L.C..59.F.A.-2 Punjab Government Press S.A.S.Nagar/8347/07-2014

Note :- To Ensure delivery at Proper destination address the return to “ The Labour

Commissioner Punjab ( Statistical Section ), S.C.O. 47, Second Floor , 17-E, Chandigarh-160017

( To be Dispatched upto 31st January )

Annual returns under various labour laws For the Year ____________

Form No.21 (Prescribed under section 110 of the Factories Act, 1948 and Rule 107(1) of the

Punjab Factory Rules, 1952) 1 Registration number and date _______________________________. 2 Name of Factory. ______________________________ 3. Name of Occupier :- _____________________________________ 4. Name of Manager :- ______________________________________ 5. Telephone No. _______________________________________ 6. Name of the Locality, Mohalla, Plot No. etc. Where the factory is situated ______________________________ 7. Postal Address ( Post Box No. etc. ) __________________________ 8. Nature of Manufacturing process ( say exactly Which is being manufactured ) _____________________________ 9. Code No. ______________________________ 10. Total investment made :_ ______________________________ 10-A Sector (a) Public (b) Private (c.) Joint (d) Co-operative

11 Average daily No. of workers

employed

ADULTS

Men

Women ADOLESCENT

Male

Female

Children

Boys

Girls

For Perennial

For Perennial

During off Season

12 No. of days worked in the year

13 No. of man days worked during

the year (total attendances)

(a) Adult

(i) Men ______________

(ii) Women _____________

(b)Adolescent

(i) Male _____________

(ii) Female _____________

(c) Children

(i) Boys ______________

(ii) Girls ________________

14 Total no. of Man hours worked

including overtime

(a) Men _________

(b) Women _______

(c) Children _______

15 Normal hours worked per week

Men _______

Women ________

16

17

(i) Does the factory carry

any operation declared

dangerous under

section87

(ii) If so, state average daily

number of workers

employed in such

dangerous operation i.e.

(a) Manufacture of a erated

water and process

incidental thereto etc.

(Schedule 1)

(b) Electrolytic plating or

oxidation of metal

article by use of an

electrolytic containing

chromic acid or other

chromium compounds

(Schedule II)

(c) Manufacture and repair

of accumulator

(Schedule III electric

(d) Manufacture and

treatment of lead and

certain compounds of

lead

(e) Liming and tanning of

raw hides and skins and

Children _________

_________________

______________

_______________

________________

_________________

_________________

process incidental

theroto

(f) Carrying of certain

process of lead and lead

material in printing

presses and type

foundries

(g) Chemical works

(h) Manufacture of pottery

and ceramics

(i) Other dangerous

Leave With Wages

18 Total No of workers

employed during year

19 No of workers who are

entitled to annual leave

with wages during the year

20 No of workers who were

granted leave during the

year

21 No. of workers discharged

or dismissed from the

service or whose services

were terminated during the

year

22 No. of each workers paid

wages in lue leave

Canteen /Cold Drinking

water ( Only for those factories which

are employing more than 250

workers )

_________________

a. Men ______

b. Women _____

c. Children ____

a. Men _______

b. Women_____

c. Children____

a. Men ______

b. Women ____

c. Children____

_________________

23 No. of canteens providing

(j) Cooked food and

refreshment

(ii) Cooked food only

(iii) Refreshment and

Tea only

(iv) Tea only

(v) State reasons for not

maintaining the canteen

(vi) Approximate average

number of workers

using daily

(vii) Is the canteen

run/managed

departmentally or

through

a contractor ?

(viii) Is the canteen running

on “ No profit” basis as

required under the Punjab

Factory Rules, 1952

(ix) Item of expenditure borne

by the occupier stating

separately the total expenditure

borne by the occupier in

subsiding sale

of food stuff or in otherwise

selling food stuff below cost

price

(x) Please state if a common

canteen is being shared with

some other factory?

_________________

_________________

_________________

_________________

_________________

_________________

_________________

_________________

_________________

_________________

_________________

________________

________________

(xi) whether provision for

cooling drinking water has been

made?

REST ROOM /SHELTERS

AND LUNCH ROOMS

( Only for those factories which

are employing more than 150

workers )

24 (i) No. of rest rooms/shelter provided _____________

(ii) No. of lunch rooms provided _____________

CRECHE

( Only for those factories which are employing more than 30 workers )

25. No. crèches provided _________________________

26. Approximate average daily attendance

of children at the crèche _______________________

WELFARE OFFICER/AMBULANCE ROOMS

( Only for those factories which are employing more than 500 or more

workers )

27. a. No. of Labour Welfare Officers

(having prescribed qualifications)

appointed. ___________________

b. Whether ambulance room is provided? ________________

c. State reasons for not appointing such

officers not keeping ambulance room

Safety Officers

(only for those factories which are employing 1000 or more

workers)___________________

28. Whether qualified Safety Officer is appointed. __________________

ACCIDENTS ( FORM NO. 31)

(Prescribed under rule, 107 (4) of the Punjab Factory Rules, 1952)

28 (a). Total Accidents Fatal __________________

Non-Fatal _______________

(b). Accidents in which workers returned to work

during the year to which this return relates: -

(ii) Accidents (persons injured) occurring during the

year in which workers return to work during the

same year

Number Man days

lost

(ii) Accidents (person injured) occurring in the

previous year in which workers return to work

during the year to which this return relates.

