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Medical Evaluation Questionnaire (29 CFR 1910.134 App C) To the Employer: Answers to questions in Section 1, and to question 9 in Section 2 do not require a medical examination. To the employee: Can
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Begin by filling out the personal information section which includes your name, address, and contact details.
03
Move on to the employment details section where you will provide information about your current job or occupation.
04
Fill out the financial information section which includes details about your income, assets, and liabilities.
05
Proceed to provide information about your dependents, if any, in the dependents section.
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Complete the declaration section by signing and dating the form.
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Review the completed form for any errors or missing information before submitting it.
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Once you are satisfied with the form, submit it according to the procedure specified by the relevant authority.
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