FORM 16

(Prescribed under Rule 68-T and 102)

Health Register

1.Serial Number in the register of adult worker:

2.Name of worker:

3.Sex: Male Female

4.Date of Birth:

0) { $sql = "SELECT a.*,b.*,c.* FROM form_32 a left join checkup_form c on a.checkup_id = c.checkup_id left join patient_master b on c.emp_id = b.id WHERE a.checkup_id = '" . $_REQUEST['checkup_id'] . "'"; error_log("FORM32::" . $sql); } else { $sql = "SELECT b.*,c.* from checkup_form c left join patient_master b on c.emp_id = b.id WHERE c.checkup_id = '" . $_REQUEST['checkup_id'] . "'"; error_log("FORM data::" . $sql); } $result = mysqli_query($conn, $sql); ?>

Department/works	Name of hazardous process	Dangerous process/operation	Nature of job/occupation	Raw materials,products or by-products likely to be exposed to	Date of joining	Date of leaving/transfer other work	Reason for discharge/transfer to other work	Medical examination Results therefore				If declared unfit for work				Signature with date of the factory Medical Officer/ the Certifying Surgeon.
Department/works	Name of hazardous process	Dangerous process/operation	Nature of job/occupation		Date of joining	Date of leaving/transfer other work	Reason for discharge/transfer to other work	Date	Signs and symptoms Observed during examination	Nature of tests & results thereof	Result Fit/Unfit	Period of temporary Withdrawal from that work	Reasons for such withdrawal	Date of declaring him Unfit for that work	Date of issuing fitness Certificate
1	2	3	4	5	6	7	8	9	10	11	12	13	14	15	16	17
										Test Performed: Result: GC- GOOD, TPR/BP-Normal,Mentally sound Test Reports - WNL.

Notes:

Separate page should be maintained for individual worker.
Fresh entry should be made for each examination