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Leave policy, annual leave with wages under the OSH Code

NAME OF THE ESTABLISHMENT

Fills 3 places in the document.

Address of the establishment

OSH registration number

Effective date of the policy

Version number

Fills 2 places in the document.

Board / Managing Director / Head of HR

Date of approval

Date of next review

State

Name of the State law or standing orders governing casual leave, sick leave and holidays

Designation of the Sanctioning Authority

Designation of the alternate Sanctioning Authority

Number of days of casual leave

Casual leave credit basis

Number of days of sick leave

Sick leave accumulation ceiling in days

Number of days of paternity leave

Months within which paternity leave is taken

Paternity leave eligibility

Total number of holidays

Days of annual leave credited each month

Last date for year-end encashment requests

Date for submitting the annual leave plan

Name of the HR system

Days of notice for annual leave

Days of notice for short leave

Working days within which leave is decided

Maximum number of spells of annual leave

Minimum days of leave for an advance of wages

Maximum days of casual leave at a time

Days after which a medical certificate is needed

Tops up the benefit to full wages / pays no wages / pays full wages against sick leave

Proof required for paternity leave

Number of festival holidays

Date by which the holiday list is published

Compensation for work on a holiday

Designation of the HR officer who holds medical certificates

Retention period for medical certificates

Days of notice of a change to the policy

Name, designation and e-mail of the HR contact

Name of the employee

Employee code and department

Annual / Casual / Sick / Paternity / Other

Leave from

Leave to

Number of days applied for

Leave balance before the application

Reason for leave

Yes / No

Date of application

Sanctioned / Sanctioned for different dates / Refused

Dates sanctioned

Reason for refusal and alternative dates

Date of decision

Date of entry in the leave register

Name of the approving signatory

Designation of the approving signatory

Previous version number

Date of the previous version

Summary of changes in this version

Date of circulation

Name of the establishment

Address of the establishment

OSH registration number

Calendar year of service

Leave year

Name of the preparer

Date of preparation

Name of the reviewer

Date of review

First day of the calendar year of service, DD.MM.YYYY

Last day of the calendar year of service, DD.MM.YYYY

Employee code, worker 1

Name of the worker, worker 1

Adult / Adolescent (1)

Date of joining, worker 1

Days actually worked, worker 1

Lay-off, maternity leave and leave days, worker 1

Employee code, worker 2

Name of the worker, worker 2

Adult / Adolescent (2)

Date of joining, worker 2

Days actually worked, worker 2

Lay-off, maternity leave and leave days, worker 2

Employee code, worker 3

Name of the worker, worker 3

Adult / Adolescent (3)

Date of joining, worker 3

Days actually worked, worker 3

Lay-off, maternity leave and leave days, worker 3

Employee code, worker 4

Name of the worker, worker 4

Adult / Adolescent (4)

Date of joining, worker 4

Days actually worked, worker 4

Lay-off, maternity leave and leave days, worker 4

Employee code, worker 5

Name of the worker, worker 5

Adult / Adolescent (5)

Date of joining, worker 5

Days actually worked, worker 5

Lay-off, maternity leave and leave days, worker 5

Employee code, worker 6

Name of the worker, worker 6

Adult / Adolescent (6)

Date of joining, worker 6

Days actually worked, worker 6

Lay-off, maternity leave and leave days, worker 6

Employee code, worker 7

Name of the worker, worker 7

Adult / Adolescent (7)

Date of joining, worker 7

Days actually worked, worker 7

Lay-off, maternity leave and leave days, worker 7

Employee code, worker 8

Name of the worker, worker 8

Adult / Adolescent (8)

Date of joining, worker 8

Days actually worked, worker 8

Lay-off, maternity leave and leave days, worker 8

Employee code, worker 9

Name of the worker, worker 9

Adult / Adolescent (9)

Date of joining, worker 9

Days actually worked, worker 9

Lay-off, maternity leave and leave days, worker 9

Employee code, worker 10

Name of the worker, worker 10

Adult / Adolescent (10)

