List of professions for medical examination sample. Who makes up the contingent of workers subject to periodic medical examination

Labor Code of the Russian Federation and others federal laws oblige employers to conduct both preliminary (at the conclusion of employment contract), so subsequent medical examinations of employees.

For example, mandatory prior medical examination at the conclusion of an employment contract, as well as subsequent medical examinations, persons who have not reached the age of 18 are subject to, as well as persons hired with harmful or dangerous working conditions, as well as for work related to traffic (Article 69,, Labor Code of the Russian Federation ).

Since failure to conduct mandatory medical examinations threatens the employer with administrative liability, proper control over the timeliness and completeness of medical examinations of employees is extremely important. One of the tools for such control is the compilation of a list of names of employees to undergo a medical examination, a sample of which will be given in our consultation.

List of workers for medical examination: sample

The need to draw up name lists of employees subject to periodic medical examinations is provided for by the Order of the Ministry of Health and Social Development of April 12, 2011 No. 302n. It is envisaged that such lists include employees who (clause 19 of the Order of the Ministry of Health and Social Development of April 12, 2011 No. 302n):

or exposed to harmful production factors specified in the List (Appendix No. 1 to the Order of the Ministry of Health and Social Development dated April 12, 2011 No. 302n);
or perform the work provided for by the List of Works (Appendix No. 2 to the Order of the Ministry of Health and Social Development of April 12, 2011 No. 302n).

The lists of names indicate (clause 22 of the Order of the Ministry of Health and Social Development dated April 12, 2011 No. 302n):

surname, name, patronymic, profession (position) of the employee subject to periodic medical examination;
name of harmful production factor or type of work
name of the structural unit of the employer (if any).

Name lists are compiled and approved by the employer and no later than 2 months before the start date agreed with the medical organization periodic inspection sent by the employer to the specified medical organization (

Structural subdivision	Profession	Full Name	Date of Birth	Work experience *		Date of last medical examination ***
Structural subdivision	Profession	Full Name	Date of Birth		In the organisation
				5
Motor transport shop	battery-torcher	Kopytov Mikhail Pavlovich
	hand forged blacksmith	Ezhov Sergey Ivanovich
		Kozlov Alexander Vasilievich
		Utkin Sergey Valerievich
		Krolikov Nikolay Ivanovich
Administration	leading power engineer	Lopatkin Andrey Vladymirovich
	transport shop manager	Koshkina Lyubov Ivanovna
		Myshkina Tatyana Petrovna
		Chizhikova Svetlana Vasilievna
	Warehouse Manager	Pyzhikova Svetlana Vasilievna

* in the column "work experience", record "9; 11" stands for 9 years 11 months;

** harmful experience should be understood as the number of years and months that an employee has worked with the factors stated in the contingents and lists;

Motor transport shop

accumulator man

hand forged blacksmith

car repairman

Administration

leading power engineer

transport shop manager

Warehouse Manager

For each profession, indicate the number of employees

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Structural subdivision	Profession	OK code 016-94	population
			population				over 10 years
				including wives	including wives	including wives		including wives
Auto-transport shop	battery-mule-traveler
	hand forged blacksmith
	car repair mechanic
Administration	leading power engineer
	transport shop manager
	Warehouse Manager

For each profession, we indicate harmful factors and work, indicating the points of the order of the Ministry of Health and Social Development of the Russian Federation No. 83 dated 16.08.2004. In order to determine which factors and work should be indicated for each specific work, you can use the program production control or last year's contingents.

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Structural subdivision

Profession

OK code 016-94

population

Including long-term employees

Harmful and dangerous production factors

app no. and paragraph of order 90/83*

over 10 years

including wives

Auto-transport shop

battery-mule-traveler

sulfur oxides, acids

Prik 90/83 App1 p1.27.1/ 1.2.32

lead and its inorganic compounds

Prik 90/83 App1 p1.25.1/ 1.2.30

hand forged blacksmith

thermal radiation above the remote control at a temperature above the remote control

Prik 90/83 App1 p5.9/3.10

elevated air temperature more than 4 degrees above the remote control

Prik90/83 App1 p5.8/3.9

physical overload

Prik 90/83 App1 p6.1/ 4.1

carbon monoxide

Prik 90/83 Annex 1 p1.32/1.2.37

nitrogen inorganic compounds

Prik 90/83 App1 p1.1/1.2.1

car repair mechanic

mineral petroleum oils

Prik 90/83 App1 p2.5/ 1.3.5

saturated and unsaturated hydrocarbons (methane, propane, paraffins, ethylene, propylene, acetylene, cyclohexane)

Prik 90/83 App1 p1.36/ 1.2.45

Prik90/83 App1 p2.5/ 1.3.5

aliphatic limiting and unsaturated aldehydes (acrolein)

Prik 90/83 App1 p1.2/ 1.2.2

physical overload

Prik 90/83 App1 p6.1/ 4.1

Administration

leading power engineer

work with PC

transport shop manager

Warehouse Manager

work with PC

Prik 90/83 App1 p6.2.3/ 4.2.3

electromagnetic fields in the range of 80 MHz - 300 GHz (VHF, UHF, SHF, EHF)

Prik 90/83 App1 p5.2.2/ 3.2.2

*Today, there are 3 orders regulating the medical examination:

Order No. 83 dated August 16, 2004,

Order of the Ministry of Health of the Russian Federation No. 90 dated 14.03.96,

Order of the Ministry of Health of the USSR dated October 29, 1989 No. 555.

Orders No. 83 and No. 90 consist of two appendices. In the first appendix, harmful factors are indicated, and in the second - harmful work. Most of the factors and work specified in Order No. 90 are also available in Order No. 83. The works specified in order No. 555 are available in order No. 83.

Therefore, opposite the factor in the column "item number by order of the Ministry of Health of the Russian Federation" should be:

order number,

application number,

Order point.

It is convenient to use the following entry: Prik 90/83 Prik1 p1.27.1 / 1.2.32

** sometimes there are professions for which there is no harmful factors and works from the orders of the Ministry of Health of the Russian Federation. In this case, in the product allocations for this profession, the cells containing information about the factors will be empty. Such workers may not be sent for medical examination.

We take laboratory test reports, or job attestation cards, and opposite each factor we put down the actually measured level of the factor or concentration. It should be remembered that for some factors (for example, general cooling in an open area or work with a PC) and for work, there are no levels and concentrations.

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Page uk-turne subdivision

Profession

OK code 016-94

population

Including long-term employees

Level

up to 5 years

5-10 years

over 10 years

Total

including wives

Total

including wives

Total

including wives

Total

including wives

Auto-transport shop

battery-mule-traveler

10047

sulfur oxides, acids

Prik90/83 App1 p1.27.1/ 1.2.32

no ism

Prik90/83 App1 p1.25.1/ 1.2.30

no ism

hand forged blacksmith

13227

Prik90/83 App1 p5.9/3.10

no ism

Prik90/83 App1 p5.8/3.9

no ism

physical overload

Prik90/83 App1 p6.1/4.1

carbon monoxide

Prik90/83 App1 p1.32/ 1.2.37

no ism

Prik90/83 App1 p1.1/1.2.1

no ism

18511

mineral petroleum oils

Prik90/83 App1 p2.5/1.3.5

no ism

Prik90/83 App1 p1.36/1.2.45

<100 мг/м3

petrol

Prik90/83 App1 p2.5/1.3.5

no ism

Prik90/83 App1 p1.2/1.2.2

no ism

physical overload

Prik90/83 App1 p6.1/4.1

Administration

leading power engineer

21039

work with PC

Prik90/83 App1 p5.2.2/ 3.2.2

21635

Warehouse Manager

22141

work with PC

Prik90/83 App1 p6.2.3/ 4.2.3

electromagnetic fields in the range of 80 MHz - 300 GHz (VHF, UHF, SHF, EHF)

Prik90/83 App1 p5.2.2/3.2.2

no ism

Now you should turn to the list of surnames compiled at the first stage.

In column 3 of the contingents, we rewrite the codes of professions.
For each employee from the contingents, we rewrite harmful factors and work, order items and levels of factors.

