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Get LEAP Academy Pre-Employment Physical Form

N the past 12 months* Height ______________ Weight_______________ Pulse ________________ Vision (R) _________ (L) _____________ Both_____________ NORMAL 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. Blood Pressure ________________ Hearing (R) ________ (L) ___________ ABNORMAL FINDINGS COMMENTS Eyes Ears/Nose/Throat Mouth and Teeth Neck Heart Lungs Abdomen Skin Genitals-Hernia Extremities Musculoskeletal Neurologic Are there any reason(s) to preclude this person from working in a school with.

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