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Form 17 - Health Register

This document is a health register form used to track workers employed in dangerous occupations in Tamil Nadu factories. It collects information like worker details, dates of employment, medical examinations, and reasons for leaving. The certifying surgeon must sign off on examination results, any suspensions and recertifications to resume duty. Detailed reasons for transfer or discharge and examination results are to be provided in the relevant columns.

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9K views2 pages

Form 17 - Health Register

This document is a health register form used to track workers employed in dangerous occupations in Tamil Nadu factories. It collects information like worker details, dates of employment, medical examinations, and reasons for leaving. The certifying surgeon must sign off on examination results, any suspensions and recertifications to resume duty. Detailed reasons for transfer or discharge and examination results are to be provided in the relevant columns.

Uploaded by

zakir84md3639
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLS, PDF, TXT or read online on Scribd
  • Health Register Form

The Tamil Nadu Factories Rules

FORM 17
(Prescribed under Rule 14)
Health Register
(In respect of persons employed in occupations declared to be dangerous operations under section 87)

Name of Certifying Surgeon: (a) Mr.___________________________________________________________ From_________________________To ________________________________

(b) Mr.___________________________________________________________ From_________________________To ________________________________

(c) Mr.___________________________________________________________ From_________________________To ________________________________

Date of Date of
Age (last) employment leaving or Reason for leaving, transfer or Nature of job, or Raw Material or by-
[Link] Works No. Name of Worker Sex birthday on present transfer to discharge occupation product handled
work other work

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10)
Date of Medical Examination by
Certifying Surgeon
If suspended from work, state period of Recertifyied fir to resume duty on (with If certificate of unfitness or suspension issued Signature with date
suspension with detailed reasons signature of Certifying Surgeon) to workers of Certifying Surgeon

Result of Medical Examination


(11) (12) (13) (14) (15)

Note: (i) Column (8)- Detailed Summary of reasons for transfer or discharge should be stated
(ii) Column (11)- Should be expressed as fit/unfit/suspended

The Tamil Nadu Factories Rules FORM 17 (Prescribed under Rule 14) Health Register (In respect of persons employed in occupat
Result of Medical Examination (11) (12) (13) (14) (15) Note: (i) Column (8)- Detailed Summary of reasons for transfer or dis

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