Sequatchie Valley Head Start Physical Exam Form printable pdf download

Sequatchie Valley Head Start

Physical Exam Form

Employee Name: _______________________________

Check type of physical / certification:

Position:

□ return to work physical

□ Coordinator or Supervisor

□ post employment offer physical

□ Office Support Staff

□ routine periodic physical

Essential functions of positions (work with disabled preschoolers is required for all positions)

Applicant / Employee must be able to:

□ sit and stand for prolonged periods of time

□ bend, kneel, and sit in office environment

□ maintain body equilibrium to prevent falling when walking, standing, crouching, or running

on narrow, slippery, or erratically moving surfaces; ability to climb on a step stool, stairs,

ramps, using feet and legs and/or hands and arms

□ express or exchange ideas by means of spoken word

□ hold telephone conversations as well as interact with parents and the community

□ hear (may utilize assistive devices) for those activities which require ability to receive

detailed information through oral communication and to make fine discriminations in sounds

□ impart oral information to clients and/or the public and activities in which they must convey

detailed or important spoken instructions to other workers

□ complete written paperwork and computer entry (required daily)

□ perceive the nature of objects through sight; ability to visually monitor young children in

office environment

□ adapt to different work environments; work area is located inside with variations in

temperature and is unventilated

□ reaching and repetitive motion may be required

□ Travel to some centers (including riding for extended periods of time) and training events is

necessary. This may require long periods of time in vehicles, as well as exposure to

preschool environments. May be required to sit in child-size furniture or help to monitor three

and four year old children, including disabled children on an occasional basis and be

required to use exposure control techniques and to supervise children who may be carriers

of contagious diseases.

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Sequatchie Valley Head Start Physical Exam Form