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Page uk-turne subdivision	Profession	OK code 016-94	Full Name	Date of Birth	Work experience *		Harmful and dangerous production factors	app no. and paragraph of order 90/83*	Level	Date of last medical examination ***
						In the organisation				in health care facilities ***	at CPP ****

Auto-transport shop	battery-mule-traveler	10047	Kopytov Mikhail Pavlovich	26.06.1949		4; 11	sulfur oxides, acids	Prik90/83 App1 p1.27.1/1.2.32	no ism	01.07.09
							lead and its inorganic compounds	Prik90/83 App1 p1.25.1/1.2.30	no ism
	hand forged blacksmith	13227	Ezhov Sergey Ivanovich	29.07.1959		12; 10	thermal radiation above the remote control at a temperature above the remote control	Prik90/83 App1 p5.9/3.10	no ism	01.07.09
							elevated air temperature more than 4 degrees above the remote control	Prik90/83 App1 p5.8/3.9	no ism
							physical overload	Prik90/83 App1 p6.1/4.1
							carbon monoxide	Prik90/83 App1 p1.32/1.2.37	no ism
							nitrogen inorganic compounds	Prik90/83 App1 p1.1/1.2.1	no ism
			Kozlov Alexander Vasilievich	27.07.1951		9; 11	thermal radiation above the remote control at a temperature above the remote control	Prik90/83 App1 p5.9/3.10	no ism	01.07.09	01.04.07
							elevated air temperature more than 4 degrees above the remote control	Prik90/83 App1 p5.8/3.9	no ism
							physical overload	Prik90/83 App1 p6.1/4.1
							carbon monoxide	Prik90/83 App1 p1.32/1.2.37	no ism
							nitrogen inorganic compounds	Prik90/83 App1 p1.1/1.2.1	no ism
			Utkin Sergey Valerievich	05.05.1958		6; 11	thermal radiation above the remote control at a temperature above the remote control	Prik90/83 App1 p5.9/3.10	no ism	01.07.09
							elevated air temperature more than 4 degrees above the remote control	Prik90/83 App1 p5.8/3.9	no ism
							physical overload	Prik90/83 App1 p6.1/4.1
							carbon monoxide	Prik90/83 App1 p1.32/1.2.37	no ism
							nitrogen inorganic compounds	Prik90/83 App1 p1.1/1.2.1	no ism
	car repair mechanic	18511	Krolikov Nikolay Ivanovich	30.04.1957		9; 11	mineral petroleum oils	Prik90/83 App1 p2.5/1.3.5	no ism	01.07.09	01.04.07
							saturated and unsaturated hydrocarbons (methane, propane, paraffins, ethylene, propylene, acetylene, cyclohexane)	Prik90/83 App1 p1.36/1.2.45	<100 мг/м3
							petrol	Prik90/83 App1 p2.5/1.3.5	no ism
							aliphatic limiting and unsaturated aldehydes (acrolein)	Prik90/83 App1 p1.2/1.2.2	no ism
							physical overload	Prik90/83 App1 p6.1/4.1
Administration	leading power engineer	21039	Lopatkin Andrey Vladymirovich	15.03.1977		6; 0	work with PC	Prik90/83 App1 p6.2.3/4.2.3		01.07.09
							electromagnetic fields in the range of 80 MHz - 300 GHz (VHF, UHF, SHF, EHF)	Prik90/83 App1 p5.2.2/3.2.2	field voltage, V/m: 48/1.72 (5Hz-2kHz/ 2kHz-400kHz) flux density, nT: 30/0 (5Hz-2kHz/ 2kHz-400kHz)
	transport shop manager	21635	Koshkina Lyubov Ivanovna	07.07.1954		4; 11				01.07.09
			Myshkina Tatyana Petrovna	22.06.1957		8; 11				01.07.09
			Chizhikova Svetlana Vasilievna	12.02.1964		9; 11				01.07.09
	Warehouse Manager	22141	Pyzhikova Svetlana Vasilievna	12.02.1964		0; 4	work with PC	Prik90/83 App1 p6.2.3/4.2.3		01.07.09
							electromagnetic fields in the range of 80 MHz - 300 GHz (VHF, UHF, SHF, EHF)	Prik90/83 App1 p5.2.2/3.2.2	field voltage, V/m: 48/1.72 (5Hz-2kHz/ 2kHz-400kHz) flux density, nT: 30/0 (5Hz-2kHz/ 2kHz-400kHz)

If the employee has no factors, then he can not be sent for a medical examination. In this case, the record with such an employee should be deleted. Only those employees who will go for a medical examination this year should remain on the list. In our example, the dispatchers of the transport shop should be deleted.

Download a file indicating typical errors in contingents.

Many companies employ specialists who strictly pass a medical examination. Management contributes to the streamlining of this process and pays. But first, it concludes an agreement with a medical institution that has the necessary license. He and the local department of Rospotrebnadzor are provided with a list of contingents subject to periodic medical examinations.

