Rule 130: Repeal and savings

130. Repeal and savings.- (1) On and from the date of commencement of these rules,- (1) The Rajasthan Beedi and Cigar Workers (Conditions of Employment) Rules, 1969; (2)The Rajasthan Building and Other Construction Workers (Regulation of Employment and Condition of Services) Rules, 2009; (3)The Rajasthan Contract Labour (Regulation and Abolition) Rules, 1971; (4) The Rajasthan Factories Rules, 1951; (5) The Rajasthan Welfare Officers (Recruitment and Conditions of Service) Rules, 1959; (6) The Rajasthan Inter-State Migrant Workmen (Regulation of Employment and Conditions of Service) Rules, 1981; and (7) The Rajasthan Motor Transport Workers Rules, 1962, are hereby repealed. (2) The repeal of the rules specified in sub-rule (1) shall not,- (i) revive anything not in force or existing at the time of such repeal; or (ii) affect the previous operation of any rules so repealed and orders or anything duly done or suffered thereunder; or (iii) affect any right, privilege, obligation, or liability acquired, accrued or incurred under the rules so repealed or orders issued under such repealed rules: (iv) affect any investigation, inquiry, verification, adjudication and any other legal proceedings or recovery of arrears or remedy in respect of any such rights, privilege, obligation, liability, forfeiture or punishment, as aforesaid, and any such investigation, inquiry, verification proceedings, adjudication and other legal proceeding or recovery of arrears or remedy may be instituted, continued or enforced, and any penalty, fine, interest, forfeiture or punishment may be levied or imposed as if these rules had not been so repealed; or (v) affect any proceedings including that relating to an appeal, revision, review or reference, instituted before, on or after the commencement of these rules and 608 ‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍राजस्‍थान‍राज-पत्र,‍जून‍30,‍2026‍‍‍‍‍ ‍‍‍‍‍ ‍भाग‍4(ग) such proceedings shall be continued under the said repealed rules as if these rules had not come into force and the said rules had not been repealed. (3) The mention of the particular matters referred to in sub-rule (2) above shall not be held to prejudice or affect the general application of provisions of the General Clauses Act, 1897 (Central Act No. 10 of 1897) with regard to the effect of repeal. Form-1 (see rule 5(1)(a), 5(6) & 6(1)) Application for Registration for existing establishment or factory/New Establishment or factory/Amendment to certificate of Registration A. Establishment Details 1. Retrieve details of Establishment through LIN: 2. Name of Establishment: 3. Location and Address of the Establishment: 4. PAN: 5. Other details of Establishment: a. Total Number of employees engaged directly in the establishment: b. Total Number of the contract employees engaged: c. Total Number of Inter-State Migrant workers employed: 5(a). For Factories: Details of the Full postal address Name and address Maximum Maximum manufacturing and situation of the of the occupier and number of Power process factory along with manager workers to be installed/used plan approval details employed on any day 1 2 3 4 5 5(b). For Beedi and Cigar Works: Details of the Full postal Name and Maximum Number of manufacturing address and address of the number of home workers process situation of the employer and workers to be establishment manager employed on any day in the establishment 1 2 3 4 5 5(c). For Motor Transport undertaking: Nature of motor Full postal Name and Maximum Total No. of transport service e.g. address and address of the number of Motor situation of the employer and workers to be transport City service, long establishment manager employed or vehicles distance passenger proposed to be service and long employed during on the date of distance freight service भाग‍4(ग) ‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍राजस्‍ थान‍राज-पत्र,‍जून‍30,‍2026‍‍‍‍‍‍‍‍ ‍‍ ‍609 etc. period of application registration 1 2 3 4 5 5(d). For building and other construction work: Type of Probable period of Expected period Details of Date of Construction commencement of for completion of approval of the Commencement work work work local authority /Probable date of Completion of work 1 2 3 4 5 5(e). For News Paper Establishments: Name of Full postal Name and address Maximum number Date of Establishment address and of the employer of workers to be Commencem s situation of the and manager employed on any ent /Probable establishment day in the date of establishment Completion of work 1 2 3 4 5 5(f). For Audio-Visual Workers: Name of Full postal Name and address Maximum number