The Occupational Safety, Health and Working Conditions (Lakshadweep) Rules, 2025
Form 21
Official text
Open in the official PDF (pp. 244–245)
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[See rule 53(7)]
Report by Laboratory
Report No. …………………………………………..
Date …………………………………………………….
I hereby certify that I …………………………………………………….Analyst working in
………………………………..duly received on the …………………………………….. day
of …………………………………………………. 20………………………. From
*…………………………………………………………. a sample of
………………………………………..for analysis.
The sample was in condition fit for analysis as reported below.
I further certify that I have analysed the aforementioned sample on
……………………………… and declare that the result of the analysis to be as follows:
**………………………………………………………………………………………………
………………………………………………………..
The condition of seals, fastening the samples on receipt was as follows:
Signed this …………………………………………….day
of ………………………………..20…………….
Address…………………………………………………………………………….
Signature (Laboratory Analyst)