Form 27 — Notice of Poisoning or Disease

Rule: Rule 122 · Signed by: Manager · Under: Factories Act 1948 / Model Factories Rules 2020

Notice under Section 89 — notifiable occupational diseases (lead, mercury, manganese, benzene poisoning; silicosis, asbestosis, chrome ulceration, anthrax, byssinosis, noise-induced hearing loss, etc.). Signed and despatched by Manager to BOTH Chief Inspector and Certifying Surgeon (CS is a recipient, not a signatory). FMO/CS contribute the diagnosis.

What the form records

• Factory name + address
• Address of occupier's office
• Residential address
• Nature of industry
• Patient name + works number + address
• Precise occupation of patient
• Nature of poisoning or disease
• Whether reported to Certifying Surgeon
• Manager signature + date

This page opens the blank statutory form in MedFactory, ready to fill, save and print. See the Form 27 reference page for the rule and signatory detail.

MedFactory — Occupational Health Centre software for Indian factories