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Accident Register (Form 29)

This document is a form for recording accidents, major accidents, and dangerous occurrences in an establishment. It includes sections for details such as date, time, nature of the injury, and information about the injured person and witnesses. The form is prescribed under Rule 111 and is used for compliance with safety regulations.

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Sʌcʜɩŋ Sʜʌʀɱʌ
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2K views2 pages

Accident Register (Form 29)

This document is a form for recording accidents, major accidents, and dangerous occurrences in an establishment. It includes sections for details such as date, time, nature of the injury, and information about the injured person and witnesses. The form is prescribed under Rule 111 and is used for compliance with safety regulations.

Uploaded by

Sʌcʜɩŋ Sʜʌʀɱʌ
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLSX, PDF, TXT or read online on Scribd

FORM NO.

29 (Prescribed under Rule 111)


Name & Address Of Establishment:-

Register of accidents, major accidents and dangerous occu

Sr. Date & Name and ESIC Date Injury/dangerous occurrence


No. time of serial Insurance Time Place Cause of Nature of
notice number of number accident/maj injury/dange
the person or rous
involved in Accident/dan occurrence
the register gerous
of occurrence
adult/child
register
1 2 3 4 5 6 7 8 9
r Rule 111)
Factory License No. :-
LIN No. :-
dents and dangerous occurrences

occurrence Name of the Name, Date of Number of Signature


What exactly person address and return of days the and
was the giving the occupation injured injured designation
notice of two Person to person was of the person
injured absent from
person, if witnesses work who makes
the work
any doing at including
the entry
that notice holidays and with date.
off
days
10 11 12 13 14 15

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