I
[See rule 61 (a), 76 (a) and 77]Manner of Test and Examination Before Taking Lifting Appliance, Loose Gear and Wire Rope Into Use For The First TimeTest Loads:(1)Lifting Appliance. - Every lifting appliance with its necessary gear, shall be subjected to a test load which shall exceed the safe working load (SWL) as specified in the following table: -
| Safe working load |
Test load |
|
Upto 20 tonnes20 to 50 tonnesOver 50 tonnes
|
25 percent in excessof safe working load5 tonnes in excess ofsafe working load10 percent in excess of safe working load
|
| Safe working load (in tonnes) |
Test load (in tonnes) |
|
Upto 25Above 25
|
2 x safe working load(1.22 x safe working load) + 20
|
| Safe working load (in tonnes) |
Test load (in tonnes) |
|
Upto 2525 to 160above 160
|
2 x safe working load(0.9933 x safeworking load) + 271.1 x safe working load
|
| Proposed safe working load (in tonnes) |
Test Load (in tonnes) |
|
Upto 1010 to 160Above 160
|
2 x safe working load(1.04 x safe workingload) + 9.61.1 x safe working load
|
| Item |
|
Co-efficient of Utilisation |
| (1) |
|
(2) |
|
(a) Wire Rope forming Part of sling-safe working load of thesling safe working load up to and equal to 10 tonnes, SWL safeworking load above 10 tonnes and up and equal to 160 tonnes
|
|
510
|
| 8.85 x SWL) + 1910 |
|
Safe working load above 160 tonnes(b) Wire Rope as Integral Part of alifting Appliance : SWL of the lifting appliance : safe workingload upto and equal to 160 tonnesSafe Working Load above 160 tonnes
|
|
310(8.85 x SWL) + 19103
|
II
Notifiable Occupational Diseases In Building and Other Construction Work[See rule 235 (a)]1. Occupational dermatitis
5. Lead poisoning including poisoning by any preparation or compound of lead or their sequelae.
6. Benezene poisoning, including poisoning by any of its homologuese, their nitro or armido derivatives or its sequelae.
9. Carbon monoxide poisoning
12. Compressed air illness (caissions disease)
13. Noise induce ( hearing loss).
14. Isocyanates poisoning
III
Contents of A First - Aid Box[See rule 236 (b)](i)A sufficient number of eye washed bottles filled with distilled water or suitable liquid clearly indicated by a distinctive sign which shall be visible at all times.(ii)4 per cent xylocaine eye drops and boric acid eye drops and soda bycarbonate eye drops.(iii)Twenty four small sterilised dressings.(iv)Twelve medium size sterilised dressings.(v)Twelve large size sterilised dressings.(vi)Twelve large size sterilized burn dressings.(vii)Twelve (fifteen centimetres) packets of sterilised cotton wool.(viii)(Two hundred ml) bottle of cetrimide solution (1 per cent) or suitable antiseptic solution.(ix)One (two hundred ml) bottle of mercurochrome (2 per cent) solution in water.(x)One (one hundred twenty ml) bottle of salvalatile having the doses and mode of administration indicated on the label.(xi)One pair of scissors.(xii)One roll of adhesive plaster (six cm x one metre).(xiii)Two rolls of adhesive plaster (2 cms x one metre).(xiv)Twelve pieces of sterilised eye pads in separate sealed packets.(xv)A bottle containing 100 tablets (each of three hundred twenty five mg) of aspirin or any other analgesic.(xvi)Twelve roller bandages ten cms. wide.(xvii)Twelve roller bandages five cms. wide.(xix)A supply of suitable splints.(xx)Three packets of safety pins.(xxii)A snake bite lancet.(xxiii)One (thirty ml) bottle containing potassium permanganate crystals.(xxiv)One copy of first aid leaflet issued by the Chief Inspector.(xxv)Six triangular bandages.(xxvi)Two pairs of suitable, sterilized latex hand gloves.
IV
[See rule 231 (c)]Articles of Ambulance Room(i)A glazed sink with hot and cold water always available.(ii)A table with a smooth top at least 180 cms. X 105 cms.(iii)Means for sterilizing instrument.(vi)Two buckets or containers with close fitting lids.(vii)Two rubber hot water bags.(viii)A kettle and spirit stove or other suitable means of boiling water.(ix)Twelve plain wooden splints 900 cms x 100 cms x 6 cms.(x)Twelve plain wooden splints 350 cms x 75 cms x 6 cms.(xi)Six plain wooden splints 250 cms x 50 cms x 12 cms.(xii)Six wooden blankets.(xiii)Three pairs of artery forceps.(xiv)One bottle of spiritus annemiae arenations (120 ml).(xv)Smelling salt (60 gm.).(xvi)Two medium size sponges.(xviii)Four kidney trays.(xix)Four cakes of toilet soap, preferably antiseptic soap.(xx)Two glass tumblers and two wine glasses.(xxi)Two clinical thermometers.(xxiii)Two graduated (120 ml.) measuring glasses.(xxiv)Two minimum measuring glasses.(xxv)One wash bottle (1000 cc) for washing eyes.(xxvi)One bottle (one litre) carbolic lotion 1 in 20.(xxix)One electric hand torch.(xxx)Four first aid boxes or cupboards stocked to the standards prescribed in the Schedule VII.(xxxi)An adequate supply of tetanus toxide.(xxxii)Injections morphia pethidine atrophine aderenaline coramine novocaine (6 each).(xxxiii)Cramine liquid (60 ml) .(xxxiv)Tablets antihistaminic antispasmodic (25 each).(xxxv)Syringes with needle 2cc, 5cc, 10cc, and 500cc.(xxxvi)Three surgical scissors.(xxxvii)Two needle holders, big and small.(xxxviii)Suturing needles and materials.(xxxix)Three dissecting forceps.(xli)One stethoscope and a B.P. apparatus.(xlii)Rubber bandage pressure bandage.(xliii)Oxygen cylinder with necessary attachments.(xliv)Autropine eye ointments.(xlv)I.V. Fluids and sets 10 nos.(xlvi)Suitable, foot operated, covered, refuse containers.(xlvii)Adequate number of sterilised, paired, latex hand gloves.
V
(See rule 232)Contents of Ambulance Van or CarriageThe Ambulance Van shall have equipment prescribed as under: -(a)General - A portable stretcher with folding and adjusting devices with the Head of the stretcher capable of being tilted upward. Fixed suction unit with equipment. Fixed oxygen supply with equipment. Pillow with case, sheets, blankets, towels, emergency bag, bed pan, urinal glass.(b)Safety Equipment - Flaros with life of three thousand minutes floor lights flash lights fire extinguishers (dry powder type) insulated gantlets.(c)Emergency care Equipment - (i) Resuscitation. - Portable suction unit, portable oxygen unit, bagvalve mask, hand operated artifical ventilation unit, airways, mouthgag, tracheotomy adapters, short spine board, I.V FLUIDS with administration unit, B.P. Manometer cuff stethoscope.(ii)Immobilisation.- Long and short padded boards wire ladder splints, triangular bandage long and short spine boards.(iii)Dressing Gauze pads. - 100m x 10 mm universal dressing 250 x 1000 mm roll of aluminium foils, softroller bandages 150 mm x 5 mm yards adhesive tape in 75 mm roll safety pins, bandage sheets, burn sheets.(iv)Poisoning. - Syrup of Ipecac, activated charcoal prepacketed dose, snake bite kit, drinking water.(v)Emergency Medicines. - As per requirement (under the advice of construction medical officer).
VI
Permissible Exposure In Cases of Continuous Noise(See rule 39)
|
Total time of exposure (continuous or a numberof short term exposure) per day (in hours)
|
|
Second Pressure level (in dBA) |
| (1) |
|
(2) |
|
864321 ½1¾½¼
|
|
90929597100102105107110115
|
2. For any period of exposure falling in between any figure and the next higher or lower figure as indicated in column (1), the permissible sound pressure level is to be determined by extrapolation on a proportionate basis.
VII
Periodicity of Medical Examination of Building Workers[See rule 86 (iv) and 228 (a) (iii)]1. The employer shall arrange a medical examination of all the building workers employed as drivers, operators of lifting appliances and transport equipment before employing, after illness or injury, if it appears that the illness or injury might have affected his fitness and, thereafter, once in every two years up to the age of forty and once in a year, thereafter.
2. Complete the confidential records of medical examination shall be maintained by the employer or the physician authorised by the employer.
3. The medical examination shall include -
(a)full medical and occupational history.(b)clinical examination with Particular reference to -(ii)Vision. - Total visual performance using standard orthorator like Titmus Vision Tester should be estimated and suitability for placement ascertained in accordance with the prescribed job standards.(iii)Hearing. - Persons with normal hearing must be able to hear a forced whisper at twenty four feet. Person using hearing aids must be able to hear a warning shout under noisy working conditions.(iv)Breathing. - Peak flow rate using standard peak flow meter and the average peak flow rate determined out of these readings of the test performed. The results recorded at preplacement medical examination could be used as a standard for the same individual at the same altitude for reference during subsequent examination.(v)Upper limbs. - Adequate arm function and grip (both arms).(vi)Lower limbs. - Adequate leg and foot function.(vii)Spine. - Adequately flexible for the job concerned.(viii)General. - Mental alertness and stability with good eye, hand and foot cordination.(c)Any other tests which the examining doctor considers necessary.
