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FORM NO.

37

(Prescribed under Rule 12-B)


Register containing particulars of monitoring of working environment required
under Section 7-A(a)(e).

1. Name of the Department / Plant.


2. Raw materials, by-products and finished products involving in the process.
3. Particulars of sampling.

Sr. Location/ Identified Sampling Airborne Average


No. Operation conta- instrument Contamination
Mentioned minant used Number Range
of samples
1 2 3 4 5 6 7

TWA Reference Number of Remarks Signature Name (in


concen- method workers of person block
tration exposed taking letter)
(As given at the samples
in location
second being
schedule monitored
8 9 10 11 12 13

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