Form 23 — Certificate of Fitness (Hazardous Processes)

Rule: Schedules to Rule 19(5) & Rule 120 · Signed by: Authorized Certifying Surgeon · Under: Factories Act 1948 / Model Factories Rules 2020

Special fitness certificate for workers in hazardous processes (Schedules to Rule 120). Pre-employment + periodic. Issued only by notified Certifying Surgeon.

What the form records

• Serial number
• Person examined (name + father's name + address)
• Designation + process + department + factory
• Age
• Fit/unfit for employment
• Re-exam period
• Previous certificate serial no.
• Examined-person signature/thumb
• Certifying Surgeon signature + date
• Extension table (date of re-exam, signs/symptoms, signature)

This page opens the blank statutory form in MedFactory, ready to fill, save and print. See the Form 23 reference page for the rule and signatory detail.

MedFactory — Occupational Health Centre software for Indian factories