Audit
Personal Information
Full Names & Surname
ID or Passport number:
Occupation:
Medical
Type of Medical Examination Required:
Booking is confirmed for:
Please ensure that you bring the following with you on the day of the examination:
Copy of Exit Medical Certificate from previous employer ( if previously employed under MHSA)
Copy of ID/Passport
Any current medication that you are taking
T-Shirt for the ladies (x-rays)
Specticles (if prescribed)
Note: Drivers & Operators
BAC (Blood Alcohol Concentrate)
TCH (tetrahydrocannabinol)
CBT (Colour Blindness Test)
Approval
This form will be requiered as proof of payment as agreed to by .......
Approved?
Signature of Tharisa Minerals Official
