Form 34
[Prescribed under rule 121(a)]
THE FACTORIES ACT. 1948
ANNEXURE 3.1
Annual Return (Revised) |
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| For the year ending 31st December, 20 |
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| 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. |
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| (a) |
Men |
| (b) |
Women |
| (c) |
Children | |
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| 10. |
Average No. of workers employed daily............... |
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(a) |
Adults |
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(b) |
Adolescent |
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(c) |
Children |
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| 11. |
Total No. of man-hours worked including overtime |
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| (a) |
Men................................... |
| (b) |
Women............................. |
| (c) |
Children............................ | |
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| 12. |
Average number of hours worked per week |
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| (a) |
Men................................... |
| (b) |
Women............................. |
| (c) |
Children............................ | |
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| 13. |
(a) |
Does the factory carry out any process or operation declared as dengerous under section 87. |
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(b) |
If so, given the following information |
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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 |
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1 |
2 |
| (i) |
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| (ii) |
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| (iii) etc. |
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LEAVE WITH WAGES |
| 14. |
Total No. of workers employed during the year |
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| (a) |
Men................................... |
| (b) |
Women............................. |
| (c) |
Children............................ | |
| 15. |
Number of workers who were entitled to annual leave with wages during the year |
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| (a) |
Men................................... |
| (b) |
Women............................. |
| (c) |
Children............................ | |
| 16. |
Number of workers who ware granted leave during the year |
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| (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 |
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(b) |
| Number of such workers in respect of whom wages in lieu of leave ware paid |
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SAFETY OFFICERS |
| 18. |
(a) |
| Number of safety Officers required to be appointed as per notification under Section 40-B |
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(b) |
| Number of safety officer appointed |
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AMBULANCE ROOM |
| 19. |
| Is there an ambulance room provided in the factory as required under Section 45 ? |
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CANTEEN |
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| 20. |
(a) |
| Is there a canteen provided in the factory as required under Section 46 ? |
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(b) |
| Is the canteen provided managed, run |
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| (i) |
Departmentally or |
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| (ii) |
Through a contractor ? |
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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 |
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(b) |
Are there adequate and suitable lunch rooms provided in the factory as required under Section 47 |
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CRECHES |
| 22. |
Is there a crèche provided in the factory as required under section 47 |
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WELFARE OFFICER |
| 23. |
(a) |
under of Welfare Officers to be appointed as required under Section 49 |
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(b) |
Number of Welfare Officers appointed |
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ACCIDENTS |
| 24. |
(a) |
Total number of accidents |
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| (i) |
Fatal |
| (ii) |
Non - Fatal | |
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(b) |
Accidents in which works returned to work during the year to which this return relates: |
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(i) |
Accidents (workers injured) occurring during the year in which injured workers returned to work during the same year. |
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| (i) |
Number of accidents. |
| (ii) |
Man-days lost due to accidents. | |
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(ii) |
Accidents (workers injured) occurring in the previous year in which injured workers returned to work during the year to which this return relates |
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| (i) |
Number of accidents. |
| (ii) |
Man-days lost due to accidents. | |
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(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 |
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| (i) |
Number of accidents. |
| (ii) |
Man-days lost due to accidents. | |
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SUGGESTION SCHEME |
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[a] |
Is a suggestion Scheme in operation in the factory |
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[b] |
If so, the number of suggestion |
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[i] |
Received during the year |
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[ii] |
Accepted during the year |
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[c] |
Amount awarded cash prizes during the peried |
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[i] |
total amount awarded |
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[ii] |
Value of the maximum cash prize awarded |
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[iii] |
Value of minimum cash prize awarded |
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Certified that the information furnished above is to the best of my knowledge and belief correct |
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Signature of the manager
Date |
Local Services 