Ordnance Equipment Factory Hazratpur, Recruitment 2016: Appendix -IV

Ordnance Equipment Factory Hazratpur, Recruitment 2016: Appendix -IV

APPENDIX – IV

The form of certificate to be produced by Physically Handicapped candidates applying for appointment to posts under the Government of India.

NAME & ADDRESS OF THE INSTITUTE/HOSPITAL

Certificate No............................... Date: .......................

DISABILITY CERTIFICATE

Recent Photograph of

the candidate showing

the disability duly

attested by the

Chairperson of the

Medical Board

This is certified that Shri/Smt/Kum………………………Son/wife/daughter of Shri……………………......... age ………sex……identification mark(s)……………….. is suffering from permanent disability of following category :

A. Locomotor or Cerebral Palsy:

(i) BL - Both legs affected but not arms

(ii) BA - Both arms affected     (a) Impaired reach

                                                   (b) Weakness of grip

(iii) BLA - Both legs and both arms affected

(iv) OL - One leg affected (right or left)    (a) Impaired reach

                                                                    (b) Weakness of grip

                                                                    (c) Ataxic

(v) OA - One arm affected                          (a) Impaired reach

                                                                    (b) Weakness of grip

                                                                    (c) Ataxic

(vi) BH - Stiff back and hips (cannot sit or stoop)

(vii) MW - Muscular weakness and limited physical endurance. 

B. Blindness or Low Vision:

(i) B - Blind

(ii)PB - Partially blind

C. Hearing impairment:

(i) D - Deaf

(ii) PD - Partially deaf

(Delete the category whichever is not applicable)

2. This condition is progressive/non-progressive/likely to improve/not likely to improve. Re-assessment of this case is not recommended/is recommended after a period of years months.*

3. Percentage of disability in his/her case is ………… Percent.

4. Shri/Smt./Kum..................... ……….. meets the following physical requirements for discharge of his/her duties: - 

(i) F -  Can perform work by manipulating with fingers.Yes/No

(ii) PP - Can perform work by pulling and pushing. Yes/No

(iii) L - Can perform work by lifting. Yes/No

(iv) KC - Can perform work by kneeling and crouching.Yes/No

(v) B - Can perform work by bending. Yes/No

(vi) S - Can perform work by sitting. Yes/No

(vii) ST - Can perform work by standing. Yes/No

(viii) W - Can perform work by walking. Yes/No

(ix) SE - Can perform work by seeing. Yes/No

(x) H - Can perform work by hearing/speaking. Yes/No

(xi) RW - Can perform work by reading and writing. Yes/No

(Dr……………………) (Dr……………………) (Dr……………………)

Member                                 Member                            Chairman 

Medical Board                      Medical Board                  Medical Board

Countersigned by the Medical Superintendent/CMO/Head of Hospital

(With Seal)

* Strike out whichever is not applicab

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