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Following Forms & s Required to be filed and maintained under The A.P Building & Other Construction Workers (Regula
Form No.
Form I
Prescribed Under Rule
Name of the /Form
See rule 23(1)
Application for Registration of Establishments Employing Building Workers
Form II
See rule 24(1) Certificate of Registration
Form III
See rule 24(2) and 25(2)
Form - IV
See rule 26(3) and 239(1)
Form - V
See rule 56 and 74(b),Schedule I
Form - VI
See rule 56 and 74(b)
Form - VII
See rule 70 and 74(b)
Form - VIII
See rule 62 and 74(b)
Form - IX
See rule 72 and 74(b)
Form - X
See rule 69 and 73
Form - XI
See rule 223 ('c)
of Establishment
Notice of Commencement/Completion of Building or Other Construction Work Certificate of Initial and Periodical Test and Examination of Winches, Derricks and Their Accessory Gear Certificate of Initial and Periodical Test and Examination of Cranes or Hoists and their Accessory Gear Certificate of Initial and Periodical Test and Examination of Loos Gear Certificate of Test and Examination of Wirerope before being taken into Use Certificate of Annealing of Loose Gears Certificate of Annual thorough Examination of Loose Gear exemted from Annealing
Cerificate of Medical Examination
Form - XII
See rule 223(d)
Form - XIII
See rule 230(a)
Form - XIV
See rule 210(7)
Form - XV
See rule 240
Form - XVI Form - XVII
See rule 241(1)(a) See rule 241(1)(a)
Form - XVIII
See rule 241(1)(a)
Form - XIX
See rule 241(1)(b)
Form - XX Form - XXI Form - XXII Form - XXIII Form - XXIV
See rule 241(1)(b) See rule 241(1)(b) See rule 241(1)(c) See rule 241(2)(a) See rule 241(2)(b)
Form - XXV
See rule 242
Form - XXVI
See rule 74(b)
Form - XXVII
See rule 33-A(2)
Health Notice of Poisoning or Occupational Notified Diseases Report of Accidents and Dangerous Occurrences of Building Workers Employed by the Employer Muster Roll Rigister of Wages Form of of Wages-cum-Muster-Roll of Deductions for Damages or Loss of Fines of Advances of Overtime Wage Book Service Certificate Annual Returns of Employer to be sent to the ing Officer of Periodical Test - Examination of Lifting Appliance and Gear, ect.
Application for the Registration of Building Workers Form - XXVIII See rule 33-A(5) Form - XXIX
See rule 33-A(6)
Form - XXX
See rule 33-B(i)
Note :
Nomination Form of Beneficiaries Identity Card
The A.P Building & Other Construction Workers (Regulation of Employment and Conditions of Service) Rules,1998 Issued/ Submitted/Maintained By whom Whom to submit Remarks
by Principal Employer
Govt.of A.P,ing Officer
Govt.of A.P,ing Officer by Principal Employer
In Triplicate along with DD showing Payment of Fees for Regestration
For any changes occurs in ownership or management or other employer shall intimate to ing officer within 30 days
Govt.of A.P,ing Officer
by Principal Employer
the employer shall before 30 days of commencement and completion of any building or other Govt.of A.P,ing Officer construction work,submit a written notice to inspector of area in form IV
Competent Person
Competent Person Competent Person Competent Person Competent Person Competent Person
issued by Medical Inspector/CMO
All the building workers employed as driver,Operators Once in every Two years up to age of lifting appliance and of 40 and Once in a year, thereafter transport equipment before employing,afetr illness or injury
Inrespect of persons employed in Building and other construction work involving hazardous processes issued by Employer/CMO by Principal Employer by Principal Employer by Principal Employer by Principal Employer by Principal Employer by Principal Employer by Principal Employer by Principal Employer by Principal Employer by Principal Employer by Principal Employer
To Building Worker
by Principal Employer
Govt.of A.P,ing Officer Year Ending 31st December …..
Competent Person
By Building Worker
Secretary,APBOCW Welfare Board
By Building Worker
Secretary,APBOCW Welfare Board
Secretary,APBOCW Welfare Board Secretary,APBOCW Welfare Board
To Building Worker
Along with Form XXVII together with the certificate of employment(containing details of name,age,father name & R.address,no. of days worked during the preceding 12 months) issued by ed Establishment,ALO.Trad Union of Construction workers.
If the number of workers to be employed as b.workers for B&O C work on one day is uoto 100 no. Rs.100/exceeds 100 but not exceed 500 no. Rs.500/exceeds 500 no. Rs.1000/-
With 2 port size photographs,age proff by School certificate or Doctor's certificate and Fees of rs.50/-
The A.P Building & Other Construction Workers (Regulation of Employment and Conditions of Service) Rules,1998 Schedules Rules Schedule I Schedule II Schedule III Schedule IV Schedule V Schedule VI Schedule VII Schedule VIII Schedule IX Schedule X Schedule XI Schedule XII
See Rules 56(a),71(a) and 72 See Rule 230(a) See Rule 231(b) See Rule 226(c) See Rule 227 See Rule 34 See Rules 81(iv)and 223(a)(iii) See Rules 209(1) and 209(2) See Rule 225 See Rule 225(b) See Rules 199(2) and 225(c) See Rule 152(a)
n Workers (Regulation of Employment and Conditions of Service) Rules,1998 Details Manner of Test and examination before Taking Lifting Appliance, Lifting Gear and Wire Rope into use for the First Time Notifiable Occupational Diseases in Building and Other Construction Work Contents of a First Aid Box Articles of Ambulance Room Contents of Ambulance Van or Carriage Permissible Exposure in case of Continuous Noise Periodicity of Medical Examination of Building Workers Number of Safety officers,Qualification,Duties.Ect. Hazardous Process Service and facilities to be provided in occupational health centers Qualification of Construction Medical Officer(CMO) Permissible Levels of Certain Chemical Substance in the Work Environment
SCHEDULE VI Permissible Exposure in case of Continuous Noise [See Rule 34] Total time of exposure (continuous or a number of short-term exposures) per day(in hours) Sound pressure level (in dBA) 1 2 8 90 6 92 4 95 3 97 2 100 1.5 102 1 105 3/4 107 1/2 110 1/4 115
FORM I [See rules 23 (1)] APPLICATION FOR REGISTRATION OF ESTABLISHMENTS EMPLOYING BUILDING WORKERS 1. Name and location of the establishment where Building or other construction work is to be carried on 2.