Date of joining, worker 10

Days actually worked, worker 10

Lay-off, maternity leave and leave days, worker 10

Opening balance, worker 1

Leave availed, worker 1

Refused leave in the balance, worker 1

Encashment asked for, worker 1

Opening balance, worker 2

Leave availed, worker 2

Refused leave in the balance, worker 2

Encashment asked for, worker 2

Opening balance, worker 3

Leave availed, worker 3

Refused leave in the balance, worker 3

Encashment asked for, worker 3

Opening balance, worker 4

Leave availed, worker 4

Refused leave in the balance, worker 4

Encashment asked for, worker 4

Opening balance, worker 5

Leave availed, worker 5

Refused leave in the balance, worker 5

Encashment asked for, worker 5

Opening balance, worker 6

Leave availed, worker 6

Refused leave in the balance, worker 6

Encashment asked for, worker 6

Opening balance, worker 7

Leave availed, worker 7

Refused leave in the balance, worker 7

Encashment asked for, worker 7

Opening balance, worker 8

Leave availed, worker 8

Refused leave in the balance, worker 8

Encashment asked for, worker 8

Opening balance, worker 9

Leave availed, worker 9

Refused leave in the balance, worker 9

Encashment asked for, worker 9

Opening balance, worker 10

Leave availed, worker 10

Refused leave in the balance, worker 10

Encashment asked for, worker 10

Monthly wages, worker 1

Paid on (date), worker 1

Payroll reference, worker 1

Monthly wages, worker 2

Paid on (date), worker 2

Payroll reference, worker 2

Monthly wages, worker 3

Paid on (date), worker 3

Payroll reference, worker 3

Monthly wages, worker 4

Paid on (date), worker 4

Payroll reference, worker 4

Monthly wages, worker 5

Paid on (date), worker 5

Payroll reference, worker 5

Monthly wages, worker 6

Paid on (date), worker 6

Payroll reference, worker 6

Monthly wages, worker 7

Paid on (date), worker 7

Payroll reference, worker 7

Monthly wages, worker 8

Paid on (date), worker 8

Payroll reference, worker 8

Monthly wages, worker 9

Paid on (date), worker 9

Payroll reference, worker 9

Monthly wages, worker 10

Paid on (date), worker 10

Payroll reference, worker 10

Employee code, leaver 1

Date of leaving, leaver 1

Discharge or retrenchment / Dismissal / Resignation / Superannuation / Death (1)

Balance brought forward, leaver 1

Days worked this year, leaver 1

Leave availed this year, leaver 1

Monthly wages, leaver 1

Employee code, leaver 2

Date of leaving, leaver 2

Discharge or retrenchment / Dismissal / Resignation / Superannuation / Death (2)

Balance brought forward, leaver 2

Days worked this year, leaver 2

Leave availed this year, leaver 2

Monthly wages, leaver 2

Employee code, leaver 3

Date of leaving, leaver 3

Discharge or retrenchment / Dismissal / Resignation / Superannuation / Death (3)

Balance brought forward, leaver 3

Days worked this year, leaver 3

Leave availed this year, leaver 3

Monthly wages, leaver 3

Employee code, leaver 4

Date of leaving, leaver 4

Discharge or retrenchment / Dismissal / Resignation / Superannuation / Death (4)

Balance brought forward, leaver 4

Days worked this year, leaver 4

Leave availed this year, leaver 4

Monthly wages, leaver 4

Employee code, leaver 5

Date of leaving, leaver 5

Discharge or retrenchment / Dismissal / Resignation / Superannuation / Death (5)

Balance brought forward, leaver 5

Days worked this year, leaver 5

Leave availed this year, leaver 5

Monthly wages, leaver 5

Designation of the preparer

Designation of the reviewer

Consent to overtime and overtime register

Name of the establishment

Address of the establishment

OSH registration number

Name of the worker

Employee code

Department

Daily / Weekly / Monthly

Normal hours of work in a day

On the Rule 69 basis / on the daily or weekly basis, whichever gives more overtime

