CCTT annual physical
CCTT annual physical Role: [text name="variable_1" default=""] Agility testing completed- meets standard (see scanned documents). ________________________________________________ Medications: [text name="variable_2" default=""] Allergies: [text name="variable_3" default=""] PMH: [textarea name="variable_4" default=""] [checkbox name="variable_5" value="Denies all risk factors and s/s of hypertrophic cardiomyopathy."] [checkbox name="variable_20" value="Denies hx of or s/s of sleep apnea."] [checkbox name="variable_19" value="Denies additional hospitalizations, chronic diseases, and need for accommodations."] ________________________________________________ EXAM Vision - L: [text name="variable_6" default=""], R: [text name="variable_7" default=""] BP: [text name="variable_8" default=""] HR: [text name="variable_9" default=""] Height: [text name="variable_10" default=""] Weight: [text name="variable_11" default=""] BMI: [text name="variable_12" default=""] Neck circumference: [text name="variable_13" default=""] ________________________________________________ Neuro: [textarea name="variable_14" default=" A&Ox3, clear speech, appropriately groomed"] MSK: [textarea name="variable_15" default=" Good muscle tone throughout, ambulating steadily, non-antalgic gait"] Lungs: [textarea name="variable_16" default=" CTAB"] Heart: [textarea name="variable_17" default=" S1, S2 noted. Absent S3, S4, murmurs"] [checkbox name="variable_18" value="FIT test not performed today, EE to be fitted by department|FIT testing completed|FIT test failed, educated on PAPR usage|Passed with Prestige Regular|Provided qualitative fit testing using bitrex or saccharin in compliance with NFPA 1500, NFPA 1404, ANSI Z88.5, ANSI Z88.21992, OSHA CRF 1910.134, and CCR Title 8 Sec. 5144. Annual respirator training provided on why the respirator is necessary and how improper fit, use or maintenance can compromise its protective effect; limitations and capabilities of the respirator; effective use in emergency situations; how to inspect, put on and remove, use and check the seals; maintenance and storage; and recognition of medical signs and symptoms that may limit or prevent effective use"] ________________________________________________ CCTT employee meets all standards for clearance. Clearance form sent to managers by front desk.
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Sandbox Metrics: Structured Data Index 0.2, 20 form elements, 46 boilerplate words, 11 text boxes, 5 text areas, 4 checkboxes, 24 total clicks
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