Labour Commissioner 
PRESCRIBED UNDER SUB-RULE (5) OF RULE 100]
ANNUAL RETURN -CRECHE
Year ending 31st December 19
1. Industry
2. Name of factory
3. Number of women workers ordinarily employed
4. Number of children admitted in the creche
5. Average daily attendance of children at the creche
(a) 2 years and below
(b) Above 2 years.
6. Details of facilities provided with regard to :-
(a) Milk
(b) Food
(c) Clothes
(d) Toys
(e) Medical Aid
(f) Other
7. Details of staff employed
(i) Doctors :-
(a) Males
(b) Females
(ii) Nurses
(iii) Teachers
(iv) Ayahs
(v) Sweepers
8. General remarks.
Signature of Occupier .......... Signature of Manager .......
Date of Dispatch .......... Date of Dispatch ..........................