The PULHHEEMS system, or variations of it, is also used by several members of the British Commonwealth, including Singapore, Canada, Australia, Sri Lanka and New Zealand.
For new recruits it is part of the first step into the armed forces, whilst for established service people it is a requirement of ongoing employment.
Furthermore, service personnel under the age of 30 are required to undergo a PULHHEEMS in order to attend certain courses, whether occupational or promotional, and also if medically downgraded.
The PULHHEEMS examination can result in medical downgrading if fitness standards do not reach required levels, whether as a consequence of injury, neglect, pregnancy, or old age.
These include: Physique Upper limbs Lower limbs (or 'Locomotion', as this includes the back) Hearing (right) Hearing (left) Eyesight right (corrected / uncorrected) Eyesight left (corrected / uncorrected) Mental function Stability (emotional) The attributes examined in PULHHEEMS receive a score from 1 to 8, with 1 being excellent and 8 being unfit for service.
Thus, a fully fit RAF serviceman will be graded A1 L1 M1 E1 (Only those that need to fly as part of their core duties would be awarded an A1 category.