Rule 12. The form of notice related to certain diseases and the time within

which the notice shall be sent and the authority to which the notice shall be sent under sub-sections (1) and (2) of section 12.-(1) A notice in the following format shall be sent forthwith electronically, to the Inspectorcum-Facilitator or Chief Inspector- cum- Facilitator, by the employer or occupier or manager of an establishment in which there occurs any disease as notified under the Third Schedule of the Code. NOTICE OF DISEASE i. Name of establishment: ii. Nature of establishment: iil. Details of Patienta. Name of Patient: b. Works number of patient: c. Address of Patient: d. Precise occupation of patient: iv. Nature of disease from which patient is suffering: V. Vi. Date of Detection of Disease: Details of Medical Practitioner: vii. Has the case been reported to the Medical Officer. Date: Signature of Employer or Occupier or Manager.

(2) If any qualified medical practitioner attends on a person who is or has been employed in an establishment and who is or is believed by the qualified medical practitioner to be suffering from any disease specified in the Third Schedule, the qualified medical practitioner shall send a medical report maintaining medical confidentiality in writing within 48 hours to the office of the Chief Inspector-cum-Facilitator and Inspector-cum-Facilitator statingi. the name and full postal address of the patient; ii. the disease from which he believes the patient to be suffering; and ili. the name and address of the establishment in which the patient is or was last employed.

(3) If any qualified medical practitioner fails to comply with the provisions of subrule (2), he shall be punishable with a penalty which may extend to ten thousand rupees