Department of Labour and Employment FORM C [See Section 4(i) Provision (b)(i)] Muster Roll to be maintained by Small establishments Name of Establishment ___________________________ Name and Address of the Employer ________________________________________________ Address (Local) ________________________________________________ (Permanent) _______________ Wages Period ________________________ SL. No. Name of the Employee Date of Employment Permanent Address Age or date of birth 1 2 3 4 5 Father's or Husband's Name For the period ending .. Number of units of work done during Total Attendance Total Overtime worked Total production in case of piece rated workers 6 7 8 9 10 Compensatory Rest Signature of Inspector with date Remarks Brought Forward from previous wage period Given During the wage period 11 12 13 14 Notes: 1. In the case of daily rated workers, the extent of overtime done on each occasion has to be reflected against each concerned date, such as "P/1" meaning "Present with one hour's overtime," "P/1 1/2" meaning "Present with one and a half hour's overtime" and so on. 2. The number of units of work done by a piece -rated worked has to be noted for each day in the Register. In case of employment of any child / adolescent, the employer shall indicate the hours worked each day with intervals of rest. 3. The compensatory rest availed by the worker has to be marked in the Register in red ink as "CR" 4. Column 7 to be filled up on each working day and the remaining columns to be completed within seven days of the expiry of the wage period. Date: Signature of the employer with full name in Capitals Place:
