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Forms

SI No. Form No. Description Download English Version Download Malayalam Version
1 Form 1
Forms under Factories Act,
1948 and Kerala Factories Rules, 1957
2 Form 2
(Prescribed under Rule 4 and 12 )
Application for Registration and Grant of Amendment of Licence And notice of occupation
3 Form 3
(Prescribed under Rule No. 3 (4))

Certificate of Stability
4 Form 4
(Prescribed under Rule 5)

Licence to work a factory
5 Form 5
(Prescribed under Rule 14)
Certificate of fitness for young person
6 Form 6
(Prescribed under Rule 22)

Humidity Register
7 Form 7
(Prescribed under Rule 15)

Record of Lime washing, painting, etc
8 Form 8
(Prescribed under Rule 74)

Report of examination or test of pressure vessels or plant
9 Form 9
(Prescribed under Rule 103)
Register of Compensatory Holidays
10 Form 10
(Prescribed under Rule 10)

Overtime, register for exempted workers
11 Form 11
(Prescribed under Rule 106)

Notice of periods of work for adult workers
12 Form 12
(Specified under Rule 107)

Register of adult workers
13 Form 13
(Prescribed under Rule 112)
Notice of periods of work for child workers

14 Form 14
(Prescribed under Rule 113)

Register of child Workers
15 Form 15
(Prescribed under Rule 114)

Register of leave with wages
16 Form 16
(Prescribed under Rule 115)

Leave Book

(Shall be the same as “Register of Leave with wages” (Form No. 15) but shall be made out separately for giving to each worker on a thick sheet).

SI No. Form No. Description Download Emglish Version Download Malayalam Version
1 Form No. 17
(Prescribed under Rule 123)
 -  Health Register  
2 Form No. 18
(Prescribed under Rule 123 (4)) -  
Report of dangerous occurrence which does  not result in bodily   injury
3 Form No. 19 Notice of poisoning or disease 
4 Form No. 20
(Prescribed under Rule 126) -   
ABSTRACT OF THE FACTORIES ACT, 1948 AND  THE KERALA FACTORIES   RULES, 1957
5 Form No. 21
(Prescribed under Rule 127) -  
Annual Return 
6 Form No. 22
(Prescribed under Rule 127) -  
Half Yearly Return 
7 Form No. 23
(Prescribed under Rule 12A) - 
Notice of Change of Manager 
8 Form No. 25
(Prescribed under Rule 130) -  
Muster Roll 
9 Form No. 26
(Prescribed under Rule 131) -  
Register of accidents, major accidents dangerous occurrences 
10 Form No. 27
(Prescribed under Rule 122) -   
Certificate of fitness for employment in hazardous  processes/dangerous operations
11 Form No. 28
(Prescribed under Rule 115 (3)) -  
Attendance Card 
12 Form No. 29
(Prescribed under Rule 81 A) - 
Certificate of fitness for employment in hazardous processes and operations
13 Form no. 31
(Prescribed under Rule 129 A Schedule) - 
Register containing particulars of monitoring of working environment required under Section 7-A (2) (e)
14 Form No. 32
(Prescribed under Rule 127 93(3)) -  
Details of Closure
15 Form No. 33
(Prescribed under Rule 132) 
 
16 Form No. 34
(Prescribed under Rule 22 (1)) -  
Register of workers employed for work on or near  moving machine 
17 Form No. 35
(Prescribed under Rule 132 and 133) -  
Particulars of rooms in the factory 
18 Form No. 36
(Prescribed under Rule 119) -  
Nomination for payment of wages in lieu of the quantum of leave to   which he was entitled in the event of death of worker.
19 Form No. 37
(Prescribed under Rule 74 - A) - 
Register of examination of gasholders 
20 Form No. 38
(Prescribed under Rule 74 - A) -  
Report of examination of water-sealed gasholder
21 Form no. 39
(Prescribed under Rule 122) -  
Certificate of fitness for dangerous operations
22 Form No. 40
(Prescribed under Rule 122) -  
Test Report ………………………..  Dust Extraction system
23 Form No. 41
(Prescribed under Rule 72) -   
Report of examination of hoists and lift 
24 Form no. 42
(Prescribed under Rule 122) -  
Certificate of Fitness 
25 Form No. 43
(Prescribed under sub-rule (4) of rules 81G) 
Record of eye examination of drivers and signalers of cranes, locomotives etc.
 26 Form No. (Prescribed under Rule 81AA)   Site Appraisal Form    

Forms under The Manufacture, Storage, and Import of Hazardous Chemicals Rules , 1989 and The Control of Major Industrial Accident Hazard (Kerala) Rules, 1993

SI No. Description Download
1   Material Safety Data Sheet  
2 Information to be furnished regarding notification of a major accident  
3 Information to be furnished for the notification of activities/sites  
4 Information to be furnished in a safety report  
5 Details to be furnished in the On- Site emergency plan  

Forms under Indian Boilers Act, 1923 and Kerala Boilers Rules, 1967

SI No. Description Download Emglish Version
1 Fee schedule for registration/inspection of
i. Boilers S.R.O. No. 1153/2001 dated 20-12-2001
ii. Economiser S.R.O. No. 1154/2001 dated 20-12-2001
 
2 Application for Certificate of Competency as Boiler Attendant (form A)  
3 Application for the inspection of boilers and steam pipes (form B1)  
4 Report in to the investigations of the accident to boiler (form C)  
5 Application for Welder Test (form D)  
6 Application for Appointment/ Recognition as Approved Boiler Repairer/ Erector (form E)  
7 Application for BOE Examination  
8 Concerned Departments Government Orders/ Notifications  
9 FORM OF APPLICATION FOR GRANT OF CERTIFICATE OF COMPETENCY TO A PERSON UNDER SUB-RULE (1) of RULE 3 A  
10 FORM OF APPLICATION FOR GRANT OF CERTIFICATE OF COMPETENCY TO AN INSTITUTION UNDER SUB-RULE (1) OF RULE 3 A  
11 QUESTIONNAIRE FORM FOR REPAIRER OF BOILERS/ECONOMISER/STEAM LINE/FEED WATER LINES ETC. UNDER THE INDIAN BOILER REGULATIONS, 1950  
12 FORM OF APPLICATION FOR GRANT OF CERTIFICATE OF COMPETENCY TO AN INSTITUTION UNDER SUB-RULE (2) OF RULE 2A  
13 CONSUMER PRICE INDEX