Kerala Social Security Rules (Draft): full text and citation

കേരള സർക്കാർ

ആത്മാവാണോ.

EXTRAORDINARY

വാല്യം 10 Vol. X തിരുവനന്തപുരം, വ്യാഴം

Thiruvananthapuram, Thursday 2021 ഡിസംബർ 16 16th December 2021 നമ്പർ No. 3667

1197 ധനു 1 1st Dhanu 1197
1943 അഗ്രഹായനം 25 25th Agrahayana 1943
1. Workmen Compensation (Venue of Proceedings) Rules, 1996; Objections and suggestions, which may be received from any person or organization with respect to the said draft rules before expiry of the period specified above, will be considered by the State Government.

Definitions.-(1) In these rules, unless the subject or context otherwise requires,-

(a) “accident” means any organic injury of functional disturbance whether immediate or subsequent, or death occurring suddenly in the course of the employment or in consequence thereof;
(c) “Board” means the Kerala Unorganised Workers Social Security Board constituted under sub-section (9) of section 6 or Kerala Building and Other Construction Workers' Welfare Board constituted under sub- section(1) of section 7;
(f) “Clinical Manifestation” of disease means clinical manifestation as given in the Annexure 1 to these rules;
(j) “diagnosis” means diagnosis of disease as per the guidelines given in the Annexure 1 to these rules.

(k) “disease” means every variation in physio, psycho and pathological status which arises as a consequence of the type of work in which the employee has been engaged or in the environment in which he is obliged to give his service;
(6) “injury” means any accident or disease to which employees are exposed in the course of the employment or any consequence thereof;
(s) “nomination” means nomination made under section 55 of the Code;

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(z a) “Useful Laboratory Investigation for diseases” means useful laboratory investigation as given in the Annexure 1 to the Rules.
(zb) “year” shall mean the financial year, that is to say, beginning from the first of April and ending with the thirty-first of March of the year following.
(2)The words and expressions used in these rule and not defined herein, but are defined in the Code shall have the same meaning as are respectively assigned to them, under the Code.

CHAPTER II

(3) The State Government may nominate two members from the Legislative Assembly under sub-clause (iii) of clause (d) of sub-section (10) of section 6.
(4) The State Government shall nominate five members under sub-clause (iv) of clause (d) of sub-section (10) of section 6 from amongst persons of eminence in the field of labour welfare, management, finance, law and administration.

(5) The State Government shall nominate ten Members under sub-clause (v) of clause (d) of sub-section (10) of section 6, one member each representing Labour, Finacne, Law, Local self Government Department in the Secretariat of the State Government, State Labour Commissioner, Director of Employment, one member representing the Social welfare Department, one member representing Kudumbasree Mission, two representatives nominated by the Government from any other department. (6) One member representing Central Government in the Ministry of Labour and Employment of clause (c) of sub-section (10) of section 6. (7) A member nominated under sub-clauses (i), (ii), (iii) and (iv) of clause (d) of sub-section (10) of the section 6, shall cease to be a member of the Board if he ceases to represent the category of interest from which he was so nominated: Provided that out of seven persons nominated under sub-clause (i), one member each from the Scheduled Caste, Scheduled Tribe, Minorities and Women shall be given representation. (8) A member nominated under sub-clause (iii) of clause (d) of sub-section (10) of section 6 shall cease to be a member of the Board if he ceases to be a member of the Legislative Assembly. (9) The official members of the Board nominated under sub - clause (v) of clause (d) of sub-section (10) of section 6 shall hold their offices in the Board so long as they serve in their official capacity. (10) The State Government shall appoint an officer not below the rank of Joint Labour Commissioner in the Labour Department as Member Secretary of the Board under clause (e) of sub-section (10) of section 6. (11) No person shall be chosen as, or continue to be, a member of the Board, if such person incurs any of the disqualifications under section 8. (12) A member, other than an ex-officio member, shall hold office for a period not exceeding three years from the date of his nomination. (13) A member shall be eligible for re-nomination:

Provided that a member shall not hold the office for more than two terms.

4. Resignation of members of the Board:- (1) A member of the Board, other than an ex-officio member, may by writing under his hand addressed to the Chairperson resign his office at any time. (2) The Chairperson shall take decision to accept or reject the resignation letter, within a month. The resignation shall be deemed to have come into effect from the date of acceptance of the resignation or on the date of expiry of one month from the date of receipt of resignation letter whichever is earlier and thereupon such member shall fall vacant with effect from that date. (4) The Board shall inform Government regarding the acceptance of resignation of a member.

Board Meeting.- (1) The Board shall meet at least once in three months. The Member Secretary shall convene the meeting at such time, date and at such place as decided by the Chairperson.

(2) The Chairperson shall convene meeting of the Board on the written requisition of not less than fifteen members jointly demanding to convene the Board meeting, within twenty days of receipt of such a requisition.

Change in the address.- (1) Each member shall inform the Member Secretary of any change in the address given in the order nominating him as a member and the Secretary shall make suitable alterations in the records.
Presiding over of the Meeting.- (1) The Chairperson shall preside over every meeting of the Board. (2) If there is no quorum for the meeting, the Chairperson may adjourn the meeting, to another date after the expiry of not less than seven days, informing the members present directly and giving notice to those who are absent and in the adjourned meeting whether there is prescribed quorum or not, it shall thereupon be lawful for him to dispose of the business irrespective of the number of members attending the meeting. (2) Every decision in the meeting of the Board shall be taken by a majority of the members present and voting at the meeting.

(2) The minutes signed by the Chairperson shall be read over to the members in the next meeting. Modifications, if any, made thereon shall be signed by the Chairperson and the Member Secretary after such modification and confirmation on it. 13. Allowance to the members of the Board.- (1) The members of the Board except the ex-officio Chairperson, and Member Secretary, members of the Legislative Assembly and the official members shall be eligible for sitting fee for attending the meeting at the rate as decided by the Government from time to time.

(b) preparation of annual budget and submission to the Government;
(c) preparation of annual report on the working of the Board and submission to the Government;
(d) Maintenance of accounts;
(f) Implementation of all matters entrusted by the Central and State Governments, according to their directions and furnishing of information required by the Government in time.

Expenditure and maintenance of accounts by the Board.-The amount for initial administrative

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expenditure required for the functioning of the Board shall be sanctioned by the Government. 17. Contribution to scheme.- (1) Any contribution or fees or any other amount fixed in the scheme notified under Rule 17 shall be paid by the unorganized worker or the self-employed person or the employer or the aggregator or the beneficiary as the case may be, at such rate and at such time and in the manner specified in such scheme or schemes. (2) The Contribution or any other amount payable to the Board as per sub-rule (1) or any Government Contribution or grant received shall be credited to the account of the Board and expended or disbursed in the manner provided in such Schemes. (3) All sums due to the Board from the Central Government or the State Government for the implementation of the provisions of the Code and the Schemes shall be obtained and made available to the Board by the State Labour Commissioner. 18. Other staffs of the Board.-(1) The Government may appoint such number of staff as they consider necessary to assist the Member Secretary and specify their service conditions.

22 .- The constitution, term, functions and powers of the Kerala Building and other Construction Workers Welfare Board constituted under sub-section (1) of section 7 of the Code:-

(1) The State Government shall, by notification, constitute a Board under sub-section (1) of section 7 as the Kerala Building and other Construction Workers Welfare Board to exercise the powers and perform such functions assigned to it under the Code
(d) A Secretary – Chief Executive Officer appointed by the Government as ex-officio
(e) The State Government shall nominate four members representing employers;

(f) The State Government shall nominate four members representing building and other

construction workers;

(g) The State Government shall nominate one member each from Labour, Finacne, Law

(iii) The Chairperson shall have powers to call special meeting of the Board at any time to decide any matter which is urgent. (ii) If the Chairperson is absent at any time, he may nominate a member of the Board to preside over such a meeting in his place and in the absence of such a nomination by the Chairperson, the members of the Board present in such meeting may elect one among them and the member so elected shall preside over that meeting. (18) Quorum of the Meeting.- (i) No business shall be transacted at any meeting of the Board unless at least one third of the members existing at the time in the Board or 5 members, whichever is less, are present of whom at least one each shall be from among those nominated under clauses (e) and (f) sub-rule (2) of Rule 23.

(ii) Every decision in the meeting of the Board shall be taken by a majority of the members present and voting at the meeting.
(iii) In the case of equal number of votes on any issue, the matter shall be decided by exercising a second vote or casting vote by the Chairperson.
(20)Minutes of the Meeting.- (i) The Secretary shall prepare the minutes of the meeting and the Chairperson and the Secretary shall affix their signatures on it.
(22) Functions of the Board.- In addition to the functions stated in sub-section(6) of section 7 of the Code, the Board shall have the following functions, namely:- (a) Realisation of fee and other charges for registration of the Building workers as members;
(c) preparation of annual report on the working of the Board and submission to the Government;

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(23) Expenditure and maintenance of accounts by the Board.- (i) The amount for initial administrative expenditure required for the functioning of the Board shall be sanctioned by the Government. (iii) All amounts received by the Board shall be deposited in the manner as decided by the Board. (27)Audit.-All accounts of the Board for an year shall be audited every year as directed by the Government and the audit report shall be submitted to the Government before 31st of December of the next year. (28). Appointment, terms and conditions of Chairperson and members under sub section (4) of Section 7,- The State Government may notify the terms and conditions of appointment and salaries and other allowances payable to the Chairperson and the other members from time to time.

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(5) A nomination or a fresh nomination or a notice of modification of nomination shall be, signed by the employee or, if illiterate, shall bear his thumb impression and shall be submitted by the employee electronically or by registered post acknowledgement due. (6) A nomination, fresh nomination or notice of modification of nomination shall take effect from the date of receipt thereof by the employer.

25 Time within which and the form in which a written application shall be made under sub-section (I) and the form of application to the competent authority under clause (b) of sub-section (5) of section 56.-

Provided that where the date of superannuation or retirement of an employee is known, the employee may apply to the employer before thirty days of the date of superannuation or retirement: Provided further that an employee on fixed term employment shall be eligible for gratuity, if he renders service under the contract for a period of one year and he shall be paid gratuity at the rate of fifteen days’ wages based on the rate of wages last drawn by him, for every completed year of service or part thereof in excess of six months.

(b) A nominee of an employee who is eligible for payment of gratuity under the second proviso to sub-section (1) of section 53 shall apply, ordinarily within thirty days from the date of gratuity became payable to him, in Form-II to the employer: Provided that an application in plain paper with relevant particulars shall also be accepted. The employer may obtain such other particulars as may be deemed necessary by him.

electronically or personal service or by registered post acknowledgement due. 26. Notice for payment of gratuity -(1) Within fifteen days of the receipt of an application under sub-rule (1) of rule 27 for payment of gratuity, the employer shall-

(i) if the claim is found admissible on verification, issue a notice in Form-III to the applicant employee, nominee or legal heir, as the case may be, specifying the amount of gratuity payable and fixing a date, not being later than the thirtieth day after the date of receipt of the application, for payment thereof, or
(2) In case payment of gratuity is due to be made in the employer's office, the date fixed for the purpose in the notice in Form-III under sub-clause (i) of sub-rule (1) shall be re-fixed by the employer, if a written application in this behalf is made by the payee explaining why it is not possible for him to be present in person on the date specified.
(4) A notice in Form-III shall be served on the applicant either by personal service after taking receipt or by registered post with acknowledgement due or electronically. Provided that intimation about the details of payment shall also be given by the employer [^]

28. Application to competent authority for direction under clause (b) of sub-section (5) of section 56:- (1) If an employer,-

c. having received an application under Rule 28 fails to issue notice as required under Rule 29 within the time specified therein, the claimant employee, nominee or legal heir, as the case may be, may, within one hundred eighty days of the occurrence of the cause for the application, apply in Form-IV to the competent authority for issuing a direction under sub- section (5) of section 56 with as many extra copies as are the opposite party: Provided that the competent authority may accept any application under this sub-rule, on sufficient cause being shown by the applicant, after the expiry of the specified period.

Procedure for dealing with application for direction - (1) On receipt of an application under rule 30 the competent authority shall, by issuing a notice in Form-V, by electronically or registered post acknowledgment due or in person call upon the applicant as well as the employer to appear before him on a specified date, time and place, either by himself or through his authorized representative together with all relevant document and witnesses, if any.

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(5) If the employer concerned fails to appear on the specified date of hearing after due service of notice without sufficient cause, the competent authority may proceed to hear and determine the application ex-parte. If the applicant fails to appear on the specified date of hearing without sufficient cause, the competent authority may dismiss the application: (ii) If no written statement has been filed by the Opposite party, within the time fixed, the Competent Authority shall proceed with the enquiry ex-parte and take evidence on the side of applicant and pronounce the order.

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Place and time of hearing.-The sittings of the competent authority shall be held at such times and at such places as he may fix and he shall inform the parties of the same in such manner as he thinks fit.

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(3) The Memorandum of appeal shall contain the facts of the case, the decision of the competent authority, the grounds of appeal and the relief sought.

the appeal by electronically or registered post or in person and a copy there of shall be sent to the competent authority returning his records of the case.

(9)On receipt of the decision of the appellate authority, the competent authority shall, if required under the decision, modify his direction for payment of gratuity and issue a notice to the employer concerned in Form-VI specifying the modified amount payable and directing payment thereof to the applicant, under intimation to the competent authority within fifteen days of the receipt of the notice by the employer. A copy of the notice shall be endorsed to the appellant employee, nominee or legal heir, as the case may be, and to the appellate authority.

CHAPTER IV

EMPLOYEES COMPENSATION

Notice of Fatal Accidents and serious bodily injuries under section 73 (1)- The notice of fatal accidents and serious bodily injuries shall be reported by the employer in Form IX to the competent authority.
Right of employer to present memorandum when information received. – Any employer who has received information of an accident may at any time, notwithstanding the fact that no claim for compensation has been instituted in respect of such accident, present to the Competent Authority a memorandum, supported by an affidavit made by himself or by any person subordinate to him having knowledge of the facts stated in the memorandum, embodying the results of any investigation or inquiry which has been made into the circumstances or cause of the accident.

(l) by the employer, on the ground that since the right to compensation was determined, the employee’s wages have increased;
(3) either by the employer or by the employee, on the ground that the determination of the rate of compensation for the time being in force was obtained by fraud or undue influence or

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other improper means;

(4) either by the employer or by the employee on the ground that in the determination of compensation there is a mistake or error apparent on the face of the record.

Procedure on application for commutation under section 80. – (1) Where application is made to the Competent Authority for the redemption of a right to receive half-monthly payments by the payment of a lump sum, the Competent Authority shall form an estimate of the probable duration of the disablement and shall award a sum equivalent to the total of the half-monthly payments which would be payable for the period during which he estimates that the disablement will continue, less one half per cent of that total for each month comprised in that period: Provided that fractions of a rupee included in the sum so computed shall be disregarded.

(2) If, when depositing compensation in respect of fatal accidents, the employer indicates in the statement referred to in sub-section (1) that he desires to be made a party to the distribution proceedings, the Competent Authority shall, before allotting the sum deposited as compensation, afford to the employer and opportunity of establishing that the person to whom he proposes to allot such sum is not a dependent of the deceased employee or, as the case may be that no one of such person is a dependent. (3) The statement of disbursements to be furnished on application by the employer under sub-section (4) of section 81 shall be in Form XIII. Provided that the Competent Authority may, at any time before issues are framed, cause notice to be given in such manner as he think fit to all or any of the dependents of the deceased employee who have not joined in the application, requiring them, if they desire to join therein to appear before him on a date specified in this behalf:

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Investment of money. -- Money in the hands of Competent Authority may be invested for the benefit of the dependents of deceased employee in Government securities or Post Office Cash Certificates or may be deposited in a Post Office Savings Bank or Nationalised Bank or State Treasuries.

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(3) The decision of the Medical Board regarding the certification of the nature of disease and the extend of incapacity shall be final and binding on the parties unless appealed to the Medical Tribunal within three months from the date on which the copy of the decision of the Board is supplied to the parties concerned.
(4) The State Government shall notify the constitution or recognition of the Medical Board, unless already done, within three months from the date of filing the application for compensation under the Code.
(6) Procedure for medical examination may be as prescribed in Rule 54 to 59:

Medical Tribunal.- (i) The State Government shall constitute a Medical Tribunal for entertaining, hearing and deciding the appeals presented to it, against the decisions of the Medical Board. (ii) (a) Medical Tribunal shall consist of sitting or retired District and Sessions Judge and two qualified medical practitioners with post graduate medical degree who have not been members of the Medical Board whose decision is appealed against. (iv) Final decision on the appeal shall be based on the decision of the majority of the members of the Tribunal other than the co-opted members. (v) The appeal shall be finally disposed of by the Tribunal within three months from the date of the first hearing of the appeal referred to it.

(ii) Hazardous operations in present and past;
(iii) Toxic work environment employment;
(iv) Clinical examination report;
(v) Haemayological, Biochemical, Pathological, Radiological etc. reports as indicated;

(v) A fresh contraction shall be presumed after the disablement period has come to an end.
(ii) (a)Normally such a date may be the first day of loss of facility where disablement benefit is claimed and;
(b) date of death, where death benefit is claimed.

Evaluation of disablement - (i) the evaluation of disablement shall be made with reference to the physical and mental manifestations for the performance of regular functions which would be expected on a healthy person of the same age, sex and socio-economic status. (ii) When there is presence of symptoms which while not providing the existence of disease and not involving immediate incapacity of work require periodical supervision of the employees, he is considered to be under observation.

Form of memorandum under sub section (1) of section 89 -- Memoranda of agreement sent to the Competent Authority shall, unless the Competent Authority otherwise directs, be in electronic and shall be in as close conformity as the circumstances of the case admit in Form XXII or Form XXIII or Form XXIV as the case may be. (2) On the date so fixed, the Competent Authority shall record the memorandum unless, after hearing any of the parties who appears and desire to be heard, he considers that it ought not to be

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(3) If, on the date fixed under sub-rule (1) the party or parties desiring the memorandum to be recorded show adequate cause for proceeding to record the same, the Competent Authority may, if information has already been given to all the parties, concerned record the agreement. If information has not been given to all such parties he shall proceed in accordance with Rule 76.

