The Uttar Pradesh Occupational Safety, Health and Working Conditions Rules, 2026
Form 8
Official text
Open in the official PDF (p. 481)
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{see sub-rule (2) of rule 13 and sub-rule (2) of Rule 75 and sub-rule (2) of Rule 139}
Certificate of Fitness
Serial Number:-
1. I certify that I have personally examined Sh/Smt………………… son/daughter of
……………………., residing at ………………………….. who is desirous of being employed as
……………(designation)in ………………………..(process, department and
factory/Establishment) and that his age…….., as nearly as can be ascertained from my
examination, is …….years, and that he is, in my opinion, fit/unfit for employment in the above
mentioned factory/Establishment.
2. He may be produced for further examination after a period of……….
3. The serial number of the previous certificate is…………
4. I extend this certificate until (if certificate is not extended, the period for which the worker is
considered unfit for work is to be mentioned)
5. Signs and symptoms observed during examination-
6. Comments/ Recommendations, if any-
Signature/ Left Thumb impression of the person
examined. Date ..............................................
Signature, seal and registration no. of qualified
medical practitioner / factory medical officer
Signature & seal
Medical Officer