<div class="modal fade" id="form_genaration_0" role="dialog" aria-hidden="true"> <div class="modal-dialog" id="modal-dialog1"> <div class="modal-content"> <div class="modal-header"> <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_0_pdf" name="form_0_pdf" method="post" target="_blank"> <div class="panel-body" id="form_0_pdf_body"> <div style="margin-top: -20px"> <div style="margin-top: 10px;"> <table width="100%" class="tbl3" id="form_header"> <tr> <td colspan="2" align="center"><strong>(FORM - O)</strong></td> </tr> <tr> <td colspan="2" align="center"><b>(See rule 29F(2) and 29L)</b></td> </tr> <tr> <td colspan="2" align="center"><b>Report of medical examination under rule 29-B(To be Issued In Triplicate)</b></td> </tr> </table> </div> <div style="margin-top: 10px; "> <input type="hidden" name="checkup_id_O" id="checkup_id_O"><input type="hidden" name="form_type_O" id="form_type_O"> <table width="100%" class="tbl3" id="table_body_form_o"> <tr> <td> <!-- <p contenteditable="true">(a)* is medically fit for any employment in mines</p> --> </td> </tr> <!-- <tr> <td> <p contenteditable="true">(b)* is suffering from.............................and medically unfit for</p> </td> </tr> --> <!-- <tr> <td> <p contenteditable="true"> (i) any employment in mines; or</p> </td> </tr> --> <!-- <tr> <td> <p contenteditable="true"> (ii)any employment below ground ; or</p> </td> </tr> --> <!-- <tr> <td> <p contenteditable="true"> (iii) any employment or work..............................</p> </td> </tr> --> <!-- <tr> <td> <p contenteditable="true">(c)* is suffering from....................and should get this disability cured/controlled and should be again examined within a period of....................Months. He will appear for reexamination with the result of test of .................and the option of............specialist from.........He may be permitted/not permitted to carry on his duties during this period.</p> </td> </tr> --> </table> <table class="tbl3" width="100%"> <tr> <td>Space for affixing</td> </tr> <tr> <td>Passport</td> </tr> <tr> <td>Size Photograph</td> </tr> <tr> <td>Of the</td> </tr> <tr> <td>Candidate</td> </tr> </table> <table width="100%" class="tbl3"> <tr> <td colspan="3" align="right"><span class="profile-picture" id="profile-picture1"> </span></td> </tr> <tr> <td align="left">Place:</span></td> <td colspan="3" align="right">Signature of examining authority</td> </tr> <tr> <td align="left">Date: </td> <td colspan="3" align="right">Name and designation in block letter:</td> </tr> </table> <table width="100%" style="margin-right: 20px"> <tr> <td width="70%"> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ </td> </tr> </table> <table width="100%" id="id_table" class="tbl3"> <tr> <td align="left">* Delete whatever is not applicable</td> </tr> <tr> <td> **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. </td> </tr> <tr> <td align="center">Report of The Examining Authority</td> </tr> <!-- <tr> <td align="center"> <p>(To be filled in for every medical examination wherever initial or periodical or re-examination or after cure/control of disability)</p> </td> </tr> --> </table> </div> </div> </div> </form> </div> <div class="modal-footer"> <div class="form-group"> <button type="button" class="btn btn-default" onclick="form_generation_for_pdf($('#form_type_O').val())"> <span class="glyphicon glyphicon-floppy-save">Open PDF</span> </button> </div> </div> </div> <form id="form_pdf" name="form_pdf" target="_blank" action="" method="POST"> <input type="hidden" name="htmlText" id="htmlText" /> </form>