Postal address of the establishment
3. Full name and permanent address of the Establishment, if any 4. Full and address of the Manager or person Responsible for the supervision and control Of the establishment 5. Nature of building or other construction work Carried /is to be carried on in the establishment 6. Maximum number of building workers Employed on any day 7. Estimated date of commencement of building or the Other construction work 8. Estimated date of completion of the building or other Construction work 9. Particulars of demand draft, enclosed (Name of the bank, amount, demand draft No. and Date) DECLARATION BY THE EMPLOYER (i) I hereby declare that the particulars given above are true to the best of my knowledge and belief. (ii) I undertake to abide by the provisions of the Building and Other the rules made there under Construction Workers (Regulation of Employment and Conditions of Service) Act, 1996, and
Principal employer Seal and stamp
FORM IV [See rules 26 (3) and 239 (1) ] NOTICE OF COMMENCEMENT / COMPLETION OF BUILDING OR OTHER CONSTRUCTION WORK
1.
(I) Name and address (permanent) of the Establishment ………………………………………………………………………………………. (ii) Name of the employer and address……………………………………………………. 2. Name and situation of place where the Building and other construction is proposed to be carried on 3.
No. and date of certificate of registration
4. Name and address of the person in charge of the Construction work 5. Address to which the communications relating to Building or other construction work may be sent 6. Nature of work involved and the facilities including Plant or machinery provided 7. The arrangement storage of explosives, if any, to be Used in building or other construction work 8. In case the notice is for commencement of work, The approximate duration of work
I/We hereby intimate that the construction of building having registration no…………………………. dated ………………………… is likely to commence/has commenced and shall be completed on ……………………………………………..
To: The Inspector …………………………. …………………………. ………………………….
Signature of employer with seal
FORM XIII [See Rule -230(a)] Notice of Poisoning and Occupational diseases 1.Name and address of the employer : ________________________________________________________
2.Name of the building workers and his work number, if any : ____________________________________
3.Address of the building worker :____________________________________________________________ _____________________________________________________________ _____________________________________________________________ 4.Sex and Age :__________________________________________________
5.Occupation : ___________________________________________________
6.State exactly what the patient was doing at the time of contracting the disease :___________________ ________________________________________________________________ 7.Nature of poisoning or disease from which the building worker is suffering from : __________________ Date: ____________________ Signature of the Employer/ Construction medical Officer Note: When a building worker contracts ant diseases specified in Schedule-XII, a notice in this form shall be sent forthwith to The Chief Inspector of Inspection of Building and other Construction.
_____________
____________
_____________ __________________ __________________
___________ __________________
____________
Form- XIV *See Rule – 210(7)+ Notice of Accidents and Dangerous Occurrences 1. Name of the Project/ Work : ________________________________________________________________ 2. Location and address of Construction work :___________________________________________________ 3. Stage of Construction work : ________________________________________________________________ 4. Particulars of Employer : ___________________________________________________________________ (a) Main contractor Firm/Company: i. Name : ii. Address : iii. Phone numbers : iv. Nature of Business : (b) Main contractor Firm/Company: i. Name : ii. Address : iii. Phone numbers : iv. Nature of Business : 5. Particulars of Injured persons: (a) Name: (First) (Middle) (Last) : (b) Home address : (c) Occupation : (d) Status of the worker- Casual/ Permanent : (e) Sex: Male/ Female : (f) Age : (g) Experience : (h) Marital status: Married/ Unmarried/ Divorced : 6. Particulars of Accident: (a) Exact place where accident occurred (b) Date (c) Time (d) What the injured person was doing at the time of accident (e) Weather conditions (f) How long employed by you for this particular job (g) Particulars of equipment/ machine/tool involved and condition of the same after the Accident occurred 7. Nature of Injuries: (a) Fatal (b) Non- fatal (c) If non-fatal; state precisely the nature of injuries (Describe in detail the nature of injury, for instance fracture of right arm, sprain etc.) (d) First aid: Given: Not given: (e) If not given, the reasons (f) Name and designation of the person by whom first aid was given
(g) If itted to Hospital, i. Name of the Hospital ii. Address of the hospital iii. Phone number iv. Name of the Doctor 8. Mode of transport used: Ambulance Truck
Tempo
Taxi
Private Car
9 (a) How much time was taken to shift the injured person? If very late, state the reasons (b) How the reporting was made: Telephone Telegram Special Messenger letter (c) Who visited the accident site first and action was proposed by him (d) What are the actions taken for investigations of the accident by the employer (Describe about photographs/ video film/ measurements taken etc.) 10. Particulars of the person given witness: (a) Name Address Occupation 1. . 2. . 3. . 4. . 5. . (b) Whether temporary/permanent 11. Particulars in case of FatalDate Time 12. Whether ed with Building and Other Construction Workers Welfare Board 13. If yes, give registration number(s) I certify that to the best of my knowledge that to the best of my knowledge and belief, the above particulars are correct in every respect. Place: ______________ Date: ______________
Signature of Employer/ Responsible person/ Supervisor Designation
cc: forwarded for information and follow-up action: 1 2 3
FORM XV [See Rule 240]
of Building Workers Employed by the Employer Name and address/location where the building or other construction work is carried on/ is to be carried on :_________________________________________________________________________ _________________________________________________________________________ __________________________________________________________________
Name and permanent address of the Establishment _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________ ____________________________________________________________________________________________________
Nature and location of work………………………………………………..
