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MEDICAL FITNESS CERTIFICATE FOR FOOD HANDLERS FOR THE YEAR/MONTH See Para No.10. 1. 2 Part-II Schedule-4 of FSS Regulations 2011 Signature of the Food Handler It is certified that Shri/Smt/Miss. employed with M/s. coming in direct contact with food items has been carefully examined by me on date. Based on the medical examination conducted he/she is found free from any infectious or communicable diseases and the person is fit to work in the above mentioned food establishment. Specific Notes If any Name and Designation with seal of Registered Medical Practioner/Civil Surgeon Medical Examinations to be conducted 1. Physical Examination 2. Eye Test 3. Skin Examination 4. Compliance with schedule of vaccine to be inoculated against enteric group of diseases. 5. Any test required to confirm any communicable or infectious disease which the person suspected to be suffering from on clinical examination*. employed with M/s. coming in direct contact with food items has been carefully examined by me on date. Based on the medical examination conducted he/she is found free from any infectious or communicable diseases and the person is fit to work in the above mentioned food establishment. Based on the medical examination conducted he/she is found free from any infectious or communicable diseases and the person is fit to work in the above mentioned food establishment. Specific Notes If any Name and Designation with seal of Registered Medical Practioner/Civil Surgeon Medical Examinations to be conducted 1. Specific Notes If any Name and Designation with seal of Registered Medical Practioner/Civil Surgeon Medical Examinations to be conducted 1. Physical Examination 2. Eye Test 3. Skin Examination 4. Compliance with schedule of vaccine to be inoculated against enteric group of diseases. Physical Examination 2. Eye Test 3. Skin Examination 4. Compliance with schedule of vaccine to be inoculated against enteric group of diseases. 5. Any test required to confirm any communicable or infectious disease which the person suspected to be suffering from on clinical examination*. employed with M/s. coming in direct contact with food items has been carefully examined by me on date. Based on the medical examination conducted he/she is found free from any infectious or communicable diseases and the person is fit to work in the above mentioned food establishment. Specific Notes If any Name and Designation with seal of Registered Medical Practioner/Civil Surgeon Medical Examinations to be conducted 1. Based on the medical examination conducted he/she is found free from any infectious or communicable diseases and the person is fit to work in the above mentioned food establishment. Specific Notes If any Name and Designation with seal of Registered Medical Practioner/Civil Surgeon Medical Examinations to be conducted 1. Physical Examination 2. Eye Test 3. Skin Examination 4. Compliance with schedule of vaccine to be inoculated against enteric group of diseases. Specific Notes If any Name and Designation with seal of Registered Medical Practioner/Civil Surgeon Medical Examinations to be conducted 1. Physical Examination 2. Eye Test 3. Skin Examination 4. Compliance with schedule of vaccine to be inoculated against enteric group of diseases. 5. Any test required to confirm any communicable or infectious disease which the person suspected to be suffering from on clinical examination*.

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