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Metalliferous Mines Regulations, 1961 - Directorate General of ...

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Date ………………………………..<br />

FIRST SCHEDULE<br />

FORM IV-C<br />

(See Regulation 9)<br />

Particulars <strong>of</strong> Injured person returned to duty<br />

(To be given separately in respect <strong>of</strong> every person within 15 days <strong>of</strong> his return to duty )<br />

1. <strong>General</strong> :<br />

(i) Name <strong>of</strong> mine ……………………………..<br />

(ii) Mineral produced …………………………<br />

(iii) Owner …………………………………….<br />

(iv) District ………………<br />

.(v) State …………<br />

2. Name <strong>of</strong> Injured Worker …………………………….<br />

3. Return to duty :<br />

(i) Date when returned to work ……………………..<br />

(ii) Whether rturned to regular job or some other job (to be specified) ……………..<br />

4. Compensation :<br />

State amount <strong>of</strong> compensation paid, or to be paid, if any ………………………..<br />

Signature …………………………<br />

Designation : Owner/Agent/Manager<br />

Date ………………………………..<br />

From :<br />

…………………………………..<br />

……………………………………<br />

FIRST SCHEDULE<br />

FORM V<br />

(See Regulation 10)<br />

Notice <strong>of</strong> Disease notified under section 25<br />

1. The Chief Inspector <strong>of</strong> <strong>Mines</strong>, …………..Dhanbd, E.Rly.<br />

2. The Regional Inspector <strong>of</strong> <strong>Mines</strong> ………………………..<br />

3. The Inspector <strong>of</strong> <strong>Mines</strong> (in case <strong>of</strong> electrical accidents only, Dhanbad).E .R. …….<br />

4. The District Magistrate/District Collector ………………<br />

Sir,

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