The Arunachal Pradesh Occupational Safety, Health and Working Conditions Rules, 2022
Form XXXIII
Official text
Open in the official PDF (p. 240)
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(See Rule - 66, 77)
Certificate of Fitness
(As Prescribed under the hazardous process, dangerous operations, Section 6(1)(c) and rules
therein)
Serial Number:-
1. I certify that I have personally examined Sh/Smt........................................ ...........son/daughter
of……………………., residing at..........................................who is desirous of being employed
as……………(designation)in ……..........……...(process, department and factory) and that his
age…..........….., as nearly as can be ascertained from my examination, is.............. years, and
that he is, in my opinion, fit/unfit for employment in the above mentioned factory.
2. He may be produced for further examination after a period of…….....................................….
3. The serial number of the previous certificate is……….....................................................….
Signature/ Left Thumb impression Signature, seal and registration no. of qualified
of the person examined. medical practitioner /Medical Officer
Date ..............................................
Signature, seal
I certify that I I extend this certificate until (if Signs and and registration
examined the certificate is not extended, the symptoms number
period for which the worker is
person mentioned considered unfit for work is to be observed during of qualified
above on mentioned) examination medical
practitioner
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