(iii) Accidents in which the workers did not return to

work during the year.

FORM L.M.N.O. (Prescribed under section 28(2)(k) of the Maternity Benefit Act, 1961 and rule 6 of the

Punjab Maternity Benefit Rules, 1967

29 No. of women who claimed

maternity benefit for actual

birth

__________________________

30 No. of claims accepted and

paid either fully or partially

__________________________

(a) Total ________

(b) From the current

year ________

31 Total medical amount of

maternity benefit paid

_________________

(including medical bonus)

32 Amount of medical bonus paid

SUGGESTION SCHEME

32-A (a) Is a Suggestion Scheme in

operation in the factory:

(b) If so, the number of

suggestion

(i) Received during the year

(ii) Accepted during the

year

B Amount awarded in cash prizes

during the year :

(i) Total amount awarded Rs.

(ii) Value of the maximum cash

prize, awarded Rs.

(iii) Value of the minimum cash

prize awarded Rs.

SCHEDULE (.. Prescribed under section 16 of the Employee’s Compensation Act, 1923 – vide Punjab

Government Notification No. 7715-IP-52-7535, dated 19th August, 1952)

33 Accidents Adults Minor

(a) No. of cases which occurred

during the year-

(i) Death

(ii) Permanent disablement

(iii) Temporary disablement

(b) No. of Injuries in respect of

which final compensation

has been paid during the

year-

(i) Death

(ii) Permanent disablement

(iii) Temporary disablement

(c) Amount of compensation

paid

(i) Death

(ii) Permanent disablement

(iii) Temporary disablement

(Occupational Diseases)

(d) No. of cases in respect of

which final compensation

has been paid during the

year

Adults Minor

(i) Death

(ii) Permanent disablement

(iii) Temporary disablement

(e) Amount of compensation

paid -

(i) Death

(ii) Permanent disablement

(iii) Temporary disablement

FORM NO. III [Prescribed under section 18(1) of the Minimum Wages Act, 1948 and Rule 21 (4A) of

the Punjab Minimum Wages Rules, 1950]

(Information may be given only for those categories of workers in respect of whom

minimum wages have been fixed under the Minimum Wages Act, 1948)

34 No. of days worked during the

year

___________________________

35 No. of man days worked during

the year (total attendance)

___________________________

36 Average No. of persons

employed daily during the year

___________________________

Adults _________

Children _________

37 Total wages paid ___________________________

38 Cash value of wages paid in

kind

___________________________

39 Deductions made on account of

Fines Damage or loss Breach of contract

No. of cases Amount No. of Cases Amount No. of

cases

Amount

40 Balance of fine fund at the

beginning of the year

__________________________

41 Disbursement from the fine

fund

Purpose Amount spent

(a) ____________________

(b) ____________________

(c) ____________________

(d) ____________________

42 Balance of the fine fund at the

end of the year

___________________________

FORM NO.4 [Prescribed under section 26(3)(d) of the payment of Wages Act, 1936 and Rule 18 of

the Punjab Payment of Wages Rules, 1937]

(Information may be given in respect of only these workers whose average monthly

wages are less than Rs. 18,000 per month)

43 No. of days worked during the

year

Adults Children

44 No. of man days worked during

the year (Total attendances)

___________________________

45 Average daily No. of persons

employed during the year

___________________________

46 Total wages paid

(a) Basic wages __________________________

(b) Dearness and other

allowances

__________________________

(c) Arrears of pay in respect of

previous year paid during

the year

__________________________

(d) Amount of bonus __________________________

At the rate of

(i) Under Bonus

Act/Agreement

__________________________

(ii) Incentive Bonus __________________________

(iii) Profit sharing Bonus __________________________

(e) Amount of leave with

wages paid to workers

dismissed, discharged/

terminated

__________________________

(f) Amount of overtime wages __________________________

paid

(g) Amount of lay-off

retrenchment compensation

paid

__________________________

(h) Money value of concession ___________________________

(i) Amount of deduction made

(j) Grand total of columns (a)

to (i)

47 Deductions made during the

year

Nature of deduction No. of cases Amount

(a) Fines

(b) Damage or loss

(c) Breach of contract

48 Balance of fine Fund at the

beginning of the year

49 Disbursement from fine fund -

Disbursement Purpose Amount

(a)

(b)

(c)

(d)

50 Balance of fine in hand at the

end of year

51 Number of workers attendances, days worked and wages paid

Month No. of

worke

rs as

on

Roll

1

Total

attendanc

es of the

workers

2

No. of days

the Factory

worked

3

Total amount

of wages paid

(for workers

getting upto

Rs. 18,000 per

month)

January

February

March

April

May

June

July

August

September

October

November

December

Total

Date Signature of

Manager

Book Post ( For official use in order to sent the return from )

ON INDIAN GOVERNMENT

SERVICE

To

The Manger ,

__________________________

__________________

Dispatcher:-

Office of the Labour

Commissioner , Punjab

S.C.O. No. 47, Second Floor

( Statistical Section ),

Sector 17-E, Chandigarh.