Doctor completion and identity
A Singapore-registered doctor completes the form and endorses amendments; the worker produces the travel document for identification. The worker declares/signs medical history. This explains the form; the doctor performs examinations and fitness certification.
Parts I–II: Particulars and history
Enter name, travel-document number, sex, height/weight, occupation, birth date and nationality; A11 also includes FIN. History covers mental illness, epilepsy, chronic asthma, diabetes, hypertension, tuberculosis, heart disease, malaria and operations, with yes/no and details.
The worker signs/dates the truth declaration and consents to release to MOM, employer and the EA assisting the Work Permit.
Part III: Clinical examination
Tick abnormalities and provide separate brief details.
| Item | Fields |
|---|---|
| Cardiovascular | Blood pressure systolic/diastolic, heart disease, ECG and severe varicose veins |
| Anaemia | Haemoglobin if clinically anaemic |
| Respiratory | Respiratory system |
| Abdomen | Hernia, enlarged liver/spleen and genitourinary system |
| Skin | Chronic conditions such as leprosy, widespread eczema and psoriasis |
| Locomotor/neurological | Amputation/deformity, coordination, spinal and other work-relevant abnormalities |
| Endocrine | Conditions such as thyrotoxicosis |
| Mental state | Practitioner examination record |
Other tests and qualifications
Chest X-ray is performed in Singapore. Tests include urine albumin/sugar/pregnancy, syphilis/VDRL, ability to hear ordinary conversation at two metres, at least6/12 in both eyes with/without glasses, each eye’s acuity, colour vision only for electricians/drivers, organic eye disease, malaria blood film and HIV. Malaria/HIV laboratories must be MOH approved.
ECG is compulsory for male Thai workers and others above fifty and for younger candidates with indications such as murmurs or symptoms suggesting myocardial ischaemia.
Parts IV–V: Vaccination and fitness
Record vaccine type, brand and first/second/third dose. The doctor certifies Fit or Unfit for the stated occupation, deletes the inapplicable option and enters block-letter name, signature, clinic address, date and telephone.
B11 reports and return
Record X-ray abnormalities and other findings, including no active lung lesion, and attach the radiological report. Return the completed form promptly to employer/EA for pass issuance.
Official source
Written independently from official MOM source material.