Form III

[See rule 3(2)]

Certificate of Registration of Establishment

Registration No. Date

A Certificate of registration containing the following particulars is hereby granted under sub section (2) of section 3 of the Occupational Safety,

Health and Working Conditions Code, 2020(37.of 2020) to…..................................................................................... (Name of the establishment)

1. Nature of work carried on in the establishment (Please tick mark)

(a) Factory (b) Mining

(c) Dock work (d) Contract Work

(e) Building or Other Construction Works (f) any other work (not covered above)

2. Details of the establishment:

a. Total Number of employees engaged directly in the establishment:

b. Total Number of the employees engaged through contractor:

c. Total Number of Contractors and their details:

d. Number of inter-state migrant workers engaged:

3 (a) For factories

Details of the Full postal Name and Maximum

manufacturing address and address of number of

process situation of the the occupier workers to be

factory and manager employed on any

day

1 2 3 4

3 (b) For mines

Name of Lease extent of Name and Average Maximum

Mineral(s) the mine (in address of the Monthly number of

Acres) owner output, persons to be

targeted employed on

(Tonne) any day

1 2 3 4 5

3 (c) For Dock work

Name of Types of Dock Name of the Name of the Name of the

Dock Work Works Cargo handled chemicals hazardous

and stored handled and Chemicals

/ Major Port

along with stored along handled and

quantity with quantity stored along

with quantity

1 2 3 4 5

3 (d) For building or other construction work

Type of Probable period Expected Details of approval of

Construction of period for the local

work commencement completion of authority

of work work

1 2 3 4

3 (e) Any Other establishment:

4. Remarks of registering officers:

Place:

Date:

/Signature E -Sign/DSC of registering officer

along with designation

Conditions of Registration

(1) Every certificate of registration issued under rule 3 shall be subject to the following conditions, namely:

(a) the certificate of registration shall be non-transferable;

(b) The number employees engaged in an establishment, whether directly or on contract, shall not, on any day, exceed the maximum number specified in the

certificate of registration; and

(c) Save as otherwise provided in these rules, the fees paid for the grant of certificate of registration shall be non-refundable.

(2) The employer shall intimate the change, if any, in the number of employees or the conditions of work to the registering officer within 30 days.

(3) The employer shall, within thirty days of the commencement or cessation of operation, intimate to the Registering Officer and Inspector-cum-Facilitator,

having jurisdiction in the area where the proposed establishment is situated or the work is executed, the actual date of such commencement or, as the case may

be, closing of establishment electronically.

(4) A copy of the certificate of registration shall be displayed at the conspicuous places at the premises where the work is being carried on.