Sl. No. Name and Surname of workman 1 2
Age and Sex 3
Father’s/ Husband’s name 4
Nature of employment/ degisnation 5
Permanent Home address of Workman(Village and Taluka and Distt.) 6
Local Address 7
Date of Commencement of employment 8
Signature or Thumb impression of workman 9
Date of termination of employment 10
Reasons for termination 11
If the building worker is/was beneficiary the date of registration as a beneficiary, the registration no. and the name of welfare board Remarks 12 13
FORM XVI [See Rule 241(1)(a)]
Muster Roll Name and permanent address of the Establishment ___________________________________________________________________ ___________________________________________________________________ ________________________________________________________________
Name and address/location where the building or other construction work is carried on/ is to be carried on _____________________________________
Nature of building or other construction work: _________________________
Sl. No. Name of the Building worker
Father’s/ Husband’s name Sex
1
2
3
4
5
6
7
8
Name and address of the Employer For the month of ________________________________ Remark 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 s
FORM XVII [See Rule 241(1)(a)]
of Wages Name and permanent address of the Establishment _______________________________________________
Name and address/location where the building or other construction work is carried on/ is to be carried on :_______________________________________________________________________ ________________________________________________________________________ _____________________________________________________________________
Name and Address of the Employer :_____________________________________________________________ Wage Period :___________________________________
Nameof the building or other construction work………………………………………………..
Amount of Wage earned
Sl. No. 1
Name and Surname of workman 2
Serial No. in the Degisnation/Nature of work of Workman done 3 4
No. of days worked 5
Units of Work Don 6
Daily rate of wages/ piece rate 7
Basic wages 8
Dearness allowances 9
Overtime 10
Other cash payments (nature of payment to be indicated) Total 11
Deductions, if any (indicate nature) 12
Net Amount paid
Initial of Signature/Thumb impression of Employer or his the worker representative 13
FORM XIX [See Rule 241(1)(b)]
for Deductions for Damage or Loss Name and Permanent address of building workers:
Name and permanent address of the Employer :
Name and address/location where the building or other construction work is carried on/ is to be carried on :______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________ Nature of building or other construction work………………………………………………..
Date of recovery
Sl. No. 1
Name of worker 2
Father’s/ Husband name 3
Designation/ Nature of employment 4
Particulars of damage or loss 5
Date of damage or loss 6
Whether building worker showed cause against deduction 7
Name of person in whose presence building worker’s explanation was heard 8
Amount of deduction imposed 9
No. of installments First Installment 10 11
Last Installment 12
FORM XX [See Rule 241(1)(b)]
of Fines Name and permanent address of the Establishment : Name and address/location where the building or other construction work is carried on/ is to be carried on :______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________ Name and permanent address of the Employer :
Sl. No. 1
Name of building worker 2
Father’s/Husband’s name 3
Designation/ Nature of employment 4
Act/Omission for which fine imposed 5
Date of Offence 6
whether building worker showed cause against fin 7
Name of person in whose presence building worker’s explanation was heard 8
Wage periods and wages payable 9
Amount of fine imposed 10
Date on which fine released 11
Remarks 12
FORM XXI [See Rule 241(1)(b)]
for Advances Name and permanent address of the Establishment :
Name and address/location where the building or other construction work is carried on/ is to be carried on :_______________________________________________________________________________________ _______________________________________________________________________________________ ______________________________________ Nature of building or other construction work………………………………………………..
Sl. No. 1
Name of building worker 2
Father’s/Husband’s name 3
Name and permanent address of the Employer :
Designation/ Nature of employment 4
Wage period and wages payable 5
Date and amount of advance given 6
Purpose(s) for which advance given 7
Date and amount of each No. of installments by which installment advance to be repaid repaid 8 9
Date on which last installment was repaid 10
Remarks 11
FORM XXII [See Rule 241(1)(c)]
for Overtime Name and permanent address of the Establishment :
Name and address/location where the building or other construction work is carried on/ is to be carried on :_________________________________________________________________ __________________________________________________________________ __________________________________________
Sl. No. 1
Name of building worker 2
Father’s/Husband’s name 3
Sex 4
Designation/ Nature of employment 5
Date on which overtime worked 6
Total hours of overtime worked or production in case of piece rated 7
Normal rates of wages 8
Overtime rate of wages 9
Overtime earnings 10
Date on which overtime wages paid 11
Remarks 12
FORM XXIII [See Rule 241(2)(a)]
Wage Book Name and address of Employer
Name and permanent address of the Establishment
Name and Address of the Establishment where building or other construction work is carried on
Nature of building or other construction work
For the week/fort night/month ending ___________________ 1. No. of days worked_______________________________________________________________________ 2. No. of units worked in case of piece rated workers____________________________________________ 3. Rate of daily/monthly wages/ piece rate_____________________________________________________ 4. Amount of overtime wages ________________________________________________________________ 5. Gross wages payable______________________________________________________________________ 6. Deductions, if any, on of the following: (a) fines:_____________________________________ (b) damage or loss:____________________________ (c) loans and advances:_________________________ (d) subscription towards provident fund:__________ (e) subscription towards the Building Workers Welfare Fund______________________________________ (f) any other deductions e.g. subscription to co-operative society or of loans from co-operative society/housing loan or contribution to any relief fund as per provisions of clause (P) of sub-section-7 of the Payment of Wages Act or for payment of any of Life Insurance Corporation. 7. Net amount of wages paid ____________________ Initials of the Employer or his Representative
FORM XXIV [See Rule 241(2)(b)]
Service Certificate Name and permanent address of the Establishment
Name and address/location where the building or other construction work is carried on/ is to be carried on
Name and location of work :_________________________________________________________ Name and address of the workman :__________________________________________________ __________________________________________________ Age or Date of birth :______________________________________________ Identification marks :_______________________________________________________________ Father’s/Husband’s name :__________________________________________________________ Total period for
SL.No. 1
From 2
To 3
Rate of Remarks wages (with If the building worker particular was a beneficiary his Nature of s of units registration No., Date Reasons/ ground on work in case of and name of the which the employee done piece Board terminated 4 5 6 7 8
Signature of the Employer or his Representative
FORM XXV [See rule 242]
ANNUAL RETURN OF EMPLOYER TO BE SENT TO THE ING OFFICER Year Ending 31 st December ………………………………..
