- Right: /5
-- Left: /5
- Posterior head:
-- Right: /5
-- Left: /5
Core strength test (60 seconds):
Back extension test (60 seconds):
Heel walk:
Toe walk:
3 Minute squat challenge:
Knees:
- Extension:
-- Right: /5
-- Left: /5
- Flexion:
-- Right: /5
-- Left: /5
Toe flexion:
- Right: /5
- Left: /5
Coordination
Finger to thumb test:
- Right:
- Left:
Heel-to-toe (tandem) gait:
Sharpened Romberg test:
Patellar tendon reflex:
- Right:
- Left:
Bideltoid shoulder breath
Measurement 1 (cm):
Measurement 2 (cm):
Measurement 3 (if required) (cm):
Measurement result (cm):
Peak flow
Best of three (l/min.):
Lung function test (spirometry)
FEV1 (measured litres):
FEV1 (predicted litres):
FEV1 (% of predicted):
FVC (measured litres):
FVC (predicted litres):
FEV1 (% of predicted):
FEV1/FVC (measured %):
FEV1/FVC (predicted %):
FEV1/FVC (% of predicted):
Urine dipstick analysis
Protein:
Blood:
Glucose:
Substance abuse screening
Stool culture
Reference(s):
Physiopedia: Range of Motion Normative Values