INDUSTRIAL CLEANING SERVICES

SUPERVISOR - VIGNESH (8939952647 )

FORM-39
(PRESCRIBED UNDER RULE 95)
Pre-employment Health Register
(In respect of persons proposed to be employed in dangerous operations under section 87.)
Date of period Raw Date of Result of Wheather Signature of If employment is given specify the
or occupation material or Medical Medical certified fit or the Certifying department/Section with works
proposed to be by product examinati examinati unfit for Suregeon number.
Age (Last given Natue of job or occupation to proposed on by on proposed (with name in Works
sl no Name of the worker Sex Signature
birth day) proposed to be given to be certifying employment capital letters) number.
handled Surgeon

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1 PRABHU GS M 17-07-1982
cleaning