VIII
[See rule 214 (1) and 214 (2)]Number of Safety officers, Qualification, Duties, Etc.Appointment of Safety officersNumber of Safety officers. - Within six months of coming into operation of these rules, every establishment employing more than 500 building workers and every other employer of building worker shall appoint safety officer, as laid down in the scale given below:(1)Upto 1000 building workers-one safety officer.(2)Upto 2000 building workers-two safety officers.(3)Upto 5000 building workers-three safety officers.(4)Upto 10000 building workers-four safety officers.For every additional 5000 building workers or Part thereof-one safety officer.Any appointment, when made shall be notified to the Inspector having jurisdiction in the area, giving full details of the qualifications, terms and conditions of service of such safety officer.Qualification. - (a) A person shall not be eligible for appointment for as a safety officer unless he:(i)possesses a recognised degree in any branch of engineering or technology or architecture and had a practical experience of working in a building or other construction work in a supervisory capacity for a period of not less than two years or possesses a recognised diploma in any branch of engineering or technology and has had a practical experience of building or other construction work in a supervisory capacity for a period of not less than five years;(ii)possesses a recognised degree or diploma in Industrial safety with atleast one paper in construction safety (as an elective subject);(iii)has adequate knowledge of the language spoken by the majority of the building workers from the construction site in which he is to be appointed.(b)Notwithstanding the provision contained in clause (a), any person who"(i)possesses a recognised degree or diploma in engineering or technology or architecture and has had experience of not less than five years in the field, dealing with the administration of Factories Act, 1948 (Act No.63 of 1948) or the Dock Workers (Safety, health and welfare) Act, 1986 (Act No.54 of 1986) or the Building and Other Construction Workers (Regulation of Employment and Condition of Service) Act, 1996 (Act No. 27 of 1996);(ii)possesses a recognised degree or diploma in engineering or technology and has had experience of not less than five years or has undergone training in education, consultancy or research in the field or accident prevention in industry, Port, or in any institution or an establishment dealing with building or other construction work, shall also be eligible for appointment as a safety officer:Provided that, in case of person who has been working as a Safety officer in industry or port, institution or an establishment dealing with building or other construction work for a period of not less than three years on the date of commencement of these rules, the Chief Inspector may, subject to such conditions that he may specify, relax all or any of the above said qualification.Condition of Service. - (a) Where, the number of Safety officers appointed exceeds one, one of them shall be designated as Chief Safety officer and shall have the status higher than the others. The Chief Safety officer shall be in overall charge of the safety functions as envisaged in sub-clause (4) and also other safety officers working under his control.(b)The Chief Safety officer or Safety officer, where only one Safety officer is appointed, shall be given the status of a Senior Executive and he shall work directly under the control of his Chief Executive. All other Safety officers shall be given appropriate status to enable them to despatch their functions.(c)The scale of pay and allowances to be granted to the Safety officers including the Chief Safety officer and the other conditions of their service shall be the same as those of the officers of corresponding status of the establishment in which they are employed.Duties of Safety officer. - (a) The duties of a Safety officer shall be to advise and assist the employer in the fulfilment of his obligations, statutory or otherwise concerning prevention of personal injuries and maintaining a safe working environment, these duties shall include the following, namely. -(i)to advise the building workers in planning and organising the measures necessary for effective control of personal injuries;(ii)to advise on safety aspects in a building or other construction work and to carry out detailed safety studies of selected activities;(iii)to check and evaluate the effectiveness of action taken or proposed to be taken to prevent personal injuries;(iv)to advise purchasing and ensuring quality of personal protective equipment confirming to national standards;(v)to carry out safety inspections of building or other construction work in order to observe the physical conditions of work and the work practices and procedures followed by building workers and to render advice on measures to be adopted for removing unsafe physical conditions and preventing unsafe actions by building workers;(vi)to investigate all fatal and other selected accidents;(vii)to investigate the cases of occupational diseases contracted and reportable dangerous occurances;(viii)to advise on the maintenance of such records as are necessary with regard to accidents, dangerous occurrences and occupational diseases;(ix)to promote the working of safety committees and to act as an advisor to such committees;(x)to organise, in association with concerned dePartments, compaigns, competitions, contests and other activities which will develop and maintain the interest of building workers in establishing and maintaining safe conditions of work and procedures;(xi)to design and conduct, either independently or in collaboration with other agencies, suitable training and educational programmes for prevention of accidents to building workers;(xii)to frame safe rules and safe working practices in consultation with senior officials of the establishment;(xiii)supervise and guide safety precautions to be taken in ports, building and other construction work of the establishment.Facilities to be provided to Safety officers. - The employer shall provide each Safety officer with such facilities, equipment and information that are necessary to enable him to despatch his duties effectively.Prohibition of performance of other duties. - No Safety officer shall be required or permitted to do any work which is unconnected to inconsistent with or detrimental to the performance of the duties prescribed in this Schedule.Exemptions. - Chief Inspector may, in writing, exempt any employer or group of employers from any or all of the provisions of these rules subject to compliance with such alternative arrangements as may be approved and notified by him in the order or such exemption.
IX
(See rule 230)Hazardous Process(3)Work under and over water.(5)Work in confined spaces.
X
[See rule 230 (b)]Services and Facilities To Be Provided In Occupational Health Centres. - (1) One full time Construction Medical officer for building or other construction work, employing workers upto 1000 and one additional Construction Medical officer for every additional 1000, workers or Part thereof.(2)The staff, including one nurse, one dresser-cum-compounder, one sweeper-cum-ward boy with each construction Medical officer for full work hours.(3)The occupational health centre with a floor area of minimum fifteen sq. metres constituting two rooms with smooth walls and impovious service, adequately illuminated and ventilated.(4)Adequate equipment for day to day treatment.(5)Necessary equipment to manage any medical emergency.
XI
[See rule 124 (2), and 230 (c)]Qualification of Construction Medical officer. - (1) MBBS degree from a medical institute recognised by the Medical Council of India, and(2)Diploma in industrial health or equivalent post graduate certificate of training in industrial health or health.(3)A medical officer having working experience in organisation/establishments involved in policy, execution and advice and safety and health of workers employed in mines, ports and docks, factories and buildings and other construction work, for a period of not less than three years may, subject to the satisfaction of the Chief Inspector, not to be required to possessing the training referred to in item (2) above.(4)The Syllabi of the courses leading to the above certificates and the organisation conducting such courses shall be approved by the Government who may also from time to time prepare a panel of such organisations.(5)Complete Particulars including name, qualification and experience of the construction medical officer will be intimated to the inspector having jurisdiction.
XII
[See rule 157 (a)]Permissible Levels of Certain Chemical Substances In The Work Environment
| |
|
Permissible limit of exposure |
| Sr. No. |
Substance |
Time-weighted average concentration (TWA) (8hrs.)
|
|
Short-term Exposure limit (STEL) (15 min.)* |
| |
|
Ppm |
mg./m3**
|
Ppm |
Mg./m3**
|
| 1 |
2 |
3 |
4 |
5 |
6 |
| 1. |
Acetaldehyde |
100 |
180 |
150 |
270 |
| 2. |
Acetic acid |
10 |
25 |
15 |
37 |
| 3. |
Acetone |
750 |
1780 |
1000 |
2375 |
| 4. |
Acrolein |
0.1 |
0.25 |
0.3 |
0.8 |
| 5. |
Acrylonitrile-Skin (S.C.) |
2 |
4.5 |
- |
- |
| 6. |
Aldrin-Skin |
- |
0.25 |
- |
- |
| 7. |
Allyl chloride |
1 |
3 |
2 |
6 |
| 8. |
Ammonia |
25 |
18 |
35 |
27 |
| 9. |
Aniline-Skin |
2 |
10 |
- |
- |
| 10. |
Anisidine (O-, p-isomers)-Skin |
0.1 |
0.5 |
- |
- |
| 11. |
Arsenic & soluble compounds (as As) |
- |
02 |
- |
- |
| 12. |
Benzene (S.C.) |
10 |
30 |
- |
- |
| 13. |
Beryllium & Compound (As Bc) (S.C.) |
- |
0.002 |
- |
- |
| 14. |
Boron trifluoride-C |
1 |
3 |
- |
- |
| 15. |
Bromine |
0.1 |
0.7 |
0.3 |
2 |
| 16. |
Butane |
800 |
1900 |
- |
- |
| 17. |
2-Butanone (Methyl ethyl Ketone-MBK) |