Date of Establishment address and of the employer of workers to be Commencem s situation of the and manager employed on any ent /Probable establishment day in the date of establishment Completion of work 1 2 3 4 5 6. Ownership Type/Sector: 7. Activity as per National Industrial Classification: 8. Details of Selected NIC Code: 9. Identification of the establishment e-sign/ digital sign of employer/ representative: B. Details of Employer 1. Name & Address of Employer / Occupier / Owner/Agent/ Chief Executive/ port authority etc.: 2. Designation: 3. Father ‘s/ Husband ‘s Name of the Employer: 4. Email Address, Telephone& Mobile No: C. Manager/ Agent Details 610 ‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍राजस्‍थान‍राज-पत्र,‍जून‍30,‍2026‍‍‍‍‍ ‍‍‍‍‍ ‍भाग‍4(ग) 1. Full name & Address of Manager/ Agent or person responsible for supervision and control of the Establishment: 2. Address of Manager/ Agent: 3. Email Address, Telephone& Mobile No: D. Contractor Details Name and Email address & Name of Work Maximum No. of Date of Address Mobile of Contract labour Commencement Contractor Contractor engaged /Probable date of Completion of work 1 2 3 4 5 E. Others Details: Signature/ E-sign/digital sign of Occupier/Employer Dated: Place: Declaration by the Occupier/Employer for Auto-Registration of Factory I hereby declare that the information furnished above, including the address of the factory, is true and correct to the best of my knowledge and belief. I further declare that I have ensured that the use of the above-mentioned premises is duly approved for the purpose of carrying out the manufacturing process specified in column (1) of the Table under clause 5(a) of Form-1. Signature/ E-sign/digital sign of Occupier/Employer Name: Designation: Date: Place: Form-2 (see rule 5(1)(d)) Certificate of Registration of Establishment Registration No. Date A Certificate of registration containing the following particulars is hereby granted under sub- section (2) of section 3 of the Occupational Safety, Health and Working Conditions Code, 2020 (Central Act No 37 of 2020) to…………………………………….. (Name of the establishment) 1. Nature of work carried on in the establishment (Please tick mark) (a) Factory (b) Mining (c) Dock work (d) Contract Work (e) Building and Other Construction Works (f) Any other work (not covered above) 2. Details of the establishment: a. Total Number of employees engaged directly in the establishment: b. Total Number of the employees engaged through contractor: भाग‍4(ग) ‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍राजस्‍ थान‍राज-पत्र,‍जून‍30,‍2026‍‍‍‍‍‍‍‍ ‍‍ ‍611 c. Total Number of Contractors and their details: d. Number of inter-state migrant workers engaged: 3. (a) For factories Details of the Full postal address and Name and address of Maximum number manufacturing situation of the factory the occupier and of workers to be process along with plan approval manager employed on details any day 1 2 3 4 3. (b) For mines Name of Lease extent of the Name and address Average Monthly Maximum Mineral(s) mine (in Acres) of the owner output, targeted number of (Tonne) persons to be employed on any day 1 2 3 4 5 3. (c) For Dock work Name of Dock Types of Dock Name of the Cargo Name of the Name of the Work / Major Works handled and chemicals handled hazardous Port stored along with and stored along chemicals quantity with quantity handled and stored along with quantity 1 2 3 4 5 3. (d) For building and other construction work Type of Details of Probable period of Expected period for Construction approval of the commencement of work completion of work work local authority 1 2 3 4 4. Amount of registration fee paid: 5. Remarks of registering officers: Signature E -Sign/DSC of Registering Officer along with designation Place: Date: Conditions of Registration (1) Every certificate of registration issued under rule 4 shall be subject to the following conditions, namely: 612 ‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍राजस्‍थान‍राज-पत्र,‍जून‍30,‍2026‍‍‍‍‍ ‍‍‍‍‍ ‍भाग‍4(ग) (a) the certificate of registration shall be non-transferable; (b) the number of workers employed in an establishment directly and contract employees shall not, on any day, exceed the maximum number specified in the certificate of registration; and (c) Save as provided in these rules, the fees paid for the grant of registration certificate shall be nonrefundable. (2) The employer shall intimate the change, if any, in the number of workers or the conditions of work to the registering officer within 30 days (3) The employer shall, within thirty days of the commencement and completion of any