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MONTHLY OCCUPATIONAL ILLNESS REPORT

Month: Name of the Contractor:


Lost Restricted
Types of Permanent Permanent Total Illnesses Total
Workday Work
Sl. No. Occupational Fatalities Total Partial Lost Time w/o Lost Time or Reportable
Cases Cases
Illnesses Disabilities Disabilities Illnesses Restricted Work Illnesses
(LWC) (RWC)
Work related
1. Muscular
Disorder
Cancer and
2. malignant blood
disease
Infections /
3. preventable
disease

Mental ill-
4.
health

Noise induced
5.
hearing

6. Poisoning

Respiratory
7.
disease

8. Skin disease

Other
9. occupational
illness

Total

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