[See rule 16]
ANNUAL RETURN FOR THE YEAR ENDING ON THE 31ST DECEMBER, 20.....
1. Name of 1[the mine or circus]
2. Situation of 1[the mine or circus]
Nearest Railway Station
3. Date of opening of l[the mine or circus]
4. Date of closing, if closed.
5. Postal address of 1[the mine or circus]
6. Name of employer.
Postal address of managing agent
7. Name of managing agent, if any.
Postal address of managing agent.
8. Name of Agent or representative of employer.
Postal address of representative of employer.
9. Name of Manager
Postal address of manager
(a) Name of medical officer, attached to 1[the mine or circus]
(b) Qualification of medical officer attached to 1 [the mine or circus]
(c) Is he resident at 1[the mine or circus]?
(d) If a part-time employee, how often does he pay visits to 1[the mine or circus]
(a) Is there any hospital at 1[the mine or circus]?
(b) If so, how many beds are provided for women employees?
(c) Is there a lady doctor?
(d) If so, what are her qualifications?
(e) Is there a qualified midwife?
(f) Has any crèche been provided?
(a) Signature of employer
Subs. by G.S.R. 59(E), dated 27th February, 1975 (w.e.f. 1-3-1975)
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