Employee Medical Statement

An employee medical statement is usually presented, verified and countersigned by the employer along with an approbated physician, and it states the medical fitness of the employee for the work he has chosen. It is part of office protocol and it is usually mandatory. The employee medical statement must be written in a concise and comprehensive manner.

The tests conducted must be specified, along with any remarks that the doctor might have to make. It is an important document which may be used later as well and therefore all care must be taken in preparing it. The employee medical statement is filed as part of the official documents pertaining to the employee.

Sample Employee Medical Statement


12 North Washington Street,


Dated: 12th June 2012

This statement has been presented by Dr. Sandy Carrick and Dr. Thomas Babington of Washington State General Hospital. The statement has been countersigned by Roger Brendan, Chief Marketing Officer, Sunlight Company Pvt. Ltd.

Name of employee: Jason Summers

Date of birth: 13th June 1980

Street address: 12B Belvedere Gardens, Washington

City: Washington

Postal Code: 34574

Phone Number: 67596734

Email address: jasonsummers@gmail.com

Social security number: 34345634


“To the best of my knowledge, the employee Jason Summers, has undergone all the necessary medical tests [please see the enclosed list] and has been found medically fit as an employee of this company. This document is part of office protocol and has been performed by Dr. Thomas Babington of Washington State General Hospital. Care has been taken to record all the information that the medical tests have provided and these have also been enclosed herewith.

I, Roger Brendan, the employer of Jason Summers, hereby declare him medically fit for his work and this information is true and accurate as far as my knowledge is concerned.”

Signature of employer:

Signature of physician in charge: