Factories Act · Form 27
Form 27 — Notice of Poisoning or Disease
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.
Rule: Rule 122 · Signed by: Manager · MFR 1963: Form 25
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
Blank statutory template. Fill, save and print Form 27 in MedFactory, or view the official layout in the Model Factories Rules gazette.
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