Can the Employee PE Form be electronically signed?

Yes. Electronic signatures are valid under the ESIGN Act (15 U.S.C. ch. 96) and UETA where adopted when the signature shows intent, consent, attribution, and the record can be retained. Ensure no statutory exception applies to the specific record or transaction.

Is HIPAA protection required for the form?

If the form contains PHI and the entity is a HIPAA-covered entity or business associate, HIPAA safeguards apply; implement administrative, physical, and technical protections and follow 45 CFR §§164.502–164.530 for compliance.

Do employers need a Business Associate Agreement (BAA)?

Yes for vendors that store or process PHI on behalf of a covered entity. A BAA defines permitted uses, safeguards, breach notification, and retention; do not send PHI to vendors without an executed BAA.

Can this form be used to complete Form I-9?

No. Medical forms cannot substitute for identity or employment authorization on Form I-9. Keep identity and authorization verification separate and follow 8 CFR §274a.2 requirements for I-9 procedures.

How long must Employee PE Forms be retained?

Retain medical exam records per HIPAA for six years from creation or last effective date (45 CFR §164.530(j)); tax or payroll records may require three years under IRC §6501(a); state law can require longer retention.

How should errors be corrected on a completed form?

Correct material errors with a dated addendum signed by the clinician; retain the original entry plus the correction to preserve an audit trail and avoid questions about document integrity.

Employee PE Form

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EMPLOYEE PE FORM

Parties and Effective Date

Employer Name: Employer Address: Employer Representative & Title: Service Provider Name: Service Provider Address: Service Provider Representative & Title:

Effective Date:

Recitals

WHEREAS, Employer Name: is engaged in the business of employing personnel and maintaining workforce performance standards; and

WHEREAS, Service Provider Name: possesses expertise in conducting employee performance evaluations and related advisory services; and

WHEREAS, the parties wish to set forth the terms and conditions under which Service Provider will perform an Employee Performance Evaluation ("PE") and any related services as described herein.

Scope of Work

Service Provider shall perform the services described below. Deliverables include written evaluation reports, individual coaching notes where applicable, and a summary executive report. All services shall be performed in a professional manner consistent with industry practice.

Detailed Scope of Services (describe tasks, deliverables, milestones):

Payment Terms

In consideration for the services, Employer shall pay Service Provider the total compensation set forth below in accordance with the schedule. Service Provider shall invoice Employer in accordance with the schedule and Employer shall pay undisputed amounts within the payment period specified. All fees are exclusive of applicable taxes.

Total Fee: Payment Schedule / Invoicing: Late Payment Fee:

If Employer disputes any portion of an invoice, Employer must provide written notice of the dispute within ten (10) business days of receipt of the invoice and shall pay any undisputed portion in accordance with the payment schedule. Interest on overdue undisputed amounts shall accrue at the rate set forth above.

Term and Termination

This Agreement shall commence on Start Date: and shall continue until End Date: unless earlier terminated as provided herein.

Notice Period for Termination Without Cause (days): Termination for Cause (describe grounds and effect):

Upon termination, Service Provider shall deliver all work in progress and Employer shall pay for all services performed and approved expenses incurred through the effective date of termination. Termination shall not relieve either party of obligations that by their nature survive termination.

Confidentiality

Each party acknowledges that in the course of performance it may receive Confidential Information of the other party. "Confidential Information" means non-public information relating to the disclosing party's business operations, personnel evaluations, employee records, compensation, trade secrets, or methodologies disclosed in connection with this Agreement. The receiving party shall: (a) hold Confidential Information in strict confidence; (b) not disclose it to any third party except as required to perform obligations under this Agreement or as required by law; and (c) use it only for the purposes contemplated by this Agreement.

Exceptions to Confidentiality (if any):

Governing Law and Miscellaneous

Governing Law (State):

This Agreement shall be governed by and construed in accordance with the laws of the state specified above, without regard to conflict of law principles. The parties agree that any dispute arising under this Agreement will be resolved in the state or federal courts located within the governing state.

Independent Contractor: Service Provider is an independent contractor and nothing in this Agreement creates an employment, joint venture, or agency relationship between the parties. Service Provider shall be solely responsible for all taxes, insurance, and other obligations arising from its performance.

Indemnification: Each party shall indemnify, defend and hold harmless the other party from and against any third-party claims arising from the indemnifying party's breach of this Agreement, negligence, or willful misconduct, subject to applicable limits of liability and defenses.

