Can the form be signed electronically?

Yes. Electronic signatures satisfy the ESIGN Act (15 U.S.C. ch. 96) and UETA in adopted states if intent, consent, attribution, and retention requirements are met; sensitive health data may require additional safeguards.

Is a notary or witness required?

Generally no for standard employee physicals, but some states or employers may require notarization or witnesses for specific declarations; verify state rules before requiring notarization.

How should health data be stored securely?

Store medical records with access controls, encryption in transit and at rest, and maintain audit logs; HIPAA-covered entities must follow 45 CFR Part 164 security and privacy rules.

What if the employee refuses to provide information?

If the information is job-related and consistent with business necessity, employers may take conditional actions, but be careful to follow ADA and privacy rules and document the lawful basis for requests.

How long must these records be kept?

Retention varies: follow industry rules such as HIPAA six-year retention (45 CFR §164.530(j)), IRS and I-9 timelines, and any state extensions; retain documentation of retention policy.

What steps if a signed form is incorrect?

Correct errors with a documented amendment or addendum, obtain new signatures if material, and keep both the original and corrected records to preserve auditability and continuity.

Electronic Signature
Templates
HR
Employee Physical Form

Employee Physical Form

This template is fully customizable. Edit the text, fill out the fields, and send it for signature. Give it a try!

EMPLOYEE PHYSICAL EXAMINATION FORM

Personal Information

Full legal name:

Home address

Phone:

Email:

Date of birth:

Position Information

Job title Department

Reporting manager:

Proposed start date:

Salary / pay rate:

Employment History (most recent first)

Employer 1 — Company name

Title:

Dates employed: From To

Primary responsibilities Reason for leaving

Employer 2 — Company name

Title:

Dates employed: From To

Primary responsibilities Reason for leaving

Education

Highest degree / certificate Institution

Graduation / completion date:

Other relevant training / certifications

References

Reference 1 — Name: Phone:
Email: Relationship:

Reference 2 — Name: Phone:
Email: Relationship:

Reference 3 — Name: Phone:
Email: Relationship:

Legal Disclosures & Applicant Authorizations

At-Will Employment: Employment with the company, if offered, is on an at-will basis unless specifically modified by a written agreement signed by an authorized company representative. This means either the employee or the employer may terminate employment at any time, with or without cause or advance notice.

Equal Opportunity: The employer provides equal employment opportunity without regard to race, color, religion, sex, national origin, age, disability, genetic information or any other status protected by applicable law.

Authorization to Verify: By signing below, I authorize the employer and its agents to contact prior employers, references, licensing bodies, educational institutions, and health care providers to verify information provided and to obtain records relevant to my employment and fitness for duty. I further authorize the release of medical information to the employer when required to determine work restrictions, reasonable accommodations, or fitness for duty.

Medical History — Employee Disclosure

Please check conditions you have now or have had in the past. Checking a box is a disclosure and does not automatically disqualify you.

Heart disease / myocardial infarction High blood pressure Diabetes Seizures Asthma / COPD Significant allergies (drug/food/environmental) Prior surgeries or hospitalizations Mental health condition requiring treatment Substance use disorder treatment

Current medications (include dose and frequency)

Systems Review (check if recent problem)

Fever, chills, or night sweats Chest pain or palpitations Shortness of breath Joint or muscle pain limiting activity Episodes of fainting or loss of consciousness Persistent digestive or abdominal complaints

Vital Signs & Screening

Height: Weight: Blood pressure:

Pulse: Respirations: Temperature:

Vision (uncorrected): Right Left Corrected with:

Hearing screening: Pass Fail

Immunizations & TB Screening

Tetanus (date): Hepatitis B series (completed): Yes No

Influenza (date): TB test (PPD/TST) date: Result:

If TB positive, comment / chest x-ray

Physical Examination Findings

General appearance Head / Eyes / Ears / Throat Cardiovascular / Respiratory Abdomen / Genitourinary Musculoskeletal / Neurologic

Functional Capacity / Fitness for Duty

Based on the examination, the medical evaluator's assessment is (check one):
Fit for duty without restrictions Fit for duty with restrictions — specify below Not fit for duty — medical reason requires removal from duty

If restrictions or not fit, specify limitations, duration, and follow-up required

Physician / Medical Provider Attestation

I hereby attest that I have examined the above-named individual and the findings recorded on this form represent my professional assessment. I have reviewed the medical history as provided and performed the relevant screening and physical examination to determine fitness for work duties.

