Following Forms & Registers Required to be filed and maintained under The A.

P Building & Other Construction Workers (Regulation of Employment and Conditions of Service) Rules,1998
Form No. Prescribed Under Rule Name of the Register/Form
Form I See rule 23(1)
Application for Registration of
Establishments Employing Building Workers
Form II See rule 24(1)
Certificate of Registration
Form III See rule 24(2) and 25(2)
Register of Establishment
Form - IV See rule 26(3) and 239(1)
Notice of Commencement/Completion of
Building or Other Construction Work
Form - V
See rule 56 and
74(b),Schedule I
Certificate of Initial and Periodical Test and
Examination of Winches, Derricks and Their
Accessory Gear
Form - VI See rule 56 and 74(b)
Certificate of Initial and Periodical Test and
Examination of Cranes or Hoists and their
Accessory Gear
Form - VII See rule 70 and 74(b)
Certificate of Initial and Periodical Test and
Examination of Loos Gear
Form - VIII See rule 62 and 74(b)
Certificate of Test and Examination of
Wirerope before being taken into Use
Form - IX See rule 72 and 74(b) Certificate of Annealing of Loose Gears
Form - X See rule 69 and 73 Certificate of Annual thorough Examination
of Loose Gear exemted from Annealing
Form - XI See rule 223 ('c)
Cerificate of Medical Examination
Form - XII See rule 223(d)
Health Register
Form - XIII See rule 230(a)
Notice of Poisoning or Occupational Notified
Diseases
Form - XIV See rule 210(7)
Report of Accidents and Dangerous
Occurrences
Form - XV See rule 240
Register of Building Workers Employed by
the Employer
Form - XVI See rule 241(1)(a) Muster Roll
Form - XVII See rule 241(1)(a) Rigister of Wages
Form - XVIII See rule 241(1)(a)
Form of Register of Wages-cum-Muster-Roll
Form - XIX See rule 241(1)(b)
Register of Deductions for Damages or Loss
Form - XX See rule 241(1)(b) Register of Fines
Form - XXI See rule 241(1)(b) Register of Advances
Form - XXII See rule 241(1)(c) Register of Overtime
Form - XXIII See rule 241(2)(a) Wage Book
Form - XXIV See rule 241(2)(b) Service Certificate
Form - XXV See rule 242
Annual Returns of Employer to be sent to
the Registering Officer
Form - XXVI See rule 74(b) Register of Periodical Test - Examination of
Lifting Appliance and Gear, ect.
Form - XXVII See rule 33-A(2)
Application for the Registration of Building
Workers
Form - XXVIII See rule 33-A(5)
Nomination Form
Form - XXIX See rule 33-A(6)
Register of Beneficiaries
Form - XXX See rule 33-B(i)
Identity Card
Note :
Following Forms & Registers Required to be filed and maintained under The A.P Building & Other Construction Workers (Regulation of Employment and Conditions of Service) Rules,1998
Issued/
Submitted/Maintained By
whom Whom to submit Remarks
by Principal Employer Govt.of A.P,Registering Officer
In Triplicate along with DD showing
Payment of Fees for Regestration
Govt.of A.P,Registering Officer by Principal Employer
For any changes occurs in
ownership or management or other
employer shall intimate to
registering officer within 30 days
Govt.of A.P,Registering Officer
by Principal Employer Govt.of A.P,Registering Officer
the employer shall before 30 days
of commencement and completion
of any building or other
construction work,submit a written
notice to inspector of area in form
IV
Competent Person
Competent Person
Competent Person
Competent Person
Competent Person
Competent Person
issued by Medical
Inspector/CMO
All the building workers
employed as driver,Operators
of lifting appliance and
transport equipment before
employing,afetr illness or injury
Once in every Two years up to age
of 40 and Once in a year, thereafter
Inrespect of persons employed in
Building and other construction
work involving hazardous processes
issued by Employer/CMO
by Principal Employer
by Principal Employer
by Principal Employer
by Principal Employer
by Principal Employer
by Principal Employer
by Principal Employer
by Principal Employer
by Principal Employer
by Principal Employer
by Principal Employer To Building Worker
by Principal Employer Govt.of A.P,Registering Officer Year Ending 31st December ..
Competent Person
By Building Worker
Secretary,APBOCW Welfare
Board
Along with Form XXVII together
with the certificate of
employment(containing details of
name,age,father name &
R.address,no. of days worked
during the preceding 12 months)
issued by Registered
Establishment,ALO.Trad Union of
Construction workers.
