Annual health examination: notice to employees and the record
A single format from the Leave, Overtime, Safety and Health pack. s.6(1)(c) OSH Code 2020 · Rule 5 and Form VIII, OSH (Central) Rules 2026 · DPDP Act 2023.
- 7 pages
- 117
- Word and PDF
- 30 October 2026
- 30 October 2026
What it covers
- 1Annual health examination: notice to employees and the records.6(1)(c) OSH Code 2020 · Rule 5 and Form VIII, OSH (Central) Rules 2026 · DPDP Act 2023
Not included
What you will still need outside this format:
- The State OSH rules, the State Shops and Establishments Act and any certified standing orders: they fix the overtime ceiling, casual and sick leave, holidays and the health examination age for State-sphere establishments, and must be read before the blanks are filled.
- The statutory registers in the prescribed form (Form XX for leave, Form IV for wages and overtime, or the State forms): the workbooks feed them but do not replace them.
- Appointment letters, consent to night work, consent to a compressed working week, the notice of periods of work and the accident register: see the OSH Formats pack.
- Maternity benefit sanction, the maternity policy and the register of women employees: see the Maternity Formats pack.
- Notice of change under section 40 of the IR Code before a change in leave or holidays: see the Exit and IR Formats pack.
- The medical practitioner's certificate (Form VIII or the State form), medical surveillance for hazardous processes, and the safety committee and medical rules for mines.
- Tax advice on the exemption for leave encashment under the Income-tax Act 2025.
Read the opening
The first part of the format, as it downloads. Blanks are highlighted.
Notice to employees, consent and privacy notice, record of examinations and follow-up · run once in every calendar year
[Name of the establishment]
Establishment: [Address of the establishment] | Registration number under section 3, OSH Code 2020: [OSH registration number]
Who must be examined. Section 6(1)(c) of the OSH Code requires the employer to provide, free of cost, an annual health examination or test for employees of the age, and in the class of establishments, prescribed by the appropriate Government. Where the Central Government is the appropriate Government, Rule 5(1) of the OSH (Central) Rules 2026 applies it to dock work, mines and building and other construction work, for employees who have completed 40 years of age; the examination is by a qualified medical practitioner, who gives a certificate in Form VIII to both the employer and the employee (Rule 5(2)), and the employer may arrange it through ESIC facilities. Mine workers have additional tests under the rules, which this format does not cover. For factories, shops, offices and other establishments in the State sphere, the State OSH rules decide the age (some States use 45 years), the classes covered, the timing and the certificate form. Where no rule covers the establishment, adopt this as a policy benefit on the same terms.