200 |
590 |
300 |
885 |
| 18. |
n-Butyl acetate |
150 |
710 |
200 |
950 |
| 19. |
n-Butyl alcohol-Skin-C |
50 |
150 |
- |
- |
| 20. |
Sec/tert.Butyl acetate |
200 |
950 |
- |
- |
| 21. |
Butyl mercaptan |
0.5 |
1.5 |
- |
- |
| 22. |
Cadmium Dust and salts (as Cd) |
- |
0.05 |
- |
- |
| 23. |
Calcium oxide |
- |
2 |
- |
- |
| 24. |
Carbaryl (Sevin) |
- |
5 |
- |
- |
| 25. |
Carbofuran (Furadan) |
- |
0.1 |
- |
- |
| 26. |
Carbon disulphide-Skin |
10 |
30 |
- |
- |
| 27. |
Carbon monoxide |
50 |
55 |
400 |
440 |
| 28. |
Carbon tetrachloride-Skin (S.C.) |
5 |
30 |
- |
- |
| 29. |
Chlordane-Skin |
- |
0.5 |
- |
- |
| 30. |
Chlorine |
1 |
3 |
3 |
9 |
| 31. |
Chlorobenzene (monochlorobenzene) |
75 |
350 |
- |
- |
| 32. |
Chloroform (S.C.) |
10 |
50 |
- |
- |
| 33. |
Bis (Chloromethyl) ether (H.C.) |
0.001 |
0.005 |
- |
- |
| 34. |
Chromic acid and chromates (as Cr.) |
- |
0.05 |
- |
- |
| |
(water soluble) |
|
|
|
|
| 35. |
Chromous salts (as Cr.) |
- |
0.5 |
- |
- |
| 36. |
Copper fume |
- |
0.2 |
- |
- |
| 37. |
Cotton dust, raw |
- |
0.2 |
- |
- |
| 38. |
Cresol, all isomers-Skin |
5 |
22 |
- |
- |
| 39. |
Cyanides (as CN)-Skin |
- |
1 |
- |
- |
| 40. |
Cyanogen |
10 |
20 |
- |
- |
| 41. |
DDT(Dishlorodiphenyl trichloroethane) |
- |
1 |
- |
- |
| 42. |
Demeton-Skin |
0.01 |
0.1 |
- |
- |
| 43. |
Diazinon-Skin |
- |
0.1 |
- |
- |
| 44. |
Dibutyl phthalate |
- |
5 |
- |
- |
| 45. |
Dicholorvos (DDVP)-Skin |
0.1 |
1 |
- |
- |
| 46. |
Dieldrin-Skin |
- |
0.25 |
- |
- |
| 47. |
Dinitrobenzene (all isomers)-Skin |
0.15 |
1 |
- |
- |
| 48. |
Dinitrotoluene-Skin |
- |
1.5 |
- |
- |
| 49. |
Diphenyl (Biphenyl) |
0.2 |
1.5 |
- |
- |
| 50. |
Endosulfan (Thiodan)-Skin |
- |
0.1 |
- |
- |
| 51. |
Endrin-Skin |
- |
0.1 |
- |
- |
| 52. |
Ethyl acetate |
400 |
1400 |
- |
- |
| 53. |
Ethyl alcohol |
1000 |
1900 |
- |
- |
| 54. |
Ethylamine |
10 |
18 |
- |
- |
| 55. |
Fluorides (as F) |
- |
2.5 |
- |
- |
| 56. |
Fluorine |
1 |
2 |
2 |
4 |
| 57. |
Formaldehyde (S.C.) |
1.0 |
1.5 |
2 |
3 |
| 58. |
Formic acid |
5 |
9 |
- |
- |
| 59. |
Gasoline |
300 |
900 |
500 |
1500 |
| 60. |
Hydrazine-Skin (S.C.) |
0.1 |
0.1 |
- |
- |
| 61. |
Hydrogen chloride-C |
5 |
7 |
- |
- |
| 62. |
Hydrogen cyanide-Skin-C |
10 |
10 |
- |
- |
| 63. |
Hydrogen fluorine (as F)-C |
3 |
2.5 |
- |
- |
| 64. |
Hydrogen peroxide |
1 |
1.5 |
- |
- |
| 65. |
Hydrogen sulphide |
10 |
14 |
15 |
21 |
| 66. |
Iodine-C |
0.1 |
1 |
- |
- |
| 67. |
Iron Oxide Fume (Fe o) (as Fe) |
- |
5 |
- |
- |
| 68. |
Isoamyl acetate |
100 |
525 |
- |
- |
| 69. |
Isoamyl alcohol |
100 |
360 |
125 |
450 |
| 70. |
Isobutyl alcohol |
50 |
150 |
- |
- |
| 71. |
Lead, inorg, dusts and fumes (as Pb) |
- |
0.15 |
- |
- |
| 72. |
Lindane-Skin |
- |
0.5 |
- |
- |
| 73. |
Malathion-Skin |
- |
10 |
- |
- |
| 74. |
Manganese dust and compounds (as Mn)-C |
- |
5 |
- |
- |
| 75. |
Manganese fume (as Mn) |
- |
1 |
- |
- |
| 76. |
Mercury(as Hg)-Skin |
|
|
|
|
| |
(i) Alkyl compounds |
- |
0.01 |
- |
0.03 |
| |
(ii) All forms except alkyl vapour |
- |
0.05 |
- |
- |
| |
(iii) Atyl and inorganic compounds |
- |
0.1 |
- |
- |
| 77. |
Methyl alcohol (Methanol)-Skin |
200 |
260 |
250 |
310 |
| 78. |
Methyl collosolve (2-Methoxy-ethonol)-Skin |
5 |
16 |
- |
- |
| 79. |
Methyl Isobutyl ketone |
50 |
205 |
75 |
300 |
| 80. |
Methyl isocyanate-Skin |
0.02 |
0.05 |
- |
- |
| 81. |
Naphthalene |
10 |
50 |
15 |
75 |
| 82. |
Nickel carbonyl (as Ni) |
0.05 |
0.35 |
- |
- |
| 83. |
Nitric acid |
2 |
5 |
4 |
10 |
| 84. |
Nitric oxide |
25 |
30 |
- |
- |
| 85. |
Nitrobenzene-Skin |
1 |
5 |
- |
- |
| 86. |
Nitrogen dioxide |
3 |
6 |
5 |
10 |
| 87. |
Oil mist. Mineral |
- |
5 |
- |
10 |
| 88. |
Ozone |
0.1 |
0.2 |
0.3 |
0.6 |
| 89. |
Parathion-Skin |
- |
0.1 |
- |
- |
| 90. |
Phenol-Skin |
5 |
19 |
- |
- |
| 91. |
Phorate (Thimet)-Skin |
- |
0.05 |
- |
0.2 |
| 92. |
Phosgene (Carbonyl chloride) |
0.1 |
0.4 |
- |
- |
| 93. |
Phosphine |
0.3 |
0.4 |
1 |
1 |
| 94. |
Phosphoric acid |
- |
1 |
- |
3 |
| 95. |
Phosphorus (yellow) |
- |
0.1 |
- |
- |
| 96. |
Phosphorus pentachloride |
0.1 |
1 |
- |
- |
| 97. |
Phosphorus trichloride |
0.2 |
1.5 |
0.5 |
3 |
| 98. |
Pierie acid-Skin |
- |
0.1 |
- |
0.3 |
| 99. |
Pyridine |
5 |
15 |
- |
- |
| 100. |
Silane (Silicon tetrahydride) |
5 |
7 |
- |
- |
| 101. |
Sodium hydroxide-C |
- |
2 |
- |
- |
| 102. |
Styrene, monomer (Phenylethylene) |
50 |
215 |
100 |
425 |
| 103. |
Sulphur dioxide |
2 |
5 |
5 |
10 |
| 104. |
Sulphur hexafluroride |
1000 |
6000 |
- |
- |
| 105. |
Sulphuric acid |
- |
1 |
- |
- |
| 106. |
Tetraethyl lead (as Pb)-Skin |
- |
0.1 |
- |
- |
| 107. |
Tolune (Toluol) |
100 |
375 |
150 |
560 |
| 108. |
O-Toluidine-Skin (S.C.) |
2 |
9 |
- |
- |
| 109. |
Tributvi phosphate |
0.2 |
2.5 |
- |
- |
| 110. |
Trichloroethylene |
50 |
270 |
200 |
1080 |
| 111. |
Uranium, natural (as U) |
- |
0.2 |
- |
0.6 |
| 112. |
Vinyl chloride (H.C.) |
5 |
10 |
- |
- |
| 113. |
Welding fumes |
- |
5 |
- |
- |
| 114. |
Xylene (o-,m-,p-isomers) |
100 |
435 |
150 |
655 |
| 115. |
Zinc oxide |
|
|
|
|
| |
(i) Fume |
- |
5.0 |
- |
10 |
| |
(ii) Dust (Total dust) |
- |
10.0 |
- |
- |
| 116. |
Ziroconium compounds (as Zr) |
- |
5 |
- |
10 |
| ppm |
Parts of vapour or gas per million Parts ofcontaminated air by volume at 25°C and 760 mm of Hg.
|
| Mg/m |
milligram of substance per cubic metre of air |
| * |
Not more than 4 times a day with at least 60min. interval between successive exposures.
|
| Molecular weight |
|
|
|
| ** mg/m3 = |
x ppm |
|
|
|
| 24.45 |
|
|
|
| G |
denotes Ceiling Limit |
|
|
|
| Skin. |
denotes potential contribution to the overallexposure by the coetaneous route including mucous membranes andeye.
|
| S.C. |
denotes Suspected Human Carcinogen. |
| H.C. |
denotes Confirmed Human Carcinogen. |
| Substance |
|
Permissible time-weighted average Concentration(TWA) (8 Hrs.)
|
| Silica, SiO |
|
|
|
|
| |
(a) Crystalline |
|
|
|
|
| |
(i) Quartz |
|
|
|
| (1) In terms of dust count mppcm |
{| |
| | 10600% Quartz + 10| mppcm |
| | 10% respirable Quartz + 2| mg/m3 |
1. Name and location of the Establishment where building or other construction work is to be carried on.
2. Postal address of the Establishment.
3. Full name and permanent address of the Establishment, if any.
4. Full name and address of the Manager or person responsible for the supervision and control of the Establishment.
5. Nature of building or other construction work carried/is to be carried on in the Establishment.
6. Maximum number of building workers to be employed on any day.
7. Estimated date of commencement of building or the other construction work.
8. Estimated date of completion of the building or other construction work.
9. Particulars of demand draft, enclosed (name of the Bank, amount, demand draft No. and date).
Declaration by the employer(i)I hereby declare that the Particulars given above are true to the best of my knowledge and belief;(ii)I undertake to abide by the provisions of the Building and other Construction Workers (Regulations of Employment and Conditions of Service) Act, 1996 and the Rules made thereunder.Date of Receipt of application: -Principal EmployerSeal and StampForm - II[See rule 24 (1)]Date:office of The Registering officerA Certificate of Registration is hereby granted under sub-section (3) of Section 7 of the Building and Other Construction Work (Regulation of Employment and Conditions of Service) Act, 1996 and the rules made thereunder, to M/s ............................. -".. having the following Particulars subject to conditions laid down in the Annexure:1. Postal Address/location where building or other construction work is to be carried on by the Employer.
2. Name and address of employer including location of the building and other construction work.
3. Name and permanent address of the establishment.
4. Nature of work in which building workers are employed or are to be employed.
5. Maximum number of building workers to be employed on any day by the employer.
6. Probable date of commencement and completion of work.
7. Other Particulars relevant to the employment of building workers.
Signature of Registering officer with SealAnnexureThe registration granted hereinabove is subject to the following conditions, namely:(a)the certificate of registration shall be non-transferable;(b)the number of workmen employed or building workers in the establishment shall not, on any day, exceed the maximum number specified in the certificate of registration;(c)save as provided in these rules, the fees paid for the grant of registration certificate shall be non-refundable;(d)the rates of wages payable to building workers by the employer shall not be less than the rates prescribed under the Minimum Wages Act, 1948 (II of 1948) for such employment where applicable, and where the rates have been fixed by agreement, settlement or award, not less than the rates so fixed; and(e)the employer shall comply with the provisions of the Act and the rules made thereunder.Form - III[See rule 25(2)]Register of Establishments
| Sl. No. |
|
Registration No. and date |
|
Name and address, location where a building orother Construction work is to be carried on
|
|
Name of the employer and his address |
|
Nature of building or other construction work |
| (1) |
|
(2) |
|
(3) |
|
(4) |
|
(5) |
| |
|
|
|
|
|
|
|
|
|
|
Name and permanentaddress of Establishment
|
|
Probable date ofcommencement of work
|
|
Maximum No. ofbuilding workers to be employed on any day
|
|
Probable duration ofbuilding or other construction work and probable date ofcompletion
|
|
Remarks |
| (6) |
|
(7) |
|
(8) |
|
(9) |
|
(10) |
| |
|
|
|
|
|
|
|
|
1. Name of the Workman/Employee with Residential address ...................................................................................................................................................................................