Reconciliation of the necessary documents with Rospotrebnadzor

Before the medical examination, documents are drawn up, provided for by the standards of the Ministry of Health and Social Development of the Russian Federation, known as Order 302n. It spelled out the rules for conducting examinations of the body of workers whose positions and professions are included in the officially approved list of works that are harmful to health and life-threatening.

The enterprise forms a list of contingents of employees who are obliged to unconditionally undergo a medical examination after the same period of time. It consists of:

a list of professions, positions corresponding to the information in the approved staffing table;
the number provided for them;
names of types of work and circumstances related to harmful and dangerous. They are established (or confirmed) after the AWP.

In the document containing the contingent for medical examination, additional indicators of a recommended nature are also prescribed. They depend on the specifics of the company's activities and the features of the technological process. For example, a separate column highlights the number of female employees holding certain positions, the frequency of inspection.

The document is approved by the head. The prepared list of the contingent by order 302n, the sample of which is arbitrary, is printed in three copies. They are sent within a ten-day period to the territorial department of Rospotrebnadzor, located where the organization is located. It is better not to send papers by mail, but to deliver them personally. This will speed up the time for consideration of documents by officials of Rospotrebnadzor.

After the specialists approve and seal the list of contingents subject to periodic medical examinations, one completed sample of the document is submitted to the medical institution with which an agreement was previously signed for its conduct.

Name lists of workers

A prerequisite for conducting a medical examination is the company's sending to a medical institution a list of names of workers who will certainly undergo it. It is certainly considered by the head of the organization and approved by him.

The detailed register lists by name the contingent of workers subject to periodic medical examinations. The sample looks something like this:

The document contains information about employees who occupy jobs according to a register containing a contingent of persons subject to periodic medical examinations. The sample (in the filled state) was sent some time ago to the local department of Rospotrebnadzor.

The list is provided to the medical institution no later than two months before the start of the first examination. The specific date is specified in the bilateral agreement.

Sample contingent of workers subject to medical examination

The list of categories of workers is compiled in the company and approved by its head once. They are updated and re-formed only when certain significant changes occur, for example:

complete reorganization of the enterprise;
the introduction of new, different from the existing, places of work. Information about them is not yet listed;
a radical improvement in the circumstances of work, allowing professions that were previously under the influence of destructive factors to be removed from the register.

A list of names of contingents of workers subject to medical examinations, a sample of which is given above, is developed every year. If employees leave or there is an influx of new specialists, it is adjusted additionally.

The form of this document has not been developed and approved in full compliance with all formalities. There is no relevant legislation. It is only stipulated what information should be in it without fail.

Therefore, OT specialists are developing a sample for filling out the list of contingents subject to medical examinations on their own.

For example, it goes like this:

In the document, if it is relevant for the enterprise, the number of persons who have not yet turned 21, women, loaded with duties in harmful conditions, is highlighted in a special column or line. The list of contingents subject to periodic medical examinations, the sample of which is formed by the OT specialist, is developed in full accordance with the provisions of Order 302n.

All documents containing information about the medical examinations of the company's employees are stored in its archives. The duration during which they gather dust there is at least three years.

Periodic medical examinations, like preliminary ones, are the most important events. Their main purpose is to preserve the health of workers, and sometimes life, to secure the passage of activities at their enterprise.

The purpose of the event is to establish whether a person is suitable for the work he performs, or for the conditions in which he will work. It also includes the timely and appropriate medical procedures for occupational ailments, the prevention of accidents.

The entire burden of responsibility regarding the organizational aspects of conducting medical examinations, their financing, is assigned to the employer. If he fails to comply with the procedure established by law, administrative liability is inevitable.

On the basis of labor legislation, standards are being developed to ensure the actions of bodies to control the production processes of enterprises. This is necessary to ensure that employees of companies receive timely medical care in the face of constant external factors affecting them. To identify diseases, a list of contingents subject to periodic medical examinations is drawn up.

Such actions should be carried out to monitor the health indicators of employees. A person working in a position receives a negative impact on his health. As a result, he may develop diseases associated with professional activities. In order to detect such a negative impact in time and check whether a citizen is suitable for this position after a certain worked period of time, organizations form a list of contingents subject to periodic medical examinations.

