Insecticides Rules, 1971 - Form XXII

Email Print This Page bookmark
Font : A-A+

FORM XXII
REGISTER OF PERSONS ENGAGED IN CONNECTION WITH INSECTICIDES AND THEIR PERIODICAL MEDICAL EXAMINATION FOR THE YEAR 20_______
[Rule 37]

Serial No:

Name:

Age:

Father's Husband's name:

Full Address:

Sex:

Identification mark:

Date of appointment:

Occupation :
(Please specify the nature of duty)

1. Past 2. Present

PAST HISTORY

Illness

Poisoning

Allergy

Exposure to pesticides (Compound)

No of years/ reason

Remarks, if any

1

2

3

4

5

6







FAMILY HISTORY

Allergy

Psychological disorders

Haemorrhagic disorders

1

2

3




PERSONAL HISTORY

Smoking

Alcohol

Other addiction

1

2

3




OBSERVATIONS

Medical Examination

Pre- employment examination

End of 1st quarter i.e. after 3 months

After 2nd quarter after 6 months

After 3rd quarter after 9 months

End of year

Remarks

1

2

3

4

5

6

7









1. General Examination
General body limit
Weight
Piles
Blood pressure
Respiration
Anaemia
Dadema
Jaundice
Skin condition
Temperature
Fatigability
Sweating
Sleep
Urination

2. Gastro Intestinal
Nausea
Vomiting
Appetite
Taste
Pain in abdomen
Bowel movement
Liver
Spleen

3. Cardio-respiratory
Nasel discharge
Wheeze
Cough
Expectoration
Tightness of chest
Dyspnoea
Palpitation
Heart
Cyanosis
Tachycardia

4. Neuro-muscular
Headache
Dizziness
Irritability
Pulse
Twitchings
Tremors
Convulsion
Paranesthesia
Hallucination
Unconsciousness
Deep reflexes
Superficial reflexes
Coordination

5. Eye
Pupil
Lachrymation
Double vision
Clumped vision

6. Psychological
Temperament
Judgment
Nervousness

7. Kidney
Kidney Condition

8. Investigation
Blood Hb%
Blood D.C.

* Serum cholinesterago
serum Bilirubin
Urine routine examination
Urine microscopic
X-ray of chest

* serum cholinesterage level should be measured in monthly intervals in case of organophosphorus/ carbamatic group of insecticides. General remarks of the doctor in the light of the above examination:

Advice given to:
1. The patient
2. The employer

Steps taken by the Employer as per Doctor's advice:

Signature/ thumb impression of:

1. Doctor

2. Employees:

3. Employer / Manufacturer

4. Licensing officer at the time of inspection.

N.B. :- In organochlorine group of insecticides the blood residue estimation should be done once a year.

Post a Comment

Comments should be on the topic and should not be abusive. The editorial team reserves the right to review and moderate the comments posted on the site.
Notify me when reply is posted
I agree to the terms and conditions
vijay7829538140 

can u pls help me to start pest control buiseness for applying license.am on 7829538140 in the name of vijay

atul446 

i want to buying pest control licence can you help me.
atul.pandey446@gmail.com

vishal awari 

standard format for packing label to be pasted on box/conbtainer

Medindia Newsletters

Subscribe to our Free Newsletters!

Terms & Conditions and Privacy Policy.

Find a Doctor
Advertisement

Stay Connected

  • Available on the Android Market
  • Available on the App Store

Facebook