PDO Medical examinations specification SP1230

Petroleum Development Oman LLCRevision: 3.0Effective: 16 Apr 20079.19 Appendix S: Routine Medical Examination Report (EX2)EX2 MEDICAL – CONFIDENTIALPetroleum Development OmanMEDICAL DEPARTMENTPERIODIC/ROUTINE EXAMINATIONREPORTPLEASE COMPLETE YOUR PERSONAL DETAILS INBLACK-BLOCK DETAILSCompany Number:Employee‟s Name & InitialsPresent Area:Next Area:Place of Examination Date Copied to:Family Name Other Names Birth Date Nationality ReligionReason for ExaminationTwoyearlyPreoverseasTransfer +40/RequestTravelRetirement anddate/ /Present Job(job type) Ref. Indicator Office Tel. No. Years withGroupDate and place of lastShell MedicalMale Single Widow(er) Relationship to EmployeeFemale Married Divorced /SeparatedSpouse Son DaughterNo. of ChildrenHome / Leave AddressName and Address of Family DoctorTel No:Tel No:Previous Medical History – All important medical events should be listed and dated at every medicalexamination. To be completed together with the interviewing Sister or Doctor who will be able to help by referringto your notes.Page 79 SP-1230 : Specification for Medical Examination, Treatment & Facilities Printed 25-Sep-08The controlled version of this CMF Document resides online in Livelink®. Printed copies are UNCONTROLLED.