Form XVII — Annual Return

Rule: Rules 72(5), 74 · Signed by: Occupier, Manager · Under: OSH & Working Conditions (Central) Rules 2026

What the form records

• Labour Identification Number
• Period of the Return (From - To)
• Name of the Establishment
• Email ID (employer)
• Telephone No. (employer)
• Mobile number (employer)
• Premise name
• Sub-locality
• District
• State
• Pin Code
• Geo Co-ordinates
• Hours of Work in a day
• Number of Shifts
• Number of hours in a shift
• Maximum No. of employees employed in the establishment in any day during the year
• Average No. of employees employed in the establishment during the year
• Maximum number of Migrant Worker during the year (Section 59 of OSH&WC Code)
• Number of fixed term employee engaged
• Name with LIN of the Contractor
• No. of Contract Labour Engaged
• Whether facility of Canteen provided (section 24(v) of OSH&WC Code, 2020)
• Crèches (section 67 of Code on Social Security Code, 2020 and section 24 of the OSH&WC Code 2020)
• Whether Crèches allowance under Rule of Social Security Code given
• Ambulance Room (section 24(2)(i) of OSH&WC Code, 2020)
• Safety Committee (section 22(1) of OSH&WC Code, 2020)
• No. of safety officers appointed (section 22(2) of OSH&WC Code, 2020)
• No. of Qualified Medical Practitioner appointed (section 12(2) of OSH&WC Code 2020)
• Is the Works Committee has been functioning (Section 3 of IR Code, 2020)
• Date of its constitution
• Whether the Safety Redressal Committee constituted (Section 4 of IR Code, 2020)

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

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