Based on the results obtained, it will become clear whether the persons are able to continue their activities and whether they have developed deviations in their health. Each organization that has factors of negative influence must undergo an examination of its employees.

Important: the organization is obliged to fully organize and finance the holding of such periodic events. If she does not do this, she may be held administratively liable.

Rules governing periodic inspections

First of all, these actions are regulated by the norms of labor legislation. Article 213 directly indicates that employees involved in hazardous or harmful production within the time limits established by law are required to undergo an examination.

The main provisions for the event are enshrined in order 302. It determines the entire list of necessary activities. In addition, this legal act defines production factors that are recognized as harmful and dangerous. According to them, a list of medical specialists is displayed for passing, when viewed for each of the certain conditions of negative impact.

So, according to the established norms, the list of contingents subject to periodic medical examinations does not have a clearly defined form. This allows each organization to independently develop a content template. However, the order contains norms that describe the necessary items that must be included in the form being drawn up.

How is the assessment of working conditions

It is necessary to determine the influencing factors dangerous to health through special commissions, which, at field events, evaluate all the conditions in which the workers live. In addition, there are also two lists in order 302:

1 list determines the presence of existing harmful conditions that may affect employees of organizations. It lists all the factors that have a negative impact on health;
2 list defines specific types of work and professions for which employees will need to conduct periodic examinations in medical institutions.

As a general rule. Before establishing a harmful or dangerous factor, it is necessary to carry out certification of workplaces. Only according to the conclusion of specialists, these directions will be recognized as dangerous. According to them, a schedule for conducting periodic reviews, as well as lists of doctors required for employee examinations, will be calculated.

Also, to determine the category of impact, the following should be carried out:

assessment of the equipment and mechanisms used in accordance with the technological documentation that is used in production;
laboratory control of the organization's activities.

Only on the basis of the listed actions can decisions be made on the appointment of certain degrees of threats or negative impacts at enterprises.

How is the contingent of people for a medical examination formed?

As already noted, the list of contingents is compiled independently by the management of the enterprise. According to the developed form, the selection of workers in the production of citizens is carried out and the time for the examination by medical workers is set.

Since each harmful or dangerous factor has its own conditions and terms for conducting inspections, as well as lists of doctors, the employer must be guided by the lists displayed in the 302H order. The presented lists have all the necessary information about the frequency of inspections and the category of harmful factors. For each of them, a list of medical positions that employees will need to pass is presented.

Based on these provisions, a final list of persons is formed who, in the coming period, are required to undergo commissions to check their health. You can view an approximate list of contingents of workers subject to medical examinations, a sample form, here.

Order of conduct

The required papers must be provided in 3 copies. One copy must be submitted for registration to the supervisory authorities at the location of the company. The list must be sent within 10 days.

The registered contingent for passing the medical examination will be kept in the specified department. One copy remains with the organization, and the second is sent directly to institutions where employees will be required to go through doctors and receive conclusions.

Sample filling in the list of contingents subject to medical examinations

Compiled papers are certified by the manager of the company. So, the contingent of workers subject to periodic medical examinations, the sample will look like this.

"APPROVE"

Avramenko Igor Stepanovich

CEO

Avramenko

" 20 " Martha 20_17 __G.

date of signing

List of contingents

subject to periodic medical examinations

________________CJSC Energoresursy ______________

____ _G. Togliatti __st. Labor 76______________________________

№	Labor site	Job title	Harmful effects	Application point for 302H order	Date of last inspection	FULL NAME	Date of Birth	Floor	Experience in years
1	Administration	Secretary	Broad spectrum electromagnetic fields	3.2.2.4	17.12.2015	Balkonskaya Anastasia Yurievna	13.11.1991	AND	3
2	Administration	Accountant			17.12.2015	Zakharchenko Yuri Andreevich	18.12.1989	M	7
3	Administration	Ch. accountant			17.12.2015	Bogdanov Alesey Sergeevich	03.07.1984	M	7
4	Administration	Labor protection engineer			17.12.2015	Borisenko Sergey Stepanovich	15.05.1979	M	11
5	Transportation Department	Driver		27.1, 27.5	03.03.2016	Yurchenko Anatoly Vladimirovich	01.12.1968	M	24
6	Transportation Department	Driver	Vehicle management	27.1, 27.5	03.03.2016	Klimenkov Vladislav Andreevich	14.08.1987	M	8

The presented sample of the contingent of workers subject to medical examination can be supplemented with other items. The results of the audit are issued to the employer, where further, based on the conclusions, decisions are made on the employees of the enterprise.