2. Name and full address of the Establishment were employed.............................................................................................................................................................................................
3. Date from which employed.......................................................................................................................................................................
4. Average monthly income and occupation................................. A. Occupation .............................. B. Income..........................
5. Copy of Appointment Letter/Wage/Slip/ /Smart Card enclosed or any other document....................................................................................................................................
6. Two Passport size photo copies enclosed...............................................................................................................................................
7. Date of Birth/Age..........................................................................................................................................................................................
8. Demand Draft of Rs. 50/- in favour of the Secretary of the GBOCWWB is enclosed................................................ D.D. No. ............................ Dated:- .................
I solemnly affirm that the above Particulars are correct to the best of my knowledge.Place:- ........................................Date:- ..........................................Signature of the Worker/EmployeeForm - V[See rule 61 and 79 (b), Schedule I]Certificate of Initial and Periodical Test and Examination of Winches, Derricks and Their Accessory GearTest Certificate No. .........................(a)In case of construction site, Name of the construction site where lifting appliances are fitted/installed/ /located:
|
Situation and Description of liftingappliances and Gear with distinguishing number or marks (if any),which have been tested, thoroughly examined
|
|
Angle to the horizontal of derrick boom atwhich test load applied
|
|
Test load applied |
|
Safe working load at the shown in Column(2) |
|
Name and address of public service,association company, or firm or testing establishment marking thetest and examination.
|
|
Name and position of the Competent Person ofpublic service, association, company or firm or testingestablishment.
|
| (1) |
|
(2) |
|
(3) |
|
(4) |
|
(5) |
|
(6) |
| |
|
(Degrees) |
|
(Tonnes) |
|
(Tonnes) |
|
|
|
|
| |
|
|
|
|
|
|
|
|
|
|
| Situation and description |
|
For jib cranes radius at the test load wasapplied
|
|
Test load applied |
|
Safe working load for jib cranes at radiusshown in column (2)
|
|
Name and address of public service,association or firm or testing establishment making the test andexamination
|
|
Name and position of competent Person ofpublic service,association company or firm or testingestablishment
|
| (1) |
|
(2) |
|
(3) |
|
(4) |
|
(5) |
|
(6) |
| |
|
(Metres) |
|
(Tonnes) |
|
(Tonnes) |
|
|
|
|
| |
|
|
|
|
|
|
|
|
|
|
|
DistinguishingNumberof Mark
|
|
Description,dimension and material of gear/device
|
|
Number tested |
|
Date of test |
|
Test load applied(tonnes)
|
|
Safe working load(tonnes) (SWL)
|
| (1) |
|
(2) |
|
(3) |
|
(4) |
|
(5) |
|
(6) |
| |
|
|
|
|
|
|
|
|
|
|
|
Name and address ofmanufacturer or suppliers
|
|
Initial andexamination certificate No. and date (only in case of periodicaltest and examination
|
|
Name and address ofpublic service association company or firm or testingestablishment making the test and examination
|
|
Name and position ofCompetent Person in public service, association, company or firmor testing establishment
|
| (7) |
|
(8) |
|
(9) |
|
(10) |
| |
|
|
|
|
|
|
|
Distinguishing Numberof Mark
|
|
Description of gear |
|
Number of thecertificate of test & examination
|
|
Number annealed |
|
Date of annealing |
| (1) |
|
(2) |
|
(3) |
|
(4) |
|
(5) |
| |
|
|
|
|
|
|
|
|
|
Defects found atcareful inspection after annealing
|
|
Name and address ofpublic service association company, or firm or testingestablishment carrying out the annealing and inspection
|
|
Name and position ofthe Competent Person of public service association, company orfirm or testing establishment
|
| (6) |
|
(7) |
|
(8) |
| |
|
|
|
|
|
|
1. Certificate Serial No. ............. Date. ..............
Date ..............2. Name ......................
Identification marks:3. Father's Name .............
4. Sex .......................
5. Residence ............................. Son/daughter of ......................
.................................................................................6. Date of birth, if available ............................
And/or certificate age ....................................7. Physical Fitness
I hereby certify that I have personally examined (name) ............... Son/daughter/wife of ................. residing at ................. who is desirous of being employed in building and construction work and that his/her age as nearly as can be ascertained from my examination is ................... years and that he/she is fit for employment in ..............as an adult/adolescent.8. Reason for -
(1)refusal of certificate ..............................................................................................................(2)certificate being revoked ....................................................................................................Signature/Left hand Thumb Impression of building workerSignature with Seal Medical Inspector/C.M.O.Note - 1. Exact details of cause of physical disability should be clearly stated.2. Functional/productive abilities should also be stated if disability is stated.
Form - XII[See rule 228 (d)]Health Register(In respect of persons employed in Building and other construction work involving hazardous processes)Name of the Construction Medical officer/Medical Inspector.(a)Mr.............................. from .............................. to ..............................(b)Mr.............................. from .............................. to ..............................(c)Mr.............................. from.............................. to ..............................
| Sl.No. |
|
Works No. |
|
Name of building worker |
|
Sex |
|
Age (last birthday) |
|
Date of employment of present work |
|
Date of leaving or transfer to other work |
| (1) |
|
(2) |
|
(3) |
|
(4) |
|
(5) |
|
(6) |
|
(7) |
|
1.2.3.4.5.
|
| |
|
|
|
|
|
|
|
|
|
|
|
|
| Reason for leaving : transfer or discharge |
|
Nature of job or occupation |
|
Raw material or bye product handled |
|
Date of medical examination by certifyingsurgeon medical Inspector/CMO
|
|
Results of medical examination |
| (8) |
|
(9) |
|
(10) |
|
(11) |
|
(12) |
|
1.2.3.4.5.
|
|
If suspended from work, state period ofsuspension with detailed reasons
|
|
Certified fit to resume duty on with signatureof Medical Inspector/CMO
|
|
If certificate of unfitness or suspensionissued to worker
|
| (13) |
|
(14) |
|
(15) |
|
1.2.3.
|
1. Name and address of the employer:
2. Name of the building workers and his work No., if any
3. Address of the building worker:
6. State exactly what the patient was doing at the time of contracting the disease
7. Nature of poisoning or disease from which the building worker is suffering from.
Date:Signature of theNote: - When a building worker contracts any disease specified in Schedule XII, a notice in this form shall be sent forthwith to the Chief Inspector.Form - XIV[See rule 215 (7)]Report of Accidents and Dangerous Occurrences
| 1. Name of the project/work |
| 2. Location of project/work |
| 3. Stage of construction work |
| 4. Particulars of Employer |
| |
(a) Main contractor firm/Co.: |
|
(b) Sub-contractor's Particulars: |
| |
Name |
|
Name |
|
| |
Address |
|
Address |
|
| |
Phone Nos. |
|
Phone Nos. |
|
| |
Nature of business |
|
Nature of business |
| 5. Particulars of injured person |
| |
(a) Name |
|
|
|
| |
(First) |
(Middle) |
(Surname) |
|
| |
(b) Home Address |
|
|
|
| |
(c) Occupation |
|
(d) Status of the worker: |
| |
|
|
Casual |
|
| |
|
|
Permanent |
|
| |
(e) Sex: Male |
Female |
(f) Age |
|
| |
(g) Experience |
|
|
|
| |
(h) Marital Status: Married/Unmarried/Divorced |
|
|
|
| 6. Particulars of Accident |
| |
(a) Exact place where accident occurred |
|
|
|
| |
(b) Date |
|
(c) Time |
|
| |
(d) What the injured person was doing at thetime of accident?
|
|
|
| |
(e) Weather condition |
|
|
|
| |
(f) How long employed by you for this Particularjob?
|
|
|
| |
(g) Particulars of equipment/machine/toolinvolved & Condition of the same after the accident occurred
|
|
|
| |
(h) Brief description of the accident |
|
|
| 7. Nature of injuries |
| |
(a) Fatal |
|
|
|
| |
(b) Non-fatal |
|
|
|
| |
(c) If non-fatal, state precisely the nature ofinjuries
|
|
|
|
(Describe in detail the nature of injury, forinstance fracture of right arm, sprain etc.)
|
|
|
| |
(d) First Aid: |
Given: |
Not given: |
|
| |
(e) If not, give the reasons |
|
|
|
| |
(f) Name & designation of the person by whomfirst aid was given
|
|
|
| |
(g) If admitted to hospital. |
|
|
|
| |
Name of the hospital: |
|
|
|
| |
Address of the hospital |
|
|
|
| |
Phone No. |
Name of the Doctor |
|
|
| 8. Mode of transport used |
| |
Ambulance |
Truck |
Tempo Taxi |
Private Car |
|
9. How much time was taken to shift the injuredperson?
|
| |
If very late, state the reason |
|
|
|
| |
(b) How the reporting was made? |
|
|
|
| |
Telephone |
Telegram |
Special Messenger |
|
| |
Letter |
|
|
|
| |
(c) Who visited the accident site first and what action wasproposed by him?
|
| |
(d) What are the actions taken for the investigations of theaccident by the employer? (Describe about photographs/ /Videofilm/measurements taken etc.)
|
| 10. Particulars of the persons given witness: |
| |
(a) Name |
Address |
Occupation |
|
| |
1. |
|
|
|
| |
2. |
|
|
|
| |
3. |
|
|
|
| |
4. |
|
|
|
| |
(b) Whether |
Temporary |
Permanent |
|
| 11. Particulars in case of fatal: |
| |
Date |
|
Time |
|
| |
Whether registeredwithBuilding and otherConstruction WorkersWelfare Board
|
|
If yes, give Reg. No. |
|
|
12. DangerousOccurrences as covered under the Regulation No.(Give details)
|
| |
(a) collapse or failure of lifting appliances,hoist, conveyors etc.
|
|
| |
(b) collapse or subsidence of soil, any wall,floor, gallery etc.
|
|
| |
(c) collapse of transmission towers, pipeline,bridges etc.
|
|
| |
(d) explosion of receiver, vessel etc. |
|
| |
(e) fire and explosion |
|
| |
(f) spillage or leakage of hazardous substances |
|
| |
(g) collapse, capsizing, toppling or collision of transportequipment.
|
|
| |
(h) leakage or release of harmful toxic gases at theconstruction site.
|
|
| |
(i) failure of lifting appliance, loose gear, hoist orbuilding and other construction work machinery, transportequipment etc.