1
Full name and full address of the establishment of the building and other construction work. (Place,post office,district )
2
Name and permanent address of the establishment
3
Name and address of the employer
4
Nature of building and other construction work carried on.
5
Full name of the manager or person responsible for supervisior and control of the establishment
6
Number of building workers ordinarily employed.
7
Total number of days during the year on which building workers were employed.
8
Total number of days worked by buildig workers during the year.
9
Maximum number of building workers employed on any day during the year.
10
The number of accident that took place during the year as under :
(a)
The total number of accidents.
(b)
The number of accidents resulting in disablment of building workers for less than 48 hours,the number of building workers involved and the number of man days lost
(c)
The number of accident resulting in disablement of building workers beyond 48 hours, but not resulting in any permanent pertial or permanent total disablement, the number of building workers involved and the mumber of man-days lost on of such accidents.
(d)
The number of accidents resulting in permanent partial or total disablement of man-days lost of such accidents.
(e)
The number of accidents resulting in deaths of building workers and the number of resultant deaths.
11
Change, if any, in the management of the establishment,its location,or any other particulars furnished to the ing Officer in the application for Registration indicating also the dates.
Place: Date :
Signature of the Employer
Form-XXVII (See rule 33-A (2)
Application for the Registration of Building Workers Registration Number (To be filled in by office)
Affix port size photograph
1. Name of the worker : 2. Age and Date of Birth : (Proof to be enclosed) 3. Name of Father / Husband : 4. Details of Dependents (Name, Age and relationship with the building worker) : 5. Permanent address : 6. Present address : 7. Are you a member of any Trade Union? If so, state the name of the Union and its Regn. No. : 8. The place of work with location in detail (Certificate of Employment to be enclosed): 9. Nature of employment and skin : Place:
Signature of the Building Worker
Date: Certificate This is to certify that Sri/Smt / Kum ………………………………… is a building worker as defined in Section 2 (e) of the Building and Other Construction . Workers (Regulation of Employment and Conditions of Service) Act, 1996 and he is eligible for Registration as Beneficiary.
Place: Date :
Signature of the Authorised Signatory
Form-XXVIII See rule 33-A (5)
Nomination Form Registration Number: I hereby nominate the persons/person below to receive the Claims due to me under Building and other construction workers (Regulation of employment and conditions of service) Act.1996 in the event of my death any amount due to me becomes payable. The nominee(s) are also entitled to receive any other amount that may become payable under Building and other construction workers (Regulation of employment and conditions of service) Act, 1996. Name and Relationship of the Name and Address of Nominee(s) with " the building Address of Worker worker 1
Age of the Nominee(s) 2
Place: Date:
Signature or left-hand thumb-impression of the Building worker
Percentage of Share to be paid to each nominee 3
Certified that the above declaration has been signed/thumb impression has been impressed by Sri/Smt./Kum………………………………………………….after he/she has read the entries (or) after the entries have been read over to him/her by me and understood by him/her.
Place: Date:
President/Secretary of a ed Trade Union/ Labour Department Officer nor below the rank of an Assistant Labour Officer/ Employer of a ed Establishment/ Chief Executive of the Government Organisation involved in building or other construction activity.
Form- XXX See Rule 33-B(i)
Identity Card Registration Number: Date:
Affix port size photograph
1. Name of the worker : 2. Name of Father/Husband : 3. Age : 4. Permanent Address : 5. Details of Dependents (Name, Age and relationship with the Building worker : 6. Present Address : 7. Occupation : 8. If the member of any Trade Union, the Registration Number of the Union : Registration should be renewed before :
Secretary, Andhra Pradesh BuikHng and Other Construction Workers Welfare Board Details of Work Done By the Building Worker (During The Year from 1-4-20 to 31-3-20)
From
To
Worked as
Name and Address of the Employer/Establishm ent
Remarks
Signature of Employer/Establishm ent
FORM I [See rule 7]
1
Name of Establishment :
2
Address :
3
Name of Work :
4
No. of Workers employed :
Registration No. under Building and other Construction Workers’ (Regulation of Employment and Condition of Service) Act, 1996. ing Authority
Date of commencement of work Date Month Year
5 6
Estimated period work : Month Year
Estimated cost of construction Details of payment of cess
Stages 1st Year 2nd Year 3rd Year 4th Year Total:
Cost
Amount Challan No. and Date
Advance-A Deduction at Source-D Final-F
Signature of Employer Name of Employer Date 7 8 9 10 11 12 13.. 14 15
TO BE FILLED BY ASSESSING OFFICER Date of completion Final cost Date of assessment Amount assessed Date of Appeal, if any Date of order in Appeal Amount as per Order in Appeal Date of transfer of cess to the Board Amount transferred Challan No. and date Signature Designation
FORM II [See rule 9 (1)] Notice of Stoppage or Reduction of Work Registration No. under Building and Other Construction Workers’ (Regulation of Employment and Condition of Service) Act, 1996
I.Name of Establishment Address:
II.Date of commencement of work Date Month Year Estimated cost of work (original)
Estimated period of work: Month Year Advance Cess/Deduction at source Date of Assessment Order Amount of Cess Assessed
III. Modification to the original estimates
Reason
Revised date of completion/date of stoppage Actual cost estimates Actual cost incurred Whether work is being handed over in any other person/agency for completion. If yes. Name/Address of such Person/agency.
Yes/No.
Signature of employer Name of employer Date TO BE USED BY ASSESSING OFFICER Date of revision of assessment Amount of cess after revision Cess already received Cess to be recovered Cess to be refunded, if any Reference to Board for refund; Date/number Signature Designation
Form No.
