FORM 33 (see Rule 162) NOTICE OF POISONING OR DISEASE (See instructions on reverse) 1. Name of factory with address : - 2. Factory Registration Number : - 3. Occupiers' Office address : - 4. Occupiers' residential address : - 5. Nature of Industry : - 6. Name and works number of patient : - 7. Residential address of patient : - 8. Sex and Age of Patient : - 9. Precise occupation of patient : - 10. Nature of poisoning or disease from which patient is suffering : - 11. Has the case been reported to the Inspector of Factories and the Certifying Surgeon? : - Full Signature of Manager/ Occupier with seal and Date ______________: ........................................... (To be filled in by the Chief Inspector) Number of the case : Remarks : ........................................... Notice of Poisoning or Disease (Extract from the Factories Act, 1948 (Section 89) Where any worker in a factory contracts any disease specified in the schedule, the manager of the factory shall send a notice thereof to such authorities, and in such form and within such time, as may be prescribed. SCHEDULE LIST OF NOTIFIABLE DISEASES 1. Lead poisoning, including poisoning by any preparation of lead or their sequelae. 2. Lead tetra-ethyl poisoning. 3. Phosphorous poisoning or its sequelae. 4. Mercury poisoning or its sequelae. 5. Manganese poisoning of its sequelae. 6. Arsenic poisoning or its sequelae. 7. Poisoning by nitrous fumes. 8. Carbon disulphide poisoning. 9. Benzene poisoning, including poisoning by any of its homologues, their nitro or amide derivatives or its sequel. 10. Chrome ulceration or its sequelae. 11. Anthrax. 12. Silicosis. 13. Poisoning by halogen derivatives of the hydrocarbons of the aliphatic series. 14. Pathological manifestations due to - a) radium or other radio-active substances; and b) x-rays 15. Primary epitheliomatous cancer of skin. 16. Toxic anemia. 17. Toxic jaundice due to poisonous substances. 18. Oil acne or dermatitis due to mineral oils and compounds containing mineral oil base. 19. Byssinosis 20. Asbestosis 21. Occupational or contract dermatitis caused by direct contract with chemicals and paints. These are of two types that is, primary irritants and allergic sensitizers. Extract from the Tripura Factories Rules, 2007 (Rule 162) A notice in Form 33 should be sent forthwith both to the Chief Inspector and to the Certifying Surgeon, by the manager of a factory if factory in which there occurs a case of lead, phosphorous, mercury, manganese, arsenic, carbon bi-sulphide or benzene poisoning; or of poisoning by nitrous fumes or by halogens or hologen derivatives of the hydrocarbons of aliphatic series; or of chrome ulceration, anthrax, silicosis, toxic anemia, toxic jaundice, primary epitheliomatous cancer of skin, or of pathological manifestations due to radium or other radio-active substances or x-rays.
