In respect to persons employed in occupations declared to be dangerous operations under section 87
Name of Certifying Surgeon :
| (1) | Serial No. : | ||
| (2) | Deptt & Code No. : | [] | |
| (3) | Name of Employee : | Vijay Gehlot | |
| (4) | Sex : | ||
| (5) | Date of Birth : | ||
| (6) | Age | No DOB Found | |
| (7) | Aadhar No. : | ||
| (8) | Mobile No. : | ||
| (9) | Date of employment on Present work : | ||
| (10) | Date of leaving transfer to Other work : | ||
| (11) | Reason of leaving transfer or Discharge : | ||
| (12) | Name of job or occupation : | ||
| (13) | Raw material or by product handled : | ||
| (14) | FORM O : | ||
| (15) | Incharge : | ||
| (16) | Bloodgroup : |
URINE:R-M-
Investigations :
Date:14/03/2025
Signature of Employee