Form XIX — Register of Accidents and Dangerous Occurrences

Rule: Rule 75 · Signed by: Manager, Safety Officer · Under: OSH & Working Conditions (Central) Rules 2026

What the form records

• Name of injured/deceased person (if any)
• Date of accident or dangerous occurrence
• Date of report to Inspector-cum-Facilitator
• Nature of accident or dangerous occurrence
• Date of return of injured person to work
• Number of days the injured person was absent from work
• Signature of employer/representative

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

MedFactory — Occupational Health Centre software for Indian factories