MEDICAL EXAMINATION & MEDICAL SURVEILLANCE MATRIX

MEDICAL ASSESSMENT*
MEDICAL SURVEILLANCE
(Preemployment/periodic + job/task related + special medical exam)

Medical Check-Up Job/Task Based

Pre-employment Periodic

Visitor/Government/ Company
Special medical assessment**

Benzene-Toluene-Xylene (BTX)

Others based on HRA updates

Security/ERT/Fire Team/Diver/
(Annually)

Organophosphates pesticide
Length of working period

Driver (LV/HV)/ Pilot/ Marine

No PARAMETER

< 3 Months

3 Months

< 1 Year
< 7 Days

≥ 1 Year
7 Days

Working at Height
to

to

Medical Workers
Confined Space

Noise Exposure
Remote area***

Crane Operator
Food Handler
SCBA Users

Guest ****
Offshore/

Mercury
Personnel age (in years old)

Crew
All < 40 ≥ 40 < 40 ≥ 40 < 40 ≥ 40 < 40 ≥ 40

1. Anamnesis/Questionnaire
1.1 Health and Occupation History Questionnaire β β γ γ δ δ ε ε
1.2 Self-reporting questionnaire (SRQ-20) β β γ γ δ δ ε ε
1.3 Company Informed Consent β β γ γ δ δ ε ε
2. Physical Examination
2.1 Vital Sign
a. Blood pressure β β γ γ δ δ ε ε ζ ζ η
b. Pulse β β γ γ δ δ ε ε ζ ζ η
c. Temperature β β γ γ δ δ ε ε ζ ζ η
d. Respiratory Rate/Oxygen Saturation β β γ γ δ δ ε ε ζ ζ η
2.2 Anthropometry
a. Height β β γ γ δ δ ε ε
b. Weight β β γ γ δ δ ε ε
c. Abdominal circumference β β γ γ δ δ ε ε
d. BMI β β γ γ δ δ ε ε
2.3 Eyes
a. Visual acuity β β γ γ δ δ ε ε
b. Color blindness β β γ γ δ δ ε ε
c. Tonometry β β γ γ δ δ ε ε
d. Perimetry (Visual field test) β β γ γ δ δ ε ε ε ε
e. Fundoscopy γ γ δ δ
f. Stereoscopy (Depth Perception) ε
2.4 Physical examination
a. Teeth and Mouth α β β γ γ δ δ ε ε
b. Ear, Nose, Throat (ENT) α β β γ γ δ δ ε ε
c. Cardiovascular system α β β γ γ δ δ ε ε
d. Respiratory system α β β γ γ δ δ ε ε
e. Digestive system α β β γ γ δ δ ε ε
f. Urinary system α β β γ γ δ δ ε ε
g. Central and peripheral nerve system α β β γ γ δ δ ε ε
h. Skin α β β γ γ δ δ ε ε
i. Lymph α β β γ γ δ δ ε ε
j. Musculoskeletal system and spine α β β γ γ δ δ ε ε
k. Power of motion (grasping, capturing, pointing) ε ε ε ε ε
l. (Phalen's testand
Coordination - Carpal Tunnel Syndrome)
balance ε ε
3. Laboratory
3.1 Complete Blood
(Blood group, Hb, WBC, RBC, Hematocrit, Platelet, Diff. Count, ESR )
Notes: β β γ γ δ δ ε ε
Blood group is initial only (no need to re-test for Periodic assessment)

3.2 Urine routine β β γ γ δ δ ε ε

3.3 Stool routine & stool culture (for salmonella, and shigella) ε
3.4 Diabetic Profile
a. Fasting Blood Sugar β β γ γ δ δ ε ε
b. HbA1c γ γ δ δ ε ε
3.5 Liver profile
a. SGOT β β γ γ δ δ ε ε
b. SGPT β β γ γ δ δ ε ε
c. Gamma GT β β γ γ δ δ ε ε
d. Bilirubin Total & direct δ δ
e. Alkaline phosphatase δ δ
f. Total protein, Albumin δ δ
3.6 Kidney Function
a. Urea β β γ γ δ δ ε ε
b. Creatinine β β γ γ δ δ ε ε
c. eGFR β β γ γ δ δ ε ε
d. Uric acid β β γ γ δ δ ε ε
3.7 Lipid profile
a. Cholesterol total β γ γ δ δ ε ε
b. Cholesterol LDL β γ γ δ δ ε ε
c. Cholesterol HDL β γ γ δ δ ε ε
d. Triglyceride β γ γ δ δ ε ε
3.8 Hepatitis B profile (only for medical worker)
a. HBsAg ε
b. Anti HBsAg ε
3.9 Drugs
a. Amphetamine β β γ γ δ δ
b. Methamphetamine β β γ γ δ δ
c. Cocaine β β γ γ δ δ
d. Benzodiazepine β β γ γ δ δ
e. THC/Cannabis β β γ γ δ δ
f. Morphine/Opiate β β γ γ δ δ
4. Imaging
4.10 Chest X-ray β β γ γ δ δ ε ε
MEDICAL EXAMINATION & MEDICAL SURVEILLANCE MATRIX
MEDICAL ASSESSMENT*
MEDICAL SURVEILLANCE
(Preemployment/periodic + job/task related + special medical exam)