work, intimate to the Inspector-cum-Facilitator , having jurisdiction in the area where the proposed establishment or as the case may be work is to be executed, intimating the actual date of the commencement or, as the case may be, completion of establishment such work in Form-4 annexed to these rules electronically. (4) A copy of the certificate of registration shall be displayed at the conspicuous places at the premises where the work is being carried on. Form-3 (See rule 5(8)) Register of Establishment SI. Nature of work Registratio Name and Name, Total Total Remark No. n No. and Address, Address number of number s Date location of the and Workers and of Contact Total contrac establishment Details of Horsepower t registered ( if any) Employer Worker s 1 2 2 3 4 5 6 (a) Factories (b) Mines (c) Dock Work (d) Building and other Construction work (e) Contract work (f) Interstate Migrant Work (g) Any other work (not covered above) भाग‍4(ग) ‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍राजस्‍ थान‍राज-पत्र,‍जून‍30,‍2026‍‍‍‍‍‍‍‍ ‍‍ ‍613 Form-4 (see rule 5(9) & 18) Notice of Commencement / completion of work/ cessation of Establishment: 1. Registration No: 2. Name and Address of Factory or Establishment: 3. Name & Designation of occupier in case of factory or employer / Port authority(who has ultimate control over the affairs of the establishment): 4. Full address to which communication relating to the factory or establishment to be sent: 5. Nature of work of the factory or establishment: 6. In case of the notice is for commencement of work the approximate duration of work (establishment only): 7. in case of completion of work/cessation of establishment, the date of completion /cessation : I/We hereby intimate that the work of factory or establishment having registration No. ………… …………………………………..dated …………………………………… is likely to commence/cessation of work is likely to be with effect from ……………………………………………………. (Date)/ On ………………………….. (Date) In case of cessation of work: I/we hereby certify that the payment of all dues to the workers employed in the establishment have been made and the premises are kept free from storage of hazardous chemicals and substances. Signature of the occupier/employer (Name and seal) To, The Inspector-cum-Facilitator 614‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍राजस्‍थान‍राज-पत्र,‍जून‍30,‍2026‍‍‍‍‍‍‍ ‍‍‍ ‍‍भाग‍4(ग) Form-5 (see rule 6(1), 12, 13(3), 16(2) & 17(2)) Application for License/Renewal of license/Amendment to license/Transfer of license of factory 1. Period of licence: 1. YEAR (s) for which licence is applied for From To 2. General Information: 2a. Full name of the factory 2b. Factory registration number (if RJ - already registered) 3. Address and contact information of Factory: 3. Full postal address along with pin code and Contact Number and email id 4. Nature of manufacturing processes: 4a. Date of start of production (for registration) 4b. Manufacturing process carried on in the factory in the last twelve months 4c. Manufacturing process to be carried on in the factory during the next twelve months 5. Workers employed: Male Female Transgender Total 5a. Maximum number of workers proposed to be employed during the year 5b. Maximum number of workers employed during the last twelve months on any day 5c. Number of workers ordinarily employed in the factory भाग‍4(ग) ‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍राजस्‍थान‍राज-पत्र,‍जून‍30,‍2026‍‍‍‍‍ ‍‍ ‍‍‍‍ ‍ ‍615 6. Power installed: 6. Total rated Horse Power or amount of Power (installed or to be installed or used) whichever is maximum and K.No. of consumer (attach sanction load certificate and first electricity bill) 7. Particulars of Factory Manager: 7. Name and address of the person who shall be the Name Factory Manager (if appointed) of the factory for the purposes of the Act Residential address Contact No. and email id 8. Particulars of Occupier: 8a. Name and address of the occupier Name (in case of a private firm.) Attach list of partners with complete details, (in case of partnership firm) Residential Address Contact No. and email id 8b. Name and address of the Director in case of a Name private/ public limited company ( attach list of Director with details) Residential Address Contact No. and email id 8c. Full name and residential address of the Name Managing Agent in case where a managing agent 616‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍राजस्‍थान‍राज-पत्र,‍जून‍30,‍2026‍‍‍‍‍‍‍ ‍‍‍ ‍‍भाग‍4(ग) is appointed by the Central Government Address / State Government / Local authority as Occupier Contact No. and email id 9. Land & Building: 9a. Full name