Factories Act · Form 23
Form 23 — Certificate of Fitness (Hazardous Processes)
Special fitness certificate for workers in hazardous processes (Schedules to Rule 120). Pre-employment + periodic. Issued only by notified Certifying Surgeon.
Rule: Schedules to Rule 19(5) & Rule 120 · Signed by: Authorized Certifying Surgeon · MFR 1963: Form 23
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)
Blank statutory template. Fill, save and print Form 23 in MedFactory, or view the official layout in the Model Factories Rules gazette.
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