Accident & Occupational Disease Final Report


Add Accident & Occupational Disease Final Report Information

Form -27(A) [Section 80 and Rule 69(3)]

Final Report of Accident and Occupational Disease (Submited within two months of the accident or the accident after joining work)

Enterprise / Factory name *
Factory Registration No:
Factory Mobile
Factory Fax
Factory Email

Accident & Occupational Disease Notice *
Business Type / Production & service of the organization *
Management & Contractor Information
*
*
*
*
Accident Information
*
*
*
*
*
Injured / Dead Worker Information
*
*
*
*
Compensation Information
Accident Information
Accident Type

As a result of Accident The injured person permanent physical disability

Accident Type Classification

Accidental Element Classification


The name and address of the registered doctor who has been given treatment in the accident
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