The Uttar Pradesh Occupational Safety, Health and Working Conditions Rules, 2026
Form 16
Official text
Open in the official PDF (p. 492)
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{see Rule 60}
Register of Accidents and Dangerous Occurrences
Serial Date of report in Form-10/11 to Time of report and Name and address of Sex Age Insurance
No. inspector cum-Facilitator and notice notice the injured person No.
to insurance authorities
1 2 3 4 5 6 7
Shift, department Injury or details of dangerous occurrence
and occupation of
Date Time Place Cause of injury or Nature of injury or What exactly was the
employee
dangerous dangerous occurrences injured person doing at
occurrences the time of injury
8 9 10 11 12 13 14
Name, occupation, Signature and Name, address Date of Name of the State Remarks,
address and signature or designation of the and occupation of return of Insurance Local if any
thumb-impression of the person who makes two witnesses injured Office to which the
person giving notice the entry person to injured person is
work attached
15 16 17 18 19 20