Govt. of India, Ministry of Labour & Employment

FORMS UNDER BOCW(RECS) ACT,1986

FORM-I

{See Rule 23(1)}

APPLICATION FOR REGISTRATION OF ESTABLISHMENT EMPLOYING BUILDING WORKERS.

1. Name and location of the establishment :

where building or other construction work

is to be carried on.

2. Postal address of the establishment. :

3. Full name and permanent address of the :

establishment, if any.

4. Full name and address of the manager or person :

responsible for the supervision and control

of the establishment.

5. Nature of building or other construction work :

to be carried on in the establishment

6. Maximum number of building workers to be :

employed on any day.

7. Estimated date of commencement of building or :

the other construction work.

8. Estimated date of completion of the building or :

other construction work

9. Particulars of demand draft, enclosed (name of :

the bank amount, demand draft No. and date).

Declaration by the employer

(i) I hereby declare that the particulars given above are true to the best of my knowledge and belief.

(ii) I undertake to abide by the provisions of the Building and Other Construction Workers' (Regulation of Employment and Conditions of Service) Act, 1996 and the Rules made there under.

Principal Employer

(Seal and Stamp)

Office of the Registering Officer appointed under the Building and Other Construction Workers' (Regulation of Employment and Conditions of Service) Act, 1996 and Central Rules made there under.

Date of Receipt of application :

FORM-IV

{(See Rule 26(3) and 239(1)}

Notice of commencement/completion of building or other construction work.

1 (i)	Name and address (permanent) of the establishment
(ii)	Name of the employer and address
2.	Name and situation of place where the building and other construction is proposed to be carried on.
3.	No. and date of Certificate of registration.
4.	Name and address of the person in charge of construction work.
5.	Address to which the communications relating to building or other construction work may be sent.
6.	Nature of work involved and the facilities including plant or machinery provided.
7.	The arrangement for storage of explosive, if any, to be used in building or other construction work.
8.	In case the notice is for commencement of work, the approximate duration of work.

I/We hereby intimate that the building or other construction work (Name or work) having registration No. …………………………….. dated ………………….. is likely to commence/is likely to be completed with effect from ………………. (date)/on …………………..(date).

Signature of the Employer

To,

The Inspector,

………………………..

……………………….

FORM V

(See rule 56 and 74(b), Schedule I)

CERTIFICATE OF INITIAL AND PERIODICAL TEST AND EXAMINATION OF WINCHES, DERRICKS AND THEIR ACCESSORY GEAR

Test Certificate No………………

(a) In case of construction site, name of the construction site where lifting appliances are fitted/installed/located :

Situation and description of lifting appliances and Gear with distinguishing number or marks (if any), which have been tested, thoroughly examined

Angle to the horizontal of derrick boom at which test load applied

Test load applied

Safe working load at the angle shown in column

Name and address of public service, association, company, or firm or testing establishment making the test and examination

Name and position of the Competent Person of public service, association, company or firm or testing establishment.

I certify that on the ……………… day of ………………. the lifting appliance shown in column (I) together with its necessary gear was tested in the manner set forth overleaf in my presence; that a careful examination of the said lifting appliances after the test showed that it had withstood the test load without injury or permanent deformation; and that the safe working load of the said lifting appliance and necessary gear is as shown in column (4).

Signature of the Competent Person

Seal Date

Registration/Authority number of the Competent Person.

FORM VII

{(See rule 70 and 74(b)}

CERTIFICATE OF INITIAL AND PERIODICAL TEST AND EXAMINATION OF LOOSE GEARS

Test Certificate No. …………………….

(a) Name of the construction site where loose gears are fitted/installed/located.

Distinguishing Number or Mark

Description, dimension and material of gear/devise

Number rested

Date of test

Test load applied (tones)

Safe working load (SWL) (tones)

Name and address of manufacturer of suppliers

Initial test and examination certificate No. and date (only in case of periodical test and examination)

Name and address of public service association, company or firm or testing establishment making the test and examination

Name and position of Competent Person in public service, association, company or firm or testing establishment

I certify that on the ……………… day of ………………. the above gear was tested and examined in the manner set forth overleaf; that the examination showed the said gear/devise withstood the test load without injury or deformation; and that the safe working load of the said gear/device is as shown in Column 6.

Signature of the Competent Person Seal Date

Registration/Authority number of the Competent Person.

