The Uttar Pradesh Occupational Safety, Health and Working Conditions Rules, 2026
Form 14
Official text
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{See sub-rule (1) of Rule 56}
LEAVE BOOK
NAME OF ESTABLISHMENT ................
Serial No:-.......................................................... Name:-...............................................................
Department:-……………..................................
Father's name:-……………………..................
Serial no. or code in the Register of employee
Date and amount of payment made:-………….
.............................................................
in lieu of leave due:-………………................
Date of entry into service:-.................
1 Calendar year service
2 Wage paid from......................to.................
3 Wages earned during the wage period
4 No. of days of work performed
5 No. of days of lay-off
No. of days worked during the
6 No. of days of maternity leave
calendar year
7 No. of days of leave enjoyed
8 Total of Columns 4 to 7
9 Balance of leave from preceding year
Leave to credit
10 Leave earned during the year mentioned in Column 1
11 Total of Columns 9 and 10
Whether leave in accordance with scheme under Section 32
12
was refused
13 Leave enjoyed from…………....to…………
14 Balance of leave to credit
15 Normal rate of wages
Remarks if any