Form 6 — Record of Eye Examination

Rule: Rule 77(4) · Signed by: Ophthalmologist · Under: Factories Act 1948 / Model Factories Rules 2020

Workers exposed to processes involving eye risk — periodic eye-sight examination by ophthalmologist. Only the ophthalmologist signs the register; FMO arranges the camp.

What the form records

• Sl. No.
• Department / Works
• Name of worker
• Sex
• Age (last birthday)
• Occupation (nature + date of employment)
• Eye-sight exam (date + result)
• Signature of ophthalmologist
• Remarks

This page opens the blank statutory form in MedFactory, ready to fill, save and print. See the Form 6 reference page for the rule and signatory detail.

MedFactory — Occupational Health Centre software for Indian factories