FORM VIII

{(See rule 62 and 74(b)}

CERTIFICATE OF TEST AND EXAMINATION OF WIRE ROPE BEFORE BEING TAKEN INTO USE.

Test Certificate No. …………………….

1.		Name and address of maker or supplier
2.	(a)	Circumference/diameter of rope
	(b)	Number of strand
	(c)	Number of wires per strand
	(d)	Lay
	(e)	Core
3		Quality of wire 9e.g. Best Plough steel)
4	(a)	Date of test of sample of rope
	(b)	Load at which sample broke (tones)
	(c)	Safe working load or rope (tones)
	(d)	Intended use
5		Name and address of public service, association, company or firm or testing establishment making the test and examination.
6.		Name and position of Competent Person in public service, association, company or firm or testing establishment making the test and examination.

I certify that the above particulars are correct, and that the test and examination were carried out by me and no defects affecting its safe working load (SWL) were found.

Signature of the Competent Person Seal Date

Registration/Authority number of the Competent Person.

FORM IX

{(See rule 72 and 74(b)}

CERTIFICATE OF ANNEALING OF LOOSE GEARS

Test Certificate No. …………………….

1. Name of the construction site where loose gears are fitted/installed/located.

Distinguishing Number or Mark

Description, of gear

Number of the certificate of test and examination

Number annealed

Date of annealing

Defects found at careful inspection after annealing

Name and address of public service association, company or firm or testing establishment carrying out the annealing and inspection

Name and position of Competent Person in public service, association, company or firm or testing establishment

I certify that on the date shown in Column (5) the gear described in columns (1) to (4) was effectually annealed under my supervision that after being so annealed every article was carefully inspection; and that no defects affecting its safe working condition were found other that those indicated in column (6).

Signature of the Competent Person Seal Date

Registration/Authority number of the Competent Person.

FORM XII

{(See rule 223(d)}

HEALTH REGISTER

(In respect of persons employed in Building and other construction work involving hazardous processes)

Name of the Construction Medical Officer/Medical Inspector.

(a) Mr………………….From ……………………… to ……………………………

(b) Mr………………….From ……………………… to ……………………………

Sl.No.

Work No.

Name of building worker

Sex

Age (on last birthday)

Date of employment on present work.

Date of leaving or transfer to other work.

Reason for leaving transfer or discharge

Nature of job or occupation

Raw Material bye-product handled

Date of Medical examination by certifying Surgeon Medical Inspector/CMO

Results of medical examination

If suspended from work, state period of suspension with detailed reasons

Certified fit to resume duty on with signature of Medical Inspector/C.M.O.

If certificate of unfitness or suspension issued to worker.

Signature with date of Medical Inspector/C.M.O.

Note – (i) Column (8) – Detailed summary of reason for transfer or discharge should be stated.

(ii) column (12) should be pressed as fit/unfit/suspended.

FORM XIII

{(See rule 230(a)}

NOTICE OF POISONING OR OCCUPATIONAL NOTIFIABLE DISEASES.

1.	Name and address of the employer
2.	Name of the building worker and his work No., if any
3.	Address of the building worker
4.	Sex and Age
5.	Occupation
6.	State exactly what the patient was doing at the time of contracting the disease.
7.	Nature of poisoning or disease from which the building worker is suffering

Date Signature of the employer/ CMO

Note - When a building worker contracts any disease specified in Schedule XII, a notice in this form shall be sent forthwith to the Director General.

FORM XIV

[See Rule 210(7)]

REPORT OF ACCIDENTS AND DANGEROUS OCCURRENCES

1.		Name of the project/work
2.		Location of project/work
3.		Stage of construction work
4.		Particulars of Employer
	a.	Main contractor firm/Co.
		Name
		Address
		Phone Nos.
		Nature of business
	b.	Sub-contractor’s particulars.
		Name
		Address
		Phone Nos.
		Nature of business
5.		Particulars of injured person
	a.	Name	(First) (Middle) (Surname)
	b.	Home Address
	c	Occupation
	d.	Status of worker:	Casual Permanent
	e	Sex:	Male Female
	f	Age
	g	Experience
	h	Marital status :	Married/un-married/divorced
6.		Particulars of accident
	a	Exact place where accident occurred
	b.	Date
	c.	Time
	d.	What the injured person was doing at the time of accident ?
	e.	Weather condition
	f.	How long employed by you for this particular job ?
	g	Particulars of equipment/machine/ tool involved and condition of the same after the accident occurred.
	h.	Brief description of the accident