and address of the owner of Name the premises or building (including the precincts thereof) (referred to in section 93 of Address the Act) Contact No. and email id 9b. Reference number and date of approval of the plans for site, whether for old or new building and for construction or extension of factory by the State Government / Chief Inspector 10. Other information a. Information of manufacturing process as per National Industrial Classification (NIC Code): 1. Activity as per National Industrial Classification: 2. Details of Selected NIC Code: b. Identification of the factory: NOTE: a. In case of any change in the above information, Department shall be informed in writing. b. Seal bearing “ authorized signatory “ shall not be used on any document. Place: Date: e-sign/Signature of Factory Manager with seal: ( Name) e-sign/Signature of occupier with seal: ( Name ) भाग‍4(ग) ‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍राजस्‍थान‍राज-पत्र,‍जून‍30,‍2026‍‍‍‍‍ ‍‍ ‍‍‍‍ ‍ ‍617 VERIFICATION I, the above named Occupier, do hereby further solemnly affirm that the contents given above are true to the best of my knowledge. Place: __________________ Date: __________________ e-sign/Signature of Occupier …………………………….……. Form-6 (see rule 8(2) & (4) & rule 106) Submission and approval of plans Application for permission for the site on which the factory is to be situated and for the construction or extension thereof 1. Details of Occupier (a) Name: (b) Father’s/Mother’s/Husband’s Name (c) Address (office): (d) Address (residential): (e) Mobile number: (f) Email 2. Details of factory (a) Name of Factory: (b) Situation of factory 1. Industrial Area/Other 2. Urban / Rural (c) Address with PIN code: (d) District: (e) Contact number: (f) Email: (g) Website: 3. Particulars of plant to be installed _________________________________________________________ _________________________________________________________ 4. Name of Manufacturing process _________________________________________________________ _________________________________________________________ 5. Maximum number of Workers Male Female Transgender (Proposed to employ) ______ _______ _______ 6. Details of (a) Raw material ________________________________________________________ (b) Intermediate product/by product ________________________________________________________ (c) Final Product ________________________________________________________ 618‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍राजस्‍थान‍राज-पत्र,‍जून‍30,‍2026‍‍‍‍‍‍‍ ‍‍‍ ‍‍भाग‍4(ग) 7. Name of Chemicals for use in the manufacturing process, if any S. No. Trade name: Chemical name: Maximum storage quantity at any time: 8. Area of the factory premises: 9. If common premises, then no. of factories working in premises: 10. Name, address, contact number of owner of premises; 11. NOTE a. In case of any change in the above information, Department shall be informed in writing within 30 days. b. Seal bearing “Authorised Signatory” shall not be used on any document Place: Date: e-sign/Signature of occupier with seal: (Name of occupier) Form-7 (see rule 8(4)) Application for factories involving non-hazardous process and employing up to 50 workers I____________________________________ S/o_____________________________ R/o _____________________________________ _________________________and Occupier of M/s______________________________ ________________ hereby state as under- 1. That I have applied for registration of my factory in the name of M/s ___________________ __________________ situated at (Complete address of the factory) ____________________________ 2. That I have gone through the Code & rules and regulations made thereunder and have fully understood the contents of the Code & Rules and undertake to abide by the same. 3. That I propose to employ up to 50 workers. 4. That I shall inform and submit relevant necessary documents as per Code and Rules, in case of: i. change of building & machinery layout; ii. change in manufacturing process; iii. addition of any manufacturing process involving hazardous process or dangerous process Major Accident Hazards (MAH) Installation; or भाग‍4(ग) ‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍राजस्‍थान‍राज-पत्र,‍जून‍30,‍2026‍‍‍‍‍ ‍‍ ‍‍‍‍ ‍ ‍619 iv. employment of more than 50 workers. 