L&T HYDROCARBON ENGINEERING — CONSTRUCTION SERVICES Ref: PM-OO-HI 1 PROFORMA FOR SCREENING WORKMEN ENGAGED BY CONTRACTORS / SUB ~ CONTRACTORS Name of the Contractor / Sub ~ Contractor : Full Name of the Workmen : Father / Husband’s Name : Permanent Address : Present Address: ¢ Date of birth Age Years, Married / Single / Widow / Widower Number of Children Mother Tongue Other Languages Known, Passport / Iqama In case of emergency person to be contacted {With address and Telephone Number if any) signature or left Hand Thumb impression of the workmen for identification Any other identification mark: Weight Height: Blood Group: Vision: Education: Year School / Board * Please obtain photocopy of birth certificate issued by School or Gram Panchayat as applicable by relevant statuteL&T HYDROCARBON ENGINEERING — CONSTRUCTION SERVICES Ref: PM-O0-HI2 PROFORMA FOR SCREENING WORKMEN ENGAGED BY CONTRACTORS / SUB - CONTRACTORS PREVIOUS WORK EXPERIENCE SL. | Name of the Contractor | Project Site | Category Period Salary 7 No. Organisation Wage Rate 1 2: 3. 4, 5. | 6 7 8 Referred by / References : Screened by me. Certificates / Details verified / not verified. Réferred to Mr. for on the job trial Suitable for employment as Site Engineer TRIAL REPORT. Seen and briefed the HSE rules of the Site HSEM/HSEO, Approved for employment by M/s. Project Site RESIDENT CONSTRUCTION MANAGER Employment Card issued and details entered into Register of workmen. Time Keeper