Department of Labour and Employment FORM 19 (Prescribed under sub rule (1) of rule 110) Annual Return Year ending 31st December 200 Name of Factory _ Name of occupier _ Name of Manager _ 1. District _ 2. Postal address _ 3. Nature of industry _ 4. Average Number of workers employed daily _ (a) Adults Male _ Female _ (b) Adolescent Male _ Female _ 5. Normal hours worked per week _ Men _ Female _ Children _ 6. Total number of man hours _ Normal Overtime Total Worked in the year 7. Number of days worked in the year 8. What rest intervals were given to adults? 9. Where rest intervals given to children? 10.Where week days sometime _ substituted for Sunday as weekly holidays? 11 The number of workers exempted _ the provisions of sections _ 51 52 53 54 55 56 12. Does the factory come under _ (i) Section 87 (Dangerous _ Operations)? (ii) Section 93? _ 13. Average daily number of workers _ employed in dangerous in dangerous operations Certified that the information furnished above is correct to the best of my knowledge and belief Signature of Manager
