OSHWC Form XII: notice of periods of work

Displayed notice of normal work periods and groups/relays, with a copy sent to the Inspector-cum-Facilitator under rule 71.

(See rule 71) · Central Rules 2026 · appropriate-government scope

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Fictional completed notice of periods of work; the selected facts and alternative branches are stated explicitly. It is not a genuine submission or official output.

Fictional, unsigned completed illustration. It demonstrates this form’s fields; it is not a filed return, medical opinion, official order or proof of an actual transaction.

When and how this form is used

Use the actual group/relay, sex-wise numbers, work periods and breaks. Rule 71 requires the notice and a copy to the Inspector-cum-Facilitator; a payroll ledger alone is not the displayed notice.

The example has eight actual work hours per normal day and 48 per six-day week. Daily/weekly limits, breaks, spread-over, overtime and category-specific rules must be considered together rather than deriving legality solely from one total.

The completed fields

Establishment and displayed work periods

Prescribed field / section	Completed fictional entry
Establishment / place / district	Illustration Central Construction Ltd (fictional), 14 Example Works, New Delhi 110001; depot project, New Delhi; district New Delhi
Group A / relay 1 / men / women	Stores support; 10 men and 10 women; total 20; one relay. Groups B–H and other relays have no workers and all period entries N/A
Working days / first period	Monday–Saturday: 09:00 to 13:00
Working days / second period	13:30 to 17:30; half-hour rest interval
Third period / partial working days	No third normal period; partial-day schedule N/A
Weekly rest / changes	Sunday weekly rest; applicable paid holidays separately recorded; overtime only with lawful consent, limits and pay, not a routine unshown shift
First exhibited / date / execution	1 October 2026; Kavita Shah, employer representative; Unsigned fictional illustration; no actual signature, DSC, seal, certification, approval or acknowledgement

Supporting records and reconciliation

Actual roster, employee/group assignments, approved work periods, break/rest records, displayed copy and communication of the notice to the prescribed authority.

Worked calculation: 4 + 4 = 8 actual hours/day; 6 × 8 = 48/week; normal spread-over 8½ hours including the break.

Official source and version

Official Gazette, OSHWC (Central) Rules 2026, Form XII, PDF pages 280–280

OSHWC Code 2020: governing Act; the form is read with its applicable section and 2026 Central Rule

Download the official source pages containing this form. Adjacent prescribed forms can share a source page; use the heading and rule identified above.

The Central Rules have their stated jurisdiction. The corresponding appropriate-government rules and any later amendment must match the real establishment and event.

Practical questions

Can I submit the sample as my own completed form?

No. Replace the fictional facts with accurate records, use the competent filing or record-keeping route described above and complete genuine signatures or certifications where required.

What makes the example specific to this form?