Employee Health Checkup Tracker
Date: ____ / ____ / ________ (DD/MM/YYYY)
Company Details:
Company Name: ________________________________
Company Address: ______________________________
Contact Person: _______________________________
Phone: ________________________
Email: ________________________
Employee Details:
1. Employee ID: _________________ Name: ____________________________ Department: ___________________________
– Medical Condition (if any): _________________________________________
– Date of Last Checkup: ____ / ____ / ________ (DD/MM/YYYY)
– Notes/Comments: ___________________________________________________
2. Employee ID: _________________ Name: ____________________________ Department: ___________________________
– Medical Condition (if any): _________________________________________
– Date of Last Checkup: ____ / ____ / ________ (DD/MM/YYYY)
– Notes/Comments: ___________________________________________________
3. Employee ID: _________________ Name: ____________________________ Department: ___________________________
– Medical Condition (if any): _________________________________________
– Date of Last Checkup: ____ / ____ / ________ (DD/MM/YYYY)
– Notes/Comments: ___________________________________________________
(Add more employees as necessary)
Health Checkup Status:
Please tick the appropriate box for each employee after their health checkup:
(Add more rows as necessary)
Notes/Comments:
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
Doctor’s Information:
Doctor’s Name: Dr. ___________________________
License Number: _______________
Clinic Address: _____________________________________________________
Phone: ________________________
Email: ________________________
Note: This tracker is to be updated after each employee’s health checkup. Ensure to record the latest information accurately.