Medical Check-Up Job/Task Based

Pre-employment Periodic

Visitor/Government/ Company
Special medical assessment**

Benzene-Toluene-Xylene (BTX)

Others based on HRA updates

Security/ERT/Fire Team/Diver/
(Annually)

Organophosphates pesticide
Length of working period

Driver (LV/HV)/ Pilot/ Marine

No PARAMETER

< 3 Months

3 Months

< 1 Year
< 7 Days

≥ 1 Year
7 Days

Working at Height
to

to

Medical Workers
Confined Space

Noise Exposure
Remote area***

Crane Operator
Food Handler
SCBA Users

Guest ****
Offshore/

Mercury
Personnel age (in years old)

Crew
All < 40 ≥ 40 < 40 ≥ 40 < 40 ≥ 40 < 40 ≥ 40

5. Cardio examination
5.1 ECG β β γ γ δ δ ε ε
5.2 Treadmill test by achieving at least 85% of maximum heart rate or
rate of perceived exertion Borg scale ≥ 17) γ δ δ ε ε ε

6. Specific examination
6.1 Audiometry (both ears, air conduction with test frequencies including
at a minimum 500, 1000, 2000, 3000, 4000, 6000 and 8000 Hz) δ δ ε ε κ

6.2 Spirometry δ δ ε ε
6.3 Biological monitoring
a. Urinary mercury + questionnaire λ
b. Urinary BTX + questionnaire λ
c. Cholinesterase λ
6.4 Others Special medical examination θ
6.5 Others medical surveillance examination λ
7. Health Status Certificate
7.1 Health Status Certificate from MCU provider's Doctor β β γ γ δ δ ε ε
7.2 Health status certificate from license medical doctor, at least contain
general medical examination and vital sign (blood pressure, pulse, α
respiratory rate, temperature)
8 Medical Declaration Form
8.1 Personnel's statement regarding his/her medical condition ι

Notes:
* Preemployment/periodic + job/task related + special medical exam
** Parameter examination will be based on particular risk(s) assessment and/or evaluation
*** Remote Area: work locations that located far away from and required as minimum 1 (one) hour from nearest medical facility defined by the Company
**** Visitor is defined non-regular field employee is defined the non-field employee who visit field and the frequency ≤6x/year and/or ≤ 2x/month;
government officers include who legally on behalf of Government, teacher or key person of the villages, Army, nave, police or company guest who quartered in Company's field facility less than 72 hours
since entry time
α (alfa) : To be tested and the result (if within normal limit) is valid < 7 days
β (beta) : To be tested for pre-employment and the result ((if within normal limit) is valid < 3 months
γ (gamma) : To be tested for pre-employment and the result (if within normal limit) is valid < 1 year
δ (delta) : To be tested for pre-employment and the result (if within normal limit) is valid = 1 year
ε (epsilon) : To be tested for periodic and/or job/task based, and the result (if within normal limit) is valid = 1 year
ζ (zeta) : To be tested prior commence the job and the result (if within normal limit) is valid for 1 day. This test is conducted by Company OH Doctor/Paramedic
η (eta) : To be tested in Day 1 in charge/on duty at site/field (after break/off) and the result (if within normal limit) is valid for 1 cycle on duty. This test including any relevance questions and physical
examination are conducted by Company OH Doctor/Paramedic
θ (teta) : To be tested if required, and the validity result (if within normal limit) will be depend on purpose
ι (Iota) : To be filled in prior to entry to field facility, and the result (if within normal limit) is valid for 3 days
κ (kapa) : To be tested if exposure to noise annually, and the result (if within normal limit) will be valid for 1 year
λ (lambda) : To be tested if required based on medical surveillance program, and the validity result (if within normal limit) will be depend on purpose