5. NOTE - Seal bearing “Authorised Signatory shall not be used. Place: Date: e-sign/Signature of occupier with seal: (Name of occupier) VERIFICATION I the above named Occupier do hereby further solemnly affirm that the contents given above are true to the best of my knowledge. Place: Date: e-sign/Signature of occupier with seal: (Name of occupier) Form-8 (see rule 9) Form of Certificate of Stability 1. Name of the factory: 2. Village, town and district in which the factory is situated: 3. Full postal address of the factory: 4. Name of the occupier of the factory: 5. Nature of manufacturing process to be carried on in the factory: 6. Name and description of building / block of building: 7. Year of construction: 8. Manufacturing process to be carried out in the building/ block of building: 9. Number of floors on which workers will be employed: I certify that I have inspected the building / block of building and carried out the required tests, the plans of which have been approved by the Chief Inspector-cum-Facilitator in his letter No................ dated ......... and examined the various parts including the foundations with special reference to the machine, plant etc., that have been installed, I am of the opinion that the building / block of building which have been constructed/ reconstructed /extended / taken to be use is/are in accordance with the plans approved by the Chief Inspector-cum-Facilitator in his letter mentioned above, that it / they/ is/are structurally sound and that its/their stability will not be endangered by its /their use as factory/part of factory for the manufacture of ............... for which the machinery, plant, etc. installed are intended. Signature with Name, address, Qualification and Contact details Of Competent Person Enclosures: (1) Details of Competency Certificate issued by Chief Inspector-cum-Facilitator (2) Test reports 620‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍राजस्‍थान‍राज-पत्र,‍जून‍30,‍2026‍‍‍‍‍‍‍ ‍‍‍ ‍‍भाग‍4(ग) Form-9 (see rule 11(1) & 16(2)) Government of Rajasthan Licence to work a Factory Registration No. ..................... Fee Rs. ............................ Licence No. ..................... Licence is hereby granted to..................valid only for the premises described below for use as a factory employing not more than persons on any one day during the year and using motive power not exceeding.... (Power Unit – HP/KW) subject to the provisions of the Occupational Safety, Health and Working Conditions Code, 2020, and the Rules made thereunder. This licence shall remain in force till the 31st day of March, 20.......... Chief Inspector-cum-Facilitator Description of the licenced premises The licenced premises shown on Plan No..............dated are.............situated in.......................and carrying out the manufacturing process .................. Date: Signature of licensing authority Conditions of Licence: 1. 2. 3. भाग‍4(ग) ‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍राजस्‍थान‍राज-पत्र,‍जून‍30,‍2026‍‍‍‍‍ ‍‍ ‍‍‍‍ ‍ ‍621 Form-10 (see rule 11(1)) Common Licence for Factory and Establishments Government of Rajasthan Registration No. Date Licence No. Fee Rs. ............................ A common licence containing the following particulars is hereby granted under the Occupational Safety, Health and Working Conditions Code, 2020 to…………………………………….. (Name of the factory/establishment etc.) 1. Nature of work carried on in the establishment (Please tick mark) (a) Factory (b) Building and Other Construction Works (c) Contract Work (d) any other work (not covered above) 2. Details of the Factory, Establishment, BOCW, Contract Work, etc.: (a) For factories 1. Valid up to ------ (Date) 2. Plan approval no. …date....3. Annual Fees….. Name of Full postal Manufacturin Name of the Maximum number of Maximum power the factory address of g process occupier workers proposed to (HP/KW) the factory be employed on installed/use/ any day sanctioned 1 2 3 4 5 6 Date of issue/renewal: Signature/ E -Sign/DSC of Licensing Authority along with designation (b) For establishment Valid up to ------(Date) Probable period of Expected period for Details of approval of Type of work commencement of work completion of work the authority 1 2 3 4 (a) Total Number of the workers and employees engaged directly and through contractor: (b) Total Number of Contractors and their details: (c) Number of inter-state migrant workers engaged: Amount of fee paid: Date: Signature/ E -Sign/DSC of Licensing Authority along with designation (c) Other ………………………………….. Valid up to ------(Date) 622‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍राजस्‍थान‍राज-पत्र,‍जून‍30,‍2026‍‍‍‍‍‍‍ ‍‍‍ ‍‍भाग‍4(ग) Probable period of Expected period for Details of approval of Type of work commencement of work completion of work the authority 1 2 3 4 (a) Total Number of the workers and employees engaged directly and through contractor: (b) Total Number of Contractors and their details: (c) Number of inter-state migrant workers engaged: Amount of fee paid: Date: Signature/ E -Sign/DSC of Licensing Authority along with designation Conditions of Licence.