Preliminary and periodic medical examinations are one of the most important measures aimed at preserving the life and health of employees in the course of their work. Their goal is to establish the suitability of a person for the work performed, or the conditions in which they will have to work, to carry out the prevention of occupational diseases in a timely manner and to prevent accidents.

Attention! Responsibility for organizing and financing mandatory medical examinations lies with the employer, who, in case of failure to comply with the established procedure, may be held administratively liable.

In accordance with Article 213 of the Labor Code of the Russian Federation, workers engaged in hard work and work with harmful and (or) dangerous working conditions(including underground works, as well as work related to traffic), undergo mandatory preliminary (when applying for a job) and periodic medical examinations.

Another category of persons undergoing a mandatory preliminary examination are workers in the food industry, public catering trade, water supply facilities, medical organizations and children's institutions.

A medical examination is an event regulated by law, associated with the execution of mandatory documentation.

One of the documents that should be developed in preparation for medical examinations is list of contingent of workers subject to preliminary and periodic medical examination. This is a local regulatory act of the organization, which contains information about the professions (positions) of employees who are required to undergo medical examinations.

Its form is not approved by law, clause 20 of the Order dated 12.04.2011 N 302n “On approval of lists of harmful and (or) hazardous production factors and work, during the performance of which mandatory preliminary and periodic medical examinations (examinations) are carried out ...” (hereinafter Order No. 302n) stipulates only what mandatory data is indicated in it.

And so, in the contingent of workers subject to preliminary and periodic medical examinations, the following are indicated:

1. the name of the profession (position) of the employee according to the staffing table.

Above, we examined which employees are subject to preliminary and periodic medical examinations.

Important! Employees under the age of 21 undergo periodic examinations annually. Therefore, if you have positions/professions in which persons under the age of 21 are employed, also do not forget to include them in the list.

I also draw your attention to the fact that not only the main employees, but also part-time workers are subject to medical examinations.

2. name of the harmful production factor.

Recall that in Appendix 1 to Order No. 302n, harmful factors are given, under the influence of which an employee must undergo a medical examination, in Appendix 2 - types of work during which employees must also undergo a medical examination.

Note! harmful production factor, is established based on the results of attestation of workplaces in terms of working conditions (since 2014, a special assessment of working conditions has been in force), as well as

As a result of laboratory studies and tests obtained in the framework of control and supervision activities,

Production laboratory control,

Using operational, technological and other documentation for machines, mechanisms, equipment, raw materials and materials used by the employer in the implementation of production activities.

In addition to the mandatory information provided for by Order No. 302n, you can include other information (name of the unit, number of employees in the organization, number of employees employed in jobs with harmful working conditions). The appendix contains several forms of the list of the contingent of persons subject to preliminary and periodic medical examination.

The list of contingents is developed and approved once, before any changes in the organization (reorganization, commissioning of new jobs, improvement of working conditions). Name lists based on the contingent will be developed annually.

From 01/01/2012, the procedure for coordinating contingents and name lists with the bodies of Rospotrebnadzor is not provided, while the employer is obliged, within 10 days from the date of approval of the list of contingents, to send it to the territorial body of the federal executive body authorized to implement the federal state sanitary- epidemiological surveillance at the actual location of the employer. Thus, you can personally transfer the list of contingents to Rospotrebnadzor, while on your copy the representative of Rospotrebnadzor must mark that he received one copy, or send it by registered mail. In this case, the letter is sent with a notification, and the notification is kept by you as confirmation that you have fulfilled the requirements of Order No. 302n.

In conclusion, I would like to recall that documents on periodic medical examinations should be stored in the organization for 3 years (paragraph 691, “List of standard documents generated in the activities of state committees, ministries, departments and other institutions, organizations, enterprises, indicating the storage periods” (approved by Main Archive of the USSR 08/15/1988) (as amended on 07/31/2007)).

S. Burlakova

Option 1

APPROVE:

Supervisor
OOO "____________________"

A.A. Ivanov

"___" ____________ 201_

Subdivision	Profession/ job title
Harmful production factor	№ item according to the Order of the Ministry of Health and Social Development of the Russian Federation dated April 12, 2011 No. 302n	Periodicity