(2) If the Competent Authority refuses to record a memorandum of agreement he shall not pass any order directing the payment of any sum or amount over and above the sum specified in the agreement, unless opportunity has been given to the party liable to pay such sum to show cause why it should not be paid. (3) Where the agreement is for the redemption of half-monthly payments by the payment of a lump sum, and the Competent Authority considers that the memorandum of agreement should not be recorded by reason of the inadequacy of the amount of sum as fixed in the agreement, he shall record his estimate of the probable duration of the disablement of the employee. "The memorandum of agreement bearing Serial No.____________________of 20_______in the register has been recorded this____________________day of _________________ (Signature) Competent Authority”

(2) Any other document, which any party desires to tender in evidence, shall be produced at or before the first hearing. 82. Manner of disposal of application.- (i) -- On receiving an application of the nature referred to in Section 93, the Competent Authority may examine the applicant on oath, or may send the application to an officer authorized by the State Government in this behalf and direct such officer to examine the applicant and his witnesses and forward the record thereof to the Competent Authority. (ii) The substance of any examination made under sub-rule (1) shall be recorded in the manner provided for the recordings of evidence in Section 97. (2) Summary dismissal of application.-- (i) The Competent Authority may after considering the application and the result of any examination of the applicant under sub rule (1), summarily dismiss the application, if, for reasons to be recorded, he is of opinion that there are no sufficient grounds for proceeding thereon. (ii) The dismissal of the application under sub-rule (1) shall not of itself preclude the applicant from presenting a fresh application for the settlement of the same matter. (3) Preliminary inquiry into application.-- If the application is not dismissed under sub rule (2), the Competent Authority may, for reasons to be recorded call upon the applicant to produce

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(5)Certificate Of Medical Officer.- (i) The Competent Authority may at any time during the dependency of a case before him or otherwise, if he considers it necessary, direct any Medical Officer in a Government Hospital or in a Medical College Hospital or Medical Board to examine the employee and issue a certificate regarding loss of earning capacity indicating the degree and extend of the physical disability, if any, sustained as a result of the accident.

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application, and any such written statement shall form part of the record.

(iii) If the opposite party contests the claim, the Competent Authority shall proceed to examine him upon the claim, and shall reduce the result of examination to writing.
(3) Framing of issues.--(i) After considering any written statement and the result of any examination of the parties, the Competent Authority shall ascertain upon what material propositions of fact or of law the parties are at variance and shall thereupon proceed to frame and record the issues upon which the right decision of the case appears to him to depend.
(8)Power to postpone trial of issues of fact where issues of law arise.-- Where issues both of law and of fact, arise in the same case, and the Competent Authority is of the opinion that the case may be disposed of on the issues of law only, he may try those issues first and for that purpose may, if he thinks fit, postpone the settlement of the issues of fact until after the issues of law have been determined.
(9)Diary. -- The Competent Authority shall maintain under his hand a brief diary of the proceedings on an application.
(10)Reasons for postponement to be recorded. -- If the Competent Authority finds it impossible to dispose of an application at one hearing he shall record the reasons, which necessitate

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a postponement. (12)Judgment.-- (i) The Competent Authority, in passing orders, shall record concisely in a judgment, his finding on each of the issues framed and his reasons for such finding. (13)Summoning of witnesses.--If an application is presented by any party to the proceedings of the citation of witnesses, the Competent Authority shall, on payment of the prescribed expenses and fees, issue summons, for the appearance of such witnesses, unless he considers that their appearance is not necessary for the just decision of the case. 83. Costs under sub - section (4) of section 93.- (1) Where the Competent Authority directs that any costs shall not follow the event, he shall state his reasons in writing.

(2) The costs which may be awarded may include:-
(a) the charge necessarily incurred on account of court fees.

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Right of entry for local inspection. -- A Competent Authority before whom any proceeding relating to an injury by accident is pending may at any time enter the place where the employee was injured, or where the employee ordinarily performed his work, for the purpose of making a local inspection or of examining any persons likely to be able to give information relevant to the proceedings: Provided that the Competent Authority shall not enter any premises of any industrial establishment, except during the ordinary working hours of that establishment, save with the

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Procedure in connection with local inspection. -- (1) If the Competent Authority proposes to conduct a local inspection with a view to examining on the spot the circumstances in which an accident took place, he shall give the parties or their representative notice of his intention to conduct such inspection, unless in his opinion the urgency of the case renders the giving of such notice impracticable. (2) Such notice may be given orally or in writing and, in the case of an employer may be given to any person upon whom notice of a claim can be served under sub-section (3) of Section 82, or the representative of any such person.
Power of Summary Examination. -- (1) The Competent Authority, during a local inspection or at any other time, save at a formal hearing of a case pending before him, may examine summarily any person likely to be able to give information relative to such case, whether such person has been or is to be called as a witness in the case or not, and, whether any or all of the parties are present or not.

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(3) Statements made by persons examined under sub-rule (1), if reduced to writing, shall not be signed by the person making the statement, nor shall they, except as hereinafter provided, be incorporated in the record or utilized by the Competent Authority for the purpose of arriving at a decision in the case. (5) Any statements or part of a statement, which is furnished to the parties under sub-rule (4) shall be incorporated in the record. (6) Where a case is settled by agreement between the parties, the Competent Authority may incorporate in the record any statement made under sub-rule (1) and may utilize such statement for the purpose of justifying his acceptance of, or refusal to accept, the agreement reached. 87. Agreement to abide by Competent Authority’s decision. -- (1) If a party states in writing his willingness to abide by the decision of the Competent Authority, the Competent Authority shall inquire whether the other party is willing to abide by his decision. (2) If the other party agrees to abide by the Competent Authority’s decision the fact of his agreement shall be recorded in writing and signed by him.

Provisions regarding signature of forms. -- Any form, other than a receipt for compensation, which is by these rules required to be signed by a Competent Authority may be signed under his direction and on his behalf by any officer subordinate to him appointed by him in writing for this purpose.
Apportionment of compensation among dependents. -- The provisions of this Part, except those contained in Rules 73, sub rule (4) or (6) of rule 84 shall, as far as may be, apply in the case of any proceedings relating to the apportionment of compensation among the dependents of a deceased employee.
Transfer of report. -- A Competent Authority transferring any matter to another Competent Authority for report in accordance with sub-section (3) of Section 92 shall, along with the documents referred to in that sub-section, transmit to such other Competent Authority a concise statement, in the form of question and answer, of the matter on which report is required. (2) A Competent Authority to whom a case is so transferred for report shall not be required to report on any question of law.
When representative must be appointed. -- Where any party to a proceeding is under the age of fifteen years or unable to make an appearance, the Competent Authority shall appoint some suitable person, who consents to the appointment to represent such party for the purposes of the proceeding.
Register of applications.-All applications presented to the Competent Authority shall be registered in a register in Form XXXI

Register of non-fatal accident.-Every Competent Authority shall maintain a separate register in Form XXXIII or non-fatal accidents which come to his knowledge in any of the following ways, namely,-

(1) On account of applications for registration of memoranda of agreements.
(3) On account of amount of compensation deposited with the Competent Authority under sub- section (2) of Section 81.

Language of the record.-The record of the Competent Authority shall be kept in the English language.
Supply of certified copies to parties.-Certified copies of any papers in any proceedings before a Competent Authority should be supplied to the parties in accordance with the rules in the Civil Rules of Practice for the time-being in force; Provided that certified copies required by Government Officers in their official capacity for purposes other than production before a Court of law shall be issued in plain paper.
Allowance to witnesses.-In cases where a Competent Authority has to issue summons

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to a witness either at the instance of a party to a proceeding before him, or on his own initiative the allowance to be paid to the witness, shall be on the same scale as obtained in the Civil Court. 99. Fees to assessors.-Where in pursuance of the provisions of sub-section (3) of Section 91, any person possessing special knowledge of any matter relevant to the case under inquiry is chosen by the Competent Authority to assist him in holding the same, he shall be entitled to such fee as the Competent Authority may fix, subject to a maximum of Rs. 5000 and a minimum of Rs. 2000; Provided that he shall be entitled to an additional fee of rupees one thousand.

(a) for each extra case if he is required to sit in more than one case on the same day; and
(b) for each of the second and third days of any one case.

CHAPTER V

SOCIAL SECURITY AND CESS IN RESPECT OF BUILDING AND OTHER

CONSTRUCTION WORKERS 100. Time limit for payment of cess under section 101.-Every employer shall pay cess payable within thirty days from the date of receipt of the assessment order. 101. Fee for Appeal under sub section (2) of Section 105.-A non-refundable fee equivalent to half percent, but not exceeding rupees twenty five thousand of the amount in dispute

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or penalty or both, as the case may be under such appeal.

CHAPTER VI

FINANCE AND ACCOUNTS

Holding of property and investment of money under Sub section (1) and (2) of section 120.- (1) The State Government may notify conditions for acquiring, selling or transferring of both movable and immovable property of social security organization from time to time. (2) The State Government may notify conditions for investment, reinvestment or realization of money of social security organization from time to time.

CHAPTER VII

Maintenance records and registers under section 123.- (1) Every employer shall maintain the following registers electronically or otherwise and shall be kept available at the office of the establishment or the nearest convenient building within the precincts of the establishment;

A combined register in Form XXXIV showing the following details namely,-

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(i) Wage paid to the employees;
(ii) Leave, leave wages, wages for overtime work and attendance;
(iii) Employees identification number;
(iv) Statutory deduction from wages in – respect of chapter III and IV of the Code;
(b) Register for Number of days for which work performed by the employees in Form XXXV;
(c) Register for Number of hours of work performed by the employees in Form XXXV;
(d) Register for Total number of employees in Form XXXV;
(f) Register for Occupational details of employees in Form XXXVI;
(i) Register of vacancies for which suitable candidates were not available in Form XXXIX;
(2) The State Government may by notification prescribed the manner and the form to be displayed by the employer in work place from time to time under Section 123 (b).

CHAPTER VIII

COMPOSITION OF OFFENCE

Compounding of Offences.-The State Government shall notify as many officers not below the rank of District Labour Officer of Labour department, as an officer for compounding of offences under sub section (1) of section 138.
Manner of compounding of offences by the officer specified under sub-section (1) of section 138.--:(1) Any accused person if intent to compound the offence alleged against him which is compoundable under this Code may submit an application in Form XL to the

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officer notified by the Government for the purpose of compounding of offences under sub-section (1) of section 138 (herein after referred to as the compounding officer).

(2) If prosecution is pending before the Judicial First Class Magistrate Court under sub section (3) of Section 136 the compounding officer shall sent an intimation of the receipt of application for composition to the court concerned.
(3) The Compounding officer, after due enquiry, found that the offence is compoundable, issue an order of composition directing to deposit the amount within fifteen days from the date of receipt of order.
(4) On receipt of the amount of composition, the compounding officer shall issue an intimation in writing to the Judicial First Class Magistrate Court where the prosecution is pending to discharge the accused.
(5) The accused person failed to remit the compounding amount within the time prescribed, in subrule (3), he is liable for a fine according to sub section (7) of section 138.

EMPLOYMENT INFORMATION AND MONITORING

Manner of establishment and maintenance of career centre and the career services under clause (9) of section 2.- (1)The State Government may establish, run and maintain Career Centre or modify and declare its already established office or employment exchange or both or a portal

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or authorize any other such centre as Career Centre by notification. Till such notification, existing local Employment Exchanges would function as Career Centres

(2)The State Government may also enter into an agreement with any institution, local authority, local body or private body for running a Career Centre .
(3)The Career Centres established under sub-rules (1) and (2) above shall inter-alia perform the following functions namely;
(a) collection and furnishing of information, either by the keeping of registers or otherwise, manually, digitally, virtually or through any other mode; relating to:
(i) persons who seek to employ employees;
(ii) persons who seek employment;
(iii) occurrence of vacancies; and
(iv) persons who seek vocational guidance and career counseling or guidance to start self-employment;
(b) providing career counseling & vocational guidance;
(c) organizing job-fairs and job drives;
(d) employment related surveys and studies;
(e) employability enhancement activities; and
(f) other services as may be decided by the appropriate Government from time to time.

Manner and form of reporting vacancies and form of filing the return by the employer, to the concerned career centre under rule 110.- (1) Reporting of Vacancies to Career Centres: (a) After the commencement of this Code the employer in every establishment in public sector in the State shall, before filling up any vacancy in any employment in that establishment, report that vacancy or cause to be reported to such Career Centre as may be specified in the notification by the State Government.

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(b) The employer in every establishment in private sector or every establishment pertaining to any class or category of establishments in private sector shall, before filling up any vacancy in any employment in that establishment, report that vacancy or cause to be reported to such Career Centre from such date as may be specified in the notification by the State Government. (c) State Government shall provide for mechanism (including digital) for receipt of vacancies reported by the employers. Career Centre to which the vacancies are reported, would provide a unique vacancy reporting number for the vacancy reported and convey it to the employer in writing, through email or digitally or through any other such media immediately but in any case not later than three working days from the date of receipt of reporting of vacancies.

(i) the State Government or a Department of the State Government
(ii) a Government company as defined in clause (45) of Section 2 of the Companies Act, 2013 (Central Act 18 of 2013);
(iii) a corporation (including a co-operative society ) or an autonomous organization or an authority or a body established by or under a State Act, which is owned, controlled or managed by the State Government; and
(iv) a local authority. (II) “Establishment in private sector” means an establishment which is not an establishment in public sector and with ordinarily 50 or more employees or such number of employees as may be notified by the State Government. (2) Type of vacancies and respective Career Centre for reporting of vacancies: All vacancies in posts of Technical and Scientific nature carrying a minimum pay or pay level or both as notified by the state Government, occurring in establishments in respect of which the State Government is the appropriate Government under the Code shall be reported to the Career Centre concerned.

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(3) Form and manner of reporting of vacancies: (a) The vacancies shall be reported in writing or through valid official email or digitally to the Career Centre specified by the State Government. (b)The vacancies shall be reported in the format given at Form-XLI, furnishing as many details as practicable, separately in respect of each type of vacancy.

i) Total number of employees (regular, contractual or fixed term employment) on 31st March of every year;
ii) Persons recruited during the year ending on 31st March;
iii) Occupational details of its employees on 31st March of every year;
iv) Vacancies for which suitable candidates were not available during the year ending on 31st March; and (b) State Government may by notification, require that from such date as may be specified in the notification, the employer in every establishment in private sector or every establishment pertaining to any class or category of establishment in private sector shall maintain records manually or electronically or digitally about

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i) Total number of employees (regular, contractual or fixed term employment) on 31st March of every year;
ii) Persons recruited during the year ending on 31st March;
iv) Vacancies for which suitable candidates were not available during the year ending on 31st March; and (6) Submission of returns: An employer shall furnish to the Career Centre concerned yearly returns inform EIR (Employment Information Return) as given at Form-XLII. Yearly returns shall be furnished manually or, electronically, or digitally, as the case may be, as specified by the respective State Government in notification, within thirty days of the due date namely 31st March of the year. (7) Declaration of Executive Officer: The Director of Employment or officer of his equivalent or above rank, controlling the work of Career Centres of the State Government, will declare in writing an enforcement /implementation of Chapter XIII (Employment Information and Monitoring) of the Code. He shall be the officer who shall exercise the rights and perform duties referred to in Section 139 of the Code, or authorize any person in writing to exercise those rights and perform duties.

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FORM I

[(See Rule 24)]

Nomination/Fresh Nomination/Modification of

Nomination (Strike out the words not applicable) To. (Give here name or description of the establishment with full address) 1, Shri/Shrimati/Kumari ………………………… (Name in full here) whose particulars are given in the statement below, hereby nominate the person(s) mentioned below/ have acquired a family within the meaning of clause (33) of Section 2 of Code on Social Security, 2020 with effect from the ………………………… (date here) in the manner indicated below and therefore nominate afresh the person(s) mentioned below to receive the gratuity payable after my death as also the gratuity standing to my credit in the event of my death before that amount has become payable, or having become payable has not been paid and direct that the said amount of gratuity shall be paid in proportion indicated against the name(s) of the nominee(s). Or 1, Shri/Shrimati/Kumari ............................................. (Name in full here) whose particulars are given in the statement below, hereby give notice that the nomination filled by me on date ............................................. and recorded under your reference No............................................. dated............................................. shall stand modified in the following manner-

meaning of clause(33) of section 2 of the Code on Social Security,2020.

3. I hereby declare tha t I have no family within the meaning of clause (33) of section 2 of the said Code.
1. 4 (a) My father/mother/parents is/are not dependent on me.
(b) My husband's father/mother/parents is/are not dependent on my husband.
1. I have excluded my husband from my family by a notice dated the........ to the Competent Authority in terms of clause (33) of Section 2 of the said Code.
1. Nomination made herein invalidates my previous nomination.

Nominee(s)

| S.No. | Name in full with full address of nominee(s) | Relationship with the employee | Age of nominee | Proportion by which the gratuity will be shared | | --- | --- | --- | --- | --- | | 1. 2. 3. So on | | | | | (Here give details as to how a family was acquired, i.e., whether by marriage or parents being rendered dependent or through other process like adoption)

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Statement

1. Full Name of employee
1. Sex
1. Religion
1. Whether unmarried/married/widow/widower
1. Department/Branch/Section where employed
1. Post held with Ticket No. or Serial No., if any
1. Date of appointment
1. Permanent address: Village.....................Taluk.....................District........................................ State............................ Post Office..................... Pin.......................... ID No....................... Mobile No....................... Email ID....................... Date: Signature/Thumb-impression of the Employee

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Certificate by the Employer

Certified that the particulars of the above nomination have been verified and recorded in this establishment. Employer's Reference No., if any Signature of the employer/Office rauthorised Designation Date: Name and address of the establishment and Stamp thereof.

Acknowledgement by the Employee

Received the duplicate copy of nomination in Form-I filed by me and duly certified by the employer. Date:.................................................................. Signature of the Employee

FORM-II

[See Rule 25]

Application for Gratuity by an Employee/Nominee/Legal heir

(Strike out the words not applicable)

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To................................................................................................................................................................................................................................................................ (Give here name or description of the establishment with full address) Sir/Madam, I,...........................................................................(name of employee/nominee/legal heir)/nominee of late...........................................................................(Name of the employee)/as a legal heir of late...........................................................................(Name of the employee), hereby apply for payment of gratuity to which I am entitled under sub-section (1) of section 53 of the Code on Social Security, 2020 on account of-

(a) my superannuation/retirement/resignation after completion of not less than five years, three years in case of working journalists, of continuous service/total disability due to accident/total disability due to disease/on termination of the contract period under fixed term employment with effect from the …………… or;
(b) death of aforesaid employee while inservice/superannuation on .................. after completion of ..................years service/total disablement of the aforesaid employee due to accident or disease while in service with effect from the .................. (date)or;
(c) death of aforesaid employee of your establishment while in service/superannuation on...................................(date) without making any nomination after completion of ...... years of service/total disablement of the aforesaid employee due to accident or diseases while in service with effect from................(date) Necessary particulars relating to my appointment are given in the statement below.
1. Name of employee in full, (if, the gratuity is claimed by an employee)
a. Marital status of employee(unmarried/married/widow/widower)
b. Address in full of employee or Name of nominee/legal heir, (if the gratuity is claimed by nominee/legalheir)
c. Name of Employee

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d. Marital status of nominee/legal heir(unmarried/married/widow/widower)
e. Relationship of nominee/legal heir with the employee
f. Address in full of nominee/legal heir
g. Date of death and proof of death of the employee
h. Reference No. of recorded nomination if available
1. Department/Branch/Section where last employed
1. Post held by employee.
1. Date of appointment.
1. Date and cause of termination of service
1. Date of Death
1. Total period of service of the employee
1. Wages last drawn by the employee.
1. Total gratuity payable to the employee/ share of gratuity claimed by a nominee/legal heir.
1. Payment may please be made by crossed bank cheque/credit in my bank account No.________of _______________ Bank at _______________ branch having IFSC Code _______________ Place: Yours faithfully Date : Signature/Thumb-impression of the applicant employee/nominee/legal heir

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FORM III

[See Rule26]

Notice for Payment/Rejecting claim of Gratuity

(Strike out the words not applicable) To................................................................................................................................................................................................................................................................ (Name and address of the applicant employee/nominee legal heir) You are hereby informed that

(a) *as required under clause (ii) of sub-rule (1) of rule 24 of Kerala Social Security Rules,2021,that your claim for payments of gratuity as indicated on your application in Form-II under the said rules is not admissible for the reasons stated below: Reasons (Here specify the reasons); or
(b)* as required under clause (i) of sub-rule (1) of Rule 24 of the Kerala Social Security Rules,2021 that a sum of Rs.………………… (Rupees…………………………………) is payable to you as gratuity/as your share of gratuity in terms of nomination made by ……………… on………………………… and………………………… recorded in this ……………………… as a legal heir of ……………………………… an employee of this establishment.
(i) * Please call at ………………………………………… (Here specify place) ………………………………………… (date) at ………………………………………… (time) for collecting your payment of gratuity crossed cheque.
(i) Amount payable shall be sent to you through demand draft or shall be credited in your bank account as desired by you.
(iv) Brief statement of calculation
Date of appointment.
Date of termination/superannuation/resignation/disability/death.
Total period of service of the employee concerned: .................... Years ...................months.

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Wages last drawn:
Proportion of the admissible gratuity payable in terms of nomination/as a

Legal heir:

Amount payable: strike out para, if, not applicable Place: Date: Signature of the Employer/authorized officer. Name or description of establishment or Copy to: The Competent Authority in case of denial of gratuity.

FORM-IV

[See Rule 28]

Application for Direction

Before the Competent Authority for Chapter III under the Code on Social Security,

2020 Application No. BETWEEN (Name in full of the applicant with full address) AND (Name in full of the employer concerned with full address)

1. The applicant is an employee of the above-mentioned employer/ a nominee of late _______________ an employee of the above mentioned employer/ a legal heir of late _______________ and employee of the above- mentioned employer, and is entitled to

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payment of gratuity under section 53 of the Code on Social Security, 2020 on account of his own/aforesaid employee's superannuation on .................... date his on retirement/ aforesaid employees resignation on .................... (date) completion of ......... years of continuous service/ his own/aforesaid employees total disablement with effect from .................... (date) due to accident/disease death of aforesaid employee on ....................

2. The applicant submitted an application under Rule............. of the Kerala Social Security Rules,2021 on the ...............(date) but the mentioned employer refused to entertain it/issued a notice dated ..................... the under clause .................... of sub-rule..................... offering an amount of gratuity which is less than my due/issued a notice dated ..................... the under clause .................... of sub-rule .................... of rule ............... rejecting my eligibility to payment of gratuity. The duplicate copy of the said notice is enclosed.
1. The applicant submits that there is a dispute on the matter (specify the dispute).
1. The applicant furnishes the necessary particulars in the annexure hereto and prays that the Competent Authority may be pleased to determine the amount of gratuity payable to the petitioner and direct the above-mentioned employer to pay the same to the petitioner.
1. The applicant declares that the particulars furnished in the annexure hereto are true and correct to the best of his knowledge and belief. Place Date: Signature/Thumb impression of the applicant.
1. Full name and address of the applicant :
1. Basis of claim (Death/Superannuation/Retirement/Resignation/Disablement of Employee/Completion of contract period under Fixed Term Employment)

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1. Full Name and address of the employee
1. Marital status of the employee(unmarried/married/widow/widower)
1. Name and address in full of the employer
1. Department/Branch/Section where the employee last employed (if known)
1. Post held by the employee with Ticket or Sl. No., if any (if known)
1. Date of appointment of the employee (if known)
1. Date and cause of termination of service of the employee (Superannuation /retirement / resignation/disability/death/completion of contract period under Fixed Term Employment)
1. Total period of service by the employee
1. Wages last drawn by the employee
1. If the employee is dead, date and cause thereof
1. Evidence/witness in support of death of the employee
1. If a nominee, No. and date of recording of nomination with the employer
1. Evidence/witness in support of being a legal heir if a legal heir
1. Total gratuity payable to the employee (if known)
1. Percentage of gratuity payable to the applicant as nominee/legal heir Place: Date: Signature/Thumb-impression of theapplicant

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FORM V⁻

(strike out the words not applicable) To, (Name and address of the employer/applicant) Whereas Shri/Smt/Kumari ...................... an employee under you/a nominee(s)/legal heir(s) of Shri./Smt/Kumari.......................... an employee under the above mentioned employer, has/have filed an application under rule 28 Kerala Social Security Rules,2021 alleging that---- (A copy of the said application is enclosed, and if, summons is issued then copy of application is not required) Now therefore, you are hereby called upon/summon to appear before the Competent Authority at ........................................... (Place) either personally or through a person duly authorised in this behalf for the purpose of answering all material questions relating to the application on the ...........................day of ....................... 20............. at ...................O’Clock in the forenoon/afternoon in support of/to answer the allegation; and as the day fixed for your appearance is appointed for final disposal of the application, you must be prepared to produce on that day all the witnesses upon whose evidence, and the documents upon which you intend to rely in support of your allegation/defence. Take notice that in default of your appearance on the day before-mentioned, the application will be dismissed/heard and determined in your absence. Whereas your attendance is required to give evidence/you are required to produce the documents mentioned in this list below, on behalf of ............ in the case arising out of the claim for gratuity by .................... from ....................and referred to this Authority by an application under section 56 of the Code on Social Security, 2020, you are hereby summoned to appear personally before this Authority on the ............ day of ............

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20.………………… at ………………… O’clock in the forenoon/afternoon and to bring with you for to send to this Authority) the said documents. List of documents-

1.
1. ...... Given under my hand and seal, this .................. day of .................. 20........ Competent Authority under the Code on Social Security Code 2020
Note 1. Strike out the words or paragraph portions not applicable
1. The summons shall be issued in duplicate. The duplicate is to be signed and

Returned by the persons served before the date fixed.

3. In case the summons is issued only for producing a document and not to give evidence it will be sufficient compliance to the summons if the documents are caused to be produced before the Competent Authority on the day and hour fixed for

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FORM VI

[See rule 36 & 37 (9)]

Notice for Payment of Gratuity as Determined by Competent/Appellate Authority

(Strike out the words not applicable) (Name and address of employer)

1. Whereas Shri/Smt./Kumari....................... of an employee............................................ (address) under you/a nominee(s)/legal heir(s) of late .............................................. and employee under you, filed an application under Section 56 of the Code on Social Security, 2020, before me; or Whereas a notice was given to you on ........................................ requiring you to make payment of Rs........................................ to Shri/Smt/Kumari ........................................ as gratuity under the Code on Social Security, 2020.
1. And whereas the application was heard in your presence on ………………………… and after the hearing have come to the finding that the said Shri./Smt./Kumari…………………………… is entitled to a payment of Rs.…………………………… as gratuity under the Code on Social Security, 2020; or Whereas you/the applicant went in appeal before the appellate authority, who has decided that an amount of Rs.............. is due to be paid to Shri/Smt/Kumari.... ........ ............. as gratuity due under the Code on Social Security,2020. Now, therefore, I hereby direct you to pay the said sum of Rs............................. to Shri./Smt./Kumari............................. within thirty days of the receipt of this notice with an intimation thereof to me. Given under my hand and seal, this the day of ............................................ 20................

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Competent Authority under the Code on Social Security Code, 2020 Copy to:

1. The Applicant- who is advised to contact the employer for collecting payment.
1. The Appellate Authority if applicable. Note.---(Strike out paragraphs if not applicable)

FORM VII

[See rule 38]

Application Before the Competent Authority

Recovery of Gratuity Application No. Date BETWEEN (Name in full of the applicant with full address) AND (Name in full of the employer/Trust/Insurer concerned with full address)

1. The applicant is an employee of the above mentioned employer/a nominee of late........................................... an employee of the above mentioned employer/legal heir of late ........................................... an employee of the above mentioned employer, and you were pleased to direct the said employer in your notice dated the ........................................... under rule 36/37 Kerala Social Security Rules, 2021 for payment of a sum of Rs........................................... as gratuity payable under the Code on Social Security,2020.
1. The applicant submits that the said employer failed to pay the said amount of

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gratuity to me as directed by you although I approached him for payment.

3. The applicant therefore prays that a certificate may be issued under section 129 of the Code for recovery of the said sum of Rs....................... due to me as gratuity in terms of your direction. Signature/Thumb-impression of applicant. Place: Date: Note. Strike out the words not applicable.

FORM VIII

REGISTER OF GRATUITY

[See Rule 39]

1. Serial No.
1. Date of the application
1. Name and address of the applicant
1. Name and address of the employer
1. Amount of gratuity claimed
1. Dates of hearing
1. Findings with date
1. Amount awarded
1. Cost, if any, awarded
1. Date of Notice issued for payment of gratuity
1. Date of appeal, if any
1. Decision of the appellate authority

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1. Date of issue of Final Notice for payment of gratuity
1. Date of payment of Gratuity by employer and mode of payment
1. Date of receipt of application for recovery of gratuity
1. Date of issue of recovery certificate
1. Date of recovery
1. Remarks if, any :
1. Signature
1. Date

FORM IX

[See rule 41]

Notice of Fatal Accidents

To ................................................................................... (Competent Authority) Sir,

1. I have the honour to submit the following report of an accident which occurred on ...................(date), at....................... (here enter details of premises) and which resulted in serious body injuries / death of the employee/employees of whom particulars are given in the statement annexed.
1. The circumstances relating to serious body injuries / death of the employee/employees were as under:-
(a) Time of accident.
(b) Place where the accident occurred.
(c) Manner in which deceased/injured was/were employed at the time.

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(d) Cause of the accident.
(e) Any other relevant particulars. (Signature and designation of person making the report)

Statement

| Name | Sex | Age | Nature of | Full postal address | | --- | --- | --- | --- | --- | | | | | Employment | Mobile No & Mail Id |

FORM X

[See sub -rule (1) of rule 46]

Deposit of Compensation of Fatal Accident

1. Compensation amounting to Rs.is hereby presented for deposit in respect of injuries resulting in the death of the employee, whose particulars are given below, which occurred on. Name __ Father’s Name (Husband’s name in case of married woman and widow) ___________ Local address __ Permanent address __

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His/her monthly wages are estimated at Rs.He/She was over/under the age of 15 years at the time of his/her death _______________ | Rs. | on__________________ | Rs.____________________ | on____________________ | Rs. | | --- | --- | --- | --- | --- | | ____________________ | on____________________ | Rs.____________________ | on____________________ | Rs. | | ____________________ | on____________________ | Rs.____________________ | on____________________ | Rs. | | ____________________ | on____________________ | Rs.____________________ | on____________________ | | Amounting to all toRs._____________________.

3. An advance of Rs.____________________Has been made on account of compensation to ______________being his/her dependent.
1. I do not desire to be made a party to the proceedings for distribution of the aforesaid compensation. Dated________20. (Employer)

FORM XI

[See rule 46 & 49]

Receipt of Compensation

[Deposited under sub section (1) Section 81 of the Social Security Code, 2020] Book No......................... Receipt No................ Register No.....................

Depositor................................................................................................................................................................................................................................................................ Deceased or injured employee Date of deposit 20 Sum deposited Rs............

FORM XII

[See sub- rule (1) of rule 46]

Deposit of Compensation for Non-Fatal Accident to a Woman or Person under

Legal Disability

2. The said injured employee has prior to the date of the deposit received the following half- monthly payments, namely: Rs.____________________on____________________Rs.____________________on ____________________Rs.____________________on____________________Rs. ____________________on____________________Rs.____________________on _______________Rs.on Dated Employer

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FORM XIII

[See sub-rule (3) of rule 46 ]

Statement of Disbursements

Serial No..................... Depositor........................................................................ Date.................................................................. Rs................................................................................................................................................................................................................................................................ Amount deposited.................. Amount deducted and repaid to the employer under the proviso to sub section (1) of Section 81. Funeral expenses paid........................................................................... Compensation paid to the following dependents: Name........................................................................ Relationship........................................................................ ....Rs Dated ................20 Total Competent Authority

FORM XIV

(See rule 48|

Application for Order for Deposit of Compensation

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The Competent Authority ...........................................(Place) residing at...........................................................................(Applicant) Versus Residing at (OppositeParty) ................................................................................................................................................................................................................................................................ It is hereby submitted that: --

(1) ………………………………………………………………………………………………………an employee employed by (a) contractor with the opposite party received personal injury by accident on …………………… arising out of and in the course of employment resulting in his death on the …………………… day of ___________20 The cause of injury was ……………… (here insert briefly in ordinary language the cause of the injury).
(2) The applicant(s) is/are dependents (s) of the deceased employee being his ____________.
(3) The monthly wages of the deceased amount is Rs.____________________. The deceased was over/under the age of 15 years at the time of his/her death.
(4) (a) Notice of the accident was served on the day of _______________.
(b) Notice was served as soon as practicable on _______________.
(c) Notice of the accident was not served (in due time by reason of)

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•

(5) The deceased before his death received as compensation the total sum of Rs.. The applicant(s) is/are accordingly entitled to receive a lump sum payment of Rs. You are, therefore, requested to award to the applicant the said compensation or any other compensation to which he may be entitled. Certified that the statement of facts contained in this application is true to the best of my knowledge and belief. Dated this the ........ day of ...............20........... Applicant.

FORM XV

[See rule 49]

Deposit of Compensation for Non-fatal Accidents, other than to a woman or

person under Legal Disability Compensation amounting to Rs.is hereby presented for depositing with respect of permanent/temporary injuries sustained by________________residing at, which occurred on_____________20___. Dated____20____ Employer

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FORM XVI

(See rule 69)

CERTIFICATE OF DISABILITY/DEATH

This is to certify that Shri/Smt ..................... Son/daughter of ..................... age ............years residing at..................... employed in ..................... Is died on..................... /was suffering from* ..................... due to** ..................... / not suffering from any disease ..................... which is/was attributable to his employment.

1. Temporary disablement

The disability is in my opinion of a temporary nature likely to last for ............years ............months.

He is temporarily unfit for work in his present employment and/or fit for employment in any other job where he is not exposed.

2. Permanent disablement

The disability is of a permanent nature and is assessed at ...............percent.

3. Death

Death is attributable to the contracting of the disease................... Place............................. Medical Inspector Date............................. Factories/Certifying Surgeon. Signature of the

of [^* Cancel out portions not applicable. ** Enter the name of the diseases (See Part A, B or C of Schedule III)]

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FORM XVII

(See rule 69)

ENDORSEMENT TO BE MADE BY MEDICAL BOARD IN CASE OF PERMANENT

DISABILITY OR DEATH This is to certify that Shri/ Smt ..................... Son/daughter of .....................aged ...................years, residing at.....................employed in..................... is /died on..................... /was suffering from* ..................... which is/was attributable to his being employed on/as**.....................

1. Permanent disablement

The disability is of a permanent nature and is assessed at ...............percent.

2. Death

This is to certify that the death of Shri/ Smt............. is attributable to contracting of the disease.................... (name of the disease) Place........................................................................... Medical Board Date........................................................................... Signature of the [^* Name of the disease ** Process/Occupation]

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FORM XVIII

[See rule (70)]

Notice to indemnifier

Whereas a claim for compensation has been made by ........................................applicant, against and the said......................... has claimed that you are liable under Section 85 (2) of the Social Security Code, 2020, to indemnify him against any compensation which he may be liable to pay in respect of the aforesaid claim. You are hereby informed that you may appear before me on-------------------------- and contest the claim for compensation made by the said applicant or the claims for indemnity made by the opposite party. In default of your appearance, you will be deemed to admit the validity of any award made against the opposite party and your liability to indemnify the opposite party for the compensation recovered from him. Dated __________ 20 __________. Competent Authority

FORM XIX

[See sub-rule (3) of Rule 70]

Notice to Person of Indemnify

Whereas a claim for compensation has been made by _____________applicant against _____________And the said _____________has claimed that _____________is liable under Section 85 (2) of the Social Security Code, 2020, to indemnify him against any compensation which he may be liable to pay in respect of the aforesaid claim, and whereas the said _____________on notice served has claimed that you __stand to him in the relation of a contractor from whom the

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applicant could have recovered compensation you are hereby informed that you may appear before me on____________________and contest the claim for compensation made by the said applicant or the claim for indemnity made by the opposite party____________________. In default of your appearance you will be deemed to admit the validity of any award made against the opposite party____________________and your liability to indemnify the opposite party for any compensation recovered from him. Dated __________ 20 __________. Competent Authority

Form XX

[See rule 72]

Notice Requiring Statement of Accident

Whereas I have received information that (1) ....................................................... an employee employed by you in (2) ....................................................... has died as the result of an accident arising out of and in the course of his employment, I hereby require you in accordance with Section 88 of the Social Security Code, 2020 to submit to me within thirty days of the receipt of this notice the enclosed Form with the particulars required in paragraphs 1, 2 and 3 and the particulars required in either paragraphs 4 or 5 duly filled in. in the event of your admitting liability to pay compensation, the necessary deposit must, under Section 88(2)) of the said Code, be made within thirty days of the receipt of this notice. Dated.................................................................................. Competent Authority

(1) Insert name of employee.
(2) Insert name of establishment.

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Form XXI

[See rule 72 & 73]

Reply Statement by the Employer

1. In reply to your notice dated the .........................20 ......................... which received by me on the .........................20 ......................... it is submitted that (1) ......................... residing at ......................... who is an employee over/under 15 years of age employed in (2) ......................... met with an accident on the .........................20 as a result of which he died on ......................... 20 ......................... The monthly wages of the deceased amounted to Rs.........................
1. The circumstances in which deceased met with his death were as follows:-
1. The deceased left the following dependents (3).
1. I admit liability to pay as compensation, on account of the deceased’s death, the amount of Rs.... which was/will be deposited with you on/before .....................20........
1. I disclaim liability to pay compensation on account of the deceased’s death on the following grounds. Employer. (Name of Establishment) & Stamp thereof
1. Insert name of employee.

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1. Insert name of establishment.
1. Insert names and addresses where known.

One of these paragraphs to be stuck out.

FORM XXII

[See rule 73]

Memorandum of agreement

It is hereby submitted on the day of __________20_________personal injury was caused to __________ resident at __________ by accident arising out of and in the course of __________ employment in _______. The said injury has resulted in temporary disablement to the said employee whereby it is estimated that he will be prevented from earning more than of his previous/any wages for a period of __________ months. The said employee has been in receipt of half-monthly payments, which have continued from the __________ day of ……20 until the continued from the day __________ of ………20 until the __________ day of __________20 amounting to Rs. in all. The said employee’s monthly wages are estimated at Rs. __________. The employee is over the age of 15 years will reach the age of 15 years on __________. It is further submitted that the............ employer of the said employee has agreed to pay, and the said employee has agreed to accept, the sum of Rs._____in full settlement of all and every claim under the Social Security Code, 2020, in respect of all disablement of a temporary nature arising out of the said accident, whether now or hereafter to became manifest. It is therefore requested that this memorandum be duly recorded.

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Dated______20 Signature of employer Witness Signature of employee Note. -- An application to register an agreement can be presented under the signature of one party: provided that the other party has agreed to the terms. But both signatures should be appended, whenever possible. Receipt (to be filed in when the money has actually been paid). In accordance with the above agreement, I have this day received the sum of Rs._________. Dated_______20.Employee The money has been paid and this receipt is signed in my presence.

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Witness Note. -- This form may be varied to suit special cases, e.g., injury by occupational disease, agreement when employee is under legal disability ,etc.

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FORM XXIII

[See rule 73]

Memorandum of Agreement

It is hereby submitted that on the______day of_______20-______personal injury was Caused to_________residing at by accident arising out of and in the course of his Employment in_________The said injury has resulted in permanent disablement to the said employee of the following nature, namely:- The said employee’s monthly wages are estimated at Rs.The employee is over the age of 15 years will reach the age of 15years on. The said employee has, prior to the date of the agreement, received the following payments, namely: -- Rs.________________________on________________________Rs.________________________on Rs.________________________on________________________Rs. ________________________on________________________Rs.________________________on Rs.on It is further submitted that the employer of the said employee has agreed to pay, and the said employee has agreed to accept, the sum of Rs._____________in full settlement of all and every claim under the Social Security Code, 2020 in receipt of the disablement stated above and all disablement now manifest. It is therefore requested that this memorandum be duly recorded. Dated________20. Signature of employer Witness

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Witness Signature of employee Note. -- Application to register an agreement can be presented under signature of one party: provided that the other party has agreed to the terms. But both signatures should be appended, whenever possible. Receipt (to be filled in when the money has actually been paid) In accordance with the above agreement, I have this day received the sum of Rs._________. Dated________________20. employee The money has been paid and this receipt signed in my presence. Witness Note. -- This form may be varied to suit special cases, e.g. injury by occupational disease, agreement when employee is under legal disability, etc.

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FORM XXIV

[See rule 73]

Memorandum of Agreement

It is hereby submitted that on the __________ day of 20__ personal injury was caused to ______________ residing at __________ by accident arising out of said in the course of employment in ___________. The said injury has resulted in temporary disablement to the said employee, who is at present in receipt of wages amounting to Rs. __________ per month/no wages. The said employee’s monthly wages prior to the accident are estimated at Rs.__________.

The employee is subject to a legal disability by reason of. It is further submitted that the employer of the employee has agreed to pay and on behalf of the said employee has agreed to accept half-monthly payments at the rate of Rs. for the period of the said temporary disablement. This agreement is subject to the condition that the amount of the half-monthly payments may be varied in accordance with provisions of the said Code on account of an alteration in the earnings of the said employee during disablement. It is further stipulated that all rights of commutation under Section 80 of the said Code are unaffected by this agreement it is therefore requested that this memorandum be duly recorded. Dated________________20. Signature of employer Witness Signature of employee Witness

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Note. -- An application to register and agreement can be presented under the signature of one party : provided that the other party has agreed to the terms. But both signatures should be appended, whenever possible. Receipt (to be filled in when the money has actually been paid). In accordance with the above agreement, I have this day received the sum of Rs._________. Employee Dated __ 20. The money has been paid and this receipt signed in my presence. Witness Note. -- This form may be varied to suit special cases, e.g., injury by occupational disease, etc.

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FORM XXV

[See rule 75]

NOTICE OF HEARING

Whereas an agreement to pay compensation is said to have been reached between ________and________and whereas has/have applied for registration of the agreement under Section89 of the Social Security Code, 2020, notice is hereby given that said agreement will be taken into consideration on________20________and that any objections to the registration of the said agreement should be made on that date. In the absence of valid objections it is my intention to proceed to the registration of the agreement. Dated __________ 20 __________. Competent Authority

FORM XXVI

[See Rules 75(3) and 76 (4)]

REJECTION ORDER FOR HEARING

Take notice that registration of the agreement to pay compensation said to have been reached between you________________on the 20 ___________has been refused for the following reasons namely:----- Dated this the .................. day of .................. 20.................. Competent Authority

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FORM XXVII

[See Rule 76(2)]

NOTICE OF HEARING

Whereas an agreement to pay compensation is said to have been reached between and__________and whereas__________has/have applied for registration of the agreement under Section 89 of the Social Security Code, 2020 and whereas it appears to me that the said agreement ought not to be registered for the following reasons namely:_______________ An opportunity will be afforded to you of showing cause on 20____ why the said agreement should be registered. *If no adequate cause is shown on that date, registration of the agreement will be refused/ Any representation, which you have to make with regard to the said agreement, should be made on that date. If adequate cause in them shown, the agreement may be registered. Dated 20 . Competent Authority

Strike out whichever is not applicable.

FORM XXVIII

[See Rule 78]

Register of Memorandum accepted for the year...................._____.

| S.No. | Date of agreement | Date of registration | Employer | Employee | Initial of Competent | Reference to orders rectifying The register | | --- | --- | --- | --- | --- | --- | --- |

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| Authority | | | | | | | | --- | --- | --- | --- | --- | --- | --- | | 1 | 2 | 3 | 4 | 5 | 6 | 7 |

FORM XXIX

[See Rule 80]

Application for Compensation by workman

To the Competent Authority Applicant..................................................................................... residing at................................................................................................................................................................................................................................................................ Versus Opposite Party.........................residing at................................................................................................................................................................................................................................................................ It is hereby submitted that:-

(1) The applicant, an employee employed by ………………(contractor with) the opposite party on the ………………day ……………… of……………… 20…………………received personal injury by accident arising out of and in the course of his employment. The cause of the injury was..................(here insert briefly in ordinary language the cause of the injury)
(2) The applicant sustained the following injuries namely:--
(3) The monthly wages of the applicant amount of Rs. __over/under the age of 15 years.
(4) (a) Notice of the accident was served on

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the ......day of. The applicant is

(b) Notice was served as soon as practicable.
(c) Notice of the accident was not served (in due time) by reason of.
(5) he applicant is accordingly entitled to receive:--
(a) half monthly payment of Rs.________________________From the __20__to
(b) a lump sum payment of Rs........day of
(6) The applicant has taken the following steps to secure a settlement by agreement, namely, but it has proved impossible to settle the question in dispute because ___________. You are therefore requested to determine the following questions in dispute, namely: --
(a) Whether the applicant is an employee within the meaning of the Code;
(b) Whether the accident arose out of or in the course of the applicants employment;
(c) Whether the a amount of compensation claimed is due, or any part of that amount;
(d) Whether the opposite party is liable to pay such compensation as is due;
(e) etc., (as required) Date________________20. Applicant

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FORM XXX

[See Rule 80 (3)]

Application for Commutation

To The Competent Authority, ••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• residing at........................................................................Applicant Versus · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · residing at........................................................................... Opposite Party It is hereby submitted that–

(1) The applicant/opposite party has been in receipt of half monthly payment from _______to_______in respect of temporary disablement by accident arising out of and in the course of his employment.
(2) The applicant is desirous that the right to receive half-monthly payments should be redeemed.
(3) (a) The opposite party is unwilling to agree to the redemption of the right to receive half-monthly payments.
(b) The parties have been unable to agree regarding the sum for which the right to receive half-monthly payment should be redeemed. You are therefore requested to pass an order—

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(a) directing that the right to receive half-monthly payments should be redeemed.
(b) Fixing a sum for the redemption of the right to receive half-monthly payments. Dated________1 . Applicant Form XXXI [See Rule 93]

REGISTER OF APPLICATIONS FOR THE YEAR 20......

| Name of Application | | | | | | | | | | | | | Order | | | | | | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | | Date of presentation of the application | Serial No. | For distribution | For Deposit | For Compensation | For half-monthly payments | For commutation | For review | For recovery | Application for registration of | Miscellaneous | Name and address of applicant | Name and address of the opposite party | Claim | Date | For whom | For what amount | Appeal | | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | greement | 11 | 12 | 13 | 14 | 15 | 16 | 17 | 18 |

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Form XXXII [See Rule 94]

REGISTER OF FATAL ACCIDENTS FOR THE YEAR 20.......

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Form XXXIII [See Rule 95]

REGISTER OF NON-FATAL ACCIDENTS FOR THE YEAR 20......

| | | | | | Name of Injury | | Amount of compensation and monthly wages | | | | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | | S er ia l N o. | Date of infor matio n | Date of accide nt | Name of emplo yee injure d | Name of emplo yer | Perma nent | Tempo rary | Lump sum | Half mont hly | Date of disp osal | | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | | | | | | | | | | | |

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FORM XXXIV

[See rules 104 (1)(a)]

Register of wages and

Deduction | Employee code | Employee name | Name of father/husband | Sex | Date of Birth | Address | Photo | Identification Mark | Designation | Category (H S/S /SS /US ) | Designation code/ grade as in Government Order | Date of joining | Education Qualification | Date of Exit | Reason for Exit | | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 | 15 | | Mobile Number | E-mail ID | Bank Name | IFSC Code | Bank Account Number | Days of attendance | Loss of pay days | Number of weekly off granted | Number of Leave granted | Basic | DA | HRA | City Compensation allowances | Gross Monthly Wages | Overtime wages | | 16 | 17 | 18 | 19 | 20 | 21 | 22 | 23 | 24 | 25 | 26 | 27 | 28 | 29 | 30 | | Leave wages | National & Festival | Arrear paid | Bonus | Maternity Benefit | Other Allowances | Advance | Total Amount | Employees Providen | Employees Stat | Welfare Fund | Professional Tax | Tax Deductedat Source | Deduction of Fine | Deduction for Los |

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100

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101

FORM XXXV

[See rule 104 (1) (b), (c), (d)]

Muster Roll

Name of establishment........................................................................... Place ........................................ | Sl No. | Name | Fathers'/Husbands' Name | Sex | Date of Entry in Service | Designation/ category | | | | | | Total number of hours work performed | | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | | | | | | | | 1 | 2 | 3 | 4 | 5 | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | [^This is a digitally signed Gazette. Authenticity may be verified through https://compose.kerala.gov.in/]

102

FORM XXXVI

[See rule 104(1)(e)]

REGISTER OF EMPLOYEES

Name of the Establishment--------------------------------------------------Name of Employer------------------------------------------------- ---LIN--------------------------------------------------- | Sl . N o. | Employ ee Code | Nam e | Gend er | Father's/ Spouse Name | Dat e of Birth | National ity | Education Qualificai on | Date of joinin g | Designati on | | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | | Category (HS/S/S S/US) | Type of Employ ment | Mobi le Num ber | U A N | P A N | E S I C I P | L W F | AAD HAAR | Ba nk A/ c Num ber | Ba nk | Bran ch (IF SC) | Prese nt Addr ess | Perman ent | | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | | 11 | 12 | 13 | 14 | 15 | 16 | 17 | 18 | 19 | 20 | 21 | 22 | 23 |

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103

FORM XXXVII

[See rule 104(1)(g)]

REGISTER OF DANGEROUS OCCURRENCES, ACCIDENTS, INJURIES

Name and address of the Establishment: Name of the Employer / Contractor:

FORM XXXVIII

[See rule 104(1)(h)]

REGISTER OF CESS

Name and address of the Establishment: Name of the Employer: | Sl | Date of | Type of | Date of | Estimated | Advance | Mode | Balance | Tot | File No | | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |

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104

FORM XXXIX

[See rule 104(1)(i)]

REGISTER OF VACANCIES

Name and address of the Establishment: Name of the Employer: | Sl. No . | Total Number of employees | | | Persons recruite d upto 31st March . ..... year | Occupation al details of employees recruited | Number of unfilled vacancies/ posts | | | | --- | --- | --- | --- | --- | --- | --- | --- | --- | | | Regul ar | Contractu al | Fixed term employme nt | | | Skill/ Qualificatio n/ technical/ experience prescribed | Essenti al | Desirab le |

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105

FORM-XL

[See rule 106]

APPLICATION FOR COMPOUNDING OF OFFENCES

1. Name of applicant ................................................................................................................................................................................................................................................................
1. Father’s / Husband’s name of the applicant................................................................................................................................................................................................................................................................
1. Address of the applicant ............................. ................................................................................................................................................................................................................................................................
1. Mobile number/email
1. Name , address, Mobile no, and email of Complainant
1. whether any case pending before any authority or Court in the same matter If Yes, Particulars ................................................................................................................................................................................................................................................................
Particulars of the offences................................................................................................................................................................................................................................................................
Provisions of the Code/Scheme/Rules/Regulations under which the offence is committed:
Maximum fine provided for the offence under the Code..................................................................................
Whether the offence is first offence or the applicant had committed any other offence prior to the offence, if had committed, then, full detail of the offence

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106

Any other information which the applicant desires to provide

I, pray for the compounding of offences as stated above.
Dated:
Applicant (Name and signature)

## FORM XLI
[See Rule 108(3)]

## Form for Reporting Vacancies to Career Centres
To
Authorised Signatory
Career Centre
|  | **Particulars of the employer:**     Name:     Address :     Telephone No. :     Mobile No.:     Email address: |  |
| --- | --- | --- |

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107

|  | Name & Type of Establishment      (Central Government, State Government, PSU,      Autonomous, Private, etc)      Registration No of establishment under the Code:      Economic activity details: |  |
| --- | --- | --- |
| 2. | **Particulars of the indenting Officer:**      Name:      Designation:      Telephone No. :      Mobile No.:      Email address : |  |
| 3. | **Particulars of vacancy(ies):**      (a) Designation/nomenclature of the    **Vacancy(ies) to be filled**      (b) Description of duties of the post      (job role/functional role) |  |
| 4. | (c) Qualifications/Skills required   **(educational, technical experience)**   **(i) Educational Qualifications**   **(ii) Technical Qualification**   **(iii) Skills** | Essential/Desira     ble/Preferable |
| --- | --- | --- |

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108

|  | (v) Experience      (d) Age Limits, if any      (Age as on last date of application)      (e) Preferences (such as Ex-servicemen, persons with      Disabilities, women, etc) if any      (f) No of Posts      (i) 3-6 months      (ii) 6-12 months      (iii) 12 months and more |  |
| --- | --- | --- |
| 5. | Whether there is any obligation for arrangement for giving reservation/ preference to any category of      persons such as Scheduled Caste(SC), Scheduled Tribe(ST), Economically Weaker Sections(EWS), Other      Backward Classes (OBC), Ex-serviceman and persons with disabilities (pwd),etc, in filling up the vacancies : Yes/No.      ( if yes, give the number of vacancies to be filled by such categories of persons as detailed below) | |
|  | Category | Number of vacancies to be filled |
|  | (a) Scheduled Caste      (b) Scheduled Tribe      (c) OBC      (d) EWS      (e) Ex-Serviceman      (f) Persons with disabilities (pwd)      (g) women      (h) Others(specify) | Total *By Priority     candidates      * (Applicable     for Central     Government      Vacancies) |
| 6. | **Pay And Allowances :**      For Government vacancies: Mention pay level/pay      scale of the post with basic pay/pay per month with |  |
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109

|  | other details if any   For others: Mention minimum total emoluments   per month with other details, if any. |  |
| --- | --- | --- |
| 7. | Place of work ( Name of the town/village   anddistrict, pin code ,etc. in which it is situated) |  |
| 8. | Mode of Application(email, online, in writing, etc)   and Last date for receipt of applications. |  |
| 9. | Particulars of officer to whom the applications be   sent/candidates should approach   (Mention Name, designation, email id, address ,   telephone No., website address in case of online) |  |
| 10 | Mode of Recruitment   {Through Career Centre, Placement Agency , self-   management, any other mode(specify) } |  |
| 11. | Would like to prefer submission of list of eligible   candidates registered with Career Centre | Yes/No |
| 12. | Any other relevant information |  |
Signature, Name & Designation of Authorised Signatory of establishment/employer with seal & date
(For Office Use- to be filled by Career Centre
- 13. Date of receipt of Vacancies
- 14. NIC Code of the establishment/
- 15. NCO Code of the post
- 16. Unique Vacancy ID(number)

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110

Signature, Name& Designation of Authorised
Signatory
of Career Centre with seal & date

## NOTE:
- 1. Career Centre to which the vacancies are reported, would provide a unique vacancy reporting number for the vacancy reported and convey it to the employer in writing, through email or digitally or through any other such media immediately but in any case not later than 3 working days from the date of receipt of reporting of vacancies.
- 2. An employer, if advertises that vacancy in any media or makes recruitment through any agency or any other mode, may invariably quote that unique vacancy reporting number in that advertisement or recruitment process.
- 3. Any change in the particulars already furnished to the Career Centre, shall be reported
in writing or through
valid official email or digitally(including through a portal) as the case may be, to the
appropriate Career Centre.
- 4. Separate forms to be used for each type of posts.

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111

# FORM-XLII
[See Rule 108(6)]

## (Employment Information Return)
Yearly Return to submitted to the Career Centre (Regional) for the Year ended
...........................................................................
The following information is to be submitted under the Code on Social Security 2020.
| Name & Address of the Employer |  | |
| --- | --- | --- |
| Whether Head Office |  | |
| Branch Office   Type of Establishment   (Public /Private Sector) |  | |
| Nature of business/Principal activity |  | |
| **Establishment Registration No. under the   Code** |  | |
| 1. (a) **EMPLOYMENT**    Total number of *manpower of establishment* including working *proprietors/partners//contingent* paid and contractual workers, out-sourced workers excluding part-time workers and apprentices. (The figures should include every person whose wage or salary is *paid*). | | |
| Category | On the last working day of the previous Year | On the last   working day of   the Year under |
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|  |  | report |
| --- | --- | --- |
| MEN |  |  |
| WOMEN |  |  |
| Other |  |  |
| (Transgender) |  |  |
| TOTAL : |  |  |
| PWD (persons |  |  |
| with disabilities) |  |  |
| out of above total |  |  |
(EIR-continued)
- 2. Number of vacancies* occurred and reported to Career Centre during the year and the number of vacancies filled during the year
| Occurred | Reported | | Filled |
| --- | --- | --- | --- |
|  | Career Centre   (Regional) | Career Centre   (Central) |  |
| 1 | 2 | 3 | 4 |
|  |  |  |  |
*As per provisions of Code on Social Security, 2020(Chapter XIII) and Rules made there under,

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## 3. MANPOWER SHORTAGES:
Vacancies/posts remained unfilled because of shortage of suitable applicants.
| Name of the occupation or designation of the post | Number of unfilled vacancies/posts | |
| --- | --- | --- |
|  | Skill/ qualifications (educational / technical/ experience) prescribed | Essential |
| 1 | 2 | 3 |
|  |  |  |
(Please list any other occupations also for which this establishment had any difficulty in obtaining suitable applicants recently.)
- 4. Estimated Manpower Requirement by Occupational Classification during the next
calendar year (Please give below the number of employees in each occupation
separately).
| Occupation | Number of   employees   Please give as far as possible approximate   number of vacancies in each   occupation you are likely to fill during the next   financial year due to   retirement/ expansion   or re-organisation. |
| --- | --- |
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|  |  | | | |
| --- | --- | --- | --- | --- |
| Description | Men | Women | Others   (trans-   gender) | Total |
| 1 | 2 | 3 | 4 | 5 |
| * |  |  |  |  |
|  |  |  |  |  |
|  |  |  |  |  |
| Total : |  |  |  |  |
- In the column (description) -Use exact terms such as Engineer (Mechanical), Assistant Director (Metallurgist); Research Officer (Economist); Supervisor (Tailoring), Inspector (Sanitary), Superintendent (Office), Manager (Sales), Manager (Accounts), Executive (Marketing), Data Entry Operator....................so on.
Signature, Name & Designation of Authorised
Signatory
of establishment/ employer with seal
& date
To
The Career Centre,

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- Note:- 1. This return is to be rendered to the Career Centre (Regional) within 30 days after the end of the *financial year* concerned by establishments/employers vide their obligation under the Code on Social Security, 2020 (Chapter XIII-Employment Information and Monitoring).
- 2. The main purpose in obtaining the information from employers is to know (i) the vacancies/employment opportunities available; (ii) type of personnel who are in short supply; and (iii) future job opportunities for providing vocational guidance to the jobseekers and connecting them with the employers. This is helpful in ascertaining the skill needs also. Employers too will be able to call on the Career Centres for getting suitable candidates as per their requirements.

## ANNEXURE I
## GUIDELINES FOR DIAGNOSIS OF OCCUPATIONAL DISEASES
- 1. Infectious and Parasitic Diseases contracted in an occupation where there is a particular risk of contamination
Occupational Exposure:
Agricultural Work :
Hospitals, laboratories, clinics, autopsy rooms, etc work involving handling of animals
and their products (veterinary clinics, slaughter houses, meat and fish markets, etc.)
Outdoor work where animal excreta may be encountered ((work in canals, rivers, ditches, sewers, docks, farm yards, construction sites, etc)
Infectious and parasitic diseases and encountered in any other occupation.
Guidelines for Diagnosis:
- (i) Circumstantial evidence or risk of exposure.


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- (ii) Positive effects on the human system (clinical manifestations)
- (iii) Positive proof (direct/indirect) of the presence of the infective agents in the diseases person
Notes :- For full description, diagnostic methods, differential diagnoses, progronoses and treatment procedures of these diseases standard medical text books have to be referred to.

## 2. Diseases caused by work in compressed AIR
Occupational Exposer :
Caisson workers, canal tunnelers, divers, mines tunnelers, rail road tunnelers, road
tunnelers, seweretunnelers and air crews and air pilots flying high in a non-compressed cabin,
any other work involving exposure to the risk concerned.
Guidelines for diagnosis:
Clinical Manifestations:
Decompression Sickness Type I & II
Type I – Sudden diffuse pair in a limb joint (from mild discomfort to intense pain). The pain may be followed by crythematous rashes over the trunk and liching.
Type II – More severe from of acute decompression sickness. The Clinical manifestations may be related to respiratory, cardiovascular, nervous or occular system.
Respiratory Manifestations :
Substernal pain, tightness in chest, pain or deep breathing and inspiratory ‘snatch’
dysnoea and cough.
Cardiovascular manifestations:
Angina, irregular pulse, hypotension and collapse.
Neurological manifestations:
Headache, vertigo, tingling and numbness in the limbs, weakness, coma, paraplegia, paralysis of bladder.
Occular manifestations:
Flashers of light, scotomata
8.Chronic Decompression Sickness (Dysbaricosternecrosis)
The lesions are symptomless and produces no disability unless the juxta articular surface of the joint is involved. A progressive Juxta articular lesion results in the rupture of the articular surface and collapse of the joint with subsequent osteoarthritis. Commonly affected sites include

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the lower end of femur, the proximal part humerus and the proximal parts of the shaft of fibia and
humerus.
Useful Laboratory investigations:
Radiographs of upper part of humerus including shoulder, joint, upper part of femur including hip joint and knee joint including upper part of tibia and fibula showing characteristic lesions.
- 3. Diseases caused by lead or its toxic compounds
- (a) Poisoning by Lead Tetra Etiyl:
Occupational Exposure:
Storage tank cleaners, TEL blenders, TEL mixers or TEL makers, any other work
involving exposure to the risk concerned,`=
Guidelines for Diagnosis:
Clinical Manifestations :
Insomn ia, headache, nightmares, nervousness, irritability and vague gastro-intestinal symptoms.
Frequent episodes of maniacal behavior, fatigue, weakness, weight loss, muscular pains, temors, slow pulse and low blood pressure.
Severe cases show symptoms of acute toxic psychosis and encephalopathy.
Useful Laboratory investigations
Analysis of blood and urine for lead. Urine lead levels are more useful (above
0.15mg/litre).
- (b) Poisoning by Lead, its compounds or Alloys or its sequelae (Excluding poisoning by
lead Tetra Ethyl)
Occupational Exposures:
Workers is smelting and storage battery manufacturing plants, scrap workers, painters, potters, workers in the ceramic industry, foundry workers, any other work involving exposure to the risk concerned.
Guidelines for Diagnosis:
Clinical Manifestations :

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Pallor, loss of weight, lassitude, constipation, abdominal colic and tenderness, nocturia,
albuminuria, numbness and tringling of extremities, tremors, headache, izzinessm mental
confusion and delinium, acute or chronic encephalopathy, optic reuritis, anemia, erythrocyte
stippling, blue line over the gums.
Useful Laboratory Investigations
- (i) Elevated levels of lead in blood and urine
- (ii) The activity of delta aminolevulinate dehydratase (ALAD) in blood.
- (iii) The amount of delta-aminoleuvlinic acid (d-ALA) in urine
- (iv) The amount of coproporphyrin in urine
- (v) The concentration of zinc protoporphyrin (Znpp) in red blood cells.

## 4.Poisoning by Nitrous Fumes
Occupational Exposure:
Brass cleaners, braziers, bright dip workers, bronze cleaners, copper cleaners, cotton
bleachers, electric arc welders, electric- platers, nitrate workers, nitric acid makes oxidized
cellulose compound makers, raw silk bleachers and silo fillers, any other work involving
exposure to the risk concerned.
Guidelines for Diagnosis:
Irritation of eyes and upper respiratory tract and yellow staining of teeth and skin.
Cough and chest pain followed by a 5 to 12 hours of symptoms free period.
Subsequently, the onset of signs and symptoms of acute pulmonary oedema. Death may result
within 24 hours. If the acute episode is survived ,sequelae such as bronchitis or emphysema may
develop.
Useful Laboratory Investigations
- (i) Chest Radiography. The pulmonary oedema following exposure to the nitrous fumes may be diagnosed by chest radiography.
- (ii) Decrease in blood PH; serum proteins.
- (iii) Increase in urinary hydroprolinic and mucopolysacharrides


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## 5. Poisoning by Organophosphrous Compounds
Occupational Exposure:
Workers involved in the manufacturing and formulation of the pesticides, spraymen, farm workers and those engaged in stocking transportation, application storage and distribution of the pesticides, any other work involving exposure to the risk connected.
Guidelines for Diagnosis :
Clinical Manifestations:
Acute:
Gastro-intestinal Excessive salivation, nausea, vomiting pain in abdomen, diarrhoeatenesmusand involuntary defaccation.
Respiratoty :- Tightness in chest, cough, wheezing expiration.
Eyes :-Lacrimation, bluming of vision, loss of accommodation, reflex, miosis
Cardiovascular – Brady – cardia, that may progress to heart-block(muscarinic effects) or tachycardia, allure elevation of blood pressure (nicotinic effects)
Musculo-skeletal-Muscular weakness, involuntary twitching and cramps progressing to generalized fasciculations,
Neurological – Headache, anxiety, restlessness, insomnia, slurred speechneurosis,
ataxia, generalized weakness, polyneuropathy has been described as a late complication of some
organo phosphorous compounds
Useful Laboratory Investigations
Inhibition of cholinesferase activity in red cells, plasma and whole blood.
Demonstration of pesticides residue in the blood.

## 6. Diseases caused by Phosphorus or its Toxic Compounds

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Occupational Exposure:
Bronze alloy makers, electroluminescent coating makers, metallic phosphide makers,
metal refiners, incendiary makers, munition workers, pesticide workers, phosphoric acid makers,
match factory workers, rat poison makers, semi conductor makers, smoke bomb makers; any
other work involving exposure to the risk concerned.
Guidelines for Diagnosis :
Acute:
Due to ingestion of yellow phosphorus, Local: Gastrointestinal irritation followed by systemic poisoning and shock. If patient survives the acute episode, death may occur at a later stage due to liver, kidney or heart failure brought about by the direct action of the phosphorus compounds. Inhalation of phosphorous fumes may lead to pulmonary oedema.
Chronic:
The chronic effects of phosphorus are mainly on bones (mandible) and liver. Periostitis with suppuration and ulceration may develop, followed by bone necrosis and severe deformity of mandible (phossy jaw). Maxilla also may be affected. Liver damage leads to the symptoms and signs of toxic hepatitis. Dermatitis and non-specific respiratory symptoms have been associated with phosphorus exposure.
Useful Laboratory Investigations:
- (i) X-ray of jaws.
- (ii) Liver function testis.

## 7. Diseases caused by Mercury or its Toxic Compound
Occupational Exposure:
Mercury ore mining, production or metallic mercury in metallurgy production of sodium
and potassium hydroxide, dyes, fluorescent lamps, production and repair of electrical measuring
devices, laboratory instruments, amalgam production in dentistry, seed treatment and wood

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protection by organic mercurial compounds; any other work involving exposure to the risk concerned.
Guidelines for Diagnosis :
Clinical Manifestations:
Acute:
Results from ingestion of mercury. The symptoms are due desequamation necrosis and bleeding of the gastro-intestinal mucosa. Inhalation of massive amount of mercury vapour leads to chemical pneumonitis.
Chronic:
Tremors of hands, which seriously impairs the ability to carry out fine and complex
movements such as hand-writing, erethism refers to a form of organic psychosis, characterised by
excessive timidity, irritability, an abnormal resentment of criticism and outburst of temper, ataxia
resulting in difficulty in walking. In methyl mercurial poisoning, cerebellar ataxia, dysarthria and
construction of the visual fields predominate the clinical picture.
Useful Laboratory Investigations:
- (i) Inorganic Mercury: Quantitative assessment of mercury in urine by atomic absorption spectrophotometer.
- (ii) Organic Mercury: Estimation of organic mercury in plasma and red cells.

## 8. Diseases caused by Benzene or its Toxic Homologues
Occupational Exposure:
Petrochemical workers, workers in laboratory and in industries using benzene, synthetic
glue makers, users of anything glues in the manufacture of shoes leather or rubber goods and
furniture, dye makers, printers (in rotogravure particularly), paint sprayers and other work
involving exposure to them risk concerned.
Guidelines for Diagnosis :
Clinical Manifestations:

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Acute:
Headache, dizziness, confusion, feeling of drunkcheck staggering gait, coma and death due to respiratory failure.
Chronic:
Early changes (Reversible).- Qualitative or quantitative deficiency of platelets associated with clothing defects and purpura, mild haemolyticaemia, splenomegaly, raised serum bilirubin levels, mild hyperplasia of bone marrow, red cell stippling, granulocytopenia, monocytosis and lymphocytosis.
Late Changes (Irreversible).- Pancytopenia with a hyperplastic marrow picture progressing to an aplastic anaemia. Elevations in serum iron and secondary clinical features resulting from anaemia, disturbed immunological mechanisms and interstitial haemorrhages in parenchymatous organis. Lymphoid and myeloid leukaemia have also been observed as late complications.
Non-hematological effect of chronic benzene poisoning is behavioural changes and
impairment of labyrinthine/vestibular system. Exposure to high concentration of benzene may
produce myocardial changes and cardiac dysrhythmias.
Useful Laboratory Investigations:
- 1. Estimation of urinary sulfates (inorganic/total Sulfates).
- 2. Estimation of phenel levels in Urine.
- 3. Hameatological examinations:
- (i) bocyce count.
- (ii) Differential leycocyte count
- (iii) Measurement of bleeding time.

## 9. Diseases caused by Toxic Nitro and Amino Derivates of Benzene or its Homologues
(a) Aniline
Occupational Exposure:


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Chemical and rubber workers, dye makers and vulcanizers, any other work involving
exposure to the risk concerned.
Guidelines for Diagnosis :
Clinical Manifestations:
Aniline absorption causes anoxia owing to the formation or methaemeplobin.
Acute poisoning.- The development of methaemoglobinemia is often insidious. Following skin absorption, the onset of symptoms may be delayed for upto four hours. Headache is commonly the first symptom and may become quite intense as the severity of methaemoglobinemia progress. Cyanosis occurs when the blood level of methaemoglobin exceeds 15g. per 100g. haemoglobin. Coma may ensure about 70g/100g. and the ethal level is estimated at 85.90g./100g. hemoglobin. Erythrocytic inclusions (Heinz bodies) develop in serious poisoning, but haemolysis is rare.
Chronic poisoning.- Although liver damage and cerebral effects from repeated exposure to
aniline have been alleged, the general view is that there are no chronic effects.
Useful Laboratory Investigations:
The Measurement of pnitrophenol in urine at the end of the workshift is the method of choice.

## 10. Disease caused by Chromium of its Toxic Compounds
Occupational Exposure:
Workers in industries producing mono and dichromate and ferrochromium alloys, stainless steel welders, chromium platers, furniture polishers, chromium pigment spray painters, leather tanners and other leather workers, cement producers and building workers, printers and photographic technicians; any other work involving exposure to the risk concerned.
Guidelines for Diagnosis :
Clinical Manifestations:
Allergiodermatitis (contact dermatitis) and asthmatic type of reactions are important effects of chronic exposure to chromium. Higher incidence of lung cancer has been reported among the individual occupationally exposed to chromium compounds.
Chrome Ulcers are usually found on the finger roots and on the finger knuckles. The skin

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ulcers may be very deep (chrome holes). They are circular well demarcated lesions, which look
as though they have been punched out of the skin. Pain is very little in absence of secondary
infection. Chrome ulcers on the nasal septum result in nasal perforation and chronic rhinitis.
Useful Laboratory Investigations:
The determination chromium concentration in erythrocytes is useful indicator of chromium exposure even upto 7-8 weeks after a single high dose exposure.

## 11. Diseases caused by Arsenic and its Toxic Compounds
Occupational Exposure:
Miners, ore smelters, workers in refineries, pesticide formulators and handlers; manufacture of food preservatives; metallurgy and electronic industry workers and lacquer industry workers; any other work involving exposure to the risk concerned.
Guidelines for Diagnosis :
Clinical Manifestations:
(a) Acute poisoning:
Ingestion: Severe vomiting, diarrhea, shock, dehydration, muscular cramps, facial oedema and cardiac abnormalities.
Inhalation: Rhnitis, pharyngitis, latyngitie.
Skin Contact: Contact dermatitis, follicultis, oczemataus, eruption and olceration.
(b) Chronic poisoning
Skin: Pigmentation, herpetic lesions around the mouth, hyperkeratosis of plams and soles and rarely skin cancer.
Respiratory: Preformations of nasal septum, chronic bronchitis and possibly basilar fibrosis of lungs.
Vascular system: Endangitisobliterans, acrodermatitis.
Haemopoetic system: Normochronic anaemias, neutropenia adthrombocytopenia. In addition
cirrhosis of liver may also occur.
Useful Laboratory Investigations:
- (i) Analysis of urine, hair or nail for arsenic.
- (ii) X-ray chest.


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- (iii) Liver function tests.
- (iv) Renal function tests.

## 12. Diseases caused by Ionizing Radiation
Occupational Exposure:
Persons at greatest risks of exposure to ionizing radiation include uranums miners and
mill workers, nuclear reactor and atomic energy plant workers; industrial radiographers(including
those doing field work involving  pipeline welding); certain personnel (radiologists), workers
employed in the production of radionuclides; scientists using radioactive material for research
and luminous dial painters; any other work involving exposure to the risk concerned.
Guidelines for Diagnosis
Clinical Manifestations:
Acute:
Whole body irradiation-Irradiation of the whole body with over 1 Gy of penetrating
radiation in a single exposure or over 1-2 days results in the so called acute radiation syndrome,
which is characterised by cell damage and death in the exposed tissues.
Dose of 1-2.5 Gy produce prodormal symptoms (nausea, vomiting, fatigue) and early
heamatological charges particularily early lymphocytopenia and transient leukoytosis. After a
latent phase, radiation induced suppression of bone marrow leads to leukopenia, thromboenia and
anaemia.
Local irradiation: Accidental exposure of parts of the body usually of the hands in occupational exposure-is more frequent than whole body irradiation.
Chronic.- Chronic relation sickness may occur in individuals who have been repeatedly exposed to ionizing radiation over a long period (several years) during which the total cumulative dose has reached at least 1.5- 4Gh.
Mild forms area revealed by the present of elightneuroregulatory disorders (slight
imbalance of the autorromic nervous system, tendency towards arterial hypotention, tachycardia
and sinus arthrythmia, dyskinesis of the intestine and the biliary tract, general excitability) and
moderate and unstable leucopenia. In more advanced cases the changes become more severe and
stable. There is a further progression of autonomic nervous disorders, inhibition of the secretary
function of the stomach, the appearance of clinical and electrocardiographic indications of

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dystrophic changes in the myocardium, persistent arterial hypotension, signs of microstructural
changes in the central nervous system, ovarian dysfunction (hypomenorrhoes and
oligomenorrhoes) in women, bone marrow hypoplapsia with persistent loukopenia (both
granulocytopenia and lymphocytopenisa) and less persistent thrombocytopenia.
Useful Laboratory Investigations:
The biological specimen (urine, blood faces, expired air etc.) is selected in relation to the target organ of the toxic substance in question. Radioactivity is measured directly or after separation of the radioactive substance by radio-chemical methods. There is also the possibility of measuring the content of some radionuclides directly by whole-body counters, scintillation detectors, etc.

## 13. Primary Eipthelimatous cancer of the Skin
Occupational Exposure:
Arsenic, tar, pitch, mineral oil, anthraneene and compounds, products and residues of these substances and exposure to radation and radio active substances; any other work involving exposure to the risk concerned.
Guidelines for Diagnosis
Long term exposure to careinogenes produce following change in the skin. Irregular areas of atrophy; patchy hyperpigmentation and hypopigmentation, work-like papillomas on damaged skin which may later develop into squamous cell careinoma.
The scortum is particularly prone to develop squamous cell caroinom the skin.
Useful Laboratory Investigations:
Biopsy of the suspected area.

## 14. Diseases caused by the Toxic Halogen Derivatives of Hydrocarbons (of the aliphatic and aromatic series)
Occupational Exposure:
Halogenated aliphatic hydrocarbons are widely used as solvents degreaser, paint removers, refrigerants, extraction agent, fire extinguishers and in chemical synthesis aromatic halogenated hydrocarbons are used as intermediate in the production of dyes, pharmaseruticals, pesticides, plastics, etc. any other work involving exposure to the risk concerned, for e.g. carbon tetrachloride, trichloroethylene, hexachloronaphthalene, polychlorinated biphenyle, and vinyl chloride.

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Guidelines for Diagnosis
Clinical Manifestations:
Local Strong irritants of eyes and throat.
Generally the bromides are more irritants than chloride compounds.
Acute.- The acute effects are narcotic and closely resemble the effects of general anaesthetic. High concentration of the compounds may produce cardiac arrhythmias. The symptoms are nausea, headache, dizziness, confusion, lack of co-ordination, vertigo and abdominal pain.
Chronic.- Single acute exposure or repeated exposures can lead to the damage of liver and kindly
which may be at times very severe. Long term exposure to vinyl chloride (Monomer) leads to the
development of angiosarcoma of liver.
Useful Laboratory Investigations:
- (i) Liver function Tests.
- (ii) Renal function Tests.

## 15. Diseases caused by Carbon disulphide
Occupational Exposure:
Viscose rayon industry, artificial silk manufacturing industry, cellophane workers, rubber
and rubber cement workers, vulcanisors, in reclaiming old rubber, in extraction of oils and fats
from hides, bones and wools, it is a solvent of sulphur and phosphorus in manufacture of matches
in manufacture of the fine chemicals, pharmaceutical products dry cleaning any other work
involving exposure to the risk concerned.
Guidelines for Diagnosis
Clinical Manifestations:
Acute poisoning.- Exposure to high concentration (3-5g/m3) results in different psychiatric and neurological symptoms and signs, including extreme irritability, hallucinations, maniac delirium, paranoia and other disturbances.
Behavioural changes associated with pyramidal and extra-pyramidal syndromes,
disturbances in automatic functions, symmetrical polynourupathy affecting mainly sensory
nerves of lower limbs.
Vascular change: Antherosclerosis in relatively young people.

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Endocrine changes: Reduced spermatogenesis; menstrual irregularity and impaired thyroid function.
Gastrointestinal changes: Dypopsia, gastritis and ulocrative changes.
Useful Laboratory Investigations:
- (i) Examination of blood lipid pattern.
- (ii) Electoencaphalography.
- (iii) Electromyography.
- (iv) Electrocardiography
- (v) Measurement of nerve conduction velocity.

## 16. Occupational Cataract due to Infra-red Radiation
Occupational Exposure:
Prolonged exposure to rays from molten or red hot materials such as during electrical are
welding, electric furnace operations, foundry operations, glass blowing; any other work involving
exposure to the risk concerned.
Guidelines for Diagnosis
Clinical Manifestations:
Slow and progressive diaminution of acuity of vision leading to development of cataract.
Useful Laboratory Investigations:
Presence of posterior polar cataract as found by slit lamp microscopy in relatively younger people.

## 17. Diseases caused by Manganese or its Toxic compounds
Occupational Exposure:
Mining, crushing and processing of manganese ore; manufacture of dry cell batteries, fire
works, manganese bricks, matches, permanganate, metal refining, are welding, any other work
involving exposure to the risk concerned.
Guidelines for Diagnosis
Clinical Manifestations:
Neorological:
Acute: Psychomotor disturbances, dysarihira and disturbance of gait followed by maniac or


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depressive psychosis and parkinsonism.
Pulmonary: Increases incidence of peneumenia and higher rate of acute and chronic bronchitis.
Useful Laboratory Investigations:
Analysis of blood, urine and hair for manganese.

## 18. Skin Diseases caused by Physical Chemical or Biological Agents not included in other items
Occupational Exposure:
Physical agents pressure or friction, weather condition, heat radiation, mineral fibres,
chemical agents, primary irritants, sensitizer acnegenic agents, photosensitizers. Biological
agents, microbes, fungi, skin parasites and their products.
Guidelines for Diagnosis
Clinical Manifestations:
- (i) Primary irritant contact dermatitis, Erythema, oedema, papules, vesicles or bullae, localised as a rule on the hands, forearms or face.
- (ii) Allergic contact dermatitis, clinical features same as those of irritant dermatitis except that the symptoms appear sometime after exposure (Sensitization) and the severity is usually less related to the dose and the patch test.
- (iii) Oil Follicultis: Follicularpopules and pustules and discolouration with comedone formation on exposure to cooling and cutting oils. Lesions are found over things and forearms.
- (iv)  Chloraene: In contrast to oil folliculitis, comedones are pale in colour and are associated with pale, yellowinsh or flesh coloured inflammatory lesions.
- (v) Occupational vitiligo or occupational leucoderma; exposure to certain substituted phenols and catechols, clinically the conditions is indistinguishable from naturally occurring vitiligo.
Useful Laboratory Investigations:
Patch test in case of allergic contract dermatitis.

## 19. Hearing Impairment caused by Noise
Occupational Exposure:

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Long term occupational exposure to high levels (more than 90 DBA) of noise.
Guidelines for Diagnosis
Clinical Manifestations:
- (i) The hearing logs is bilateral and symmertrical.
- (ii) The hearing loss is inner ear type.
- (iii) The hearing loss commences at 4000 Hz with a characteristic ‘V’ shaped notch in audiogram and then spreads to the other frequencies.
- (iv) The hearing loss is permanent and stable even after the removal of worker from further exposure.
Useful Laboratory Investigations:
Audiometry

## 20. Poisoning by Dinitrophenol or a Homologue or by substituted Dinitrophenol or by the
Salts of such substances
Occupational Exposure:
The use or handling or exposure to the fumes of or vapour containing such substances as
in dye makers, explosive workers, herbs workers, wood preservative workers.
Guidelines for Diagnosis
Clinical Manifestations:
Local:- Allergic (Urticaria and exfoliative dermatitis). 2,4Hinitrochlorobenzene (DNCB) is a
powerful sensitizer of the skin and can induce delayed hypersensitivity.
Systemic:-Anorezia, nausea vomiting, sweating, thirst dyspnoea, tachycardia and fever. All these symptoms are due to stimulation of basal metabolic rate (BMR) .Other manifestations are neutropenia, agranulocytosis hepatitis, peripheral neuritis and cataract formation. There is intense yellow staining of the tissues.
Useful Laboratory Investigations:
Estimation of dinitrophenol and aminonitrophenel in ruine.

## 21. Diseases caused by Beryllium or its Toxic Compounds
Occupational Exposure:
Aerospace industry manufacture of precision instruments and computers X-ray tubes, fluorescenttybes, vaccum electrodes, heater cathodes, moderator for use in nuclear industry, or any

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other work involving exposure to the risk concerned.
Guidelines for Diagnosis
Clinical Manifestations:
Acute: Nasopharyngitis, tracheobronchitis, bronchitis or pulmonary cedema, appearing 1-2 days after exposure.
Chronic: The manifestations of chronic beryllium poisoning are due to formation of granulomas, which are confined mainly to the lungs but may be found in liver, spleen, skin etc. Usual signs and symptoms are breathlessness on exertion cough and fever.
Useful Laboratory Investigations:
- (i) X-ray chest, diffuse bilateral granulomatosis.
- (ii) Pulmonary function tests, reduced diffusion capacity.
- (iii)  Other laboratory tests, rise in serum immunoglobulins (IgA and IgG), hyperuricaemia, hypercalcaemia and hyupercalcinuria.
- (iv) Presence of beryllium, in tissue or urine.

## 22. Diseases caused by Cadmium or its Toxic Compounds
Occupational Exposure:
Primary or secondary cadmium smelters, cadmium plating industries, alkaline battery, vadmium
pigment makers and welders.
Guidelines for Diagnosis
Clinical Manifestations:
Acute: Gastrointestinal disturbances and chemical penumonitis.
Chronic: Renal: Proteinuria, glycosuria, aninociduria, impaired acid secretion, decreased urine concentrating capacity of the kidney.
Respiratory: Emphysema, obstructive pulmonary disease, interstitial fibrosis.
Bone lesions: Osteomalacia, ostosporosis, spontaneous fractures.
Useful Laboratory Investigations:
- (i) Estimation of cadmium concentration in urine.
- (ii) Quantitative determination of total protein (bui retmethod ) albumin, retinol, binding protein and Betazmicroglobulim concentration in urine.

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- (iii) Pulmonary function tests.
- (iv) X-ray chest.

## 23. Occupational Asthma
Workers at greatest risk includes those who handle grains and cereals (silo workers, millers, bakers); grain storage, workers expose to mites, workers exposed to dusts from castor or coffee beans and those involved in tea shifting and packing, woodworker, sawmill operators and workers in the furniture industry, printing workers, laboratory workers handling animals, manufactures of detergent enzymes, platinum refiners, (rarely chromium or nickel platers), workers in the chemical and pharmaceutical Industries manufacturers or polyurethane foam using isocyanates, painters and insulation workers meant wrappers exposed to fumes of polyvinyl chloride (PVC) soft-wrap film and health personnel, any other work involving exposure to the risk concerned.
Guidelines for Diagnosis
Clinical Manifestations:
The clinical symptoms of bronchial hyperreaction and chemical asthma are identical to those of asthma of non occupational origin. They include spnoea, chest tightness, wheezing and pulmonary function impairment of the obstructive type. With an immediate hypersensitivity reaction, the attack develops within a few minutes after exposure at the work place itself and the patient recovers within about two hours after withdrawal from exposure. The late hypersensitivity reaction starts several hours after the first exposure, often after the work-shift or at night and recovery may take more than 24 hours.
Useful Laboratory Investigations:
- (i) Simple lung function tests.
- (ii) Reliable biological tests of exposure are available for only a limited number of chemical substances. If there is a relevant antigen, skin tests and IgE estimations may indicate hypersensitivity in symptom free workers, reflecting the allergenic potency of the agent.

## 24. Diseases caused by Fluorine or its Toxic Compounds
Occupational Exposure:
Workers in phosphate fertilizer manufacture, open hearth and basic oxygen furnaces in steel

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plants and aluminum reduction cell room operation and cryolit plant or fluor spar miners are at
greatest risk. Others who may also be exposed include cement, porcelain, enamel, magnesium
foundry and certain electroplating workers.
Guidelines for Diagnosis
Clinical Manifestations:
Acute: Acute poisoning may occur after exposure to high concentration in-of are of flourine and hydrogen flouride. In such cases, there is immediate irritation of the exposed tissues, including the eyes and the respiratory tract.
Chronic: The most significant consequence of excessive flouride exposure is the damage to the skeletal system and associated tissues. The first stage of ostelgluoresis consists of an increase in the density of pelvic and vertebra bones, with coarsense and blurring of bone trabecular. After some years the second stage ensures with increased density and blurring of contour of the pelvic and vertebral bones, libs and extremities.
Useful Laboratory Investigations:
The most practical indicatory of flourine body burden is the concentration of flourides in the
urine which can be accurately and quikly measured with iron-specific electrodes.

## 25. Diseases caused by Nitroglycerin and other Nitric
(a) Acid Esters:
Workers engaged in the production of these substance and in the manufacture and use of explosives (e.g. in mines) are at greatest risk of exposure, workers handling these substances in the pharmaceutical industry may also be at risk, any other work involving exposure to the risk concerned.
Guidelines for Diagnosis
Clinical Manifestations:
Nitrocesters and the intermediates of ethylene glycol dinitrate metabolism (Mononitroglycol and nitrites) causes vasodilation with a subsequent fall in blood pressure; heart rate acceleration and pulse pressure reduction. After the first contact with nitrocesters or on resuming work after a long period of rests, the worker may develop headache, nausea, weakness and palpitaiotns and may even collapse. Physical examination of such patients reveal a weak accelerated pulse and decreased blood pressure after daily repeated exposure most workers acquire a tolerance and the fall in blood pressure is less. This is not due to changes in metabolism

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but to the physiological regulatory mechanism. However, there may be a decreased tolerance to
alcohol, digestive troubles, sleep disturbances parasthesias, tremor and mental inhibition.
Useful Laboratory Investigations:
Although the determination of nitroesters in blood and of inorganic nitrates in urine is possible, the levels are not reliable reflections of exposure.

## 26. Diseases caused by Alcohols Glycols and Ketones
(a) Alcohols and Glycols
Occupational Exposure:
Workers in the production or use of these substances, dye makers, dyers, printers are at
greatest risk of exposure any other work involving exposure to the risk concerned.
Guidelines for Diagnosis
Clinical Manifestations:
Acute Poisoning: Acute poisoning from alcohols and glycols in industry is rare and occurs mainly as a result of accidental ingestion. Acutely intoxicated patients complain of headache, vertigo, confusion feeling of drunkenss, nausea, vomiting, epigastrio pain and sensory function impairment. Methyl alcohol poisoning also produces visual disturbances due to optic, retrobulbar neuritis, which may progress to optic atrophy Metabolic acidosis due to the formation of formic acid is the typical bio-chemical feature of acute methyl alcohol poisoning.
Chronic poisoning: Except for occasional headache and upper respiratory tract irritation, no typical syndromes are usually associated with chronic exposure. Eye and upper respiratory tract irritation, optic neuritis with Photophobia and disturbed vision and central nervous system disorders are the manifestations of chronic methyl alcohol intoxication.
Useful Laboratory Investigations:
There are no reliable routine methods for biological monitoring. The final metabolities in
urine or volatile alcohols in expired air could be measures but the exact relationship between
exposure level and amounts excreted is unknown.
(b) Ketones:
Occupational Exposure:
Workers in the production of ketone and those in the above mentioned industries are at
greatest risk, any other work involving exposure to the risk concerned.
Guidelines for Diagnosis

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Clinical Manifestations:
Acute poisoning: All ketones are moderate irritants of mucous membranes. High Level exposure
to ketones results in central nervous system depression and pre-narcotic symptoms which may
progress to narcosis.
Chronic poisoning: Prolonged exposure to MBK (and to mixtures of MBK with methyl ethyl ketone) may produce a toxic sensory motor peripheral neuropathy similar to that caused by other industrial toxins (e.g. carbon disulfide, acrylamide and n-hexane.)
Useful Laboratory Investigations:
There are no reliable methods for the biological monitoring of exposure. The metabolic end-products of methyl n-butyl metone (MBK) and methyl ethyl ketone can be measures in the urine, or the unchanged ketone can be measured in the expired air, but the analytical methods are rather complicated and the exact relationship between exposure level and the amounr excreted is not well established.

## 27. Diseases caused by Asphyxianta: Carbon Monoxide Hydrogen cyanide and its Toxic Derivates and Hydrogen Sulfide
(a) Carbon Monoxide:
Occupational Exposure:
Workers in the manufacture and distribution of gas (coal gas) made from solid fuel, garage mechanics, engine operators, traffic personnel, acetylene welders, boiler –room workers, chemical workers fire fighters, miners are at greatest risk, any other work involving exposure to the risk concerned.
Guidelines for Diagnosis
Clinical Manifestations:
Acute Poisoning: Exposure to high concentrations of carbon monoxide cause acute poisoning. Typical signs and symptoms are headache, dizziness drowsiness, nausea and vomiting. Depending on the concentration of CO in the air, duration of exposure and resulting carboxyhaemoglobin concentration in the blood, collapse, coma and death may occur.
Chronic poisoning.- Health impairment can occur due to long-term exposure to concentrations of carbon monoxide insufficient to cause acute poisoning. The following symptoms could be attributed to long term exposure, headache, memory defects, falling work output, sleep, disturbances, vertigo, emotional liability, signs of central and peripheral nervous


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system impairment (encephalopathy, neuropathy) autonomic nervous system disorders (particularly impairment of its regulatory function over the cardio vascular system) and increased concentratons of serum cholesterol, lipoproteins and glucose.
Useful Laboratory Investigations:
There are two biological methods of determining exposure (a) by measuring the
carboxyhaemoglobin concentration in blood and (b) by measuring the carbon monoxide
concentration in the expired air. Since carbon monoxide also occurs naturally in the body (as a
product of hseme breakdown) so does carboxyhaemoglobin. The normal level of
carboxyhaemoglobin is upto 0.5/100 g. haemoglobin, but if any haemolytic disorders are present
it may be as high as 5/g/100g.
(b) Hydrogen cyanide and its Toxic Derivatitives:
Occupational Exposure:
Fumigant workers, organic chemical synthesizers, electroplaters, gold and silver
extractors, steel workers and workers in the production of plastics (particularly arcyonitrile-
styrene)
Guidelines for Diagnosis
Clinical Manifestations:
Acute effects.- Initial symptoms of acute hydrogen cyanide poisoning include weakness
headache, confusion and occasionally nausea and vomiting. In severe cases, coma, convulsions,
and death due to respiratory arrest may occur.
Chronic effect.- the following conditions are allegedly caused by chronic exposure of hydrogen cyanide and its derivatives, neurasthenia with autonomic nervous system involvement, psycho alterations, precordial pains, breathlessness on exertion, breadycardin, arterial hypotonia, polyoythaemia, dyspepsia, hepatic impairment and thyroidal hypofunction. Allergic dermatoses due to skin contact with certain cyanides have been observed.
Useful Laboratory Investigations:
The determination of the CN ion in blood or tissues is of significance only in acute poisoning. In occupational exposure to cyanides, the concentration of thiocyanates in the urine may be elevated.
(c) Hydrogen Sulfide:
Occupational Exposure:


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Sewage treatment plant workers, miners, metallurgists, silo workers, sugar beet
processors, tannery workers, viscose rayon and cellophane workers, chemical workers
(manufacturing of sulfuric acids, barium salts etc.) are at greatest risk of exposure, any other
work involving exposure to the risk concerned.
Guidelines for Diagnosis
Clinical Manifestations:
Acute effects:- Hydrogen sulfide has a direct irritant action on the eyes which sometimes
leads to keratoconjunctivits. It is also an irritant of the respiratory tract and may causes bronchitis
or even pulmonary cedema.
Chronic poisoning: Nonspecific symptoms and disorders such as impaired, sleep,
headache, vertigo poor concentration, liability of mood, hyperhydrosis autonomic nervous system
impairment, chronic bronchitis and dyspepsia are accepted by some authorities as resulting from
long term exposure to concentrations of hydrogen sulphide lower than those causing acute
poisoning.
Useful Laboratory Investigations:
There are no methods of biological assessment.

