OSH Code · Form XV

Form XV — Register for Wages, Overtime and Deductions

Form XV of the OSH & Working Conditions (Central) Rules 2026, prescribed under Rule 72(1)(iii).

Rule: Rule 72(1)(iii) · Signed by: Manager

Register columns

Name of Establishment
Name of the Employer/owner
PAN/TAN of the Employer
Registration Number of the establishment (LIN)
Wage Period from dd/mm/yyyy to dd/mm/yyyy (Monthly/Fortnightly/Weekly/Daily/Piece Rated)
Serial Number
Employee Code Number
Name of the employee
Designation
Department
Duration of Payment of wages (Monthly/Fortnightly/Weekly/Piece rated)
Wage Period from- to
Total number of days worked during the wage period
Total overtime hours worked or overtime production in case of piece workers
Rate of Wage - a) Basic
Rate of Wage - b) DA
Rate of Wage - c) Other allowance
Amount of wages earned - Basic
DA
Allowances
Overtime
Total wages earned
EPF
ESIC
Society
Income Tax
Insurance
Advances
Recovery of Fine
Recovery on amount of damages/losses
Total deductions
Others
Net Payment
Date of Payment
Receipt by employee/Bank Transaction ID
Nature of acts and omissions for which fine imposed with date
Amount of fine imposed
Damage or loss caused to the employer by neglect or default of the employee
Signature of Employer/Employer Representative

Part of the Seventh Schedule to the OSH & Working Conditions (Central) Rules 2026. View the official form layout in the gazette, or open the OSH Code forms in MedFactory.

MedFactoryOpen the OSH Code statutory forms.