- Licence shall be subject to the following conditions, namely: (1) the number of workers employed in a factory or establishment directly and contract employees shall not, on any day, exceed the maximum number specified in the license; (2) the employer shall intimate the change, if any, in the number of workers or the conditions of work to the Licensing Officer within 30 days (3) the employer shall, within thirty days of the commencement and completion of any work, intimate to the Inspector-cum-Facilitator , having jurisdiction in the area where the proposed establishment or as the case may be work is to be executed, intimating the actual date of the commencement or, as the case may be, completion of establishment such work in Form-IV of Occupational Safety, Health and Working Conditions (Central) Rules, 2020 electronically. (4) a copy of this licence shall be displayed at the conspicuous places at the premises where the work is being carried on. Other conditions for: (1) Factory 1. 2. 3. (2) Building and other construction work 1. 2. 3. (3) Other work 1. 2. भाग‍4(ग) ‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍राजस्‍थान‍राज-पत्र,‍जून‍30,‍2026‍‍‍‍‍ ‍‍ ‍‍‍‍ ‍ ‍623 Form-11 (see rule 14) Notice of change of Manager 1. Name of factory with registration and licence number : 2. Postal address: 3. Name of outgoing Manager: 4. Name of new Manager with postal address of the residence and Telephone number, if installed: 5. Date of appointment of the new Manager : Signature and seal of new Manager (Name) Signature and seal of occupier (Name) Form-12 (see rule 28) Health Check-up for employee PART–A (Sl. No. 1-11) : To be filled by the Employee:................. Date..................... Note.— Exact details of cause of physical disability should be clearly stated. 1. Name of employee………………………………………………2. Sex…. ….. 3. Age (with DOB)…….. 4. Company…………………………………. 5.Designation……………………………….5a. UAN:…………… 6. In-charge Employer / Executive Contacts………………………………… 7. Complete personal /plant Address ………………………………… 8. Mobile /Phone …………………………… 9. Email………………………………… 10. Medical illness (Current) and under treatment & medication, If any……………………………… --------------------------------------------------------------------------------------------------------------------------- 11. Nature of Job (furnish more details, if hazardous and work-related viz. Physical, Chemical, Biological, Ergonomic etc) ……………………………………… Date: Signature of Employee ----------------------------------------------------------------------------------------------------------------------------- - PART-B 12. Medical Test Carried out & Reports to be Attached as Annex . Medical Officer’s interpretation/ Opinion of the Tests below (To indicate only if abnormal , referring the attached Test reports) : 624‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍राजस्‍थान‍राज-पत्र,‍जून‍30,‍2026‍‍‍‍‍‍‍ ‍‍‍ ‍‍भाग‍4(ग) a. Ht. Wt. Chest, Waist Circumference, Body Mass Index: …………………… b. Vision (Ophthalmologist tests): i. Visual Acuity both Right & left eyes …………………………. ii. Colour Vision……………………………………………….. c. Blood Pressure ……………………………………….. d. Complete Blood Count: ……………………………… e. Blood Sugar (Fasting/PPBS/HbAC1)………………. f. SpO2……………………….. g. Blood Urea Nitrogen (BUN)….………………………….. h. SGOT/SGPT……………………………………………….. i. Lipid profile………………….. j. ESR……………………………….. k. Thyroid profile…………………………………. l. X-ray Chest etc………………………………… m. ECG…………… n. Others if any…………………………………………. ---------------------------------------------------------------------------------------------------------------------- 13. Final Diagnosis/ Opinion / Treatment if any, advise by qualified medical practitioner ………………… 14. Does the person have seizure (s) related disorders or difficulties working at Height? If yes, explain the works to be avoided: Yes/No/ NA (Not applicable) Date: Signature of the qualified medical practitioner SEAL NOTE: All the above information is highly confidential between the Applicant and the Examining Physician. Sharing of the above with Employer or any other agency/persons is permitted only on obtaining Consent from the Applicant/Employee. भाग‍4(ग) ‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍राजस्‍थान‍राज-पत्र,‍जून‍30,‍2026‍‍‍‍‍ ‍‍ ‍‍‍‍ ‍ ‍625 Form-13 (see rule 30(1), (2) & (3)) NOTICE OF ACCIDENT OR DANGEROUS OCCURRENCE E.S.I.C. Employer’s Code number: E.S.I.C. Insurance Number of the injured person: 1. Name of employer: 2. Address of works / premises where the