Entire Agreement and Amendments

This Agreement, together with any exhibits or attachments expressly incorporated herein, constitutes the entire agreement between the parties with respect to the subject matter and supersedes all prior and contemporaneous agreements, representations, and understandings, whether written or oral. No amendment or modification of this Agreement shall be effective unless in writing and signed by both parties.

Notices

All notices required or permitted under this Agreement shall be in writing and delivered to the addresses set forth above or to such other address as either party may designate in writing. Notices shall be deemed given when delivered personally, by certified mail, or by nationally recognized overnight courier.

Signatures

Employer:

By:

Date:

Service Provider:

By:

Date:

What the Employee PE Form Is and when it’s used

The Employee PE Form is a standardized pre-employment physical examination record used by employers to document a candidate's fitness for duty, job-related medical clearances, immunizations, and work restrictions. It normally captures the clinician's objective findings, screening test results, functional limitations, and any recommended accommodations tied to essential job functions. Employers and occupational health providers use the form to support safe hiring decisions, consistent ADA accommodation evaluations, and defensible recordkeeping when clinical data are required for employment eligibility or safety-sensitive placements.

Why a consistent Employee PE Form matters

A consistent Employee PE Form creates an auditable medical record, reduces documentation errors, and clarifies fitness-for-duty decisions while supporting ADA accommodation processes and occupational safety obligations.

Who typically completes and reviews this form

Employers, occupational health clinics, and HR teams commonly use the Employee PE Form to document pre-employment medical clearance and job-specific fitness evaluations.

HR managers overseeing hiring for safety-sensitive roles and ADA accommodation reviews.
Occupational health clinicians completing physicals and documenting medical restrictions for employment.
Safety officers, hiring supervisors, and benefits administrators reviewing clearance outcomes for placement decisions.

Use the form to centralize decisions, provide a single source of truth for clinicians and HR, and reduce variability across hiring units.

Essential sections that every Employee PE Form should include

A professional Employee PE Form groups identification, clinical findings, job-specific testing, functional limitations, clinician conclusions, and signatures to support legal defensibility and operational clarity.

Identifying Data

Full legal name, date of birth, contact details, employer name, exact position title, and employee ID; mismatches with HR records can delay clearance and complicate retention and reporting.

Medical Findings

Document vital signs, focused systems exam, vision and hearing screening, and objective measures; separate numeric results from clinician interpretation for clarity in later review.

Functional Limits

Specify measurable restrictions (lifting, standing, exposure limits), duration, and whether limits are temporary or permanent for ADA accommodation and safety planning.

Testing & Immunizations

Record job-relevant test names, dates, numeric results, and immunization status; attach lab reports or provide lab reference data when applicable for verification.

Clinician Conclusion

State whether the candidate is cleared, cleared with restrictions, or not cleared; provide concise rationale, suggested accommodations, and recommended re-evaluation interval.

Signatures

Include examiner printed name, professional credentials, license number, clinic address, signature date, and electronic signature metadata when used for legal and audit purposes.

Security and privacy items to include on or around the form

Protected Health Info: Contains PHI under HIPAA rules

Minimum Necessary: Collect only job-related medical data

Access Controls: Limit to HR and clinicians only

Encryption: TLS 1.2/1.3 and AES-256 at rest

Audit Trail: Record timestamps, IP, signer identity

BAA Required: Execute BAA for HIPAA-covered entities

Step-by-step flow for completing and finalizing the form

Follow a clear sequence from intake through secure retention to ensure valid clearance and a complete audit trail for the Employee PE Form.

01

Collect Intake: Obtain consent, ID, and medical history before the exam.
02

Conduct Exam: Perform required clinical tests and document objective findings.
03

Determine Clearance: Record clearance status, restrictions, and accommodation needs.
04

Store Securely: Save signed copy with encryption and audit trail.

Recommended online workflow settings for the Employee PE Form

Configure validations, routing, and signature capture so forms are complete, routed to clinicians, and archived with audit trails and access controls.

Field	Configuration
Intake Consent	Require checkbox; include ESIGN disclosure
Field Validation	Use required fields and format masks
Routing	Auto-route to occupational clinician or HR
Authentication	Optional SMS code or email link for signer

How the electronic submission and review process works

The typical flow moves from employee intake to clinician review, employer sign-off, and secure archival, with each action recorded in the audit trail.

Upload Form: Employee or clinician uploads completed PDF or completes the web form.
Assign Reviewer: Route to occupational clinician for assessment and sign-off.
Sign: Clinician and authorized employer rep sign electronically with audit details.
Archive: Store in encrypted repository and log retention metadata.

Digital signing and platform requirements

Use an eSignature platform that supports HIPAA compliance, detailed audit trails, and secure storage when handling Employee PE Forms.

