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Form42 PDF

This document is a Certificate of Fitness certifying that an individual named [name] has been examined and determined to be fit/unfit for employment in a specific process, department, and factory based on their age and the certifying surgeon's opinion. The certificate provides the individual's personal details including name, address, and age. It also specifies whether they are fit or unfit for the designated employment and the period before requiring re-examination.

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nathamar100
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188 views1 page

Form42 PDF

This document is a Certificate of Fitness certifying that an individual named [name] has been examined and determined to be fit/unfit for employment in a specific process, department, and factory based on their age and the certifying surgeon's opinion. The certificate provides the individual's personal details including name, address, and age. It also specifies whether they are fit or unfit for the designated employment and the period before requiring re-examination.

Uploaded by

nathamar100
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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FORM No.

42

(Prescribed under Schedule XXI of Rule 122)

CERTIFICATE OF FITNESS
Serial No.

I Certify that I have personally


examined..(name) son of
.. residing
at(address) who is desirous of being
employed
as.(
designation) is..(process, department and
factory) and that his age, as nearly as can be ascertained from my
examination, is .years, and that he is, in my opinion,
fit/unfit for employment in the above mentioned factory as
mentioned above.

2 He may be produced for further examination after a period


of..
3 The serial number of the previous certificate is ..

Signature /Left thumb impression


Of the person examined. Signature of the
Certifying Surgeon

Date.

I Certify that I extent this Signature


I examined certificates until (if and Signature
the person certificate is not Symptoms of the
mentioned extended, the period Observed
above on for which the worker During Certifying
is considered unfit examination
for work is to be Surgeon
mentioned.,

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