By Building Worker
Secretary,APBOCW Welfare
Board
Secretary,APBOCW Welfare
Board
Secretary,APBOCW Welfare
Board
To Building Worker
If the number of workers to
be employed as b.workers
for B&O C work on one day
is uoto 100 no. Rs.100/-
exceeds 100 but not
exceed 500 no. Rs.500/-
exceeds 500 no. Rs.1000/-
With 2 passport size
photographs,age proff by
School certificate or
Doctor's certificate and
Fees of rs.50/-
The A.P Building & Other Construction Workers (Regulation of Employment and Conditions of Service) Rules,1998
Schedules Rules
Schedule I See Rules 56(a),71(a) and 72
Schedule II See Rule 230(a)
Schedule III See Rule 231(b)
Schedule IV See Rule 226(c)
Schedule V See Rule 227
Schedule VI See Rule 34
Schedule VII See Rules 81(iv)and 223(a)(iii)
Schedule VIII See Rules 209(1) and 209(2)
Schedule IX See Rule 225
Schedule X See Rule 225(b)
Schedule XI See Rules 199(2) and 225(c)
Schedule XII See Rule 152(a)
The A.P Building & Other Construction Workers (Regulation of Employment and Conditions of Service) Rules,1998
Details
Manner of Test and examination before Taking Lifting Appliance, Lifting Gear and
Wire Rope into use for the First Time
Notifiable Occupational Diseases in Building and Other Construction Work
Contents of a First Aid Box
Articles of Ambulance Room
Contents of Ambulance Van or Carriage
Permissible Exposure in case of Continuous Noise
Periodicity of Medical Examination of Building Workers
Number of Safety officers,Qualification,Duties.Ect.
Hazardous Process
Service and facilities to be provided in occupational health centers
Qualification of Construction Medical Officer(CMO)
Permissible Levels of Certain Chemical Substance in the Work Environment
Total time of exposure
(continuous or a number of
short-term exposures) per
day(in hours) Sound pressure level (in dBA)
1 2
8 90
6 92
4 95
3 97
2 100
1.5 102
1 105
3/4 107
1/2 110
1/4 115
SCHEDULE VI
Permissible Exposure in case of Continuous Noise
[See Rule 34]
1. Name and location of the establishment where Building
or other construction work is to be carried on
2. Postal address of the establishment
3. Full name and permanent address of the
Establishment, if any
4. Full and address of the Manager or person
Responsible for the supervision and control
Of the establishment
5. Nature of building or other construction work
Carried /is to be carried on in the establishment
6. Maximum number of building workers
Employed on any day
7. Estimated date of commencement of building or the
Other construction work
8. Estimated date of completion of the building or other
Construction work
9. Particulars of demand draft, enclosed
(Name of the bank, amount, demand draft No. and
Date)
DECLARATION BY THE EMPLOYER
(i) I hereby declare that the particulars given above are true to the best of my knowledge and belief.
(ii) I undertake to abide by the provisions of the Building and Other the rules made there under
Construction Workers (Regulation of Employment and Conditions of Service) Act, 1996, and
Principal employer
Seal and stamp
FORM I
[See rules 23 (1)]
APPLICATION FOR REGISTRATION OF ESTABLISHMENTS EMPLOYING BUILDING WORKERS
1. (I) Name and address (permanent) of the
Establishment .
(ii) Name of the employer and address.
2. Name and situation of place where the
Building and other construction is proposed to
be carried on
3. No. and date of certificate of registration
4. Name and address of the person in charge of the
Construction work
5. Address to which the communications relating to
Building or other construction work may be sent
6. Nature of work involved and the facilities including
Plant or machinery provided
7. The arrangement storage of explosives, if any, to be
Used in building or other construction work
8. In case the notice is for commencement of work,
The approximate duration of work
Signature of employer
To: with seal
The Inspector
.
.
.
FORM IV
[See rules 26 (3) and 239 (1) ]
NOTICE OF COMMENCEMENT / COMPLETION OF BUILDING OR OTHER CONSTRUCTION WORK
I/We hereby intimate that the construction of building having registration no. dated
is likely to commence/has commenced and shall be completed on
..