## 28. Lung Cancer and Mesotheliomas caused by Asbestos
Occupational Exposure:
Workers in the following occupations are at-greatest risk: mining milling and processing of asbestos, transport of mined or milled asbestos manufacture of asbestos products, disposal of waste material from asbestos, mining, milling etc. any use or dismantling of asbestos products that causes airborne asbestos dust, any other work involving exposure to the risk concerned.
Guidelines for Diagnosis
Clinical Manifestations:
Asbestos related lung cancer is clinically indistinguishable from lung cancer unrelated to asbestos exposure. Adenocarcinoe is more common in workers exposed to asbestos. Crocidolite is casually related to mesotheliomas in man.
Chest pain and shortness of breath due to massive blood-stained pleural effusion frequently occur in pleuatal tumours, peritoneal tumours generally give abdominal pain and swelling from gross ascitis.
Useful Laboratory Investigations:

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- 1. Using the ILO international classification of radiographers of puenumoconics,
Pulmonary, changes resulting from expose to asbestos can be detected by radiography.
- (ii) Pulmonary function tests are useful but are less specified than radiography.
29. Primary Neoplasm of the Dpithelial Lining of the Urinary Bladder or the kidney or the ureter
Occupational Exposure:
Work involving exposure to any of the following substances.
- (a) Alpha-naphthylamine, betanephtlylamine or methylene bis-orthochlereaniline.
- (b) Diphenyl substituted by at least one nitro and primary amino group (including benzidine)
- (c) Any of the substances in sub paragraph
- (d) Above if furthering substituted by halogen, methyl or methoxy groups.
- (e) Auramine or mageta.
Guidelines for Diagnosis
Clinical Manifestations:
Painless haematuria and colic due to obstruction by blood clot Tenderness in the flank may be present.
Useful Laboratory Investigations:
- (i) Microscopic examination of urine
- (ii) Urography and Uthasonography
- (iii) Cystoscopy
- (iv) Exfoliative cytology of urine
- (v) Boopsy
30. Pneumoconiosis caused by Sclerogenic Mineral Dust
(a) Silicosis and Silico-Tuberculosis:
Occupational Exposure:
Mining, tunneling, drilling of rocks, foundries and ceramic industries, slate pencil industry, glass

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manufacturing quartzl grinding, agate polishing, stone cutting and dressing sand blasting
industries, any other work involving exposure to the risk concerned.
Guidelines for Diagnosis
Clinical Manifestations:
Progressive dysphoea, cough and expectoration. Presence of heamoptysis and fever usually indicate complication by tubercular infection.
Useful Laboratory Investigations:
- (i) X-ray chest, bilateral symmetrical modular opacities which may be accompanied by irregular massive shadows and egg shell calcification of hilar glands.
- (ii) Pulmonary function tests, restrictive or combined (restrictive and obstructive) type of functional abnormality.
- (iii) Culture of mycobacteria in spectrum in case of silico-tuberculosis.
- (c) Coal-Miners’ Pneumoconiosis (Coal Workers’ Peneumconiosis of Anthraco-Silicosis)
Occupational Exposure:
Coal mining, trimming of coal in the ship, fuelling of coal in the power generating plants.

Anthraco-silicosis is caused by exposure to mixed dust in which free silica is present.
Guidelines for Diagnosis
Clinical Manifestations:
Cough, blackish sputum and dyspnoea on exertion.
Useful Laboratory Investigations:
- (i) X-ray chest: Simple pneumoconiosis; small, rounded bilaterally symmetrical, pinhead opacities. Progressive massive fibrosis (PMF) Large, irregular opacities, usually confined to the upper lung fields.
- (ii) Pulmonary function test: May be normal in simple pneumoconiosis or there may be restrictive of combined type of functional abnormality. Transfer factor is normal.
Asbestosts
Occupational Exposure:
Working or handling of asbestos or any admixture of asbestos;
Manufacture of repair of asbestos textiles or other articles containing or composed of

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asbestos;
Cleaning of any machinery or plant used in any of the foregoing operations and of any
chambers, fixtures of appliances for the collections of asbestos dust;
Any other work involving exposure to the risk concerned.
Guidelines for Diagnosis
Clinical Manifestations:
Increasing breathlessness, cough and sometimes tightness of chest, Dry end-inspiratory
rales (crackles) at the basis of the lungs and exillac just above the diaphragm.
Useful Laboratory Investigations:
- (i) Pulmonary Function Test: Restrictive type of pulmonary function abnormality and transfer factor.
- (ii)  X-ray chest: showing bilateral, irregular opacities prominent at the lung bases.

## 31. Bagassosis
Occupational Exposure:
Occupational exposure to bagassas (remains of sugarcane after juice is extracted) as in manufacture of different types of paper and cardboard and a variety of building materials such as insulating wall and board and fillers for veneered doors; any other work involving exposure to the risk concerned.
Guidelines for Diagnosis
Clinical Manifestations:
Acute and subacute: Symptoms occur 4 to 8 hours after exposure. They include nausea vomiting, fever, chest tightness, breathlessness, cough, cyanosis and crepitations on auscultation.
Chronic: Dyspnoea on exertion.
Useful Laboratory Investigations:
X-ray chest: small opacities, symmetrically distributed over middle and lower lung fields. In chronic cases the radiographic appearances resemble diffuse interstitial pulmonary fibrosis.
Pulmonary function tests: Diminished ventilator capacity and gas transfer factor.

## 32. Bronchopulmonary Diseases caused by cotton dust flax, hemp and sisal dust (Byssionisis)


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Occupational Exposure:
Prolonged occupational exposure to cotton, flax and soft hemp.
Guidelines for Diagnosis
Clinical Manifestations:
Chest tightness on the first day of the work after holidays. With progress of the disease, chest
tightness accompanied by breathlessness and the symptoms are more severe and persist longer.
Useful Laboratory Investigations:
Pulmonary function tests: Fall in FEV 1.0 following exposure on the first day of the work after holidays.

## 33. Extrinsic Allergic Aiveolitis caused by the inhalation of organic dust.
Occupational Exposure:
Exposure to microbial spores; Moulding vegetable matt such as hay and barely, mushroom compost, bagassae and wood bark.
Guidelines for Diagnosis
Clinical Manifestations:
Acute: Breathlessness with fever and flu like symptoms such headache and muscular pains.
Sub acute: Follows repeated but intermittent heavy exposure to spores breathlessness, malaise, weight loss and fever, Chronic (Irreversible pulmonary fibrosis): Breathlessness without constitutional symptoms other than weight loss, fins clubbing and scattered inspiratory crackles and squeaks head over the lungs.
Useful Laboratory Investigations:
- (i) X-ray chest: Diffuse bitateral mottling
- (ii)  Pulmonary functionaries: Restrictive functional abnormality with reduced diffusion capacity.
- (iii) Immunological Tests: Positive serological test against appropriate antigen.

## 34. Bronchopulmonary diseases caused by hard metal dusts
Occupational Exposure:
Workers at greatest risk are those engaged in the production of sintered carbides (mixing, pulverizing, forming furnace heating machining, precision grinding) and in the manufacture of

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tools and machine parts as well as those responsible for sharpening the tools produced, Although
those engaged in grinding and sharpening are the most exposure to the hazard, workers engaged
in other tasks in the immediate vicinity in the same workshop may also run a high risk of
exposure.

## Guidelines for Diagnosis
Clinical Manifestations:
In a majority of those exposure a variety or irritative symptoms are seen including cough, allergic rhinitis, asthma like dyspnoea and dyspnoea on exertion. The symptoms improve after the cessation of exposure. Deffuse interstitial pulmonary fibrosis is far less cum and affects about 1.4% of workers.
The early signs of disease begin to appear following exposure for more than three years. These include dry or weight loss, progressive dyspnoea on exertion. Crepitant rules may be heard on auscultation. Chest X-rays which difficult to interpret at the onset of the disease, show liner marking and reticular shadows of varying capacity.

## Useful Laboratory Investigations:
Increased excretion of cobalt in the urine may be used as supplementary test of environment exposure. However, the relationship between hard metal dust exposure and cobalt urine is obscure.

## ANNEXURE II
## GUIDELINES FOR ASSESSMENT OF DISABILITY (VIDE RULE II)
Introduction:
The evaluation of disability due to occupational diseases is usually governed by the same principles as applied to accident injuries. However evaluation is more difficult in case of disease than in the case of injury since quantification entails not only diagnosis but also determination of severity. It is not possible to draw up schedules for diseases and assessment will depend both on amount of information available and on the assessor’s crit faculty consequently accurate

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evaluation of disability due to industrial diseases demands increasingly refined and accurate
instrumentation and particularly gified assessors.
When evaluating reduced working capacity due to occupational diseases it is essential to determine both the extent of the pathological manifestations and their repercussions on the subject’s personality. Allowance should be made for re-existing factors that may effect the significance of the diagnosis, such as the outcome of recent therapy or the effect of specific, contingent climate conditions (for example Chronic Bronchitis which becomes acute in person with pneumnchorisis) in cardio-vascular function tests, allowance must be made for the subjects current physical conditions which will depend on whether he is actively employed or moderate or heavy work or confined to bed. The evaluation of such factors implies reliable methods of investigation and considerable experience on the part of the assessor.
Definitions:
Physical impair leads to functional limitations and functional limitation leads to disability. Hence physical impairment, functional limitation and disability have been defined by W.H.O. as follows:-
- (i) Impairment: An impairment is a permanent or transitory Psychological or anatomical loss and /or abnormality. For example a missing or defective part, tissue organ, or mechanism of thrombosis, restricted pulmonary capacity, diabetes, myopia, disfigurement, mental retardation, Hypertension, perceptual disturbance.
- (ii) Functional limitation: Impairment may cause functional limitations which are the partial or total inability to perform those activities necessary for motor, sensory, or mental functions within the range and manner of which a human being is normally capable such as walking, lifting, seeing, speaking, bearing, reading, writing, counting, taking interest in and making contact with surroundings. A functional limitation may last for a short time, a long time, be permanent or reversible. It should be quantifiable whenever possible. Limitations may be described as “progressive” or “regressive”.
- (iii) Disabilities: Disability in which functional limitation and on impairment is a causative factor is defined as an existing difficulty in performing one or more activities which, in accordance with the subject’s age, sex and normative social role, are generally accepted as essential, basic components of daily living, such as selfcare, social

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relations and economic activity. Depending in part on the duration of the functional
limitation, disability may be short term and long term or permanent. In this context we
will only deal with long term and permanent disability.
Medically disability is physical impairment and inability to perform physical functions normally.
Legally, disability is a permanent injury to body for which the person should or should not compensated.
Under the statutes or Workmen’s Compensation disability may be divided into three periods which are:
- 1. Temporary total disability is that period in which injured person is totally unable to work. During this time the received orthopaedic or other medical treatment.
- 2. Temporary partial disability is that period when recovery has reached the stage of improvement so that the person may begin some kind of gainful occupation.
- 3. Permanent disability applies to permanent damage or to loss of use of some part of the
body after the state of maximum improvement, from orthopaedic or other medical
treatment, has been reached and the condition is stationary.
The Doctor and the Evaluaiton:
The doctor may be called upon to testify as an expert witness in the court of justice. The expert witness is legally bound to declare his knowledge of the case and express his opinions.
Effects of disability are physical, social, psychological and vocational. Since the total disability is not purely a medical condition, medical man should evaluate the permanent physical impairment rather than total disability. Physical..................................impairment evaluation certificate is to be issued only by Medical Doctors who are registered under the 1st schedule of M.C.I Act, 1956. Aggregate of permanent physical impairment should not exceed more than 100%.
Hearing Impairment:
The ultimate test in any formula for determining hearing disability is the ability to understand speech, but because speech audiometry has certain limitations for practical use, pure-tone audiometry is used. The most commonly used frequencies for calculating hearing impairment are 500, 1000 and 2000 Hz. Recently the AAO has recommended that 3000 Hz also be included. A so-called low fence has been determined, below which a hearing loss is considering insufficient

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to warrant compensation. There is a difference of opinions as to precisely where this “low fence” be maintained at 25dB. Each state has its own method of paying disability and uses its own formula and provides a method for measuring and calculating binaural hearing impairment. The hearing level for each frequency is the number of decibels at which the listeners threshold of hearing lies above the standard audiometric O for that frequency. The hearing level for speech is a simple average of the hearing level at the frequencies 500, 1000, 2000 and now 3000 Hz. The following is an example of how to calculate hearing impairment for compensation purpose (AAO guidelines 1978):
- 1. The average of the hearing threshold levels at 500, 1000, 2000 and 3000 Hz should calculated for each ear.
- 2. The percent impairment for each ear should be calculated by multiplying by 1.5% the amount by which the above average hearing threshold level exceeds 25 dB (low fence) upto a maximum of 100%, which is reached at 92 dB (high fence).
- 3. The hearing handicap a binaural assessment, should then be calculated by multiplying the smaller percentage (better ear) by 5, adding the figure to the larger percentage (poorer ear) and dividing the total by 6.
Hearing Loss:
|  | 500 Hz | 1000Hz | 2000Hz | 3000Hz |
| --- | --- | --- | --- | --- |
| Right ear | 15 | 25 | 45 | 55 |
| Left ear | 20 | 30 | 50 | 60 |
| AAO method: 25-dB Fence      1. Right ear 15+25+45+55 = 140 = 35-dB average     ---------------- ----     4 4      2. Left ear 20+30+50+60 = 160 = 40-dB average     ---------------- ----     4 4 | | | | |
Monural Impairment
- 3. Right ear 35 - 25 = 10dB x 1.5% - 15%

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- 4. Left ear 40-25 = 15 dB x 1.5% - 22.5%
- 5. Better ear 15x5 = 75
- 6. Poorer ear 22.5% x 1 = 22.5
- 7. Total 97.5 x 6 = 16.25%
The per cent of binaural hearing impairment as related to the whole man can be calculated as
per the Table given below.

## Per cent of binaural hearing impairment as related to the whole man Impairment.
| Impairment of   Binaural Hearing % | Whole man % | Important of Binaural   Hearing % | Whole man % |
| --- | --- | --- | --- |
| 0-1.7 | 0 | 50.0-53.1 | 18 |
| 1.8-4.2 | 1 | 53.2-55.7 | 19 |
| 4.3-7.4 | 2 | 55.8-58.8 | 20 |
| 7.5-9.9 | 3 | 58.9-61.4 | 21 |
| 10.0-13.1 | 4 | 61.5-64.5 | 22 |
| 13.2-15.9 | 5 | 64.6-67.1 | 23 |
| 16.0-18.8 | 6 | 67.2-70.0 | 24 |
| 18.9-21.4 | 7 | 70.1-72.8 | 25 |
| 21.5-24.5 | 8 | 72.9-75.9 | 26 |
| 24.6-27.1 | 9 | 76.0-78.5 | 27 |
| 27.2-30.0 | 10 | 78.6-81.7 | 28 |
| 30.1-32.8 | 11 | 81.8-84.2 | 29 |
| 32.9-35.9 | 12 | 84.3-87.4 | 30 |
| 36.0-38.5 | 13 | 87.5-89.9 | 31 |
| 38.6-41.7 | 14 | 90.0-93.1 | 32 |
| 41.8-44.2 | 15 | 93.2-95.7 | 33 |
| 44.3-47.4 | 16 | 95.7-98.8 | 34 |
| 47.5-49.9 | 17 | 98.9-100.0 | 35 |
Note:- Impairment of whole man contributed binaural hearing impairment may rounded in the nearest 5% only when it is the sole impairment involved.

## CRITERIA FOR EVALUATING PERMANENT SKIN IMPAIRMENT
|  | Class -1 | Class-2 | Class-3 | Class-4 | Class-5 |
| --- | --- | --- | --- | --- | --- |

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| Impairment 0%-   5% | Impairment 10%-   20% | Impairment   25%-50% | Impairment   55%-80% | Impairment 85%-   95% |
| --- | --- | --- | --- | --- |
| Signs or symptoms   of skin disorder are   present   AND    With treatment   there is no or   minimal limitation   in the performance   of the activities of   daily living | Signs or   symptoms of skin   disorder are   present   AND    Intermittent   treatment is   required   AND   There is limitation   in the   performance of   some of the   activities of daily   living | Signs or   symptoms of   skin disorder are   present   AND    Continuous   treatments is   required   AND   There is   limitation in the   performance of   may of the   activities of daily   living | Signs or   symptoms of   skin disorder are   present   AND    Continuous   treatment is   required which   may include   periodic   confinement at   home of other   domicile   AND   There is   limitation in the   performance of   may of the   activities of daily   living | Signs or   symptoms of   skin disorder are   present   AND    Continuous   treatment is   required which   necessitates   confinement at   home or other   domicile   AND   There is severe   limitation in the   performance of   the activities of   daily living |
| CLASSES OF RESPIRATORY IMPAIRMENT | | | | |
| Dyspnea | When it occurs is   consistment with   the circumstances   of activity | Does no occur at   rest and seldom   occurs during the   performance of   the usual   activities of daily   living | Does not occur at   rest but does   occur during the   usual activities of   daily living | Occurs during   such activities as   climbing one   flight of stairs or   walking 100   yards on the   level, on less |


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| Test of Ventilatory Function (At least two should be perfomed) FBC 1.oMVV | Not less than 85% of predicted | 70% - 85% | 55%-70% of predicted | exertion or even at test.    Less than 55% of predicted |
| --- | --- | --- | --- | --- |
| Arterial Oxygen Saturation (when performed) | Not applicable | Not applicable | Usually 88% or greater at test and after exercise | Usually less than 88% at test and after exercise |
| Roentgenogram Appearance | Usually normal but there may be evidence of healed or inactive chest diseases. | May be normal or abnormal | Usually is abnormal but may be normal | Usually is abnormal |

## CLASSES OF AIR PASSAGE DEFECTS
| Class I (0-10%   impairment of whole   man) | Class II (10-20%   impairment of whole   man) | Class III (25-350%   impairment of whole   man) | Class IV (50-70%   impairment of whole   man) |
| --- | --- | --- | --- |
| (1) | (2) | (3) | (4) |
| A recognized air   passage defect exists      Dyspnea does NOT   occur at rest      Dyspnea is NOT   produced by walking | A recognized air   passage defect exists      Dyspnea does NOT   occur at rest      Dyspnea IS produced   by stress, prolonged | A recognized air   passage defect exists      Dyspnea does NOT   occur at rest      Dyspnea IS produced   by walking more than | A recognized air   passage defect exists      Dyspnea occurs at rest   although patient is not   necessarily bed ridden      Dyspnea is aggravated   by the performance of   any of the usual |