7.		Nature of injuries.
	a.	Fatal
	b.,	Non-fatal
	c.	If non-fatal, state precisely the nature of injuries(Describe in detail the nature of injury, for instance fracture of right arm, sprain etc.)
	d.	First Aid:	Given Not given
	e.	If not, give the reasons
	f.	Name and designation of the person by whom first-aid was given
	g.	If admitted to hospital name of the hospital
		Address of the hospital
		Name of the Doctor.
		Phone No.
8.		Mode of transport used Ambulance/ Truck/ Tempo/ Taxi/ Private Car
9.		How much time was taken to shift the injured person
		If very late, state the reasons
	b.	How the reporting was made ? Telephone/ Telegram/ Special messenger letter
	c.	Who visited the accident site first and what action was proposed by him?
	d.	What are the actions taken for the investigation of the accident by the employer ? (Describe about photographs/ Video film/ measurements taken, etc.)
10.		Particulars of persons given witness.
	a.	Name Address Occupation
	1.
	2.
	3.
	4.
	b.	Whether Temporary/ Permanent
11.		Particulars in case of fatal
		Date/Time
		Whether registered with Building and Construction Workers’ Welfare Board. If yes, give Reg. No.

12.		Dangerous Occurrences as covered under the Regulation No. (Give details)
	a.	Collapse or failure of lifting appliances, hoist conveyors, etc.
	b.	Collapse or subsidence of soil, any wall, floor, gallery etc.
	c.	Collapse of transmission towers, pipeline, bridges, etc.
	d.	Explosion of receiver, vessel, etc.
	e	Fire and explosion
	f	Spillage or leakage of hazardous substances
	g	Collapse, capsizing, toppling or collision of transport equipment
	h	Leakage or release of harmful toxic gases at the construction site.
	i.	Failure of lifting appliance, loose gear, hoist or building and other construction work machinery, transport equipment, etc.
13.		Certificate from the Employer or authorized signatory.

I certify that to the best of my knowledge and belief, the above particulars are correct in every respect.

Place : Signature

Date : Designation

C.C. - Forwarded for information and follow-up action :

Note- If more than one person is involved, then for each person, information is to be filled up in separate forms.

FORM XV

[See Rule 240]

Register of building workers employed by the employer

Name and address of the establishment where building and other construction work is to be carried on : .........	Name and permanent address of establishment : ..............



Nature and location of work : ...........

Sl. No.

Name and surname of workmen

Age and Sex

Father's/
Husband's name

Nature of Employment/ Designation

Permanent home address of workmen (Village and Tehsil / Taluk and District)

Local address

Date of commencement of employment

Signature or thumb-impression of workmen

Date of termination of employment

Reasons for termination

If the building worker is/was beneficiary, the date of registration as a beneficiary, the registration No. and the name of Welfare Board.

Remarks

FORM XVI

[See Rule 241(1) (a)]

Muster Roll

Name and permanent address of the establishment			Name and address of establishment where building or other construction work is carried on/is to be carried on


Nature of building or other construction work			Name and address of Employer

			For the month of

Sl. No.

Name of building worker

Father's / Husband's name

Sex

Dates

Remarks

FORM XVII

[See Rule 241 (1) (a)]

Register of Wages

Name and address of the establishment where building or other construction work is carried on : .....	Name and permanent address of Establishment : ....

Nature of building or other construction work : ....	Name and address of the employer: ....



	Wage period: Monthly

Sl. No.

Name of workman

Serial No. in the register of workman

Designation / nature of work done

No. of days worked

Units of works done

	Amount of wages earned
Daily rate of wages/piece rate	Basic wages	Dearness Allowances	Overtime	Other cash payments (Nature of payment to be indicated)	Total
7	8	9	10	11	12

Deductions, if any, (indicate nature)

Net amount paid

Signature / Thumb impression of workman

Initial of employer or his representative

FORM XVIII

[See Rule 241 (1)(a)]

Form of Register of Wages-cum-Muster Roll

Name and address of the establishment where building or other construction work is carried on/is to be carried on : ...	Name and permanent address of establishment: ...