File Formats: PDF, DOCX supported
Integrations: HRIS, EHR, and cloud storage
Authentication: Email, SMS, KBA options

Timing and scheduling considerations

Timelines depend on hiring start dates, clinical re-evaluation intervals, and regulatory reporting triggers; plan the exam to avoid onboarding delays.

Pre-hire Exam Timing:

Complete the physical before the start date for safety-sensitive positions.

Follow-up Exams:

Schedule re-evaluations per clinician recommendations or policy.

Record Retention Start:

Retention begins on the exam date or document creation.

I-9 Related Timing:

Medical forms do not establish identity for Form I-9 verification.

Occupational Reporting:

OSHA reporting obligations may be triggered by certain work-related injuries.

Common mistakes to avoid when preparing the form

Leaving required fields blank such as exam date or clinician license number often requires recontact and delays clearance; validate required inputs before submission.
Using vague restrictions like 'limited duty' without measurable parameters creates ambiguity and undermines ADA-compliant accommodation documentation.
Storing unencrypted scans or emailing PHI without safeguards risks HIPAA breaches and potential enforcement actions; use encrypted repositories and BAAs.
Accepting unsigned or initial-only documents can invalidate the clearance; ensure full signatures with dates and audit metadata are captured.

Penalties and business risks for incorrect or mishandled forms

HIPAA Violations: Civil and criminal penalties

ADA Noncompliance: Discrimination claim risk

OSHA Reporting: Potential citations and fines

I-9 Errors: Penalties per DHS rule

Insurance Exposure: Denied claims or higher premiums

Operational Delays: Delayed onboarding and cost increases

Real example implementations using electronic workflows

These examples show how organizations leverage e-sign and secure workflows to process clinical and employment-related medical forms without excessive paper handling.

Fertility Centers of Illinois

Fertility Centers of Illinois adopted eSignature to process clinical consents and staff health clearances securely and reduce paper handling.

Clinicians sign onsite or remotely during intake.
John Butler said the airSlate SignNow team has been exceptional, responsive, the API has been great, and we're extremely happy that we chose airSlate SignNow as a company, which helped streamline secure form processing.

Martin Properties

A mid-size property manager moved employee health checks and contractor fit-for-duty forms online to speed onboarding.

Field staff completed forms on mobile devices.
Tim Martin reported, I can process and execute all of these documents online with 100% compliance and built-in security. Whether on mobile or working offline, I can get forms back to their necessary parties efficiently.

Typical pricing and feature comparison for eSignature platforms

Compare basic starting prices and common feature availability across leading eSignature providers; signNow is listed first per vendor comparison practice.

	signNow	DocuSign	Adobe Sign	PandaDoc	HelloSign
Starting Price	$8/user/mo	$15/user/mo	$14/user/mo	$19/user/mo	$15/user/mo
Free Trial	Yes, 7-day free trial	Varies	Varies	Varies	Varies
Bulk Send	Yes	Yes	Yes	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No

Frequently asked questions about completing and managing the Employee PE Form

Answers to common questions on e-signing, HIPAA, retention, and correcting or revoking Employee PE Forms to help employers and clinicians comply with legal and operational requirements.

Need help? Contact support

Can the Employee PE Form be electronically signed?
Yes. Electronic signatures are valid under the ESIGN Act (15 U.S.C. ch. 96) and UETA where adopted when the signature shows intent, consent, attribution, and the record can be retained. Ensure no statutory exception applies to the specific record or transaction.
Is HIPAA protection required for the form?
If the form contains PHI and the entity is a HIPAA-covered entity or business associate, HIPAA safeguards apply; implement administrative, physical, and technical protections and follow 45 CFR §§164.502–164.530 for compliance.
Do employers need a Business Associate Agreement (BAA)?
Yes for vendors that store or process PHI on behalf of a covered entity. A BAA defines permitted uses, safeguards, breach notification, and retention; do not send PHI to vendors without an executed BAA.
Can this form be used to complete Form I-9?
No. Medical forms cannot substitute for identity or employment authorization on Form I-9. Keep identity and authorization verification separate and follow 8 CFR §274a.2 requirements for I-9 procedures.
How long must Employee PE Forms be retained?
Retain medical exam records per HIPAA for six years from creation or last effective date (45 CFR §164.530(j)); tax or payroll records may require three years under IRC §6501(a); state law can require longer retention.
How should errors be corrected on a completed form?
Correct material errors with a dated addendum signed by the clinician; retain the original entry plus the correction to preserve an audit trail and avoid questions about document integrity.

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