Single format · FV10-G11-7

Register of accidents and dangerous occurrences

A single format from the OSH Formats pack. content of Form XIX, OSH (Central) Rules 2026, retained 5 years.

Length
1 page
Blanks to fill
55
Files
Word and PDF
Law stated to
12 September 2026

What it covers

  1. 1Register of accidents and dangerous occurrencescontent of Form XIX, OSH (Central) Rules 2026, retained 5 years55 blanks

Read the opening

The first part of the format, as it downloads. Blanks are highlighted.

Maintained continuously, in retrievable and non-editable electronic form, and written up contemporaneously

[COMPANY NAME] PRIVATE LIMITED
Establishment: [Address of the establishment] | Registration number (s.3, OSH Code): [OSH Code registration number]
Register for the calendar year [Calendar year of the register] | Maintained by: [name and designation]

Sl.

Date and time

Category and place

Person(s) affected

Description, cause and injury

Form XI filed

Action taken and closure

[1]

[DD.MM.YYYY]
[HH:MM]

[Fatal / Non-fatal 48h+ / Dangerous occurrence]
[exact location]

[Name]
[age / sex]
[designation]
[Direct / Contract — contractor]
ESI no.: [__]

[what happened; machinery, plant or substance involved; nature and extent of injury; days of disablement]

Date: [DD.MM.YYYY]
Time: [HH:MM]
Ack. no.: [__]
ESI Form 12: [DD.MM.YYYY]

[root cause; corrective action; date completed; improvement notice reference, if any; date closed]

[2]

[__]

[__]

[__]

[__]

[__]

[__]

[3]

[__]

[__]

[__]

[__]

[__]

[__]

[4]

[__]

[__]

[__]

[__]

[__]

[__]

4 more paragraphs and tables follow in the full format.

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