FORM NO. 18-A [Prescribed under Rule 96] Notice of dangerous occurrence which does not result in death or bodily injury [Vide para 2 of the Schedule under Rule 96] I certify that, to the best of my knowledge and belief, the above particulars are correct in every respect. Signature of the Occupier or Manager Date of dispatch of report: Note:- to be completed in legible handwriting or preferably typewriting. (This space is to be completed by the inspector of Factories. District: Number of accidents or dangerous occurrence: Industry No: Other particulars (Example fatal, leg injury, arm injury etc.): Causation No.: Date of receipt: Date of investigation: Result of investigation:
