Report off Medical Examination under Mines Rules 298 as per the recommendations of ‘National Safety Conferences in Mines Certificate No: Name: Identification Marks: Result of Lung Function Test (Spirometry) Parameters Predicted Value _| Performed Value | % of Predicted Forced Vital Capacity (FVC) Fel Sih Forced Expiratory Volume 1 (FEV) B-SA 3-22, Qo FEVIUFVC B36 13 3 Peak Expiratory Flow. BB 16-96, ns ‘Spirometry report encloses 1._Cardiological Assessment: “Auseultation Si NokmAL 32 neon ‘Additional Sound Nit Electrocardiograph (12 leads) findings Normal / Abaormal Enclosed ECG 2._ Neurological Assessment: Findings ‘Normal / Abnormal ‘Superficial reflexes Neamae Deep refiexes, hoe mea Peripheral Circulation NoRmaa— z ‘Vibration syndromes NoRmAt— 3,_ILO Classification of Chest Rediograph: ARsewl rofusion of Pneumoconiotic opacities _| Grade Types Prosent / Absent Enclosed Chest Radiograph 4,_Audiometry Findings: ‘Conduction Type TeftEar Right Ear Ear Conduction Nortnal /Abaermal Normal / Abaerra Bone Conduction ‘Normal / Abnormal Normal / Abnemral Enclosed Audiometty Report 5. Pathological / Microbiological investigations: 'S.No._| Tests Findings 1 Blood TC, DG, Hb, ESR, Platelets INU Abnormal 24 Blood Sugar-Fasting & PP DAWNL/ Abnocal EE Lipid Profile| INLI Abnorsnal a Blood Urea, Creatinine INU Abnormal 3. Urine Routine. << PWNL Abnormal 6. ‘Stool Routine WNL! Abrorel Enclosed Investigation Reports 6._ Special Test for Mn exposure, ‘Behavioral Disturbances ‘Present /Not Present_— Neurological Disturbances | Spooch Defect resent /Not Present_— Tremor resent / Not Present_— ‘Adladocokinesia resent / Not Present_—~ ‘Emotional Changes resent / Not Present_— 7. Any other Special Test Required: 3|Page Ww” ‘Signature of the\Examination Authority DR. REMA NAIR Sou PRCTNONE 4. BASHAVER EDDA Cen