TNAG-0585-FCO40-718-Employment-of-children-in-Hong-Kong-1976 — Page 32

A 28

CAP. 59]

Factories and Industrial Undertakings Regulations

[1973 Ed.

[Subsidiary]

Part III. (To be completed in duplicate by examining medical practitioner).

A. General Nutrition

Weight

lbs. Height

ins.

Eyes: Visual acuity R.

Cardiovascular System Pulse rate

L.

Ears

B.P.

Abdomen

Hernias

Genito-urinary System

Urine

Sp. G. ............ Alb.

..... Sugar ...

Skeletal System

Upper limbs

Lower limbs

Nervous System

.)

reports as

B.

Chest X-ray Examination (date

Dr.

(medical practitioner by whom X-ray examination is made)

follows:

C. I have examined the above named

(full name)

in accordance with this report, and consider that he is fit/unfit* to work underground in an industrial undertaking to which Part IIA of the Factories and Industrial Undertakings Regulations applies.

Date:

Signature of Examining Medical Practitioner:

Name of Examining Medical Practitioner:

Address:

(block capitals)

Telephone Number:

Notes: (a) One copy of this completed form should be sent by the examining medical practi- tioner under confidential cover to the senior industrial health officer, Industrial Health Division, Labour Department. The other copy is to be retained by the examining medical practitioner.

(b) * Delete whichever is inapplicable.