The Maharashtra Factories Rules
FORM 24A
(See rule 115)
Notice of Dangerous Occurrence
1. Name and address of the factory ......
2. Name and address of the occupier ......
3. Name and address of the Manager ......
4. Nature of industry ......
5. Branch or Department and exact place where the dangerous occurrence took place ......
6. Date and hour of occurrence ......
7. Nature of dangerous occurrence (State exactly what happened) ......
I certify that to the best of my knowledge and belief, the above particulars are correct in every respect.
Place: / Signature of the Occupier/Manager.Date of despatch of Report ......
Note:- To be written in legible handwriting or preferably to be typewritten.
This space to be completed by Inspector of Factories
District / Date of ReceiptDangerous Occurrence Number / Date of investigation
Causation Number.
Result of Investigation ......
FORM 25
(See rule 11(6))
To be filled in by the Chief Inspector No. of Case ......Remarks ......
Notice of Poisoning of Disease
(See instructions on reverse)
Factory Particulars ...... / 1. Name of factory ............
2. Address of factory ......
......
3. Address of office or private residence of occupier ......
4. Nature of Industry ...... ………......
5. Name and address of the undertaking in which the patient presumes that he was exposed to the risk to which the Poisoning or Disease is attributed.
6. Harmful agent or process to which Poisoning or Disease is attributed.
7. Name and Work Number of patient ...... …………...... ……………………………………......
8. Address of patient ......
9. Sex and age of patient ...... …......
......
Person affected ...... / 10. Precise occupation of the patient.-
(a) at the place or last place of employment ......
(b) at the undertaking in which the patient presumes that he was exposed to the risk to which Poisoning or Disease is attributed ...... ……… ...... ……………
......
11. Nature of poisoning or Disease from which the patient is suffering
12. Approximate date of beginning and cessation of exposure of the patient to the harmful agent or process to which Poisoning or Disease is attributed according to item 6 above ...... ………………………….
General particulars / 13. [Has the case been reported to the Medical Inspector of Factories?]
Signature of Factory Manager ......
Date ......
Notice of Poisoning or Disease
Extract from Factories Act, 1948
(Section 89)
Where any worker in a factory contacts any disease specified in the Schedule, the manager of the factory shall send notice thereof to such authorities, and in such form and within such time, as may be prescribed.
Extract from the Maharashtra Factories Rules, 1963
(Rule 116)
A notice in Form No. 25 should be sent forthwith to the Chief Inspector or Certifying Surgeon and Administrative medical Officer, Employees’ State Insurance Scheme, Bombay, appointed as Additional Inspector under the Act, by the Manager of a factory in which there occurs a case of lead, phosphorus, mercury, manganese, arsenic, carbon, bisulphide or benzene poisoning, or poisoning by nitrous fumes, or by halogens or halogens-derivatives of the hydrocarbons of the aliphatic series; or of chrome ulceration, anthrax, silicosis, toxic anaemia, toxic jaundice, primary optheliomatous cancer of the skin or pathological manifestations due to radium or other radio-active substances or X-rays.