134 lines
4.3 KiB
PHP
134 lines
4.3 KiB
PHP
<div class="modal fade" id="form_genaration" role="dialog"
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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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<h5 class='modal-title'>Form 32</h5>
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<button type="button" class="close" id="form_close"
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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_32" name="form_32" method="post"
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target="_blank">
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<div class="panel-body">
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<?php
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error_reporting(0);
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$query = "select company_logo,image_type from company_profile where company_id =5 ";
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//echo $query;
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$result = mysqli_query($conn,$query);
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$row = mysqli_fetch_array($result);
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@extract($row);?>
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<table width="100%" class="tbl4">
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<tr>
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<td align="center" style="font-weight:900;">RCCPL PRIVATE LIMITED, BHARAULI (MAIHAR)</td></tr>
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<tr><td align="center" style="font-weight:900;">MADHYAPRADESH -485773</td> </tr>
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</table>
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<hr>
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<br>
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<div
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style="margin-top: 20px; margin-left: 10px; margin-right: 10px" id="form_32_div">
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<table width="100%" id="header_table"><input type="hidden" name="medical_exam_id" id="medical_exam_id"><input type="hidden" name="form_type" id="form_type">
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<tr>
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<td colspan="2" align="center" style="font-weight:900;">FORM NO- 32</td>
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</tr>
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<tr>
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<td colspan="2" align="center">CERTIFICATE OF FITNESS FOR
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HAZARDIOUS PROCESS/DANGERIOUS OPERATION</td>
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</tr>
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<tr>
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<td colspan="2" align="center">[Prescribed under rule 131 &
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Sch.XVII (7)]</td>
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</tr>
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<tr>
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<td colspan="2" align="center">ORIGINAL/COUNTER FOIL</td>
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</tr>
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</table>
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<div style="margin-top: 20px">
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<table width="100%" id="table_body" class="tbl3">
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<tr>
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<td><p contenteditable="true">2. He/She is Medically Fit to be employed but may be employed on some other non-hazardous operation such as..................</p></td>
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</tr>
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<tr>
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<td><p contenteditable="true">3. He/She may be produced for further examination after a period of.......</p></td>
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</tr>
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<tr>
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<td><p contenteditable="true">4. He/She is advised following further examination..............................</p></td>
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</tr>
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<tr>
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<td><p contenteditable="true">5. He/She is advised following treatment............</p></td>
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</tr>
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<tr>
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<td><p contenteditable="true">6. The serial No. Of the previous certificate is..........</p></td>
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</tr>
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<tr>
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<td align="center" id="valid_date"></td>
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</tr>
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</table>
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</div>
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<div style="margin-top: 100px">
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<table width="100%" class="tbl3">
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<tr>
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<td>Signature / LTI of person examined </td>
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<td align="right"><span align="right" class="profile-picture" id="profile-picture" >
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</span></br>Digital Signature with Stamp</td>
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</tr>
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<tr>
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<td align="left">Name of Medical assistant</td>
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</tr>
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<tr>
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<td colspan="2" align="right">( Factory Medical Officer)</td>
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</tr>
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<tr>
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<td colspan="2" align="right" id="doctor_name"></td>
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</tr>
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<tr>
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<td colspan="2" align="right" id="qualification"></td>
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</tr>
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<tr>
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<td colspan="2" align="right" id="registration_no"></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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</div>
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</form>
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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"
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onclick="form_generation_for_pdf($('#form_type').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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</div>
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</div>
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