Form II

[See Rule-3(1)(iii)]

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 (….of 2020)

to…………………………………….. (Name of the establishment)

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

(a) Factory (b) Contract Work

(c) Building and Other Construction Works (d) 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:

c. Number of inter-state migrant workers engaged:

3 Extra Details of establishment-

(a) For factories:

Details of the Full postal Name and Maximum Nature &

manufacturing address and address of number of Total amount

process situation of the the workers to be of H.P.

factory along occupier employed installs or

with plan and on any day propos &

approval details manager installed.

1 2 3 4 5

(b) For Motor Transport Workers-

Nature of motor transport Total number of Total Total number of

services (e.g. City route route transport vehicle

Services, Long distance mileage on the last date of

freight etc) preceding year

1 2 3 4

(c) For building and other construction work:

Type of Construction Probable period of Expected Details of

work commencement of period for approval of

work completion of the local

work authority

1 2 3 4

(d) For Plantation-

Total Full name(s) and Full name and Full name and

grant of residential address(es) of residential adress(es) address(es) of the

plantation the Propreitor's and of the Directors in the Chief Executives

in hectare Partner's of the case of a Company or General

plantation in case it is registered under the Manager of the

not registered under the Companies Act, 1956. Plantation in the

Companies Act, 1956 Public Sector

1 2 3 4

4. Amount of registration fee paid…..

5. Remarks of registering officers

/Signature E -Sign/DSC of Registering Officer

along with designation

Place:

Date:

Conditions of Registration

(1). Every certificate of registration issued under rule 4 shall be subject to the following

conditions, namely:

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

(b) the number of workers employed in an establishment directly and contract

employees shall not, on any day, exceed the maximum number specified in the

certificate of registration; and

(c) Save as provided in these rules, the fees paid for the grant of registration certificate

shall be non-refundable.

(2) The employer shall intimate the change, if any, in the number of workers or the conditions

of work to the registering officer within 30 days

(3) The employer shall, within thirty days of the commencement and completion of any work,

intimate to the Inspector -cum-Facilitator, having jurisdiction in the area where the

proposed establishment or as the case may be work is to be executed, intimating the actual

date of the commencement or, as the case may be, completion of establishment such work

in Form IV annexed to these rules 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.