Hours in the ordinary working day

Quarterly overtime ceiling in hours

Rule 69 of the OSH (Central) Rules 2026 / the State OSH rules

Weekly overtime limit in hours

Designation of the officer who receives withdrawals

First day of the quarter

Last day of the quarter

Overtime hours agreed for the occasion

Dates of the overtime

Reason for the overtime

Has been read by me / has been read and explained to me in the language stated below

Language in which the terms were explained

Date of the consent

Name of the witness

Designation of the witness

Name of the authorised signatory

Designation of the authorised signatory

Date the copy was given to the worker

Date of withdrawal

Name of the officer who received the withdrawal

Date the withdrawal was received

Rule 69 basis / Higher of daily and weekly

Employee code, row 1

Week beginning (date), row 1

Mon hours, row 1

Tue hours, row 1

Wed hours, row 1

Thu hours, row 1

Fri hours, row 1

Sat hours, row 1

Sun hours, row 1

Employee code, row 2

Week beginning (date), row 2

Mon hours, row 2

Tue hours, row 2

Wed hours, row 2

Thu hours, row 2

Fri hours, row 2

Sat hours, row 2

Sun hours, row 2

Employee code, row 3

Week beginning (date), row 3

Mon hours, row 3

Tue hours, row 3

Wed hours, row 3

Thu hours, row 3

Fri hours, row 3

Sat hours, row 3

Sun hours, row 3

Employee code, row 4

Week beginning (date), row 4

Mon hours, row 4

Tue hours, row 4

Wed hours, row 4

Thu hours, row 4

Fri hours, row 4

Sat hours, row 4

Sun hours, row 4

Employee code, row 5

Week beginning (date), row 5

Mon hours, row 5

Tue hours, row 5

Wed hours, row 5

Thu hours, row 5

Fri hours, row 5

Sat hours, row 5

Sun hours, row 5

Employee code, row 6

Week beginning (date), row 6

Mon hours, row 6

Tue hours, row 6

Wed hours, row 6

Thu hours, row 6

Fri hours, row 6

Sat hours, row 6

Sun hours, row 6

Employee code, row 7

Week beginning (date), row 7

Mon hours, row 7

Tue hours, row 7

Wed hours, row 7

Thu hours, row 7

Fri hours, row 7

Sat hours, row 7

Sun hours, row 7

Employee code, row 8

Week beginning (date), row 8

Mon hours, row 8

Tue hours, row 8

Wed hours, row 8

Thu hours, row 8

Fri hours, row 8

Sat hours, row 8

Sun hours, row 8

Employee code, row 9

Week beginning (date), row 9

Mon hours, row 9

Tue hours, row 9

Wed hours, row 9

Thu hours, row 9

Fri hours, row 9

Sat hours, row 9

Sun hours, row 9

Employee code, row 10

Week beginning (date), row 10

Mon hours, row 10

Tue hours, row 10

Wed hours, row 10

Thu hours, row 10

Fri hours, row 10

Sat hours, row 10

Sun hours, row 10

Employee code, row 11

Week beginning (date), row 11

Mon hours, row 11

Tue hours, row 11

Wed hours, row 11

Thu hours, row 11

Fri hours, row 11

Sat hours, row 11

Sun hours, row 11

Employee code, row 12

Week beginning (date), row 12

Mon hours, row 12

Tue hours, row 12

Wed hours, row 12

Thu hours, row 12

Fri hours, row 12

Sat hours, row 12

Sun hours, row 12

Employee code, row 13

Week beginning (date), row 13

Mon hours, row 13

Tue hours, row 13

Wed hours, row 13

Thu hours, row 13

Fri hours, row 13

Sat hours, row 13

Sun hours, row 13

Employee code, row 14

Week beginning (date), row 14

Mon hours, row 14

Tue hours, row 14

Wed hours, row 14

Thu hours, row 14

Fri hours, row 14

Sat hours, row 14

Sun hours, row 14

Employee code, row 15

Week beginning (date), row 15

Mon hours, row 15

Tue hours, row 15

Wed hours, row 15

Thu hours, row 15

Fri hours, row 15

Sat hours, row 15

Sun hours, row 15

Daily-rated / Other (1)

Other hours at the overtime rate, row 1

Yes / No (1)

Monthly wages, row 1

Daily-rated / Other (2)

