Contents of the OSH Rules (Rajasthan)

The Rajasthan Occupational Safety, Health and Working Conditions Rules, 2026

Form 19

Official text

Open in the official PDF (pp. 190–191)

Tables and forms lose their layout when extracted; the PDF is the authoritative version.

(see rule 49(1)(d) & 53)

Register of leave with Wages

Registration No. of factory or establishment……

Name of factory or establishment:

Part I - Adults

Part II - Adolescents

Name of worker :

Father’s Name:

Department :

Sl. Sl.no. in Date of Interruptions

the entry

N register into Sickness Authorize Lock Out or Involuntary Others

o of service and d Leave unemployment

worker accident Legal Strike

s s

1 2 3 4 5 6 7 8

Leave Whether Date from Wages for Discharged Remarks

due with leave not which the worker

desired worker is Leave

effect from during the allowed Paid in Date of Date &

amount of

next 12 leave

Discharge payment

months

made in

lieu of

leave due

9 10 11 12 13 14 15

Note: - Separate page shall be allotted to each worker

‍633

Source: The Rajasthan Occupational Safety, Health and Working Conditions Rules, 2026, S.O. 23 — Rajasthan Gazette Extraordinary, Part 4 (Ga), Sub-section (II), pp. 190–191 of the PDF. Open our copy at p. 190 · official download · all sources