The Occupational Safety, Health and Working Conditions (Central) Rules, 2026
Form XX
Official text
Open in the official PDF (p. 305)
Tables and forms lose their layout when extracted; the PDF is the authoritative version.
(See rule 76)
REGISTER FOR LEAVE WITH WAGES
Part I - Adults
Part II - Adolescents
Establishment: Name of worker :
Department : Father’ s Name:
Sl. Sl.no. in the Date Interruptions Leave Whether Date from Wages for Discharged Leave Remarks
No register of due leave not which the Leave Paid worker
of workers entry with desired worker is in
into Sickness and Authori Lock Out Involuntar Others effect during the allowed Date of Date and amount Accumulated
service accidents sed or Legal y from next 12 leave Discharge of payment made in carry forward
Leave Strike unemploy months lieu of leave due leave
ment
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
Note: - Separate page shall be allotted to each worker
Signature of Employer/Register Keeper/Representative