|
|
|
13. Certificate from the Employer or authorisedsignatory.
|
| |
I certify that to the best of my knowledge andbelief, the above Particulars are correct in every respect.
|
| |
Place: |
|
Signature |
|
| |
Date: |
|
Designation |
|
| |
C. C. forwarded for information and follow-up action: |
|
|
| |
1. |
|
|
|
| |
2. |
|
|
|
|
Note:- If more than one person isinvolved, then for each person, information is to be filled-up inseparate forms.
|
|
Name and addressof establishmentwhere building andother construction workis tobe carried on
|
|
Name and permanent address of establishment |
|
Nature and location of work....................................................
|
| Sl. No. |
Name and Surnameof workman |
Age and Sex |
Father's/Husband'sname |
Nature of EmploymentDesignation |
Permanent Home addressof workman(Village andTeluka and Distt.)
|
Local Address |
| (1) |
(2) |
(3) |
(4) |
(5) |
(6) |
(7) |
|
1.2.3.4.
|
|
Date ofcommencement of employment
|
|
Signature or thumb impression of workman |
|
Date of termination of employment |
|
Reason for termination |
| (8) |
|
(9) |
|
(10) |
|
(11) |
|
1.2.3.4.
|
| |
|
If the building worker is/was beneficiary, thedate of registration as a beneficiary, the registration No. andthe name of Welfare Board
|
|
Remarks |
| (12) |
|
(13) |
|
1.2.3.4.5.
|
| Name and permanent address of the establishment |
|
Name and address of establishment where buildingor other construction work is called on/is to be carried on
|
| Nature of building or other construction work |
|
Name and address of Employer |
| For the month of ................ |
| Sl. No. |
|
Name of the building Worker |
|
Father's/Husband's name |
|
Sex |
|
Dates |
|
remarks |
| (1) |
|
(2) |
|
(3) |
|
(4) |
|
(5) |
|
(6) |
|
1.2.3.4.5.
|
|
1.2.3.4.5.
|
|
Name and addressof the establishment where building or other construction work iscarried on
|
|
Name and permanent address of establishment |
| |
| Name of building or other construction work |
|
Name and address of the Employer Wage period :Monthly
|
| Sl. No. |
|
Name of Workman |
|
Serial No. in the register of workman |
|
Designation/nature of work done |
|
No. of days worked |
|
Units of works done |
| (1) |
|
(2) |
|
(3) |
|
(4) |
|
(5) |
|
(6) |
| |
| Amount of wages earned |
| Daily rate of wages/piece rate |
|
Basic Wages |
|
Dearness allowances |
|
Overtime |
|
Other cash payments (Nature of payment to beindicated)
|
|
Total |
| (7) |
|
(8) |
|
(9) |
|
(10) |
|
(11) |
|
(12) |
| |
|
|
|
|
|
|
|
|
|
|
| |
|
|
|
|
|
|
|
|
|
|
| Deductions if any/(indicate nature) |
|
Net amount paid |
|
signature/Thumb impression of workman |
|
Initial of employer or his representative |
| (13) |
|
(14) |
|
(15) |
|
(16) |
| |
|
Name and address of the establishment wherebuilding or other construction work is carried on/is to becarried on Nature of building or other construction work
|
|
Name and permanent address of establishment |
| S. No. |
|
Sl. No. in Register of building workers |
|
Name of employee |
|
Designation/nature of work done |
|
Daily attendance/units worked |
|
Total attendance/units of work done |
| (1) |
|
(2) |
|
(3) |
|
(4) |
|
(5) |
|
(6) |
| |
| Amount of wages earned |
| Daily rate of wages/piece rate |
|
Basic wages |
|
Dearness allowances |
|
Overtime |
|
Other cash payments (nature of payment to beindicated)
|
|
Total |
| (7) |
|
(8) |
|
(9) |
|
(10) |
|
(11) |
|
(12) |
| |
|
|
|
|
|
|
|
|
|
|
| |
|
|
|
|
|
|
|
|
|
|
| Deductions if any (indicate nature) |
|
Net amount paid |
|
Signature/thumb impression of workman |
|
Initial of employer or his representative |
| (13) |
|
(14) |
|
(15) |
|
(16) |
| |
|
Name and address of establishment where buildingor other construction work is carried on/is to be carried on
|
|
Name and permanent address of establishment |
| |
| Nature of building or other construction work |
|
| Sl. No. |
|
Name of work |
|
Father's/Husband's |
|
Designation/nature of employment |
|
Particulars of damage or loss |
|
Date of damage or loss |
|
Whether building worker showed cause againstdeduction
|
| (1) |
|
(2) |
|
(3) |
|
(4) |
|
(5) |
|
(6) |
|
(7) |
| |
|
|
|
|
|
|
|
|
|
|
|
|
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
Name of person in where presence buildingworker's explanation was heard
|
|
Amount deduction imposed |
|
No. of instalment |
|
Date of recovery |
|
|
| First instalment |
|
Last instalment |
| (8) |
|
(9) |
|
(10) |
|
(11) |
|
(12) |
|
|
| |
|
Name and address ofestablishment where building or other construction work iscarried on/is to be carried onNature of building or other construction work
|
|
Name and permanentaddress of establishmentName and address of the employer
|
| Sr. No. |
|
Name |
|
Father's/Husband's name |
|
Designation/nature of employment |
|
Act/omission for which fine imposed |
|
Date of offence |
| (1) |
|
(2) |
|
(3) |
|
(4) |
|
(5) |
|
(6) |
| |
| |
|
Whether building worker showed cause againstdeductions
|
|
Name of person in whose presence buildingworker's explanation was heard
|
|
Wage periods and wages payable |
|
Amount of the fine imposed |
|
Date on which fine realised |
|
Remarks |
| (7) |
|
(8) |
|
(9) |
|
(10) |
|
(11) |
|
(12) |
| |
|
Name and address ofestablishment where building or on/is to be carried onNature of building or other construction work
|
|
Name and permanentaddress of establishmentName and address of the employer
|
| Sr. No. |
|
Name |
|
Father's/Husband's name |
|
Designation/Nature of employment/Designation |
|
Wage period and wages payable |
|
Date and amount of advance given |
| (1) |
|
(2) |
|
(3) |
|
(4) |
|
(5) |
|
(6) |
| |
| |
| Purpose(s) for which advance given |
|
No of instalments by which advance to berepaid
|
|
Date and amount ofeach instalment repayed |
|
Date on which last Instalment was repaid |
|
Remarks |
| (7) |
|
(8) |
|
(9) |
|
(10) |
|
(11) |
| |
|
Name and address of Establishment where buildingor other construction work is called on/is to be carried on
|
|
Name and permanent address of establishment |
| Sl. No. |
|
Name of building worker |
|
Father's/Husband's name |
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Sex |
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Designation/nature of employment |
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Date on which overtime worked |
| (1) |
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(2) |
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(3) |
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(4) |
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(5) |
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(6) |
| |
| |
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Total overtime worked or production in case ofpiece rated
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Normal rates of wages |
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Overtime rate of wages |
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Overtime earnings |
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Date on which overtime wages paid |
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Remarks |
| (7) |
|
(8) |
|
(9) |
|
(10) |
|
(11) |
|
(12) |
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Name and address of Employer Name and address ofestablishment where building or other construction work iscarried on
|
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Name and permanent address of establishmentNature of building or other construction work
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| |
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For the Week/Fortnight/ Month ending............ |
1. No. of days worked ............
2. No. of units worked in case of piece-rate workers ............
3. Rate of daily/monthly wages/piece-rate ................
4. Amount of overtime wages ..................................................
5. Gross wages payable .........................................................
6. Deduction, if any, on account of the following: -
(d)subscription towards provident fund(e)subscription towards the fund of the Building Workers Welfare(f)any other deductions e.g. subscriptions to Co-operative society or account of loans from Co-operative society/ housing loan, or contribution to any relief fund as per provision of clause (P) of sub-section (2) of Section 7 of the Payment of Wages Act or for payment of any premium of Life Insurance Corporation.7. Net amount of wages paid .............
Initials of the Employer or his RepresentativeForm - XXIV[See rule 246 (2) (b)]Service Certificate
| Name and permanent address of the Establishment |
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Name and address/location where the building orother construction work carried on/to be carried on
|
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Nature and location of work:.......................................................................
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| Name and address of the workman : |
| ..................................................................................................................... |
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Age or Date of Birth:.................................................................................
|
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Identification Marks:.................................................................................
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Father's/Husband's name:..............................................................................
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| S No. |
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Total period for which employed |
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Nature of work done |
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Rate of wages (with particulars of unit incase of (piece work)
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If the building worker was a beneficiary hisregistration No. date and the name of the Board
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From |
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To |
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| (1) |
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(2) |
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(3) |
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(4) |
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(5) |
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(6) |
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Reasons/grounds on which the employmentterminated
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Remarks |
| (7) |
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(8) |
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Signature |
1. Full name and full address of the establishment of the building and other construction work (Place, post office, District).
2. Name and permanent address of the establishment.
3. Name and address of the employer.
4. Nature of building and other construction work carried on.
5. Full name of the Manager or person responsible for supervision and control of the establishment.
6. Number of building workers ordinarily employed.
7. Total number of days during the year on which building workers were employed.
8. Total number of man-days worked by building workers during the year.
9. Maximum number of building workers employed on any day during the year.
10. The number of accident that took place during the year as under:
(a)The total number of accidents(b)The number of accidents resulting in disablement of building workers for less than 48 hours, the number of building workers involved and the number of man-days lost.(c)The number of accidents resulting in disablement of building workers beyond 48 hours but not resulting in any permanent Partial or permanent total disablement, the number of building workers involved, and the number of man-days lost on account of such accidents.(d)The number of accidents resulting in permanent Partial or total disablement, the number of building workers involved and the number of man-days lost on account of such accidents.(e)The number of accidents resulting in deaths of building workers and the number of resultant deaths.The Chief Inspector or Inspectors appointed by the Government under the Act shall direct the owners of establishments registered under this Act, to send the copies of annual Returns submitted by the employers of registered establishments in respect of the concerned State Government by virtue of provisions of section 60 of the Act.The Chief Inspector of Inspectors appointed under this Act by the Government shall direct the owners of such establishments as are registered under this Act by registering officers appointed by the Government to send copies of the Annual returns to the Director General by virtue of provisions of Section 60 of the Act.11. Change, if any, in the management of the establishment, its location, or any other Particulars furnished to the Registering officer in the application for Registration indicating also the dates.