Form I
Prescribed Under Rule
Name of the /Form
See rule 23(1)
Application for Registration of Establishments Employing Building Workers
Form II
See rule 24(1) Certificate of Registration
Form III
See rule 24(2) and 25(2)
Form - IV
See rule 26(3) and 239(1)
Form - V
See rule 56 and 74(b),Schedule I
Form - VI
See rule 56 and 74(b)
Form - VII
See rule 70 and 74(b)
Form - VIII
See rule 62 and 74(b)
Form - IX
See rule 72 and 74(b)
Form - X
See rule 69 and 73
Form - XI
See rule 223 ('c)
of Establishment
Notice of Commencement/Completion of Building or Other Construction Work Certificate of Initial and Periodical Test and Examination of Winches, Derricks and Their Accessory Gear Certificate of Initial and Periodical Test and Examination of Cranes or Hoists and their Accessory Gear Certificate of Initial and Periodical Test and Examination of Loos Gear Certificate of Test and Examination of Wirerope before being taken into Use Certificate of Annealing of Loose Gears Certificate of Annual thorough Examination of Loose Gear exemted from Annealing
Cerificate of Medical Examination
Form - XII
See rule 223(d)
Form - XIII
See rule 230(a)
Form - XIV
See rule 210(7)
Form - XV
See rule 240
Form - XVI Form - XVII
See rule 241(1)(a) See rule 241(1)(a)
Form - XVIII
See rule 241(1)(a)
Form - XIX
See rule 241(1)(b)
Form - XX Form - XXI Form - XXII Form - XXIII Form - XXIV
See rule 241(1)(b) See rule 241(1)(b) See rule 241(1)(c) See rule 241(2)(a) See rule 241(2)(b)
Form - XXV
See rule 242
Form - XXVI
See rule 74(b)
Form - XXVII
See rule 33-A(2)
Health Notice of Poisoning or Occupational Notified Diseases Report of Accidents and Dangerous Occurrences of Building Workers Employed by the Employer Muster Roll Rigister of Wages Form of of Wages-cum-Muster-Roll of Deductions for Damages or Loss of Fines of Advances of Overtime Wage Book Service Certificate Annual Returns of Employer to be sent to the ing Officer of Periodical Test - Examination of Lifting Appliance and Gear, ect.
Application for the Registration of Building Workers Form - XXVIII See rule 33-A(5) Form - XXIX
See rule 33-A(6)
Form - XXX
See rule 33-B(i)
Note :
Nomination Form of Beneficiaries Identity Card
The A.P Building & Other Construction Workers (Regulation of Employment and Conditions of Service) Rules,1998 Issued/ Submitted/Maintained By whom Whom to submit Remarks
by Principal Employer
Govt.of A.P,ing Officer
Govt.of A.P,ing Officer by Principal Employer
In Triplicate along with DD showing Payment of Fees for Regestration
For any changes occurs in ownership or management or other employer shall intimate to ing officer within 30 days
Govt.of A.P,ing Officer
by Principal Employer
the employer shall before 30 days of commencement and completion of any building or other Govt.of A.P,ing Officer construction work,submit a written notice to inspector of area in form IV
Competent Person
Competent Person Competent Person Competent Person Competent Person Competent Person
issued by Medical Inspector/CMO
All the building workers employed as driver,Operators Once in every Two years up to age of lifting appliance and of 40 and Once in a year, thereafter transport equipment before employing,afetr illness or injury
Inrespect of persons employed in Building and other construction work involving hazardous processes issued by Employer/CMO by Principal Employer by Principal Employer by Principal Employer by Principal Employer by Principal Employer by Principal Employer by Principal Employer by Principal Employer by Principal Employer by Principal Employer by Principal Employer
To Building Worker
by Principal Employer
Govt.of A.P,ing Officer Year Ending 31st December …..
Competent Person
By Building Worker
Secretary,APBOCW Welfare Board
By Building Worker
Secretary,APBOCW Welfare Board
Secretary,APBOCW Welfare Board Secretary,APBOCW Welfare Board
To Building Worker
Along with Form XXVII together with the certificate of employment(containing details of name,age,father name & R.address,no. of days worked during the preceding 12 months) issued by ed Establishment,ALO.Trad Union of Construction workers.
If the number of workers to be employed as b.workers for B&O C work on one day is uoto 100 no. Rs.100/exceeds 100 but not exceed 500 no. Rs.500/exceeds 500 no. Rs.1000/-
With 2 port size photographs,age proff by School certificate or Doctor's certificate and Fees of rs.50/-
The A.P Building & Other Construction Workers (Regulation of Employment and Conditions of Service) Rules,1998 Schedules Rules Schedule I Schedule II Schedule III Schedule IV Schedule V Schedule VI Schedule VII Schedule VIII Schedule IX Schedule X Schedule XI Schedule XII
See Rules 56(a),71(a) and 72 See Rule 230(a) See Rule 231(b) See Rule 226(c) See Rule 227 See Rule 34 See Rules 81(iv)and 223(a)(iii) See Rules 209(1) and 209(2) See Rule 225 See Rule 225(b) See Rules 199(2) and 225(c) See Rule 152(a)
n Workers (Regulation of Employment and Conditions of Service) Rules,1998 Details Manner of Test and examination before Taking Lifting Appliance, Lifting Gear and Wire Rope into use for the First Time Notifiable Occupational Diseases in Building and Other Construction Work Contents of a First Aid Box Articles of Ambulance Room Contents of Ambulance Van or Carriage Permissible Exposure in case of Continuous Noise Periodicity of Medical Examination of Building Workers Number of Safety officers,Qualification,Duties.Ect. Hazardous Process Service and facilities to be provided in occupational health centers Qualification of Construction Medical Officer(CMO) Permissible Levels of Certain Chemical Substance in the Work Environment
SCHEDULE VI Permissible Exposure in case of Continuous Noise [See Rule 34] Total time of exposure (continuous or a number of short-term exposures) per day(in hours) Sound pressure level (in dBA) 1 2 8 90 6 92 4 95 3 97 2 100 1.5 102 1 105 3/4 107 1/2 110 1/4 115
FORM I [See rules 23 (1)] APPLICATION FOR REGISTRATION OF ESTABLISHMENTS EMPLOYING BUILDING WORKERS 1. Name and location of the establishment where Building or other construction work is to be carried on 2.
