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General Inspection


S No. District Dated
1 Name of the Establishment  
2 Address  
3 Nature of activity of Business  
4 i. Name of proprietor / partner / Directors/occupiers  
ii. Whether Registered under Factories Act, 1948 Yes No
5 No. of workmen/employees employed Regular Daily Wages Piece Rate
  i. No of Male  
  ii. No .of Female  
  iii. Total  
6 Category of employees/workmen & their nos.  
  i. Unskilled  
  ii. Semi-skilled  
  iii. Skilled  
  vi. Supervisor  
  v. Managerial  
7 Whether contractual workmen employed  Yes No
  i. No. of Contract Labour employed  
  ii. Name & address of the contractor  
  iii. Whether Licence obtained under Contract Labour (Regulation & Abolition) Act, 1970. Yes No
  iv. Whether principal employer has obtained registration certificate under Contract Labour (Regulation & Abolition) Act, 1970. Yes No
8 Whether following statutory records are 
  i. Appointment letter issued Yes No
  ii. Wages Register Yes No
  iii. Attendance Register/card, Yes No
  iv. Wage slip Yes No
  v. O.T. Register Yes No
  vi. Leave Card Yes No
  vii. Fine Register Yes No
  viii. Whether Leave book/leave card beingmaintained Yes No
9 Coverage of employees under ESIC 1948. if applicable, if employing more than 10 workers.  Yes No
10 Coverage of employees under EPF & MPA
1952, if applicable. If employing more than 20 workers
Yes No
11 Whether Register A. B. C under Payment of Bonus Act, 1965 is maintained Yes No
12 Whether Register maintained by the occupier u/s 11 of Child Labour (R&A) Act, 1986. Yes No
13 Whether abstract of Minimum Wages Act.
1948, displayed
Yes No
14 Potential No. of workers assessed on the basis of machines installed, area of the factory, packaging needs and no. of shifts. Yes No
15 Remarks, if any.    


  • Name & Sign of Inspector
  • Name & Sign of Occupier / Proprietor/partner/Director/Manager/Employees