Provider printed name Medical license / NPI number Facility / clinic

Provider phone: Date of exam:

Provider comments or recommended work accommodations

Employee Authorization & Certification

I certify that the information I have provided on this form is true and complete to the best of my knowledge. I understand that knowingly providing false information is grounds for denial of employment or discipline. I authorize the release of my medical information, including examination findings and immunization records, to the employer for the purpose of determining fitness for duty and compliance with job requirements.

Employee consent to release medical records (check)

I authorize the release of my medical records to the employer as described above. I authorize background checks and verification of prior employment and education for employment purposes.

Employee Printed Name:

Signature:

Date:

What the Employee Physical Form Is and when it's used

The Employee Physical Form documents a pre-employment or periodic medical evaluation that assesses fitness for duty, job-related restrictions, and clearance for specific tasks. It typically records medical history, physical exam findings, functional limitations, immunizations, and any work restrictions. Employers use this form to satisfy occupational health, safety, disability accommodation, or regulatory requirements while documenting the basis for hiring or continued placement in safety-sensitive roles. When medical information is collected, the form is subject to privacy and recordkeeping rules that affect storage, sharing, and retention.

Why a clear Employee Physical Form matters

A properly completed Employee Physical Form reduces workplace risk, documents compliance with safety and accommodation obligations, and creates an auditable health record. Accurate forms support consistent hiring decisions and limit legal exposure by showing objective medical findings and employer decision rationale.

Who typically completes and reviews this form

Employers, occupational health providers, safety officers, and HR teams commonly handle Employee Physical Forms.

Occupational Health Providers: Conduct exams, record findings, and recommend work limitations or clearances.
Human Resources: Collects signed forms, applies privacy controls, and maintains retention schedules.
Hiring Managers/Safety Officers: Use results to place employees in appropriate roles and track accommodations.

Collaboration between medical staff and HR ensures lawful handling of protected health information while meeting operational needs.

Step-by-step: Completing the Employee Physical Form

Follow a consistent sequence to collect, confirm, sign, and store the Employee Physical Form to ensure accuracy and compliance.

01

1. Request: Send the form to the candidate or employee with clear instructions and deadline.
02

2. Examine: Licensed clinician completes the medical history, exam, and tests as applicable.
03

3. Signatures: Clinician and employee sign and date; include witness or notary if required.
04

4. Store: File securely under access controls and apply retention schedule.

Typical eSignature vendor pricing and capability snapshot

Compare common eSignature plans for processing Employee Physical Forms. signNow is listed first per vendor-comparison convention.

	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	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
Envelope Cap	No cap	100 envelopes/user/year	Varies	Varies	Varies

Key settings to configure for online completion and signing

Configure the workflow to require necessary fields, apply authentication, and route signed copies to appropriate recipients.

Field	Configuration
Required Fields	Mark name, exam date, and signature fields as mandatory.
Authentication	Choose email link, SMS code, or stronger verification per sensitivity.
Templates	Save standard exam forms as templates with pre-placed fields to reduce errors.
Notifications	Enable copy to HR and occupational health upon completion.

Digital signing, file formats, and integration essentials

Select an eSignature workflow that supports secure storage, audit trails, and commonly used file types for medical records.

File Types: PDF, DOCX, or scanned images supported.
Integrations: Connectors for HRIS and cloud storage are recommended.
Security: TLS in transit and AES-256 at rest.