EmployerPlace ............Date .............Form - XXVI[See rule 79 (a)]Register of Periodical Test-Examination of Lifting Appliance and Gears EtcPart 1 – Initial and Periodical Load Test of Lifting Appliances and Their Annual Thorough Examination
"Thorough examination" means a visual examination, supplemented, if necessary, by other means such as a hammer test, carried out as carefully as the conditions permit, in order to arrive at a reliable conclusion as to the safety of the Parts examined, and if necessary, for such examination Parts of the lifting appliances and gear shall be dismantled.(A){||-| Initial and periodical load tests of liftingappliance|-|Situation and description of liftingappliances tested with distinguishing number of marks, if any|| No. of certificate of test and examination ofcompetent person|| I certainly that on the date on which I haveappended my signature the lifting appliance shown in column(1)was tested and no defects affecting its safe working conditionwere found than those shown in column(5)|| Remarks (to be signed and dated)|-||| Date and signature with seal|| Date and signature with seal|||-| (1)|| (2)|| (3)|| (4)|| (5)|-| 1.2.
|}(B)Annual thorough examinationI certify that on the date to which I have appended my signature, the lifting appliance shown in column (1) was thoroughly examined and no defects affecting its safe working conditions were found other that those shown in column (12).
| Date and signature with seal |
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Date and signature with seal |
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Date and signature with seal |
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Date and signature with seal |
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Date and signature with seal |
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Date and signature with seal |
|
Remark(to be signed and dated) |
| (6) |
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(7) |
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(8) |
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(9) |
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(10) |
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(11) |
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(12) |
| |
1. Chains made of maleable cast iron;
3. Chains, rings, hooks, shackles and swivels made of steel;
5. Rings, hooks, shackles and swivels permanently attached to pitched chains, pulley blocks, container, spreaders, trays, slings, baskets, etc. and any other similar gear.
6. Hooks and swivels having screw-threaded Parts or ball bearing or other case-hardened Parts; and
7. Bordeaux connections
Initial Test and Periodical Load Test of Loose Gears
| Distinguishing No. and marks |
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Description of loose gear tested and examined |
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No. of certificate of test and examination ofcompetent person
|
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I certify that on the date to which I haveappended my signature the loose gears in column (1) and (2) wasthoroughly examined and no defects affecting where its safeworking condition were found than those shown in column(6)
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Date and signature with seal |
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Date and signature with seal |
| (1) |
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(2) |
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(3) |
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(4) |
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(5) |
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1.2.3.4.5.
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| Remarks (to be signed and dated) |
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I certify that on the date to which I haveappended my signature the loose gears shown in column (1) and (2)were thoroughly examined by me and no defects affecting theirsafe working condition were found other than those shown incolumn(10).
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Date and signature with seal |
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Date and signature with seal |
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Date and signature with seal |
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Remarks (to be signed and dated) |
| (6) |
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(7) |
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(8) |
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(9) |
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(10) |
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1.2.3.4.5.
|
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12.5 mm and smaller chains, rings, hooks,shackles and swivels in general use. Other chains, rings hooks,shackles and swivels in general use.
|
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If used with liftingappliance driven by power, must be annealed once atleast in everysix months.If used solely withlifting appliance worked by hand, must be annealed once atleastin every twelve months.If used with liftingappliance driven by power, must be annealed once atleast intwelve months.If used solely with lifting appliance worked byhand, must be annealed once atleast in every two years.
|
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Note:- It is recommended though notrequired by rules that annealing should be carried out in asuitably constructed furnace heated to temperature between 1100degree and 1300 degree Fahrenheit or 600 degree and 700 degreeCentigrade, for a period between 30 and 60 minutes.
|
| Distinguishing No. or mark |
|
Description of gear annealed |
|
No. of the certificate of test and examination |
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I certify that on the date to which I haveappended my signature, the gear described in columns 1 & 2was effectually annealed under my supervision; that after beingso annealed every article was carefully inspected were foundother than those shown in col.7
|
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Remarks(To be signed and dated) |
| |
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Date and Signature with seal |
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Date and Signature with seal |
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Date and Signature with seal |
|
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| (1) |
|
(2) |
|
(3) |
|
(4) |
|
(5) |
|
(6) |
|
(7) |
| |
| Date of Registration |
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Registration No. |
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Name and Local address of the workman |
|
Date of Birth/age |
|
Father's/Husband Name |
|
Nature of employment/ designation |
| (1) |
|
(2) |
|
(3) |
|
(4) |
|
(5) |
|
(6) |
| |
| Permanent Home address of the workman |
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Name and full address of theestablishment/employer
|
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Date of Cessation as beneficiary |
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Signature andthumbimpression ofworkman/beneficiary
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Signature of Secretary (GBOCWWB) |
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Photo of Workman/ Beneficiary |
| (7) |
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(8) |
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(9) |
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(10) |
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(11) |
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(12) |
| |
5. Marital Status (Married, Unmarried or widow):
7. Name, address and Register No. of the Establishment where the applicant is working:
9. Name and address of employer: :
11. Rate of subscription: :
12. Name of Bank and Branch, where subscription is to be paid :
13. If the applicant is already a member of any other Welfare Board, the name of such Board and registration No. of the applicant
The above facts are true to the best of my knowledge and information.
|
Place ...........Date ............
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Signature of theapplicant.Name and Signature of Employer
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| Name & Address of Nominee / Nominees |
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Relationship with member |
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Age of Nominee |
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Amount to be given to each Nominee |
| |
|
Place ...........Date ............
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Name, signature, Regn. No. & Address of the Worker |
1. (a) Name of the applicant:
4. (a) Register No.:
(d)Date of first remittance:(e)Date of last remittance:(f)Total amount remitter:(g)Whether the membership has ever been revived, if so, details:5. Purpose of grant (new construction/Maintenance/ /Purchase of land with building):
6. Whether the applicant has a house of his own (give details):
7. Amount of grant required:
8. Details of land property:
(g)Valuation of the property:9. Whether the applicant has received any other loan for construction of house, give details:
10. Estimate for construction/maintenance of building as per plan:
11. Details of the amount raised aPart from the loan:
12. Whether the applicant has received Loan previously from this Board:
DeclarationI hereby declare that the above statements are true and correct to the best of my knowledge and belief.
|
Place ...........Date ............
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Signature ....................Name ....................
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1. Plan and estimate (approved).
2. Encumbrance Certificate of 14 years.
6. Attested copy of ration card (Pages 2, 4) for maintenance application.
7. Ownership of the building (for maintenance only).
8. Terminal benefit declaration.
9. Attested copies of identity card and passbook.
10. Title clearance certificate.
11. Age certificate of the building (for maintenance only).
12. Valuation certificate of the building (for maintenance only).
13. No objection certificate from the authorities for construction.
14. Declaration from the applicant that neither he/she/nor his/her spouse or children own a house (for new construction).
[***]
|
Mortgage DeedThis Deed of mortgage is executed on this the ...........day of .......... two thousand hundred and .......... by Shri/Smt. ............ son/daughter/wife of ........... aged .......... residing .............. at Village ........... Taluka ........... District ........... and Shri/Smt. ............ son/daughter/wife of Shri ............ aged ............ residing at ............ Village ........... Taluka ........... District ...........(Thereinafter called the Mortgagor/Mortgagors which expression shall include his / her / their executors, administers, legal representatives and assigns) in favour of The Goa Building and Other Construction Workers Welfare Board established under the Building and Other Construction Workers Welfare Act and having its Chief office at Panaji (thereinafter called "the Mortgage" which expression shall include its successors or assigns wherever the context or meaning thereof shall so require or permit).Whereas the Mortgagor/Mortgagors has/have applied to the Mortgage for a loan of Rs. 50,000 (Rupees fifty thousand only) for the construction of a house on the land, more Particularly mentioned and described in the Schedule hereunder written:-And whereas on the request of the Mortgagor/Mortgagors the Mortgagee has agreed to lent an advance in two instalments to be Mortgager a loan of Rs. 50,000 (Rupees fifty thousand only) subject to the covenants, terms and conditions herein contained and having the repayment thereof, secured in the manner hereinafter expressed.Now This Deed Witnesseth As Follows:1. In pursuance of the said agreement and in consideration of the sum of Rs. 50,000 (Rupees fifty thousand only) now lent and advance/and paid by the Mortgagee to the Mortgagor/Mortgagors (the receipt whereof the Mortgagor hereby admits and acknowledge) the Mortgagor/Mortgagors hereby transfers/ transfer by way of simple Mortgage the immovable property, more Particularly mentioned and described in the schedule hereunder written together with the building to be constructed thereon and other improvements thereon from time to time to the intent that of the said property and the building and other improvements shall remain and be charged as security for payment to the Mortgagee of the said loan amount interest and cost and the Mortgagee shall have the first charge over the same.2. The loan amount shall be paid to the Mortgagor/Mortgagors by the Mortgagee in two instalments that the first instalments of a sum of Rs. 20,000 (Rupees twenty thousand only) equal to 40% of the loan sanctioned shall be paid to the Mortgagor/Mortgagors for starting construction, that the 2nd and final instalment of Rs. 30,000 (Rupees thirty thousand only) equal to 60% of the loan shall be paid after completing the construction of roof and on starting finishing works. The construction of the building shall be completed in all respects utilizing the 2nd instalment and certificate of completion shall be produced within two months from the receipt of last instalment.3. The instalments shall be paid only subject to the availability of funds and