Postal address of the establishment
3. Full name and permanent address of the Establishment, if any 4. Full and address of the Manager or person Responsible for the supervision and control Of the establishment 5. Nature of building or other construction work Carried /is to be carried on in the establishment 6. Maximum number of building workers Employed on any day 7. Estimated date of commencement of building or the Other construction work 8. Estimated date of completion of the building or other Construction work 9. Particulars of demand draft, enclosed (Name of the bank, amount, demand draft No. and Date) DECLARATION BY THE EMPLOYER (i) I hereby declare that the particulars given above are true to the best of my knowledge and belief. (ii) I undertake to abide by the provisions of the Building and Other the rules made there under Construction Workers (Regulation of Employment and Conditions of Service) Act, 1996, and
Principal employer Seal and stamp
FORM IV [See rules 26 (3) and 239 (1) ] NOTICE OF COMMENCEMENT / COMPLETION OF BUILDING OR OTHER CONSTRUCTION WORK
1.
(I) Name and address (permanent) of the Establishment ………………………………………………………………………………………. (ii) Name of the employer and address……………………………………………………. 2. Name and situation of place where the Building and other construction is proposed to be carried on 3.
No. and date of certificate of registration
4. Name and address of the person in charge of the Construction work 5. Address to which the communications relating to Building or other construction work may be sent 6. Nature of work involved and the facilities including Plant or machinery provided 7. The arrangement storage of explosives, if any, to be Used in building or other construction work 8. In case the notice is for commencement of work, The approximate duration of work
I/We hereby intimate that the construction of building having registration no…………………………. dated ………………………… is likely to commence/has commenced and shall be completed on ……………………………………………..
To: The Inspector …………………………. …………………………. ………………………….
Signature of employer with seal
FORM XIII [See Rule -230(a)] Notice of Poisoning and Occupational diseases 1.Name and address of the employer : ________________________________________________________
2.Name of the building workers and his work number, if any : ____________________________________
3.Address of the building worker :____________________________________________________________ _____________________________________________________________ _____________________________________________________________ 4.Sex and Age :__________________________________________________
5.Occupation : ___________________________________________________
6.State exactly what the patient was doing at the time of contracting the disease :___________________ ________________________________________________________________ 7.Nature of poisoning or disease from which the building worker is suffering from : __________________ Date: ____________________ Signature of the Employer/ Construction medical Officer Note: When a building worker contracts ant diseases specified in Schedule-XII, a notice in this form shall be sent forthwith to The Chief Inspector of Inspection of Building and other Construction.
_____________
____________
_____________ __________________ __________________
___________ __________________
____________
Form- XIV *See Rule – 210(7)+ Notice of Accidents and Dangerous Occurrences 1. Name of the Project/ Work : ________________________________________________________________ 2. Location and address of Construction work :___________________________________________________ 3. Stage of Construction work : ________________________________________________________________ 4. Particulars of Employer : ___________________________________________________________________ (a) Main contractor Firm/Company: i. Name : ii. Address : iii. Phone numbers : iv. Nature of Business : (b) Main contractor Firm/Company: i. Name : ii. Address : iii. Phone numbers : iv. Nature of Business : 5. Particulars of Injured persons: (a) Name: (First) (Middle) (Last) : (b) Home address : (c) Occupation : (d) Status of the worker- Casual/ Permanent : (e) Sex: Male/ Female : (f) Age : (g) Experience : (h) Marital status: Married/ Unmarried/ Divorced : 6. Particulars of Accident: (a) Exact place where accident occurred (b) Date (c) Time (d) What the injured person was doing at the time of accident (e) Weather conditions (f) How long employed by you for this particular job (g) Particulars of equipment/ machine/tool involved and condition of the same after the Accident occurred 7. Nature of Injuries: (a) Fatal (b) Non- fatal (c) If non-fatal; state precisely the nature of injuries (Describe in detail the nature of injury, for instance fracture of right arm, sprain etc.) (d) First aid: Given: Not given: (e) If not given, the reasons (f) Name and designation of the person by whom first aid was given
(g) If itted to Hospital, i. Name of the Hospital ii. Address of the hospital iii. Phone number iv. Name of the Doctor 8. Mode of transport used: Ambulance Truck
Tempo
Taxi
Private Car
9 (a) How much time was taken to shift the injured person? If very late, state the reasons (b) How the reporting was made: Telephone Telegram Special Messenger letter (c) Who visited the accident site first and action was proposed by him (d) What are the actions taken for investigations of the accident by the employer (Describe about photographs/ video film/ measurements taken etc.) 10. Particulars of the person given witness: (a) Name Address Occupation 1. . 2. . 3. . 4. . 5. . (b) Whether temporary/permanent 11. Particulars in case of FatalDate Time 12. Whether ed with Building and Other Construction Workers Welfare Board 13. If yes, give registration number(s) I certify that to the best of my knowledge that to the best of my knowledge and belief, the above particulars are correct in every respect. Place: ______________ Date: ______________
Signature of Employer/ Responsible person/ Supervisor Designation
cc: forwarded for information and follow-up action: 1 2 3
FORM XV [See Rule 240]
of Building Workers Employed by the Employer Name and address/location where the building or other construction work is carried on/ is to be carried on :_________________________________________________________________________ _________________________________________________________________________ __________________________________________________________________
Name and permanent address of the Establishment _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________ ____________________________________________________________________________________________________
Nature and location of work………………………………………………..