Essential data elements to capture on the form

Employee ID: Internal identifier

Full Name: Legal name

Birth Date: MM/DD/YYYY

Exam Date: MM/DD/YYYY

Provider Info: Name and license

Restrictions: Work limitations

Consequences and compliance risks to consider

HIPAA Violation: Civil penalties apply

I-9 Errors: Fines may apply

Discrimination Claims: Improper use risks litigation

Record Loss: Regulatory exposure

Unclear Consent: Invalidates electronic records

Improper Storage: Data breach risk

Common mistakes when preparing Employee Physical Forms

Missing signatures or dates that delay clearance and can require repeating the exam.
Collecting unnecessary health details that increase privacy risk and complicate HIPAA compliance.
Failing to standardize the form across locations, resulting in inconsistent decisions and audit difficulties.
Storing signed forms without encryption or access controls, exposing sensitive health information to unauthorized viewers.

Core sections every professional Employee Physical Form should include

A complete form balances clinical detail with privacy controls and administrative fields. Include discrete, structured sections for clarity.

Identifying Information

Employee identifiers, demographic data, and employer details allow accurate recordkeeping and linking to HR systems without exposing unnecessary health data.

Medical History

Structured medical history questions tailored to job risk factors support consistent evaluation and defensible medical decision-making.

Physical Exam Findings

Objective exam results, vital signs, and test outcomes documented with units and reference ranges where applicable.

Functional Assessment

Clear description of functional limitations, work restrictions, and recommended accommodations tied to job demands.

Provider Certification

Clinician name, license, signature, and date establish the exam's authenticity and support audit trails.

Privacy and Consent

Explicit employee consent for release of medical information and a note on how health data will be used and retained.

Typical digital submission and signing flow

A secure online workflow minimizes manual handling and creates an auditable trail for the Employee Physical Form.

Upload Document: Sender uploads the form as PDF or DOCX.
Place Fields: Add signature, date, and required fields.
Authenticate: Signers verify by email, SMS, or stronger method.
Complete: Signed copy and audit trail are stored automatically.

Timing and submission expectations for medical clearances

Set clear deadlines to avoid onboarding delays and ensure medical clearances align with start dates and regulatory checks.

Pre-employment Submission:

Provide completed form before the employee's start date whenever feasible.

Exam Validity Window:

Record the exam date and note any employer-defined expiration for clearance.

I-9 Retention Reminder:

Retain relevant employment eligibility records per 8 CFR §274a.2 retention rules.

Follow-up Exams:

Schedule re-exams as required by job duties or regulatory guidance.

Incident-triggered Testing:

Require prompt examinations after workplace incidents per employer policy.

FAQs: Common questions about Employee Physical Forms

Answers to frequent questions about validity, electronic signatures, privacy, and retention for Employee Physical Forms.

Need help? Contact support

Can the form be signed electronically?
Yes. Electronic signatures satisfy the ESIGN Act (15 U.S.C. ch. 96) and UETA in adopted states if intent, consent, attribution, and retention requirements are met; sensitive health data may require additional safeguards.
Is a notary or witness required?
Generally no for standard employee physicals, but some states or employers may require notarization or witnesses for specific declarations; verify state rules before requiring notarization.
How should health data be stored securely?
Store medical records with access controls, encryption in transit and at rest, and maintain audit logs; HIPAA-covered entities must follow 45 CFR Part 164 security and privacy rules.
What if the employee refuses to provide information?
If the information is job-related and consistent with business necessity, employers may take conditional actions, but be careful to follow ADA and privacy rules and document the lawful basis for requests.
How long must these records be kept?
Retention varies: follow industry rules such as HIPAA six-year retention (45 CFR §164.530(j)), IRS and I-9 timelines, and any state extensions; retain documentation of retention policy.
What steps if a signed form is incorrect?
Correct errors with a documented amendment or addendum, obtain new signatures if material, and keep both the original and corrected records to preserve auditability and continuity.

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