Other hours at the overtime rate, row 2

Yes / No (2)

Monthly wages, row 2

Daily-rated / Other (3)

Other hours at the overtime rate, row 3

Yes / No (3)

Monthly wages, row 3

Daily-rated / Other (4)

Other hours at the overtime rate, row 4

Yes / No (4)

Monthly wages, row 4

Daily-rated / Other (5)

Other hours at the overtime rate, row 5

Yes / No (5)

Monthly wages, row 5

Daily-rated / Other (6)

Other hours at the overtime rate, row 6

Yes / No (6)

Monthly wages, row 6

Daily-rated / Other (7)

Other hours at the overtime rate, row 7

Yes / No (7)

Monthly wages, row 7

Daily-rated / Other (8)

Other hours at the overtime rate, row 8

Yes / No (8)

Monthly wages, row 8

Daily-rated / Other (9)

Other hours at the overtime rate, row 9

Yes / No (9)

Monthly wages, row 9

Daily-rated / Other (10)

Other hours at the overtime rate, row 10

Yes / No (10)

Monthly wages, row 10

Daily-rated / Other (11)

Other hours at the overtime rate, row 11

Yes / No (11)

Monthly wages, row 11

Daily-rated / Other (12)

Other hours at the overtime rate, row 12

Yes / No (12)

Monthly wages, row 12

Daily-rated / Other (13)

Other hours at the overtime rate, row 13

Yes / No (13)

Monthly wages, row 13

Daily-rated / Other (14)

Other hours at the overtime rate, row 14

Yes / No (14)

Monthly wages, row 14

Daily-rated / Other (15)

Other hours at the overtime rate, row 15

Yes / No (15)

Monthly wages, row 15

Employee code, summary row 1

Name of the worker, summary row 1

Employee code, summary row 2

Name of the worker, summary row 2

Employee code, summary row 3

Name of the worker, summary row 3

Employee code, summary row 4

Name of the worker, summary row 4

Employee code, summary row 5

Name of the worker, summary row 5

Employee code, summary row 6

Name of the worker, summary row 6

Employee code, summary row 7

Name of the worker, summary row 7

Employee code, summary row 8

Name of the worker, summary row 8

Employee code, summary row 9

Name of the worker, summary row 9

Employee code, summary row 10

Name of the worker, summary row 10

Name of the preparer

Designation of the preparer

Date of preparation

Name of the reviewer

Designation of the reviewer

Date of review

Constitution of the safety committee, with the minutes of its first meeting

Name of the establishment

Address of the establishment

OSH registration number

Office order number

Date of the office order

Rules 14 and 15 of the OSH (Central) Rules 2026 / the State OSH rules

Number of workers ordinarily employed

Date of constitution of the Committee

Name of the Chairman (1)

Designation of the Chairman

Name of the Safety Officer (1)

Name of the medical practitioner

Designation of the medical practitioner

Name of member 4

Designation of member 4

Name of member 5

Designation of member 5

Name of member 6

Designation of member 6

Name of member 7

Designation of member 7

Name of member 8

Designation of member 8

Name of member 9

Designation of member 9

Name of member 10

Designation of member 10

Name of member 11

Designation of member 11

Name of member 12

Designation of member 12

Percentage of women in the workforce

The negotiating union / the negotiating council / the workers, by election under Part 2

The Regional Labour Commissioner (Central) / the authority named in the State OSH rules

Date on which the tenure ends

Date of the first meeting

Days of notice of a meeting

Quorum of the Committee

Days within which minutes are circulated

Languages of display

Name of the employer's signatory

Designation of the employer's signatory

Negotiating union or council, if any

Number of workers' seats

Number of seats for women workers

Last date and time for nominations

Place or link for nominations

Date of display of valid nominations

Last date for withdrawal of nominations

Place or link for withdrawals

Date and hours of polling

Polling place or voting link

Date of declaration of results

Date on which the electoral roll is fixed

Number of votes each worker has

Name of the returning officer

Date of the election notice

Time of the first meeting

Place of the first meeting

Name of the Chairman (2)

Present / Absent (1)

Name of the Safety Officer (2)

