🏥 Hospital Details
👤 Employee Details
🩺 Medical Assessment for WFH
✅ Result
👨⚕️ Doctor Details
WORK FROM HOME
🏥
CITY CARE HOSPITAL
Occupational Health Centre
12, MG Road, Bangalore - 560001 | Ph: +91 80 4567 8901
Work From Home Fitness Certificate
Cert. No: WFH001 | Date: 25 Aug 2026
Certified for Remote Work · Tech Solutions Pvt. Ltd.
Employee Name
________________
Employee ID
EMP001
Age / Gender
__ / Male
Department
Software Development
WFH Fitness Assessment
Vision (Screen): Normal - Fit for screen work
Musculoskeletal: Normal
Mental Health: Stable - Fit for remote work
General Health: Good
Remarks: Fit for prolonged computer work with regular breaks
Medical Opinion
FIT FOR WORK FROM HOME
Valid until: -
Recommendations: Ergonomic chair, 20-20-20 eye rule, regular breaks
This is to certify that the above named employee has been examined and found medically fit to perform duties under Work From Home arrangement as per occupational health guidelines.
Employee Signature
WFH
FIT ✓
FIT ✓
Dr. R. Sharma
Dr. R. Sharma
MBBS, MD
Reg: MCI-12345/2020
MBBS, MD
Reg: MCI-12345/2020