Unitatea medical:

Cabinet de medicina muncii _____________________________________

Adresa ______________________________________________________
Telefon ________________________ Fax __________________________

Unitatea medical:
Cabinet de medicina muncii _____________________________________
Adresa ______________________________________________________
Telefon ________________________ Fax __________________________

Angajare

Angajare

Control
medical
periodic

Adaptare

Reluare a
muncii

Supraveghere
special

Altele

Control
medical
periodic

Adaptare

Reluare a
muncii

Supraveghere
special

Altele

Medicina muncii - FI DE APTITUDINE nr. ......../.......................

Medicina muncii - FI DE APTITUDINE nr. ......../.......................

(Un exemplar se trimite la angajator, unul se nmneaz angajatului)

(Un exemplar se trimite la angajator, unul se nmneaz angajatului)

Societatea ___________________________________________________

Societatea ___________________________________________________

Adresa _____________________________________________________

Adresa _____________________________________________________

Telefon _____________________________________________________

Telefon _____________________________________________________

Nume ............................................. Prenume ..........................................................

Nume ............................................. Prenume ..........................................................

Codul numeric personal ..........................................................................................

Codul numeric personal ..........................................................................................

Ocupaie/funcie ......................................................................................................

Ocupaie/funcie ......................................................................................................

Postul i locul de munc .........................................................................................

Postul i locul de munc .........................................................................................

AVIZ MEDICAL:

Recomandri:

AVIZ MEDICAL:

Recomandri:

APT

______________________________

APT

______________________________

APT CONDIIONAT

______________________________

APT CONDIIONAT

______________________________

INAPT TEMPORAR

______________________________

INAPT TEMPORAR

______________________________

INAPT

______________________________

INAPT

______________________________

Data ____________________

Medic de medicina muncii

Data ____________________

Medic de medicina muncii

(semntura i parafa)

(semntura i parafa)

______________________

______________________

Data urmtorului examen medical: .............................................................................

Data urmatorului examen medical...................................

Data urmtorului examen medical: .............................................................................

Data urmatorului examen medical...................................