Present / Absent (2)

Name of the member, attendance row 3

Present / Absent (3)

Name of the member, attendance row 4

Present / Absent (4)

Name of the member, attendance row 5

Present / Absent (5)

Name of the member, attendance row 6

Present / Absent (6)

Name of the member, attendance row 7

Present / Absent (7)

Name of the member, attendance row 8

Present / Absent (8)

Names and designations of invitees

Name of the Chairman (3)

Date notice of the first meeting was given

The negotiating union / the negotiating council / the workers, at the poll under Part 2

Dates of the quarterly meetings

Days within which a special meeting is called

Registration position

Gap, status item 1

Safety officer position

Gap, status item 2

First aid position

Gap, status item 3

Fire safety position

Gap, status item 4

PPE position

Gap, status item 5

Display position

Gap, status item 6

Health examination position

Gap, status item 7

Accident reporting position

Gap, status item 8

Inspection position

Gap, status item 9

Number of months reviewed

Date to which the accident data was reviewed

Number of accidents

Number of reportable accidents

Number of person-days lost

Number of dangerous occurrences

Number of near misses

Main causes of accidents

Principal hazards identified

Areas to be inspected

Frequency of joint inspections

Training topics approved

Groups of workers to be trained

Date by which training is completed

Channel for raising safety concerns

Any other matter discussed

Date of the next meeting

Time the meeting ended

Date the minutes were signed

Name of the Safety Officer (3)

Date of the meeting confirming the minutes

Recommendation 1

Date recommendation 1 received

Accepted / Accepted with modification / Not accepted (1)

Action or reasons, recommendation 1

Person responsible, recommendation 1

Target date, recommendation 1

Open / Closed (1)

Recommendation 2

Date recommendation 2 received

Accepted / Accepted with modification / Not accepted (2)

Action or reasons, recommendation 2

Person responsible, recommendation 2

Target date, recommendation 2

Open / Closed (2)

Recommendation 3

Date recommendation 3 received

Accepted / Accepted with modification / Not accepted (3)

Action or reasons, recommendation 3

Person responsible, recommendation 3

Target date, recommendation 3

Open / Closed (3)

Recommendation 4

Date recommendation 4 received

Accepted / Accepted with modification / Not accepted (4)

Action or reasons, recommendation 4

Person responsible, recommendation 4

Target date, recommendation 4

Open / Closed (4)

Recommendation 5

Date recommendation 5 received

Accepted / Accepted with modification / Not accepted (5)

Action or reasons, recommendation 5

Person responsible, recommendation 5

Target date, recommendation 5

Open / Closed (5)

Annual health examination: notice to employees and the record

Name of the establishment

Address of the establishment

OSH registration number

Calendar year of the examination

Date of the notice

Qualifying age in years

Date on which age is reckoned

Other employees or classes of work covered

Name and designation of the HR contact

Name and address of the examining facility

First day of the examination period

Last day of the examination period

Days of advance notice of the slot

ESIC facility, where the examination is arranged through ESIC

Age from which an ECG is done

Process-specific test

Employees in the process or area concerned

Basis for the process-specific test

Telephone and e-mail of the HR contact

Name of the authorised signatory

Designation of the authorised signatory

Date of display of the notice

Languages of display

Date the notice was sent to employees

Name of the employee

Employee code

Age of the employee

Designation of the officer who holds health records

Retention period for health records

Name and e-mail of the person handling data grievances

Date of the employee's consent

Name of the HR officer receiving the form

Date the form was received

Date of declining

Employee code and name, employee 1

Age and DOB, employee 1

Department and nature of work, employee 1

Date of examination, employee 1

Fit / Fit with restrictions / Temporarily unfit / Referred / Declined (1)

Date certificate given, employee 1

Follow-up required, employee 1

Date follow-up closed, employee 1

Employee code and name, employee 2

Age and DOB, employee 2

Department and nature of work, employee 2

Date of examination, employee 2

Fit / Fit with restrictions / Temporarily unfit / Referred / Declined (2)