the non-payment of amounts due to paucity of funds shall not entitle the Mortgagor/Mortgagors to realize any loss that he/she/they may sustain on that account from the Mortgagee.4. The Mortgagor/Mortgagors hereby assures/assure upto the Mortgagee that he/she/they is/are the absolute owners of the property mentioned in the schedule hereto and that they are free from any encumbrance or charge of any description, whatsoever or any attachment or restraints on alienation.5. The Mortgagor/Mortgagors shall not at any time during the continuance of this security create any Mortgage lien or charge by way of hypothecation, pledge or otherwise create encumbrance of any kind whatsoever in respect of the properties described in the schedule hereto or any Part thereof, or let or lease them except with the prior permission in writing of the Chief Executive officer, The Goa Building and Other Construction Workers Welfare Board until the whole amount with interest are fully repaid.6. The loan shall bear interest at the rate of 5% per annum or such other higher rate of interest as may be fixed by the Mortgage from time to time.7. The loan shall be repaid by the Mortgagor/Mortgagors in monthly instalments at the rate as would be fixed and intimated by the Mortgagee. The first instalment becoming due on the expiry of 6 months from the date of disbursement of the first instalment, subsequent instalments shall be paid on or before the 10th day of succeeding month for 167 months. Any interest due on the loan amount outstanding on the date of payment of an instalment shall be paid alongwith the instalment.8. At the time of disbursement of the 2nd instalment the Mortgagee shall deduct the interest and other expenses due on the 1st instalment till the date of payment of the 2nd instalment. If the Mortgagee pays only a Part of the loan amount to the Mortgagor due to the non-availability of funds such Part of the loan shall be repaid by the Mortgagor in instalments at the rate as would be fixed and intimated by the Mortgagee.9. If the Mortgagor/Mortgagors dies/die before the disbursement of the remaining instalments of the loan after having received one or more instalments of the loan and if his/her/their heir or heirs executor/executors refuses/refuse to avail of the remaining instalment and also refuses or refuse to complete the construction of the house according the approved plan and estimate within one year after the date of disbursement of the first instalment of the loan the whole loan advance with interest shall be liable to be summarily recovered by proceedings against the property movable or immovable of the deceased Mortgagor/Mortgagors under the provisions of the revenue recovery at for the time being enforced and the relevant provisions of The Goa Building and Other Construction Workers Welfare Rules, as if some were arrears of public revenue due on land or in such other manner as the Mortgagee may deem fit.10. If the heir/heirs executors of the deceased Mortgagor/Mortgagors does/do not require the balance instalments of the loan and are, however willing to complete the construction at her/his/their cost, the amount already paid to the Mortgagor/Mortgagors out of the sanctioned loans will be treated all the actual amount of the loan sanctioned and the recovery shall be effective at the rate of instalment prescribed for that amount of loan.11. The Mortgagor/Mortgagors shall remit the instalments in the Banks prescribed by the Mortgagee in the manner specified for this purpose or by the challans prescribed by The Goa Building and Other Construction Workers Welfare Board.12. If any instalment of principal or interest is not remitted on the due dates a penal interest at the rate of 5% in addition to the usual rates shall be paid and such amount as are not paid on due dates.13. The loan amount shall be utilized only for the purpose for which it is sanctioned. Each instalment of the loan referred to in Clause II above shall be utilized within the time limit prescribed. In case the Mortgagor/Mortgagors fails/ /fail to claim the subsequent instalment within three months from the drawal of the previous instalments such previous instalment shall be treated as the last instalment unless the time is extended by the Mortgagee and recovery shall commence as provided in the terms and conditions prescribed for the grant of the loan.14. If the Mortgagor/Mortgagors fails/fail to utilize any instalment of loan within the maximum period admissible and does not apply for subsequent instalment of loan as provided in the conditions the entire amount already disbursed shall be recoverable from him/her/them with interest in lumpsum.14. (a) If the Mortgagor/Mortgagors is / are found to have failed in utilizing the amount for the construction of house as specified in the Mortgage deed within the prescribed period, the mortgagee is entitled to realize the entire loan amount plus other charges with interest in a lumpsum after the issuance of a registered notice directing to pay the amount within a period of 30 days.(i) If the Mortgagor/Mortgagors repay the amount due in lumpsum within the stipulated period the Mortgage deed shall be released;(ii) If the Mortgagor/Mortgagors fails/fail to repay the amount due within the period of 60 days as stipulated above the Mortgagee will have the right to take step to realize the entire dues to the Board in lumpsum. In addition to that a penalty not exceeding 5 % of the loan amount actually received by the loanee or Rs. 1000 (Rupees one thousand only) whichever is higher shall also be realized from the Mortgagor/Mortgagors.15. In the event of any information furnished in the application being found false or materially incorrect, the Mortgagee shall be cancel the loan and recover the entire amount outstanding in lumpsum with interest accrued thereon by selling the mortgaged property besides taking such legal action against the borrower as may be considered desirable.16. The Mortgagor/Mortgagors shall not alter or modify the building constructed in accordance with the plan approved by the Mortgage so as to diminish the value of the property or construct any other building in the property, offered as security till the entire amount with interest are repaid.17. In case of the Mortgagor/Mortgagors at any time make default in the payment of two consecutive instalments or commits breach of all or any of the terms and conditions contained herein the balance of the principal of sum which shall for the time being remain unpaid together with interest accrued thereon and all sums found due to the Mortgagee under or by virtue of these presents shall forthwith become payable in a lumpsum at once and in case of default of payment of the whole sum immediately the Mortgagee shall have power without the intervention of any court to take possession of the Mortgaged property and to sell the same. The balance of the sale proceeds after adjusting all amounts due to the Mortgagee will be disbursed to the Mortgagor. The Mortgagee shall also have all the powers vested in the Mortgagee under the provision of the Transfer of Property Act, 1882.18. Without prejudice to any or all of the other rights and remedies of the Mortgagee all sums found due to the Mortgagee under or by virtue of these presents shall be recoverable from the Mortgagor/Mortgagors and his/her/their properties, movable and immovable under the provisions of the Revenue Recovery Act for the time being in force as though they are arrears of Public Revenue due on land and in accordance with the relevant provision of The Goa Building and Other Construction Workers Act in any other manner as the Mortgagee may deem fit.19. The Mortgagor/Mortgagors shall be bound by the terms of the application form and the condition attached thereto which shall form Part of this deed as if they are incorporated on this deed.20. This Mortgage has been fully explained to the Mortgagor/Mortgagors and the Mortgagor/Mortgagors has/have executed these presents fully understanding the implications thereof and all his/her/their obligations thereunder and after receiving such advice.The Schedule Above Referred To(here enter details of all land and buildings)In Witness Where of Shri................ the Mortgagor(s) here to set his/her/their hands the day and year first above, written and signed by Shri/Smt. .............in the presence of witness:1.2.Signed by Shri/Smt.................. in the presence of witnesses:1.2.Stage Certificate For Release of Second Instalment of Advance Sanctioned by the Goa Building and Other Construction Workers Welfare Board Under Housing Loan Scheme{|
|
| Beneficiary |
|
Property |
|
1. Regn.No.......................................
|
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District.........................................
|
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2. Name............................................
|
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Taluka..........................................
|
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3. Address............................................
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Village.........................................
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4. Signature......................................
|
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Sy. No..........................................
|
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Place ...........Date ............
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Signature of District, Executiveofficer/T.E.O. or any Authorisedofficer with name & designation Name of office. |
| Sl. No. |
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No. of workers as on the close of previousmonth
|
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No. & Name(s) of workers(s) who leftservice during the month
|
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No & Names(s) of worker(s) to beregistered
|
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No. of workers as on the close of currentmonth
|
| |
|
Place ...........Date ............
|
Name and Signature of the Employer |
| (Office Seal) |
1. Name of the Establishment:
2. Nature of Establishment Whether Company/Partnership Firm/sole Proprietorship:
3. Names of the Partners/Directors/ /Proprietor:
4. Name of Managing Partner/Managing Director/Person who is in ultimate Control of the establishment:
6. Details of occupiers:
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Place ...........Date ............
|
Name, Signature and Designation |
| (Office Seal) |
| Sl. No. |
|
No. of identity cards |
|
Date of issue |
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Name and address of the worker |
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Signature of District Executive officer |
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Remarks |
| (1) |
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(2) |
|
(3) |
|
(4) |
|
(5) |
|
(6) |
| |
1. Name and address of applicant:
3. Age and date of birth:
6. Have you applied for this benefit earlier:
7. If so how many times and give details:
9. Date of payment of 1st subscription and amount:
10. Date of payment of last subscription:
11. Name of bank and place :
12. List of Documents submitted:
(a)Copy of Challans or copy of pass book.(b)Medical certificate in original.The facts furnished above are true to my knowledge and information.
|
Place ...........Date ............
|
Name and signature of applicant |
|
Place ...........Date ............
|
Name of Doctor & Seal |
1. Name and address of applicant:
3. Date of completion of 60 years:
4. Date of payment of 1st subscription amount and name of bank:
5. Default, if any and reasons thereof:
6. Date of payment of last subscription amount, date and name of bank:
8. Address at which pension is to be sent:
9. Any other information (Details of benefit if any, from Other Welfare Boards):
The facts mentioned above are true to my knowledge and information
|
Place ...........Date ............
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Name and signature of applicant |
| PPO No. |
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Name & addressof thepensioner withmembership No. in the D.B.O.C.W.W. Board
|
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Date of BirthDate ofentry in the scheme |
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Date of Retirement |
|
Total Service |
|
No. & date oforder ofsanctioningauthority
|
|
Date ofcommencementof pension |
|
Monthly rate of pension Rs. |
| (1) |
|
(2) |
|
(3) |
|
(4) |
|
(5) |
|
(6) |
|
(7) |
|
(8) |
| |
| |
| Dated initial of Secretary/D.E.O |
|
Remarksorder on cancellation of pension etc. may oncancellation reason and date effect under initials ofsecretary/DEO
|
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Details of Pension Paid Month/Year D.E.O/S.S |
|
Amount of Pension |
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Date of sending of Money order |
|
Dated-initials of D.E.O/S.S. |
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Remarks(Details of undelivered)H.O. etc. maybe noted here
|
| (9) |
|
(10) |
|
(11) |
|
(12) |
|
(13) |
|
(14) |
|
(15) |
| |
1. Name and address of applicant:
2. Relationship with worker:
3. Name and address of the worker:
6. Worker whether married:
7. Nature of Death (Give details):
8. Details of documents submitted:
9. Amount of financial assistance applied for:
The above details are true to my knowledge and information
|
Place ...........Date ............
