141 lines
3.9 KiB
PHP
141 lines
3.9 KiB
PHP
<div class="modal fade" id="form_genaration" 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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<h5 class='modal-title'>Form 33</h5>
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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_33" name="form_33" method="post" 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 * 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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<br>
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<div style="margin-top: 20px; margin-left: 10px; margin-right: 10px" id="form_33_div">
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<table width="100%" id="header_table"><input type="hidden" name="checkup_id" id="checkup_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- 33</td>
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</tr>
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<tr>
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<td colspan="2" align="center">[Prescribed under Rules 68-T and 102]</td>
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</tr>
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<tr>
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<td colspan="2" align="center"><b style="font-weight: 800">Certificate of fitness for employment in hazardous process and operations.</b></td>
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</tr>
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<tr>
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<td colspan="2" align="center">(To be issued by Factory Medical Officer)</td>
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</tr>
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</table>
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<div style="margin-top: 50px">
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<table width="100%" class="tbl3">
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<!-- <tr>
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<td width="60%" align="left">The serial number of previous certificate is.............</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>Signature or left hand thumb
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impression of the person examined :</td>
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<td height="20%" align="right"><span align="right" class="profile-picture" id="profile-picture">
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</span></br>Signature of the Factory Medical Officer :</td>
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</tr>
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<tr>
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</tr>
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</table>
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<br>
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<table width="100%" class="tbl3">
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<tr>
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<td width="60%" align="left"></td>
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<td align="right">Stamp of factory
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Medical Officer with
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Name of the Factory</td>
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</tr>
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</table>
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<br>
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<table width="100%" class="tbl3">
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<tr>
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<td colspan="2" align="left">Date:</td>
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</tr>
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</table>
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<hr>
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<p align="right">P.T.O</p>
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<table width="100%" border="1" cellspacing="0">
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<tr>
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<th>I certify that I
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examined the
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person
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mentioned
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above on
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(date of
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examination)
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</th>
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<th>I extend this certificate
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unfit (if certificate is not
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extended, the period
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for which the worker
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is considered unfit
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for work is to be
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mentioned)
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</th>
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<th>Signs and
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symptoms
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observed during
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examination</th>
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<th>Signature of the
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Factory medical
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Officer with date.
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</th>
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</tr>
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<tr rowspan="10">
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<td height="600"></td>
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<td></td>
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<td></td>
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<td></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" 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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<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>
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</div>
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</div>
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</div>
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