Date certificate given, employee 2

Follow-up required, employee 2

Date follow-up closed, employee 2

Employee code and name, employee 3

Age and DOB, employee 3

Department and nature of work, employee 3

Date of examination, employee 3

Fit / Fit with restrictions / Temporarily unfit / Referred / Declined (3)

Date certificate given, employee 3

Follow-up required, employee 3

Date follow-up closed, employee 3

Employee code and name, employee 4

Age and DOB, employee 4

Department and nature of work, employee 4

Date of examination, employee 4

Fit / Fit with restrictions / Temporarily unfit / Referred / Declined (4)

Date certificate given, employee 4

Follow-up required, employee 4

Date follow-up closed, employee 4

Employee code and name, employee 5

Age and DOB, employee 5

Department and nature of work, employee 5

Date of examination, employee 5

Fit / Fit with restrictions / Temporarily unfit / Referred / Declined (5)

Date certificate given, employee 5

Follow-up required, employee 5

Date follow-up closed, employee 5

Employee code and name, employee 6

Age and DOB, employee 6

Department and nature of work, employee 6

Date of examination, employee 6

Fit / Fit with restrictions / Temporarily unfit / Referred / Declined (6)

Date certificate given, employee 6

Follow-up required, employee 6

Date follow-up closed, employee 6

Employee code and name, employee 7

Age and DOB, employee 7

Department and nature of work, employee 7

Date of examination, employee 7

Fit / Fit with restrictions / Temporarily unfit / Referred / Declined (7)

Date certificate given, employee 7

Follow-up required, employee 7

Date follow-up closed, employee 7

Employee code and name, employee 8

Age and DOB, employee 8

Department and nature of work, employee 8

Date of examination, employee 8

Fit / Fit with restrictions / Temporarily unfit / Referred / Declined (8)

Date certificate given, employee 8

Follow-up required, employee 8

Date follow-up closed, employee 8

Days to issue the certificate

Days to adjust work after a restriction

Days within which a referral is followed up

Days to consider reasonable accommodation

Date by which the offer is repeated

Number of employees eligible

Number of employees examined

Number of employees who declined

Number found fit

Number fit with restrictions

Number temporarily unfit

Number referred

Number of follow-up items open

Work-related factors identified

Name of the officer who prepared the summary

Date of the annual summary

Name of the reviewer

Designation of the reviewer

Date of review of the summary

Standing policy for the employee handbook · approve, circulate and enclose with every appointment letter

[NAME OF THE ESTABLISHMENT]
LEAVE AND HOLIDAYS POLICY

Establishment: [Address of the establishment] | Registration number under section 3, OSH Code 2020: [OSH registration number]
Effective from: [Effective date of the policy] | Version: [Version number] | Approved by: [Board / Managing Director / Head of HR] on [Date of approval] | Next review: [Date of next review]

Use this policy with the "Appointment letter, permanent employee" and the "Notice of periods of work, for display" (OSH Formats pack) and the "Maternity benefit policy, for the employee handbook" (Maternity Formats pack). The "Register of leave with wages and encashment working" in this pack applies the figures in clauses 4 to 6. Fill the casual leave, sick leave and holiday figures only after checking the State law named in clause 1.2.

1. Purpose, scope and the law that applies

1.1 This policy sets out the leave and holidays allowed to the employees of [Name of the establishment] (the "Company") at every place of work of the Company in [State], and how leave is applied for and sanctioned.

1.2 Annual leave with wages is governed by section 32 of the Occupational Safety, Health and Working Conditions Code 2020 (the "OSH Code"), in force from 21 November 2025, read with the rules made by the appropriate Government. Hours of work and the weekly rest day are governed by sections 25 and 26 of the OSH Code. Maternity benefit is governed by Chapter VI of the Code on Social Security 2020. Casual leave, sick leave and national and festival holidays are governed by [Name of the State law or standing orders governing casual leave, sick leave and holidays].

1.3 The [State] Shops and Establishments Act continues to apply to the Company's shops and offices. Where that Act, the standing orders applicable to the Company, a settlement or an employee's contract gives a more favourable entitlement than this policy, the more favourable entitlement applies. Nothing in this policy reduces a statutory entitlement.

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