|
Name and signature |
| Sl. No. |
|
Date of receipt of application |
|
Name and Register No. of worker |
|
Period of remittance |
|
Date of death |
|
order No. and date |
| (1) |
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(2) |
|
(3) |
|
(4) |
|
(5) |
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(6) |
| |
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Name & Address of nominee withRelationship to Member
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Amount of Death Benefit |
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Refund of Amount |
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Total |
|
Initial |
| (7) |
|
(8) |
|
(9) |
|
(10) |
|
(11) |
| |
1. Name and address of applicant:
2. Age and date of birth:
4. Date of payment of first subscription: amount and Name of Bank & Branch
5. Date of payment of last subscription amount and Name of Bank:
6. Total amount of subscription:
7. Details of disease/accident:
8. Nature of disability due to disease/accident:
9. Details of treatment in Government hospitals Date of admission and date of Discharge:
10. Whether the patient was in plaster: If so, for how many days?:
11. Amount spent for treatment (should: be supported by medical bills countersigned by the treating doctor)
12. List of documents submitted:
13. Details of benefits received, if any before:
14. Details of benefits received, if any from Government or any other institution for the above treatment:
The above facts are true to my knowledge and information
|
Place ...........Date ............
|
Name and signature of applicant |
1. Name of the applicant:
2. Father's/Husband's Name:
5. Name of Bank in which contribution remitted:
8. Details of other properties if any, owned or possessed by the applicant:
9. Whether salary certificate from the employer is attached:
10. Particulars of Instruments to be purchased:
(d)Invoice price (copy enclosed):(e)Name & Address of supplier/dealer:11. (a) Amount of grant applied for:
DeclarationA. I/We confirm that the funds will be used for the stated purpose only and will not be used for speculation and/or anti-social purpose.B. I/We understand that the Board has the right to recall the funds if they are not used for the stated purpose.C. I/We understand that the sanction of the facility is at the discretion of the Board and I/We will execute necessary Security documents as per the Board's requirements to its satisfaction.
|
Place ...........Date ............
|
Signature of applicant |
1. Date of entry into service ....................
2. Date of which continuous service begins ................................
3. Date of retirement........................................
Details of His/her Pay, Etc. are As Under
| 1. Basic pay ........... |
(a) Provident Fund ........... |
| 2. Dearness Allowance ........... |
(b) LIC recoveries ........... |
| 3. HRA .................... |
(c) Income Tax ........... |
| 4. Compensatory Allowance ........... |
(d) Loan recoveries ........... |
| |
1. ....................... |
| |
2. ....................... |
| |
3. ....................... |
| 5. Other Allowance .................... |
(e) Other recoveries .................... |
| |
1. .................... |
| |
2. .................... |
| Total (A) .................... |
Total(B) ....................
|
| Net Salary: .. |
(A)– (B) Rs. ..................
|
| Place .................... |
Signature |
| Date ..................... |
Name |
| |
Designation of theHead of office/Department......................
|
1. Name and address of applicant :
2. Relationship of applicant with the Worker :
3. Name and address of worker :
5. Date of registration :
6. Date of payment & first subscription amount and name of bank, branch:
7. Date of payment of last subscription amount, name of bank, branch:
8. Duration of membership :
9. Whether membership was live? :
10. Date of death of the worker :
12. Whether applicant is the nominee of the worker:
13. If not, whether the applicant has submitted dependence certificate:
14. Name, age and date of birth of the : Nominee:
15. If nominees are minor, name of guardian and his relationships with the children:
16. Whether consent letters from other Nominees submitted? (where the No. of nominees is more than one) :
17. Whether certificate of guardianship: submitted by the minor children
18. Amount of benefit, applied for :
The above facts are true to my best of knowledge and information.Signature name and address of applicantPlace : ...........Date: ...........Form - XLII(See rule 285)Application For Medical Benefit1. Name and address of applicant:
2. Age and date of birth:
4. Date of payment of first subscription, amount and name of Bank :
5. Date of payment of last subscription, amount and name of Bank :
6. Total amount remitted :
7. Details regarding disease/surgery :
8. Disability if any, due to disease or surgery:
9. Period of treatment as patient in Government Hospital (Date of admission in the Hospital and date of discharge):
10. List of documents submitted :
11. Details of medical benefit received, if any before:
The facts mentioned above are true to my knowledge and information.
|
Place ...........Date ............
|
Signature name and address of applicant |
2. Male/Female :
(b)Whether proof is attached3. Name of college and affiliated University/Board:
4. Name and year of course:
5. Date of admission to the course :
6. Age & date of birth of the student :
7. Details of qualifying examination Passed:
| Name of Exam |
|
Name of affiliated University/Board/State |
|
Month 7 years of passing qualifying examination |
| 8. Marks scored in the qualifying Examination |
Maximum marks |
|
SubjectTotal Marks
|
|
Marks scored |
|
Maximum Marks |
Percentage |
9. (a) Name of parent of applicant :
(c)Date of payment of first subscription:(d)Date of payment of last subscription:(e)No. of installments paid total subscription paid:(g)Has the membership been revived: Yes/Noif so, period of revival:The facts mentioned above are true to my knowledge. If selected for the scholarship. I promise that I will abide by the condition stipulated in the Scheme.
|
Place ...........Date ............
|
Name and signature of the student |
1. My son/daughter Shri/Smt. ........ is studying for ...... (name and years of course ).
2. I am a member of the Board since ......(Year )with registration No.
3. Subscription has been paid upto ..........
4. If any of the above facts are found to be wrong later, the scholarship amount granted to the student will be remitted back by me. The decision of Secretary in this regard will be applicable to me and it will be final and I agree with the same.
5. I also agree to recover any amount of default due from me.
|
Place ...........Date ............
|
Name and signature |
| Place............................ |
|
Attesting OfficerNameOfficial designation |
| Date............................... |
|
|
| |
|
|
| |
(Seal) |
|
| |
(Office Seal) |
Signature of Principal/Head |
| Place............................ |
|
Name |
| Date............................... |
|
Official designation |
1. Shri/Smt. ....................................................... - is a live member of this Board, having registration No......... and is paying subscription regularly.
2. He has paid subscription regularly from ......... to ......... He has not defaulted payment of subscription. Membership has been revived for the period from .......... to ...... I recommend/do not recommend the application (reason for rejection).
District Executive officerForm - XLIV(See rule 287)Application For Marriage Assistance4. Age and date of Birth :
5. Date of payment of first subscription, amount and Name of bank and branch:
6. Date of payment of last subscription, amount name of the bank and branch :
7. Duration of membership :
9. If application is for the marriage of son/daughter
(1)Whether husband or wife a member of this Board:(2)If so, has she/he applied for the financial assistance:(3)Date of birth of the son/daughter who is getting:(4)Address of the bride or bridegroom of the son/daughter:(5)Date and place of marriage:(6)Date & No. of the Certificate of marriage name and address of the authority who issued the Certificate:(7)Have you applied for financial assistance for the marriage of any other son/daughter, if so, details of the same:10. If application is for the marriage of self (for women worker only)
(1)Name and address of husband/bridegroom:(2)Date & place of marriage:(3)No. & date of marriage certificate name of authority who issued the certificate:11. Are you in receipt of any financial assistance for the purpose from Government or any other institution.
The above facts are true to the best of my knowledge and information.
|
Place ...........Date ............
|
Name and signature of the applicant |
1. Name and address of applicant:
2. Address of the pensioner/worker :
3. Relationship with worker :
4. Date of death or the worker :
5. Monthly pension received by the worker :
6. Whether applicant is receiving Pension from Government/Semi -Government or any other Institution? If yes, details thereof :
7. Whether applicant is receiving salary from Government/Semi -Government/private institutions? If yes, details thereof :
8. List of documents submitted:
The above facts are true to the best of my knowledge and information.
|
Place ...........Date ............
|
Name and signature of the applicant |
1. Death certificate of the worker.
2. Village officer's Certificate showing relationship between the applicant and the worker.
3. Village officer's Certificate stating that the applicant is not receiving any pension from Government/Semi-Government/ Private Institution.
4. Village officer's Certificate stating that the applicant is not receiving any salary from Government/Semi-Government/ Private Institutions.
Form - XLVI(See rule 285)Application For Ex-Gratia Medical Assistance For Accidents1. Name and address of applicant:
2. Age and date of birth:
4. Date of payment of first subscription amount, challan No. and name of bank, branch:
5. Date of payment of last subscription challan No. amount name of bank branch:
6. Total amount of subscription:
7. Details regarding accident:
8. Nature of disability due to accident:
9. Whether treated in Government and date of discharge:
10. Whether applicant was in plaster? If so for how many days:
11. Details of documents submitted:
12. Financial assistance applied for:
13. Have you received any financial assistance for treatment before? If yes, give Particulars:
The above facts are true to the best of my knowledge and information.
|
Place ...........Date ............
|
Name and signature of the applicant |
1.
) Name of the applicant in full (in block letters)2.
) Full address of the applicant4.
) Date of Birth and Age of the child/dependent (supported by Birth certificate)5.
) Age and relationship with the worker/applicant.6.
) Full address of the Hospital where the dependent is undergoing the treatment7.
) Amount claimed as subsistence allowance showing the duration of the claim. I, hereby declare that the particulars furnished above are correct to the best of my knowledge and belief. If any of the particulars is found to be incorrect, I realize that I will be liable for suitable action apart from refund of financial assistance received by me.Signature of the Applicant or Thumb impression(name in block letters)Place:Date:Certificate of The Medical Office of The Recognised Mental HospitalCertified that Kum. ____________________ son/daughter of Shri./Smt. __________________ who is employed as _______________________ in the establishment of __________________ has been examined in this Hospital and has been diagnosed as a case of Mental Retardation/Spasticity and does/does not need active treatment.Seal of the Medical Superintendent of the Institute of Psychiatry and Human Behaviour, Bambolim in case of mentally retarded child and of orthopedic surgeon/physician of Asilo Hospital Mapusa, Hospicio, Margao and Goa Medical College in case of Spasticity.Certificate From The Registered Workers UnionI, the undersigned do hereby certify that Shri/Smt. _________________ is working as a construction worker and performs the work a _______________ since last ______________ months/years.This certificate is issued in order to certify that the above mentioned person as a building construction worker and for availing the benefits available under the Goa Building and Other Construction Workers Welfare Board.(Seal)__________________________________________ (Signature, Name and address of Union Leader)Self CertificateCertified that Shri/Smt. _________________ having beneficiary registration No._____________ has worked for 90 days in building and other construction activities in the preceding twelve months in Goa.Place:Date:__________________________ (signature of the applicant)
