FORM NO. 27-C [Prescribed under Schedule XXI to Rule 95] Health Register Sl. No. Department/ Works Name Of worker Sex Age last birth day Date of employment On present work Date of leaving or transfer to other work with reasons of discharge or transfer Nature of job / occupation Raw material, bi-products likely to be exposed to Date of medical examination and results thereof Signs and symptoms observed during examination Nature of tests and results thereof If declared unfit for work, state period of suspension with reason in detail Whether certificate of unfitness issued to the workers Re-certified to resume duty on Signature of the certifying surgeon with date Date Result Fit or unfit
