FORM No. 34

(Prescribed under Rule 22 (1))

 Register of workers employed for work on or near  moving machinery

 

1.       Name of worker                          :

2.       Serial Number as in the register of       :

          adult workers.

3.       Father’s Name                            :

4.       Date of birth and age                   :

5.       Nature of work                            :

6.       Qualifications, if any, or period    :
          of service on similar work.

7.       Date when right fitting clothing     :
          was provided.

8.       Remarks                                     :

 

I certify that the above mentioned worker whose signature or left hand thumb impression is given below is a properly trained male adult worker who is competent to mount or ship belts, lubricate or do other adjusting operations on the machinery installed in my factory while they are in motion.

 

Signature or left hand thumb                  Signature of Manager
impression of worker                            Name (in block letters)

 

Date :