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ANJ Screening of Worker Format

Screening

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vikrant kadam (Vikrant)
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© © All Rights Reserved
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15 views

ANJ Screening of Worker Format

Screening

Uploaded by

vikrant kadam (Vikrant)
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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Screening of Worker

Worker ID No _________________________________Date___________
Name of the Contractor / Sub – Contractor:
_____________________________
Photo
Full Name of the workmen:
____________________________________________
Father / Husband’s Name:
____________________________________________
Permanent Address:
__________________________________________________

Date of birth ________________ Sex_______________Age ____ Years


Marital status: -Married / Single
____________________________________________________________
_______
Mother Tongue _______________ Other Languages Known_______________
In case of emergency person Present Address:__________________________
to be contacted
________________________________________________
(With address and Telephone Number if any)
Any other identification mark:
Vision Normal If not Normal specify
Health Normal the problem
Weight KG Height cms Blood group

Declaration by the Worker


The above information given by me is correct to be best of my knowledge
Signature / Left Hand Thumb impression of the worker
Declaration by the Subcontractor / Contractor
We declare that this employee will be working for us in this side He / She shall follow the entire site safety requirement
We take responsibility for his/her safety in the site
Signature of the Contractor / Representative – ____________________
Name & Signature
Screened by me Details verified / not verified
Suitable for employment as ____________________
Site in charge / Site Engineer - Name & Signature
TRIAL REPORT: - Seen and briefed the EHS rules of the Site
HSE Representative - ____________________
Name & Signature

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