Order on Arranging Pre-employment or Periodic Medical Examinations

Employer / organization​

No. Order number​ dated Order date · City​ Medical organization, license and contract: Contract with the medical organization and license details​. Under Article 220 of the Labor Code of the Russian Federation (ТК РФ) and the Procedure approved by Order of the Ministry of Health of Russia of 28.01.2021 No. 29n (29н), I hereby order: Arrange periodic medical examinations for employees on the named list Named list: date, number and persons included​ at Medical organization​, Medical organization's address​. Ground: the calendar plan developed by the medical organization, agreed with the employer and approved by the medical organization's head: Calendar plan: agreement and approval particulars​. Approve an internal attendance schedule consistent with that calendar plan:

Schedule: employees/groups, date, time and place​ The schedule is introduced for the first time. Coordinator: Position of the employee being appointed​, Full name of the employee being appointed​. Check referrals, named lists and consistency of dates. Ensure the approved named list is sent to the medical organization at least two months before the agreed examination start date; use a different period only on a ground provided by paragraph 24 of Procedure No. 29n. Send a copy of this order to the medical organization to arrange attendance. Familiarize employees with the calendar plan at least 10 working days before the agreed start of periodic examinations; communicate any changes in good time. Unit heads shall ensure attendance and release employees from work for mandatory examinations. The employer bears examination costs; statutory guarantees shall be maintained. Monitor receipt of medical examination conclusions and completion of examinations. In the event of non-completion or contraindications, decide on authorization to work under the prescribed procedure; do not include diagnoses in the schedule. This order establishes the employer's attendance arrangements and does not replace approval of the calendar plan by the medical organization's head. I retain oversight.

Head's position​ __________ / Head's full name​ /

Persons acquainted with the order (personal signatures and dates): Acknowledgment: full name, position, actual date and signature​

Obtain the final report under the prescribed procedure and determine the necessary measures without including diagnoses in generally accessible documents. Specific arrangements: Organizational action based on the final report​.

Additional rows for the list of factors and types of work​ Grounds are checked against the current lists, working condition assessment results and work performed; diagnoses are not included in the list.

The list is approved and sent to the medical organization separately; access is restricted. This form supplements the details of the appendix Named list: date, number and persons included​.