Nature of building or other construction work: ...

Sl. No.

Sl. No. in Register of building workers

Name of employee

Designation/ nature of work

Daily attendance units worked

Total attendance / units of work done

	Amount of wages earned
Daily-rate of wages/piece-rate	Basic Wages	Dearness allowance	Overtime	Other cash payment (nature of payments to be indicated)	Total
7	8	9	10	11	12

Deduction, if any, (indicate nature)

Net amount paid

Signature / Thumb impression of workman

Initials of employer or his representative

FORM XIX

[See Rule 241 (1) (b)]

Register of Deductions for Damage or Loss

Name and address of establishment where building or other construction work is carried on/is to be carried on : ...	Name and permanent address of building workers: ...
	Name and permanent address of the employer: ...

Name of building or other construction work : ...

Sl. No.

Name of work

Father's / Husband's name

Designation/ Nature of Employment

Particulars of damage or loss

Date of damage or loss

Whether building worker showed cause against deduction

			Date of recovery
Name of person in whose presence building worker’s explanation was heard	Amount of deduction imposed	No. of installments
	Amount of deduction imposed	No. of installments	First installment	Last installment
8	9	10	11	12

FORM XX

[See Rule 241(1) (b)]

Register of Fines

Name and address of establishment where building or other construction work is carried on/is to be carried on : ...	Name and permanent address of establishment : ...


Name of building or other construction work: ...	Name and address of the Employer : ...

Sl.

No.

Name of the building worker

Father's/ Husband name

Designation / nature of employment

Act/ Omission for which fine imposed

Date of offence

Whether building worker showed cause against fine

Name of person in whose presence building worker’s explanation was heard

Wage periods and wages payable

Amount of fine imposed

Date on which fine realized

Remarks

FORM XXI

[See Rule 241(1) (b)]

Register of Advances

Name and address of establishment where building or other construction work is carried on/is to be carried on: ...	Name and permanent address of Establishment : ...
	Name and address of the Employer: ...

Nature of building or other construction work: ...

Sl.

No.

Name

Father's/ Husband name

Nature of employment Designation

Wage period and wages payable

Date & amount of advance given

Purpose(s) for which advance made

No. of installments by which advance to be repaid

Date & amount of each installment repaid

Date on which last installment was repaid

Remarks

FORM XXII

[See Rule 241(I) (c)]

Register of Overtime

Name and address of establishment where building or other construction work is carried on/is to be carried on : ...	Name and permanent address of Establishment : ...

Sl. No.

Name of the building worker

Father's / Husband's name

Sex

Designation/ nature of employment

Date on which overtime worked

Total overtime worked or production in case of piece work

Normal rates of wages

Overtime rate of wages

Overtime earnings

Date on which overtime wages paid

Remarks

FORM XXIII

[See Rule 241(2) (1)]

Wage Book

Name and address of employer: ...		Name and permanent address of establishment: ...


Nature and address of the establishment where building or other construction work is carried on : ...		Nature of building or other construction work : ... For the Week/Fortnight/Month ending : ...


1.	No. of days worked
2.	No. of units worked in case of piece
	rate workers
3.	Rate of daily/monthly wages/piece-rate
4.	Amount of overtime wages
5.	Gross wages payable
6.	Deductions, if any on account of the following
(a) (b) (c) (d) (e) (f) 7.	Fines Damage or loss Loans and advances Subscription towards provident fund Subscription towards the Building Workers’ Welfare Fund Any other deductions e.g. subscriptions to Co-operative Society or account of loans from Co-operative Society/ housing loan, or contribution to any relief fund as per provision of clause (p) of sub-section (2) of section 7 of the Payment of Wages Act or for payment of any premium of Life Insurance Corporation. Net amount of wages paid

Initials of the employer or his
Representative

FORM XXIV

[See Rule 241(2)(b)}

Service Certificate

Name and permanent address of the establishment: ...							Name and address/location where the building or other construction work carried on/to be carried on : ...


Nature and location of work: ...
Name and address of the workman: ...


Age or Date of Birth : ...
Identification Marks: ...
Father's / Husband's name: ...

Sl.No.	Total period for which employed		Nature of work done	Rate of wages (with particulars of unit in case of piece work)	If the building worker was beneficiary his registration No., date and the name of the Board
	From	To
1	2