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Centralized Circular
Form 34  Annual Return under The Factories Act, 1948

 
For the year ending 31st December, 20


1. Registration number of factory .........................................................................................
2. Name of factory.............................................................................................................
3. Name of occupier ...........................................................................................................
4. Name of the Manager .....................................................................................................
5. District ......................................................................................................................
6. Full postal address of factory ..................................................................................................
7. Nature of industry .................................................................................................................
Number of Workers and Particulars of Employment
8. No. of days worked in the year
9. No. of man-days worked during the year.



(a) Men  
(b) Women
(c) Children
   
10. Average No. of workers employed daily...............
       

(a) Adults
(a) Men  
(b) Women

(b) Adolescent
(a) Male  
(b) Female

(c) Children
(a) Boys  
(b) Girls
   
11. Total No. of man-hours worked including overtime
       



(a) Men...................................
(b) Women.............................
(c) Children............................
   
12. Average number of hours worked per week
       



(a) Men...................................
(b) Women.............................
(c) Children............................
     
13. (a) Does the factory carry out any process or operation declared as dengerous under section 87.

(b) If so, given the following information
       



  Name of the dangerous processes or opera­tions carried on Average No. of persons employed daily in each of the processes or operations given in Col. 1
  1 2
(i)    
(ii)    
(iii) etc.    



 



LEAVE WITH WAGES
14. Total No. of workers employed during the year



(a) Men...................................
(b) Women.............................
(c) Children............................
15. Number of workers who were entitled to annual leave with wages during the year



(a) Men...................................
(b) Women.............................
(c) Children............................
16. Number of workers who ware granted leave during the year



(a) Men...................................
(b) Women.............................
(c) Children............................
17. (a)
Numbers of workers who were discharged, or dismissed from the service, or quit employment, or were superannuated, or who died -------------------------------------------------------

(b)
Number of such workers in respect of whom wages in lieu of leave ware paid -------------------------------------------------------



 



SAFETY OFFICERS
18. (a)
Number of safety Officers required to be appointed as per notification under Section 40-B -------------------------------------------------------

(b)
Number of safety officer appointed -------------------------------------------------------



 



AMBULANCE ROOM
19.
Is there an ambulance room provided in the factory as required under Section 45 ? -------------------------------------------------------
       



CANTEEN



 
20. (a)
Is there a canteen provided in the factory as required under Section 46 ? -------------------------------------------------------

(b)
Is the canteen provided managed, run  
(i) Departmentally or -------------------------------------------------------
(ii) Through a contractor ? -------------------------------------------------------



 



SHELTERS OR REST ROOMS AND LUNCH ROOMS
21. (a) Are there adequate and suitable shelters or rest rooms provided in the factory as required under Section 47

(b) Are there adequate and suitable lunch rooms provided in the factory as required under Section 47



 



CRECHES
22. Is there a crèche provided in the factory as required under section 47



 



WELFARE OFFICER
23. (a) under of Welfare Officers to be appointed as required under Section 49

(b) Number of Welfare Officers appointed



 



ACCIDENTS
24. (a) Total number of accidents
     
(i) Fatal
(ii) Non - Fatal

(b) Accidents in which works returned to work during the year to which this return relates:


(i) Accidents (workers injured) occurring during the year in which injured workers returned to work during the same year.
     
(i) Number of accidents.
(ii) Man-days lost due to accidents.
    (ii) Accidents (workers injured) occurring in the previous year in which injured workers returned to work during the year to which this return relates
     
(i) Number of accidents.
(ii) Man-days lost due to accidents.

(c) Accidents (workers injured) occurring during the year in which injured workers did not return to work during the year to which this return relates



(i) Number of accidents.
(ii) Man-days lost due to accidents.



 



SUGGESTION SCHEME



 

[a] Is a suggestion Scheme in operation in the factory

[b] If so, the number of suggestion


[i] Received during the year


[ii] Accepted during the year

[c] Amount awarded cash prizes during the peried


[i] total amount awarded


[ii] Value of the maximum cash prize awarded


[iii] Value of minimum cash prize awarded

Certified that the information furnished above is to the best of my knowledge and belief correct
   
   
  Signature of the manager

Date
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