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| or climbing stairs freely, performance of other usual activities of daily living, stress, prolonged exertion, hurrying, hill climbing, recreation, requiring intensive effort of similar activity | exertion, hurrying, hill climbing, recreation except sedentary forms or similar activity Dyspnea is NOT produced by walking freely on the level, climbing at least one flight of ordinary stairs or the performance of other usual activities of daily living | the or two blocks on the level or climbing one flight or ordinary stairs even with periods of rest, performance of other usual activities of daily living, stress, hurrying hill-climbing recreation or similar activity | activities of daily living beyond personal cleaning dressing, grooming or its equivalent |
| --- | --- | --- | --- |
| (1)     Examination reveals ONE or more of the following partial obstruction of oropharynx, laryngopharynx, larynx, upper reaches to (4th ring) lower traches, bronchi, or complete obstruction of the nose ( bilateral or nasopharynx) | (2)     Examination reveals ONE or more of the following partial obstruction of oropharynx, laryngopharynx, larynx, upper reaches to (4th ring) lower traches, bronchi, or complete obstruction of the nose ( bilateral or nasopharynx) | (3)     Examination reveals ONE or more of the following partial obstruction of oropharynx, laryngopharynx, larynx, upper reaches to (4th ring) lower traches, bronchi, | (4)     Examination reveals ONE or more of the following partial obstruction of oropharynx, laryngopharynx, larynx, upper reaches to (4th ring) lower traches, bronchi, |
| Classes of Organic Heart Disease – Guide for Evaluating-Impairment of the whole man ( Adopted with revision from the American Heart Association (New York Heart Association) and American Medical Association (Committee on Medical Rating or Physical Imairment) | | | |
| Class I Prime   (None) | Class I   (Minimum) | Class II   (Moderate) | Class III (Severe) | Class IV (Very   Severe) |
| --- | --- | --- | --- | --- |
| Energy   expenditure over | Energy   Expenditure | Energy   Expenditure | Energy   Expenditure | Energy   Expenditure upto |

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| 7 Calories/min. | continuous upto 5 Calories/min, intermittent to 6.6 Calories/min. | continuous upto 2.5 Calories/min, intermittent to 4 Calories/min. | continuous upto 2 Calories/min, intermittent to 2.7 Calories/min | 1.5 Calories min. |
| --- | --- | --- | --- | --- |
| No symptoms with any type of activity | No symptoms with ordinary activity | Slight symptoms with ordinary activity, none at rest | Less than ordinary activity causes symptoms none at rest | Symptoms even at rest |
| Walking, climbing stairs freely and all activities of daily living do not produce symptoms | Walking climbing stairs and usual activities or daily living do not produce symptoms | Walking on level climbing one flight of stairs (average pace) and usual activities of living do not produce symptoms | Walking more than one block on level or climbing one flight of stairs (average pace) or usual activities of daily living produce symptoms | Performance of any of activities of daily living beyond personal toilet of its equivalent produce increased discomfort |
| Continuous (3 min. or longer) very severe (rapid action of mass musculature physical, exertion, hurrying, hill climbing, severe or competitive recreation do not produce | Intermittent (2min.or less) severe physical exertion, hurrying hill climbing, active recreation and marked emotional stress do not produce symptoms | Emotional stress, hurrying hill climbing, active recreation or similar physical activity produce slight symptoms | Emotional stress, hurrying hill climbing, active reaction or similar activities produce marked symptoms | Symptoms increase with emotional reaction any physical activity increases discomfort |

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| symptoms. Signs of congestive heart failure are not present | Signs of congestive heart failure are not present | Signs of congestive heart failure are not present | Signs of congestive heart failure may be present and if so are usually relieved by therapy | Signs of congestive heart failure, if present, are usually resistant to therapy |
| --- | --- | --- | --- | --- |

## OCCUPATION
Watch repairing 1.6
Typing 1.8
Driving tractor 1.9
Painting sitting 2.0
Gardening light 2.1
Armature winding 2.2
Gobbling 2.2
Hammering nails 2.4
Using hand tools 2.5
Radio assembly 2.7
Drive car or truck 2.8
Sewing at machine 2.9
Upholstering 3.0
Saw, power hand 3.1
Planning wood, soft 3.4
Sweep or rake 3.4
Mow lawn, power 3.8
Brick laying 4.0
Plastering 4.0
Tractor plugging 4.2
Assembly line work 4.5


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| Pump tire | 5.0 |  |
| --- | --- | --- |
| Wheel barrow, 115 lbs | 5.0 |  |
| Horse ploughing | 5.9 |  |
| Saw soft wood |  | 6.3 |
| Carry 50 lbs | 6.7 |  |
| Carpentry | 6.8 |  |
| Pusingsheel barrow | 7.0 |  |
| Pull, lightly | 7.0 |  |
| Saw hard wood | 7.3 |  |
| Mow lawn by hand | 7.7 |  |
| Digging | 8.0 |  |
| Felling tree | 8.0 |  |
| Shoveling earth | 8.5 |  |
| Ascending stairs 17 lb.load | 9.0 |  |
| Shoveling sand | 9.0 |  |
| Splitting wood |  | 9.0 |
| Planning wood, hard | 9.1 |  |
| Pull, hard | 10.0 |  |
| Tending furnace | 10.2 |  |
| Climb ladder | 10.4 |  |
| Chop with ax, pick or |  |  |
| Sledge hammer | 10.8 |  |
| Chopping trees | 12.0 |  |
| Lift more than 100 lbs |  | 16.0 |

## SELF CARE
| Rest supine | 1.0 |
| --- | --- |
| Sitting | 1.2 |
| Standing relaxed | 1.4 |
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153

| Feeding self, sitting | 1.4 |
| --- | --- |
| Conversation | 1.4 |
| Dressing, undressing | 2.3 |
| Propulsion wheel chair | 2.4 |
| Washing hands, face standing | 2.5 |
| Walking slowly, I mile in 24 min. | 3.5 |
| Beside commode | 3.6 |
| Dressing, Washing, Shaving | 3.8 |
| Showering | 4.2 |
| Using bedpan | 4.7 |
| Walking downstairs | 5.2 |
| Walking (military) 1 mile in 6 min. | 5.6 |
| Walking, level icy street | 5.6 |
| Walking moderately fast 1 mile |  |
| in 15 min. | 6.2 |
| Walking up hill 5” slope | 7.2 |
| Ambulation braces and crutches | 8.0 |
| Walking fast, 1 mile 2.5 min. | 8.0 |
| Climbing, descending 2 flights |  |
| stairs/min. | 8.5 |
| Walking level 2 ½” | 10.7 |
| Walking uphill 10” slope | 13.01 |

## OCCUPATIONAL THERAPY
| Leather tooling reclining | 1.2 |  |
| --- | --- | --- |
| Making link belt, reclining | 1.3 |  |
| Rug hooking, sitting | 1.3 |  |
| Chip carving reclining |  | 1.5 |
| Knitting | 1.5 |  |

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| Book binding | 1.6 |
| --- | --- |
| Copper tooling | 1.6 |
| Leather carving, sitting | 1.8 |
| Typing | 1.8 |
| Painting sitting | 2.0 |
| Weaving, floor loom | 2.0 |
| Chisel carving c mallet standing | 2.0 |
| Chisel carving c mallet sitting | 2.2 |
| Power standing | 2.2 |
| Sawing softwood | 6.3 |
| Sawing hardwood | 7.3 |

## EXERCISE
| Walking slowly, 1 mile in 24 min | 3.5 |
| --- | --- |
| Cycling, 5.5 mph, 1 mile in 11 min. | 4.5 |
| Straight leg raising | 4.8 |
| Swimming 20 yds/min | 5.0 |
| Walking briskly, 1 mile in 20 min. | 5.0 |
| Walking (military) 1 mile in 16 min. | 5.6 |
| Rowing, alone | 6.0 |
| Swimming 30 yds/min | 7.0 |
| Walking fast 1 mile in 12.5 min | 8.0 |
| Up and down 2 fights of stairs in min. | 8.5 |
| Master two step test | 9.0 |
| Deep knee bends 30/min | 8.8 |
| Push up 30 min | 9.0 |
| Running 1 mile 11 min | 11.0 |
| Cycling 13 mph 1 mile in 45 min | 11.0 |
| Walking 5 mph 1 mile in 12 min | 11.0 |
| Running 1 mile 9 min | 14.0 |


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Running 1 mile 7.5min 17.0

## HOUSEWORK
| Hand sewing | 1.4 |  |
| --- | --- | --- |
| Cooking standing | 1.6 |  |
| Painting | 1.6 |  |
| Sweeping floors, light |  | 1.7 |
| Machine sewing | 1.8 |  |
| Polishing furniture | 2.4 |  |
| Light ironing standing |  | 2.7 |
| Scrubbing standing | 2.9 |  |
| Peeling potatoes | 2.9 |  |
| Washing small clothes | 3.0 |  |
| Dusting | 3.1 |  |
| Vaccum cleaning | 3.2 |  |
| Kneading dough | 3.3 |  |
| Scrubbing floors | 3.6 |  |
| Cleaning windows | 3.7 |  |
| Mow lawn power | 3.8 |  |
| Filling washing machine | 4.1 |  |
| House painting | 4.1 |  |
| Making beds | 4.1 |  |
| Heavy ironing | 4.2 |  |
| Mopping | 4.2 |  |
| Waxing by hand | 4.4 |  |
| Hanging wash | 4.5 |  |
| Beating carpets | 4.9 |  |
| Washing floors | 5.3 |  |
| Carrying 20 lbs | 5.3 |  |
| Putting wash thru hand wringer | 5.7 |  |

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| Carrying 50 lbs | 6.7 |
| --- | --- |
| Shoveling snow moderately |  |
| wet 10/min | 11.4 |

## RECREATIONAL
| Embroidering | 1.2 |
| --- | --- |
| Rug hooking sitting | 1.3 |
| Knitting | 1.5 |
| Typing | 1.8 |
| Plying cards | 2.0 |
| Painting sitting | 2.0 |
| Chisel carving | 2.0 |
| Work in garden light | 2.1 |
| Power sanding | 2.2 |
| Playing Piano | 2.5 |
| Driving car | 2.8 |
| Golf putting | 3.0 |
| Horseback riding slow | 3.0 |
| Volley ball | 3.5 |
| Walking slow I mile in 24 min | 3.5 |
| Golf using irons | 3.7 |
| Throwing | 4.0 |
| Bowling | 4.4 |
| Cycling 1 mile in 11 min | 4.5 |
| Golf using woods | 5.0 |
| Swimming 20 yards/min | 5.0 |
| Cycling 10 mph 1 mile in 6 min | 5.3 |
| Dancing foxtrot | 5.5 |
| Gardening moderate | 5.6 |
| Golf, walking caddle | 6.2 |

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| Ice skating | 6.2 |
| --- | --- |
| Sawing soft wood | 6.3 |
| Table Tennis | 6.5 |
| Wash-wax car | 6.5 |
| Dancing rumba | 7.0 |
| Golf, pulling cart also carrying cart | 7.0 |
| Tennis doubles | 7.1 |
| Sawing hard wood | 7.3 |
| Trotting horse | 8.0 |
| Canoeing | 8.3 |
| Spading | 8.6 |
| Sking, tow, downhill | 9.9 |
| Squash | 10.2 |
| Cycling, 13 mph 1 mile in 4.5 min | 11.0 |
| Swimming, crawl, fast | 11.5 |
| Running 1 mile in 8 min | 11.7 |
| Sking, corss country | 12.0 |

## Assessment of Physical Impairment in Neurological Conditions
- 1. Assessment in neurological condition is not the assessment of disease but it is the assessment of the effect, i.e, clinical manifestations
- 2. Any neurological assessment has to be done after six months of onset.
- 3. These guidelines will only be used for central and upper motor neuronelesions
- 4. Proforma A&B will be utilised for assessment of lower motor neurone lesions, muscular disorders and other locomotor conditions
- 5. Total percentage of physical impairment in neurological conditions will not exceed 100%.
- 6. In the mixed cases the highest score will be taken into consideration. The lower score will be added to it and calculations will be done by the formula
a+b(100-a)
100


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- 7. Additional rating of 4% will be given for dominant upper extremely
- 8. Additional 10% has been given for sensation in each extremity, but the maximum total physical impairment will not exceed 100%
_TABLE I_
| Altered Sensorium | Disability Rate |
| --- | --- |
|  | 100% |
_TABLE II_

## Intellectual Disability (to be assessed by Clinical Psychologist)
|  | Disability Rate |
| --- | --- |
| Mild (I.Q. 80-90) | 25% |
| Moderate (I.Q. 70-80) | 50% |
| Severe (I.Q.60-70) | 75% |
| Very Severe (I.Q. below 60) | 100% |
_TABLE III_

## Speech Disability
|  | Disability Rate |
| --- | --- |
| Mild | 25% |
| Moderate | 50% |
| Severe | 75% |
| Very Severe | 100% |
Tested by a 100 word text. Ability to read (in educated) comprehend, when read out, answer question on text clearly and ability to write a synopsis (in educated)
_TABLE IV_

## Cranial Nerve Disability
| Disability Rate |
| --- |

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- (a) Motor carnial nerves: total or partial 20% for each nerve
- (b) Sensory: Total or partial 10% for each nerve
|  | Unilateral | Bilateral |
| --- | --- | --- |
| Mild | 20% | 30% |
| Moderate | 40% | 70% |
| Severe | 60% | 100% |
_TABLE V_

## Motor System Disability
|  | Disability Rate |
| --- | --- |
| Monoparesis | 25% |
| Monoplegia |  |
| Hemiparesis | 50% |
| Paraparesis | 75% |
| Paraplegia | 100% |
| Hemiplegia |  |
| Quadriparesis | 75% |
| Quadriplegia | 100% |
_TABLE VI_

## Sensory System Disability
|  | Disability Rate |
| --- | --- |
| Anaesthesis |  |
| Hypoaesthesis |  |
| Paraesthesis | Each limb 10% |
| For involvement of hand/hands, foot/feet | 25% |
_TABLE VII_

## Bladder disability due to Neurogenic involvement

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|  | Disability Rate |
| --- | --- |
| Mild (Hesitancy/Frequency) | 25% |
| Moderate (Precipitancy) | 50% |
| Severe (Occational incontinence) | 75% |
| Very Severe (Retention/Total incontinence) | 100% |
_TABLE VIII_

## Post head injury Fits and Epileptics
|  | Disability Rate |
| --- | --- |
| Mild (Occurrence of a convulsion) | 25% |
| Moderate (1.5 fits/month on adequate medication) | 50% |
| Severe (6-10 fits/month on adequate medication) | 75% |
| Very Severe (10 fits/month on adequate medication) | 100% |
_TABLE IX_

## Ataxia (Sensory or cerebellar)
|  | Disability Rate |
| --- | --- |
| Mild (Detected on examination) | 25% |
| Moderate (Symptomatic but not disability) | 50% |
| Severe (partial disability) | 75% |
| Very Severe (total disability) | 100% |

## References:
- 1. Early detection of occupational diseases: W.H.O. Geneva. 1986.
- 2. Manual for Doctors to evaluate permanent physical impairment, D.G.H.S., W.H.O., A.I.I.M.S
- 3. Plunkett. E.R. Handbook of Industrial Toxicology, U.S.A., 1987
- 4. I.L.O. Encyclopedia of Occupational Health & Safety, Vol. I & II, Geneva. 1983.
- 5. Parkes, W.R. Occupational Lung Disorders, Butter worths, London. 1982.

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- 6. Sataloff, R.T., et.al: Occupational Hearing Loss marcel Dekkar Inc., U.S.A., 1987
- 7. Brawnwold, et. al; Harrison’s Principles of Internal Medicine, U.S.A., 1987.
- 8. Levy,B.S. and Wegman, D.H., Occupational Health. Recognizing and Preventing work
related disease, Boston, U.S.A., 1988.
- 9. Rom W.N. Environmental and Occupational Medicine Boston, U.S.A. 1983.
By Order of the Governor
MINI ANTONY,
Secretary to Government

PUBLISHED BY THE SUPERINTENDENT OF GOVERNMENT PRESSES
AT THE GOVERNMENT CENTRAL PRESS, THIRUVANANTHAPURAM, 2021

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Digitally signed by Salim A
Date:2021.12.16 02:58:20 +05:30

Kerala Code on Social Security Draft Rules

Full rule text

ആത്മാവാണോ.

EXTRAORDINARY

CHAPTER II

25 Time within which and the form in which a written application shall be made under sub-section (I) and the form of application to the competent authority under clause (b) of sub-section (5) of section 56.-

28. Application to competent authority for direction under clause (b) of sub-section (5) of section 56:- (1) If an employer,-

CHAPTER IV

EMPLOYEES COMPENSATION

CHAPTER V

SOCIAL SECURITY AND CESS IN RESPECT OF BUILDING AND OTHER

CHAPTER VI

FINANCE AND ACCOUNTS

CHAPTER VII

CHAPTER VIII

COMPOSITION OF OFFENCE

EMPLOYMENT INFORMATION AND MONITORING

FORM I

Nomination/Fresh Nomination/Modification of

Nominee(s)

Statement

Certificate by the Employer

Acknowledgement by the Employee

FORM-II

Application for Gratuity by an Employee/Nominee/Legal heir

FORM III

Notice for Payment/Rejecting claim of Gratuity

FORM-IV

Application for Direction

Before the Competent Authority for Chapter III under the Code on Social Security,

FORM V⁻

FORM VI

Notice for Payment of Gratuity as Determined by Competent/Appellate Authority

FORM VII

Application Before the Competent Authority

FORM VIII

REGISTER OF GRATUITY

FORM IX

[See rule 41]

Notice of Fatal Accidents

Statement

FORM X

Deposit of Compensation of Fatal Accident

FORM XI

[See rule 46 & 49]

Receipt of Compensation

FORM XII

Deposit of Compensation for Non-Fatal Accident to a Woman or Person under

FORM XIII

Statement of Disbursements

FORM XIV

Application for Order for Deposit of Compensation

FORM XV

[See rule 49]

Deposit of Compensation for Non-fatal Accidents, other than to a woman or

FORM XVI

CERTIFICATE OF DISABILITY/DEATH

1. Temporary disablement

2. Permanent disablement

3. Death

FORM XVII

ENDORSEMENT TO BE MADE BY MEDICAL BOARD IN CASE OF PERMANENT

1. Permanent disablement

2. Death

FORM XVIII

Notice to indemnifier

FORM XIX

Notice to Person of Indemnify

Form XX

[See rule 72]

Notice Requiring Statement of Accident

Form XXI

[See rule 72 & 73]

Reply Statement by the Employer

FORM XXII

[See rule 73]

Memorandum of agreement

FORM XXIII

[See rule 73]

Memorandum of Agreement