<div class="modal fade" id="form_genaration" role="dialog" aria-hidden="true"> <div class="modal-dialog" id="modal-dialog1"> <div class="modal-content"> <div class="modal-header"> <h5 class='modal-title'>Form 32</h5> <button type="button" class="close" id="form_close" data-dismiss="modal" aria-label="Close"> <span aria-hidden="true">×</span> </button> </div> <div id="pdfModal"> <form class="form" id="form_32" name="form_32" method="post" target="_blank"> <div class="panel-body"> <?php error_reporting(0); $query = "select company_logo,image_type from company_profile where company_id =5 "; //echo $query; $result = mysqli_query($conn,$query); $row = mysqli_fetch_array($result); @extract($row);?> <table width="100%" class="tbl4"> <tr> <td align="center" style="font-weight:900;">RCCPL PRIVATE LIMITED, BHARAULI (MAIHAR)</td></tr> <tr><td align="center" style="font-weight:900;">MADHYAPRADESH -485773</td> </tr> </table> <hr> <br> <div style="margin-top: 20px; margin-left: 10px; margin-right: 10px" id="form_32_div"> <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"> <tr> <td colspan="2" align="center" style="font-weight:900;">FORM NO- 32</td> </tr> <tr> <td colspan="2" align="center">CERTIFICATE OF FITNESS FOR HAZARDIOUS PROCESS/DANGERIOUS OPERATION</td> </tr> <tr> <td colspan="2" align="center">[Prescribed under rule 131 & Sch.XVII (7)]</td> </tr> <tr> <td colspan="2" align="center">ORIGINAL/COUNTER FOIL</td> </tr> </table> <div style="margin-top: 20px"> <table width="100%" id="table_body" class="tbl3"> <tr> <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> </tr> <tr> <td><p contenteditable="true">3. He/She may be produced for further examination after a period of.......</p></td> </tr> <tr> <td><p contenteditable="true">4. He/She is advised following further examination..............................</p></td> </tr> <tr> <td><p contenteditable="true">5. He/She is advised following treatment............</p></td> </tr> <tr> <td><p contenteditable="true">6. The serial No. Of the previous certificate is..........</p></td> </tr> <tr> <td align="center" id="valid_date"></td> </tr> </table> </div> <div style="margin-top: 100px"> <table width="100%" class="tbl3"> <tr> <td>Signature / LTI of person examined </td> <td align="right"><span align="right" class="profile-picture" id="profile-picture" > </span></br>Digital Signature with Stamp</td> </tr> <tr> <td align="left">Name of Medical assistant</td> </tr> <tr> <td colspan="2" align="right">( Factory Medical Officer)</td> </tr> <tr> <td colspan="2" align="right" id="doctor_name"></td> </tr> <tr> <td colspan="2" align="right" id="qualification"></td> </tr> <tr> <td colspan="2" align="right" id="registration_no"></td> </tr> </table> </div> </div> </div> </div> </form> <div class="modal-footer"> <div class="form-group"> <button type="button" class="btn btn-default" onclick="form_generation_for_pdf($('#form_type').val())"> <span class="glyphicon glyphicon-floppy-save">Open PDF</span> </button> </div> </div> </div> </div> </div>