Get Annual Physical / Eye Examination Certification - Los Angeles ... - Laccd

This guide provides step-by-step instructions for completing the Annual Physical / Eye Examination Certification online. Completing this form accurately is essential to verify your absence time due to your annual physical or eye examination.

Follow the steps to complete your certification online.

1. Press the ‘Get Form’ button to access the form and open it in your preferred editing tool.
2. Begin by filling in your personal information. In the section labeled 'A. TO BE COMPLETED BY THE EMPLOYEE,' provide your last name, middle name, first name, and personnel number.
3. Indicate the type of examination you completed by checking one of the options: 'Comprehensive Physical Examination' or 'Eye Examination – Unit 1 Employees Only'.
4. Record the date and times for your examinations. Fill in the date and time for each day you attended the appointment, ensuring to specify AM or PM for accuracy.
5. Sign and date the form in the area provided, certifying the completion of your examination.
6. The next section, 'B. TO BE COMPLETED BY THE PHYSICIAN / LICENSED EYE PROFESSIONAL CERTIFICATION,' will be filled out by your healthcare provider. They will include their signature, printed name, and license number.
7. Ensure the completed form is returned directly to you by your healthcare provider.
8. Finally, submit the signed form along with your Absence Certification / Request form to your location's Personnel-Payroll Office.

Complete your certification forms online today for efficient processing.