Sl. No. Name and Surname of workman 1 2
Age and Sex 3
Father’s/ Husband’s name 4
Nature of employment/ degisnation 5
Permanent Home address of Workman(Village and Taluka and Distt.) 6
Local Address 7
Date of Commencement of employment 8
Signature or Thumb impression of workman 9
Date of termination of employment 10
Reasons for termination 11
If the building worker is/was beneficiary the date of registration as a beneficiary, the registration no. and the name of welfare board Remarks 12 13
FORM XVI [See Rule 241(1)(a)]
Muster Roll Name and permanent address of the Establishment ___________________________________________________________________ ___________________________________________________________________ ________________________________________________________________
Name and address/location where the building or other construction work is carried on/ is to be carried on _____________________________________
Nature of building or other construction work: _________________________
Sl. No. Name of the Building worker
Father’s/ Husband’s name Sex
1
2
3
4
5
6
7
8
Name and address of the Employer For the month of ________________________________ Remark 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 s
FORM XVII [See Rule 241(1)(a)]
of Wages Name and permanent address of the Establishment _______________________________________________
Name and address/location where the building or other construction work is carried on/ is to be carried on :_______________________________________________________________________ ________________________________________________________________________ _____________________________________________________________________
Name and Address of the Employer :_____________________________________________________________ Wage Period :___________________________________
Nameof the building or other construction work………………………………………………..
Amount of Wage earned
Sl. No. 1
Name and Surname of workman 2
Serial No. in the Degisnation/Nature of work of Workman done 3 4
No. of days worked 5
Units of Work Don 6
Daily rate of wages/ piece rate 7
Basic wages 8
Dearness allowances 9
Overtime 10
Other cash payments (nature of payment to be indicated) Total 11
Deductions, if any (indicate nature) 12
Net Amount paid
Initial of Signature/Thumb impression of Employer or his the worker representative 13
FORM XIX [See Rule 241(1)(b)]
for Deductions for Damage or Loss Name and Permanent address of building workers:
Name and permanent address of the Employer :
Name and address/location where the building or other construction work is carried on/ is to be carried on :______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________ Nature of building or other construction work………………………………………………..
Date of recovery
Sl. No. 1
Name of worker 2
Father’s/ Husband name 3
Designation/ Nature of employment 4
Particulars of damage or loss 5
Date of damage or loss 6
Whether building worker showed cause against deduction 7
Name of person in whose presence building worker’s explanation was heard 8
Amount of deduction imposed 9
No. of installments First Installment 10 11
Last Installment 12
FORM XX [See Rule 241(1)(b)]
of Fines Name and permanent address of the Establishment : Name and address/location where the building or other construction work is carried on/ is to be carried on :______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________ Name and permanent address of the Employer :
Sl. No. 1
Name of building worker 2
Father’s/Husband’s name 3
Designation/ Nature of employment 4
Act/Omission for which fine imposed 5
Date of Offence 6
whether building worker showed cause against fin 7
Name of person in whose presence building worker’s explanation was heard 8
Wage periods and wages payable 9
Amount of fine imposed 10
Date on which fine released 11
Remarks 12
FORM XXI [See Rule 241(1)(b)]
for Advances Name and permanent address of the Establishment :
Name and address/location where the building or other construction work is carried on/ is to be carried on :_______________________________________________________________________________________ _______________________________________________________________________________________ ______________________________________ Nature of building or other construction work………………………………………………..
Sl. No. 1
Name of building worker 2
Father’s/Husband’s name 3
Name and permanent address of the Employer :
Designation/ Nature of employment 4
Wage period and wages payable 5
Date and amount of advance given 6
Purpose(s) for which advance given 7
Date and amount of each No. of installments by which installment advance to be repaid repaid 8 9
Date on which last installment was repaid 10
Remarks 11
FORM XXII [See Rule 241(1)(c)]
for Overtime Name and permanent address of the Establishment :
Name and address/location where the building or other construction work is carried on/ is to be carried on :_________________________________________________________________ __________________________________________________________________ __________________________________________
Sl. No. 1
Name of building worker 2
Father’s/Husband’s name 3
Sex 4
Designation/ Nature of employment 5
Date on which overtime worked 6
Total hours of overtime worked or production in case of piece rated 7
Normal rates of wages 8
Overtime rate of wages 9
Overtime earnings 10
Date on which overtime wages paid 11
Remarks 12
FORM XXIII [See Rule 241(2)(a)]
Wage Book Name and address of Employer
Name and permanent address of the Establishment
Name and Address of the Establishment where building or other construction work is carried on
Nature of building or other construction work
For the week/fort night/month ending ___________________ 1. No. of days worked_______________________________________________________________________ 2. No. of units worked in case of piece rated workers____________________________________________ 3. Rate of daily/monthly wages/ piece rate_____________________________________________________ 4. Amount of overtime wages ________________________________________________________________ 5. Gross wages payable______________________________________________________________________ 6. Deductions, if any, on of the following: (a) fines:_____________________________________ (b) damage or loss:____________________________ (c) loans and advances:_________________________ (d) subscription towards provident fund:__________ (e) subscription towards the Building Workers Welfare Fund______________________________________ (f) any other deductions e.g. subscription to co-operative society or of loans from co-operative society/housing loan or contribution to any relief fund as per provisions of clause (P) of sub-section-7 of the Payment of Wages Act or for payment of any of Life Insurance Corporation. 7. Net amount of wages paid ____________________ Initials of the Employer or his Representative
FORM XXIV [See Rule 241(2)(b)]
Service Certificate Name and permanent address of the Establishment
Name and address/location where the building or other construction work is carried on/ is to be carried on
Name and location of work :_________________________________________________________ Name and address of the workman :__________________________________________________ __________________________________________________ Age or Date of birth :______________________________________________ Identification marks :_______________________________________________________________ Father’s/Husband’s name :__________________________________________________________ Total period for
SL.No. 1
From 2
To 3
Rate of Remarks wages (with If the building worker particular was a beneficiary his Nature of s of units registration No., Date Reasons/ ground on work in case of and name of the which the employee done piece Board terminated 4 5 6 7 8
Signature of the Employer or his Representative
FORM XXV [See rule 242]
ANNUAL RETURN OF EMPLOYER TO BE SENT TO THE ING OFFICER Year Ending 31 st December ………………………………..
