FORM 31 [see Rule 161 (2)] REPORT OF DANGEROUS OCCURRENCE WHICH DOES NOT RESULT IN DEATH OR BODILY INJURY 1. Name and address of factory : 2. Name of Occupier : 3. Name of Manager : 4. Nature of industry : 5. Branch or department and exact place where the dangerous occurrence took place : 6. Date and hour of dangerous occurrence : 7. Nature of dangerous occurrence (State exactly what happened) : I certify that to the best of my knowledge and belief the above particulars are correct in every respect. Signature of manager : Name, designation and address of manager : Date of dispatch of report : (To be completed by the Inspector of Factories) District ................. : Date or receipt : Name of the accident Causation : or dangerous occurrence : Other particulars (e.g. fatal, leg injury, arm injury, etc) : Date of investigation : Result of investigation :
