FORM 35 [see Rule 165 (a)] ANNUAL RETURN For the year ending 31st December, 2 .... 1. Registration number of Factory ..................... 2. Name of Factory : - 3. Name of Occupier : - 4. Name of the Manager : - 5. District : - 6. Full postal address of Factory : - 7. Nature of Industry : - Number of workers and particulars of employment 8. No. of days worked in the year : - 9. No. of man-days worked during the year a) Men : - b) Women : - c) Children : - 10. Average number of workers employed daily (See explanatory note) - a) Adults i) Men : - ii) Women : - b) Adolescent i) Male : - ii) Female : - c) Children i) Boys : - ii) Girls : - 11. Total No. of man-hours worked including overtime - a) Men : - b) Women : - c) Children : - 12. Average number of hours worked per week (See explanatory note) a) Men : - b) Women : - c) Children : - 13. a) Does the factory carry out any process or operation declared as dangerous under section 87 ? (See Rule 160) b) If so, give the following information : - Name of the dangerous processes or operations carried on. (State the Schedule number under Rule 160) Average No. of persons employed daily in each of the processes or operation given in Col.1 1. 2. i) ii) iii) LEAVE WITH WAGES 14. Total number of workers employed during the year ___________________ a) Men : - b) Women : - c) Children : - 15. Number of workers who were entitled to annual leave with wages during the year - a) Men : - b) Women : - c) Children : - 16. Number of workers who were granted leave during the year - a) Men : - b) Women : - c) Children : - 17. a) Number of workers who were discharged, or dismissed from the service, or quit employment, or were superannuated, or who died while in service during the year. b) Number of such workers in respect or whom wages in lieu of leave were paid. Safety Officers 18. a) Number of Safety Officers required to be appointed as per Notification under Section 40-B. b) Number of Safety Officers appointed. Ambulance-room 19. Is there an ambulance room provided in the factory as required under section 45? Canteen 20. a) Is there a canteen provided managed - i) Departmentally, or ii) Through a contractor? Shelter or Rest rooms and Lunch rooms 21. a) Are there adequate and suitable shelters or rest rooms provided in the factory as required under section 47? b) Are there adequate and suitable lunch rooms provided in the factory as required under section 47? Creches 22. Is there a Creche provided in the factory as required under section 48? Welfare Officers 23. a) Number of Welfare Officers to be appointed as required under section 49. b) Number of Welfare Officers appointed. Accidents 24. a) Total number of accidents (See explanatory note) i) Fatal ii) Non-fatal b) Accidents in which workers returned to work during the year to which injured workers returned to work during the year to which this return relates. i) Accidents (workers injured) occurring during the year in which injured workers returned to work during the year to which this return relates. aa) Number of accidents : - bb) Man-days lost due to accidents : - ii) Accidents (workers injured) occurring in the previous years in which injured workers returned to work during the year to which this return relates. aa) Number of accidents : - bb) Man-days lost due to accidents : - iii) Accidents (workers injured) occurring during the year in which injured workers did not return to work during the year to which this return relates. aa) Number of accidents : - bb) Man-days lost due to accidents : - Certified that the information furnished above is to the best of my knowledge and belief correct. Date _______________________ Signature of the Manager Explanatory Notes: 1. The average number of workers employed daily should be calculated by dividing the aggregate number of attendances on working days (that is, man-days worked) by the number of working days in the year. In reckoning attendance, attendance by temporary as well as permanent employees should be counted and all employees should be included, whether they are employed directly or by or through any agency including contractors. Attendance on separate shifts (e.g. night and day shifts) should be counted separately. Days on which the factory was closed for whatever cause, and days on which manufacturing process were not carried on should not be treated as working days. Partial attendance for less than half a shift on working days should be ignored, while attendance for half a shift or more on such day should be treated as full attendance. 2. For seasonal factories, the average number of workers employed during the working season and the off-season should be given separately. Similarly the number of days worked and average number of man hours worked per week during the working and off-season should be given separately. 3. The average number of hours worked per week means the total actual hours worked by all workers during the year excluding the rest intervals but including over-time work divided by the product of total number of workers employed in the factory during the year and 52. In case the factory has not worked for the whole year, the number of weeks during which the factory worked should be used in place of the figure 52. 4. Every person killed or injured should be treated as one separate accident. If in one occurrence, six persons were injured of killed, it should be counted as six accidents. 5. In item 24(a), the number of accidents which took place during the year should be given. In case of non-fatal accidents only those accidents which prevented workers from working for 48 hours or more, should be indicated.
