351 lines
5.5 KiB
PHP
351 lines
5.5 KiB
PHP
<div class="modal fade" id="form_genaration_0" role="dialog" aria-hidden="true">
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<div class="modal-dialog" id="modal-dialog1">
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<div class="modal-content">
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<div class="modal-header">
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<button type="button" class="close" id="form_close" data-dismiss="modal" aria-label="Close">
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<span aria-hidden="true">×</span>
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</button>
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</div>
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<div id="pdfModal">
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<form class="form" id="form_0_pdf" name="form_0_pdf" method="post" target="_blank">
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<div class="panel-body" id="form_0_pdf_body">
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<div style="margin-top: -20px">
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<div style="margin-top: 10px;">
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<table width="100%" class="tbl3" id="form_header">
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<tr>
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<td colspan="2" align="center"><strong>(FORM - O)</strong></td>
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</tr>
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<tr>
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<td colspan="2" align="center"><b>(See rule 29F(2) and 29L)</b></td>
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</tr>
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<tr>
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<td colspan="2" align="center"><b>Report of medical examination under rule 29-B(To be Issued In Triplicate)</b></td>
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</tr>
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</table>
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</div>
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<div style="margin-top: 10px; ">
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<input type="hidden" name="checkup_id_O" id="checkup_id_O"><input type="hidden" name="form_type_O" id="form_type_O">
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<table width="100%" class="tbl3" id="table_body_form_o">
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<tr>
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<td>
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<!-- <p contenteditable="true">(a)* is medically fit for any
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employment in mines</p> -->
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</td>
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</tr>
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<!-- <tr>
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<td>
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<p contenteditable="true">(b)* is suffering
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from.............................and medically unfit for</p>
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</td>
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</tr> -->
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<!-- <tr>
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<td>
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<p contenteditable="true"> (i) any employment in mines; or</p>
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</td>
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</tr> -->
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<!-- <tr>
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<td>
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<p contenteditable="true"> (ii)any employment below ground
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; or</p>
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</td>
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</tr> -->
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<!-- <tr>
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<td>
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<p contenteditable="true"> (iii) any employment or
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work..............................</p>
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</td>
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</tr> -->
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<!-- <tr>
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<td>
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<p contenteditable="true">(c)* is suffering
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from....................and should get this disability
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cured/controlled and should be again examined within a
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period of....................Months. He will appear for
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reexamination with the result of test of
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.................and the option of............specialist
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from.........He may be permitted/not permitted to carry on
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his duties during this period.</p>
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</td>
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</tr> -->
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</table>
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<table class="tbl3" width="100%">
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<tr>
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<td>Space for affixing</td>
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</tr>
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<tr>
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<td>Passport</td>
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</tr>
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<tr>
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<td>Size Photograph</td>
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</tr>
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<tr>
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<td>Of the</td>
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</tr>
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<tr>
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<td>Candidate</td>
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</tr>
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</table>
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<table width="100%" class="tbl3">
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<tr>
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<td colspan="3" align="right"><span class="profile-picture" id="profile-picture1"> </span></td>
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</tr>
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<tr>
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<td align="left">Place:</span></td>
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<td colspan="3" align="right">Signature of examining authority</td>
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</tr>
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<tr>
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<td align="left">Date: </td>
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<td colspan="3" align="right">Name and designation in block letter:</td>
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</tr>
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</table>
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<table width="100%" style="margin-right: 20px">
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<tr>
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<td width="70%">
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------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
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</td>
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</tr>
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</table>
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<table width="100%" id="id_table" class="tbl3">
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<tr>
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<td align="left">* Delete whatever is not applicable</td>
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</tr>
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<tr>
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<td>
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**One copy of the certificate shall be handed over to the person concerned and another copy shall be send to the manager of the mine concerned by registered post; and the third copy shall be retained by the examining authority.
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</td>
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</tr>
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<tr>
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<td align="center">Report of The Examining Authority</td>
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</tr>
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<!-- <tr>
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<td align="center">
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<p>(To be filled in for every medical examination wherever initial or periodical or re-examination or after cure/control of disability)</p>
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</td>
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</tr> -->
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</table>
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</div>
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</div>
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</div>
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</form>
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</div>
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<div class="modal-footer">
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<div class="form-group">
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<button type="button" class="btn btn-default" onclick="form_generation_for_pdf($('#form_type_O').val())">
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<span class="glyphicon glyphicon-floppy-save">Open PDF</span>
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</button>
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</div>
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</div>
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</div>
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<form id="form_pdf" name="form_pdf" target="_blank" action="" method="POST">
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<input type="hidden" name="htmlText" id="htmlText" />
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</form> |