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Factory Return Form

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29 views4 pages

Factory Return Form

Uploaded by

vehiclebihar
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Form No.

20

[(Prescribed under Rule 100(1)]

Annual Return for the year ending 31st December ‘2008

1. Registration number of factory__________________________


2. Name of factory _____________________________________
3. Name of Occupier ____________________________________
4. Name of the Manager __________________________________
5. District _____________________________________________
6. Full postal address of factory ____________________________
7. Nature of Industry ____________________________________
Number of workers and particulars of employment.

8. No. of days worked in the year.


9. No. of man-days worked during the year.
(a) Men
(b) Women
(c) Children
10. Average number of workers employed daily (see explanatory note):-
(a) Adult-
(i)Men

(ii)Women

(b)Adolescent-

(i) Male

(ii) Female

( c) Children-

(i) Male

(ii)Female

11. Total no. of man-hours worked including overtime:-


(a)Men

(b)Women

(c )Children

12. Average number of hours worked per week (see explanatory note):-
(a)Men

(b)Women
(c) Children

13. (a) Does the factory carry out any process or operation declared as dangerous under section 87
(see Rule 95)?

(b) If so give the following information-

Name of the dangerous process or Average no. of persons employed daily in

Operations carried on- each of the processes or operation given.

(i)

(ii)

(iii) etc. Leave with Wages.

14.Total numbers of workers employed during the year …………..

a.Men

b.Women

c.Children

15. Number of workers who were entitled to annual leave with wages during the year ………..

a.Men

b.Women

c.Children

16. Number of workers who were granted leave during the year …………..

a.Men

b.Women

c.Children

17. (a) Number of workers who were discharged of dismissed from the service, or quit employment or
were superannuated, or died while in service during the year.

(b) Number of such workers in respect of whom wages in lieu of leaves were paid.

Safety officers

18. (a) Number of Safety Officers required to be appointed as per rule notified under Sec-40-B.
(b)Number of Safety Officers already appointed.

Ambulance room

19. Is there a ambulance room provided in the factory as required under section 45 ?

Canteen

20.(a) Is there a canteen provided in the factory as required under section 46 ?

(b) Is the canteen provided managed …………..

i) Departmentally, or

ii) Through a contractor ?

Shelter or Rest Room and Lunch Rooms.

21.(a) Are there adequate and suitable shelters or rest rooms provided in the factory as required under
section 47?

(b)Are there adequate and suitable Lunch rooms provided in the factory as required U/S-47 ?

22.Is there a crèche provided in the factory as required under section-48 ?

23.(a) Number of Welfare Officers to be appointed as required by rule notified under section 49.

24.(a) Total numbers of accidents (See explanatory note)

(b) Accidents in which workers returned to work during the year to which this return relates.

(b)Accidents (Workers injured occurring during the year in which injured worker returned to work
during the same year……….

(aa) Number of accidents .

(bb) Mondays lost due to accident.

(ii) Accidents (worker injured occurring in the previous year in which injured workers returned to work
during the year to which this return relates.

(aa) Number of accidents.

(bb) Mondays lost due to accident.


( c) Accidents (worker injure) occurring during the year in which injured workers did not return to work
during the year to which the return relates

(aa) Number of accidents.

(bb) Mondays lost due to accident.

Certified that the information furnished above is to be best of my knowledge and belief, correct .

Date………………

Signature of the Managers.

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