The Occupational Safety, Health and Working Conditions (Lakshadweep) Rules, 2025
Form 10
Official text
Open in the official PDF (p. 235)
Tables and forms lose their layout when extracted; the PDF is the authoritative version.
(See Rule 16)
Notice of Disease
1. Name of the Establishment
2. Address of the Establishment
3. Address of employer
4. Nature of activity being carried out
5. Particulars of worker/ employee
(a) Name
(b) Address
(c) Gender
(d) Age
6. Precise occupation of worker/employee
7. Nature of disease from which worker/employee is suffering
Signature of employer or Qualified Medical Practitioner