accident or dangerous occurrence took place: 3. Nature of industry and LIN of the establishment: 4. Branch or department and exact place where the accident or dangerous occurrence took place: 5. Name and address of the injured person: 6. (a) Sex: (b) Age (at the last birthday): (c) Occupation of the injured Person: 7. Local E.S.I.C. Office to which the injured person is attached: 8. Date, shift and hour of accident or dangerous occurrence: 9. (a) Hour at which the injured person started work on the day of accident or dangerous occurrence: (b) whether wages in full or part are payable to him for the day of the accident or dangerous occurrence: 10. (a) Cause or nature of accident or dangerous occurrence: (b) If caused by machinery- (i) Give the name of machine and the part causing the accident or dangerous occurrence: (ii) state whether it was moved by mechanical power at the time of accident or dangerous occurrence: (c) State exactly what the injured person was doing at the time of accident or dangerous occurrence: (d) In your opinion, was the injured person at the time of accident or dangerous occurrence - (i) acting in contravention of provisions of any law applicable to him; or (ii) acting in contravention of any orders given by or on behalf of his employer; or (iii) acting without instructions from his employer? (e) In case reply to (d) (i), (ii) or (iii) is in the affirmative , state whether the act was done for the purpose of and in connection with the employer‘s trade or business.: 11. In case the accident or dangerous occurrence took place while travelling in the employer‘s transport, state whether - 626‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍राजस्‍थान‍राज-पत्र,‍जून‍30,‍2026‍‍‍‍‍‍‍ ‍‍‍ ‍‍भाग‍4(ग) (a) the injured person was travelling as a passenger to or from his place of works; (b) the injured person was travelling with the express or implied permission of his employer; (c) the transport is being operated by or on behalf of the employer or some other person by whom it is provided in pursuance of arrangements made with the employer; and : (d) the vehicle is being/not being operated in the ordinary course of public transport service : 12. In case the accident or dangerous occurrence took place while meeting emergency, state- (a) its nature ; and (b) whether the injured person at the time of accident or dangerous occurrence was employed for the purpose of his employer‘s trade or business in or about the premises at which the accident or dangerous occurrence took place.: 13. Describe briefly how the accident or dangerous occurrence took place : 14. Names and addresses of witnesses : (1) (2) 15. (a) Nature and extent of injury (e.g. fatal, loss of finger, fracture of leg, scald, scratch followed by sepsis, etc.): (b) Location of injury (e.g. right leg, left hand, left eye, etc.) 16. (a) If the accident or dangerous occurrence was not fatal, state whether the injured person was disabled for more than 48 hours : (b) date and hour of return of work : 17. (a) Physician, dispensary or hospital from whom or which the injured person received or is receiving treatment: (b) Name of dispensary/panel doctor elected by the injured person: 18. (a) Has the injured person died ?: (b) If so, date of death: I certify that to the best of my knowledge and belief the above particulars are correct in every respect. Signature and Name and Designation of owner/ employer /manager/agent भाग‍4(ग) ‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍राजस्‍थान‍राज-पत्र,‍जून‍30,‍2026‍‍‍‍‍ ‍‍ ‍‍‍‍ ‍ ‍627 Date of dispatch of report : Place: Form-14 (see rule 45(2)) Register of Compensatory Holidays Registration number …………. Name of factory or factory or establishment.............Address.................District...................Year………. Sr. Name of Father’s / Date on which Date on which Remarks No. worker/employee Husband’s / weekly holiday compensatory holiday and work id Mother’s name not given allowed as per sub- section (3) of section 26 for weekly holiday in column 4 1 2 3 4 5 6 January to March April to June July to September October to December 7 8 9 10 Date of compensatory holidays given in Last rest days Remarks January to March April to June July to October to carried to the September December next year 11 12 13 14 15 16 Form-15 (see rule 48) NOTICE OF PERIODS OF WORK Name of the Establishment…………………………Place…………………………………District…………………… Perio Men Women Descriptio Remarks ds of n of work Total no. of men Total no. of women Groups, Group employed employed Nature of s, work Relays A B C D E F G H 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 628‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍राजस्‍थान‍राज-पत्र,‍जून‍30,‍2026‍‍‍‍‍‍‍ ‍‍‍ ‍‍भाग‍4(ग) On working days From .. To .. From .. To .. From .. To .. On partial Working days From .. To .. From .. To .. Date on which this notice is first exhibited : Signature of Occupier/owner/employer/manager: Date : Form-16 (see rule 49(1)(a)) Register of employees Registration number …………. Name of factory or establishment.............Address.................District................... Labour Identification Number (LIN):…………. (The register can also be maintained in electronically capturing, inter-alia the following details) Name of Establishment: Name of the Employer/owner: Labour Identification Number (LIN)/Registration Number of Establishment To be maintained for all employees of the establishments 1. Employee Code 2. Name 3. Surname 4. Gender भाग‍4(ग) ‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍राजस्‍थान‍राज-पत्र,‍जून‍30,‍2026‍‍‍‍‍ ‍‍ ‍‍‍‍ ‍ ‍629 5. Father’s/Spouse’s Name 6. Date of Birth 7. Place of Birth 8. Nationality 9. Education level 10. Date of Joining 11. Designation 12. Category (unskilled, semi-skilled, skilled or highly skilled) 13. Type of employees / worker 14. Mobile Number 15. Universal Account Number (UAN) 16. PAN 17. PPF No. 18. Nominee 19. EPS/NPS 20. Details of Family 21. Details of Posting 22. Scale of Pay 23. Promotion 24. ESIC IP Insurance No. 25. Aadhaar number 26. Bank A/c No. 27. Bank 28. Branch(IFSC) 29. Present address 30. Permanent address 31. Service Book No. 32. Date of Exit 33. Reason for Exit 34. Mark of Identification 35. Photo 36. Specimen Signature/Thumb Impression 37. Remarks 630‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍राजस्‍थान‍राज-पत्र,‍जून‍30,‍2026‍‍‍‍‍‍‍ ‍‍‍ ‍‍भाग‍4(ग) Form-17 (see rule 49(1)(b)) Attendance muster roll register Registration number …………. Name of factory or factory or establishment.............Address.................District................... Month---Year (The attendance register-cum-muster roll can also be maintained in electronically capturing, inter- alia the following details) For the Month of ………. , year 20........ Name of Establishment: Name of the Employer/owner: Labour Identification Number (LIN)/Registration Number of Establishment 1. Serial Number 2. Employee Code 3. Name 4. Designation 5. Shift or relay 6. Place of work/department/section 7. Date and timings of In and Out 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 8. Total number of days worked 9. Total number of extra hours worked 10. In case of tour or assignments outside the work place suitable entries may be made 11. Signature of Register keeper भाग‍4(ग) ‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍राजस्‍थान‍राज-पत्र,‍जून‍30,‍2026‍‍‍‍‍ ‍‍ ‍‍‍‍ ‍ ‍631 Form-18 (see rule 49(1)(c)) Month ending...............20... REGISTER FOR WAGES, OVERTIME AND DEDUCTIONS (The register can also be maintained in electronically capturing, inter-alia the following details) Name of Establishment: Name of the Employer/owner: Labour Identification Number (LIN)/Registration Number of Establishment Wage Period from dd/mm/yyyy to dd/mm/yyyy (Monthly/Fortnightly/Weekly/Daily/Piece Rated) 1. Serial Number 2. Employee Code Number 3. Name 4. Designation 5. Rate of Wage a)Basic b)DA c)Other allowance d)Total 6. No. of days worked 7. Overtime hours worked 8. Amount of Wages Earned a)Basic b)DA c)Other allowance d)Payment of overtime e)Total wages earned 9. Deductions a)EPF b)ESIC c)Society d)Income Tax e)Insurance f)Others g)Recovery of Fine h)Recovery of Damaged/Losses Total Deductions 10. Net Payment 632‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍राजस्‍थान‍राज-पत्र,‍जून‍30,‍2026‍‍‍‍‍‍‍ ‍‍‍ ‍‍भाग‍4(ग) 11. Receipt by Employees/Bank Transaction ID 12. Date of Payment 13. Initials of Employer/Representative 14. Remarks Form-19 (see rule 49(1)(d) & 53) Register of leave with Wages Registration No. of factory or establishment…… Name of factory or establishment: Part I - Adults Name of worker : Father’s Name: Department : Sl. Sl.no. in Date of Interruptions the entry N register into Sickness Authorize Lock Out or Involuntary Others o of service and d Leave unemployment worker accident Legal Strike s s 1 2 3 4 5 6 7 8 Leave Whether Date from Wages for Discharged Remarks due with leave not which the worker desired worker is Leave effect from during the allowed Paid in Date of Date & next 12 leave amount of months Discharge payment made in lieu of leave due 9 10 11 12 13 14 15 Note: - Separate page shall be allotted to each worker भाग‍4(ग) ‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍राजस्‍थान‍राज-पत्र,‍जून‍30,‍2026‍‍‍‍‍ ‍‍ ‍‍‍‍ ‍ ‍633