Form IX

(See Rule-29)

ANNUAL RETURN

UNIFIED ANNUAL RETURN FORM

FOR THE YEAR ENDING……..

Single Integrated Return to be filed On-line under the Occupational Safety, Health and Working

Conditions Code, 2020,

the Code on Industrial Relations, 2020, the Code on Social Security , 2020, and the Code on Wages, 2019

Instructions to fill up the Annual Return

(1) This return is to be filled-up and furnished on or before 28th or 29th February every year.

(2) The terms Establishment shall have the same meaning as under the Occupational Safety, Health

and Working Conditions Code, 2020.

(3) This return is to be filled-up in case of Contractor or manpower supplier who have engaged more

than 50 workers employed in the relevant period.

Applicable to All Establishments - Part-I

A. General Information:

Sl. Instructions for filling the column

No.

1 Labour Identification EPFO, ESIC, MCA, MoLE (LIN)

Number/Registration No.

2 Period of the Return From - Period should be calendar year

To-

3 Name of the Establishment

4 Email ID

5 Telephone No.

6 Mobile number

7 Premise name

8 Sub-locality

9 District

10 State

11 Pin code

12 Geo Co-ordinates

B(a). Hours of Work in a day

B(b). Number of Shifts

C. Details of Manpower Deployed

Details Directly employed Employed through Grand

Contractor Total

Skill Category

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(i) Maximum No. of employees employed

in the establishment in any day during the

year

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(ii) Average No. of employees employed in

the establishment during the year

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(iii) Migrant Worker out of

(ii) above

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(iv)Number of fixed term employee

engaged

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D. Details of contractors engaged in the Establishment:

Sl. No. Name with LIN/Registration No. of Contract

Number of the Contractor Labour Engaged

E. Details of various Health and Welfare Amenities provided.

Sl. Nature of various Statutory (specify Instructions for filling

No welfare amenities the statute)

. provided

1 Whether facility of Tick yes or no in the Applicable to all establishments where in

Canteen provided box hundred or more worker including contract

(as per section 24(v) labour were

of OSH Code, ordinarily employed

2020)

2 Crèches (as per Tick yes or no in the Applicable to all establishments where fifty or

section 67 of Code box more workers are employed

on Social Security

Code, 2020 and

Section 24 of the

OSH Code 2020)

3 Ambulance Room Tick yes or no in the Applicable to mine, building and other

(as per section box construction work wherein more than five

24(2)(i) of OSH hundred workers are ordinarily employed

Code, 2020)

4 Safety Committee Tick yes or no in the Applicable to establishments and factories

(as per Section box employing 500 workers or more, factory

22(1) of OSH Code, carrying on hazardous process and BoCW

2020. employing 250 workers or more, and mines

employing 100 or more workers

5 Safety Officer (as No. of safety officers In case of mine 100 or more workers and in

per section 22(2) of appointed case of BoCW 250 or more workers are

OSH Code, 2020) ordinarily employed.

6 Qualified Medical No. of Qualified There is no specification for minimum number

Practitioner (as per Medical Practitioner of Qualified Medical Practitioner employed in

Section 12 (2) of appointed. establishment. However, this detail is required

OSH Code 2020. to have data on occupational health.

F. The Industrial Relations: Instructions for filling

Is the Works Committee has been Industrial establishment

1 functioning. (section 3 of IR Code, Yes/No in which 100 or more

2020) workers are employed

(a) Date of its constitution.

Whether the Grievance Redressal Industrial establishment

2 Committee constituted (section 4 of IR Yes/No employing 20 or more

Code, 2020) workers are employed

3 Number of Unions in the establishments.

Whether any negotiation union exist

4 Yes/No

(Section 14 of IR Code, 2020)

Whether any negotiating council is

5 constituted (Section 14 of IR Code, Yes/No

2020)

Number of workers discharged, dismissed, retrenched or whose

6

services were terminated during the year:

Terminated or Grand

Discharged Dismissed Retrenched

Removed Total

7 Man-days lost during the year on account of

Loss in

Sl. Period / No. of man-

Reasons term of

No. Date days lost

money

(a) Strike

(b) Lockout

8. Details of retrenchment / lay off

No. of persons Details of payment No. of workers No. of man-

Sl.

retrenched during paid to retrenched laid off during days lost due

No.

the period employees the period to lay-off

G. Details pertaining to maternity benefit:

No. of female No. of female No. of female No. of deduction of

employees employees availed employees paid wages, if any made

maternity leave medical bonus from female

employees

H. Details of payment of bonus:

Sl. No. No. of employees covered Total amount Date on which the Bonus paid

under the Bonus of bonus

provision actually paid

I. Details of accidents, dangerous occurrence and notifiable diseases:

Sl. Total number of Total number of Total number of Total number of

No. accidents by which a fatal accidents Dangerous cases of Notifiable

person injured is and names of the Occurrences as Diseases specified in

prevented from deceased as per defined under Third Schedule of

working for a period of Section 10 of the Section 11 of the the OSH Code, 2020

48 hours or more as per OSH Code, 2020. OSH Code, 2020 along with the

Section 10 of the OSH details of affected

Code, 2020. persons

J. Mandays and Production Lost due to accidents / dangerous occurrence

Sl. Accident/Dangerous Mandays lost Production Lost

No. Occurrence