FORM No.

23
[See Rule 138]

REGISTER OF ACCIDENTS AND DANGEROUS OCCURRENCES

Name of Date of
Time and mode Date of report (in Nature of Accident Date of return Number of days Signature
injured accident or Details of
of message to Form No. 17 to or dangerous of injured injured person was of
person dangerous injury
the Inspector Inspector) occurrence person to work absent from work Manager
(if any) occurrence

1 2 3 4 5 6 7 8 9

Note : To be in duplicate and perforated copy to be submitted to the Inspector at the end of the month.