1
Full name and full address of the establishment of the building and other construction work. (Place,post office,district )
2
Name and permanent address of the establishment
3
Name and address of the employer
4
Nature of building and other construction work carried on.
5
Full name of the manager or person responsible for supervisior and control of the establishment
6
Number of building workers ordinarily employed.
7
Total number of days during the year on which building workers were employed.
8
Total number of days worked by buildig workers during the year.
9
Maximum number of building workers employed on any day during the year.
10
The number of accident that took place during the year as under :
(a)
The total number of accidents.
(b)
The number of accidents resulting in disablment of building workers for less than 48 hours,the number of building workers involved and the number of man days lost
(c)
The number of accident resulting in disablement of building workers beyond 48 hours, but not resulting in any permanent pertial or permanent total disablement, the number of building workers involved and the mumber of man-days lost on of such accidents.
(d)
The number of accidents resulting in permanent partial or total disablement of man-days lost of such accidents.
(e)
The number of accidents resulting in deaths of building workers and the number of resultant deaths.
11
Change, if any, in the management of the establishment,its location,or any other particulars furnished to the ing Officer in the application for Registration indicating also the dates.
Place: Date :
Signature of the Employer
Form-XXVII (See rule 33-A (2)
Application for the Registration of Building Workers Registration Number (To be filled in by office)
Affix port size photograph
1. Name of the worker : 2. Age and Date of Birth : (Proof to be enclosed) 3. Name of Father / Husband : 4. Details of Dependents (Name, Age and relationship with the building worker) : 5. Permanent address : 6. Present address : 7. Are you a member of any Trade Union? If so, state the name of the Union and its Regn. No. : 8. The place of work with location in detail (Certificate of Employment to be enclosed): 9. Nature of employment and skin : Place:
Signature of the Building Worker
Date: Certificate This is to certify that Sri/Smt / Kum ………………………………… is a building worker as defined in Section 2 (e) of the Building and Other Construction . Workers (Regulation of Employment and Conditions of Service) Act, 1996 and he is eligible for Registration as Beneficiary.
Place: Date :
Signature of the Authorised Signatory
Form-XXVIII See rule 33-A (5)
Nomination Form Registration Number: I hereby nominate the persons/person below to receive the Claims due to me under Building and other construction workers (Regulation of employment and conditions of service) Act.1996 in the event of my death any amount due to me becomes payable. The nominee(s) are also entitled to receive any other amount that may become payable under Building and other construction workers (Regulation of employment and conditions of service) Act, 1996. Name and Relationship of the Name and Address of Nominee(s) with " the building Address of Worker worker 1
Age of the Nominee(s) 2
Place: Date:
Signature or left-hand thumb-impression of the Building worker
Percentage of Share to be paid to each nominee 3
Certified that the above declaration has been signed/thumb impression has been impressed by Sri/Smt./Kum………………………………………………….after he/she has read the entries (or) after the entries have been read over to him/her by me and understood by him/her.
Place: Date:
President/Secretary of a ed Trade Union/ Labour Department Officer nor below the rank of an Assistant Labour Officer/ Employer of a ed Establishment/ Chief Executive of the Government Organisation involved in building or other construction activity.
Form- XXX See Rule 33-B(i)
Identity Card Registration Number: Date:
Affix port size photograph
1. Name of the worker : 2. Name of Father/Husband : 3. Age : 4. Permanent Address : 5. Details of Dependents (Name, Age and relationship with the Building worker : 6. Present Address : 7. Occupation : 8. If the member of any Trade Union, the Registration Number of the Union : Registration should be renewed before :
Secretary, Andhra Pradesh BuikHng and Other Construction Workers Welfare Board Details of Work Done By the Building Worker (During The Year from 1-4-20 to 31-3-20)
From
To
Worked as
Name and Address of the Employer/Establishm ent
Remarks
Signature of Employer/Establishm ent
FORM I [See rule 7]
1
Name of Establishment :
2
Address :
3
Name of Work :
4
No. of Workers employed :
Registration No. under Building and other Construction Workers’ (Regulation of Employment and Condition of Service) Act, 1996. ing Authority
Date of commencement of work Date Month Year
5 6
Estimated period work : Month Year
Estimated cost of construction Details of payment of cess
Stages 1st Year 2nd Year 3rd Year 4th Year Total:
Cost
Amount Challan No. and Date
Advance-A Deduction at Source-D Final-F
Signature of Employer Name of Employer Date 7 8 9 10 11 12 13.. 14 15
TO BE FILLED BY ASSESSING OFFICER Date of completion Final cost Date of assessment Amount assessed Date of Appeal, if any Date of order in Appeal Amount as per Order in Appeal Date of transfer of cess to the Board Amount transferred Challan No. and date Signature Designation
FORM II [See rule 9 (1)] Notice of Stoppage or Reduction of Work Registration No. under Building and Other Construction Workers’ (Regulation of Employment and Condition of Service) Act, 1996
I.Name of Establishment Address:
II.Date of commencement of work Date Month Year Estimated cost of work (original)
Estimated period of work: Month Year Advance Cess/Deduction at source Date of Assessment Order Amount of Cess Assessed
III. Modification to the original estimates
Reason
Revised date of completion/date of stoppage Actual cost estimates Actual cost incurred Whether work is being handed over in any other person/agency for completion. If yes. Name/Address of such Person/agency.
Yes/No.
Signature of employer Name of employer Date TO BE USED BY ASSESSING OFFICER Date of revision of assessment Amount of cess after revision Cess already received Cess to be recovered Cess to be refunded, if any Reference to Board for refund; Date/number Signature Designation
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