1.Name and address of the employer : ________________________________________________________
2.Name of the building workers and his work number, if any : ____________________________________
3.Address of the building worker :____________________________________________________________
_____________________________________________________________
_____________________________________________________________
4.Sex and Age :__________________________________________________
5.Occupation : ___________________________________________________
6.State exactly what the patient was doing at the time of contracting the disease :___________________
________________________________________________________________
7.Nature of poisoning or disease from which the building worker is suffering from : __________________
Date: ____________________
Signature of the Employer/
Construction medical Officer
Note: When a building worker contracts ant diseases specified in Schedule-XII,
a notice in this form shall be sent forthwith to The Chief Inspector of Inspection
of Building and other Construction.
Notice of Poisoning and Occupational diseases
[See Rule -230(a)]
FORM XIII
1.Name and address of the employer : ________________________________________________________
2.Name of the building workers and his work number, if any : ____________________________________
3.Address of the building worker :____________________________________________________________
_____________________________________________________________
_____________________________________________________________
6.State exactly what the patient was doing at the time of contracting the disease :___________________
________________________________________________________________
7.Nature of poisoning or disease from which the building worker is suffering from : __________________
Notice of Poisoning and Occupational diseases
[See Rule -230(a)]
FORM XIII
1. Name of the Project/ Work : ________________________________________________________________
2. Location and address of Construction work :___________________________________________________
3. Stage of Construction work : ________________________________________________________________
4. Particulars of Employer : ___________________________________________________________________
(a) Main contractor Firm/Company:
i. Name :
ii. Address :
iii. Phone numbers :
iv. Nature of Business :
(b) Main contractor Firm/Company:
i. Name :
ii. Address :
iii. Phone numbers :
iv. Nature of Business :
5. Particulars of Injured persons:
(a) Name: (First) (Middle) (Last) :
(b) Home address :
(c) Occupation :
(d) Status of the worker- Casual/ Permanent :
(e) Sex: Male/ Female :
(f) Age :
(g) Experience :
(h) Marital status: Married/ Unmarried/ Divorced :
6. Particulars of Accident:
(a) Exact place where accident occurred
(b) Date
(c) Time
(d) What the injured person was doing at the time of accident
(e) Weather conditions
(f) How long employed by you for this particular job
(g) Particulars of equipment/ machine/tool involved and condition of the same after the Accident occurred
7. Nature of Injuries:
(a) Fatal
(b) Non- fatal
(c) If non-fatal; state precisely the nature of injuries
(Describe in detail the nature of injury, for instance fracture of right arm, sprain etc.)
(d) First aid: Given: Not given:
(e) If not given, the reasons
(f) Name and designation of the person by whom first aid was given
Form- XIV
Notice of Accidents and Dangerous Occurrences
*See Rule 210(7)+
(g) If admitted to Hospital,
i. Name of the Hospital
ii. Address of the hospital
iii. Phone number
iv. Name of the Doctor
8. Mode of transport used:
Ambulance Truck Tempo Taxi Private Car
9
(a) How much time was taken to shift the injured person? If very late, state the reasons
(b) How the reporting was made:
Telephone Telegram Special Messenger letter
(c) Who visited the accident site first and action was proposed by him
(d) What are the actions taken for investigations of the accident by the
employer (Describe about photographs/ video film/ measurements taken etc.)
10. Particulars of the person given witness:
(a) Name Address Occupation
1. .
2. .
3. .
4. .
5. .
(b) Whether temporary/permanent
11. Particulars in case of Fatal-
Date Time
12. Whether registered with Building and Other Construction Workers Welfare Board
13. If yes, give registration number(s)
I certify that to the best of my knowledge that to the best of my knowledge and belief,
the above particulars are correct in every respect.
Place: ______________ Signature of Employer/ Responsible person/ Supervisor
Date: ______________ Designation
cc: forwarded for information and follow-up action:
1
2
3
Nature and location of work..
Sl. No. Name and Surname of workman Age and Sex Fathers/ Husbands name
Nature of
employment/
degisnation
Permanent Home address of
Workman(Village and Taluka and
Distt.) Local Address
Date of
Commencement
of employment
Signature or
Thumb
impression of
workman
Date of
termination
of
employment
Reasons for
termination
If the building worker is/was
beneficiary the date of
registration as a beneficiary, the
registration no. and the name of
welfare board Remarks
1 2 3 4 5 6 7 8 9 10 11 12 13
FORM XV
[See Rule 240]
Register of Building Workers Employed by the Employer
Name and address/location where the building or other construction work is carried on/ is
to be carried on
:_________________________________________________________________________
_________________________________________________________________________
__________________________________________________________________
Name and permanent address of the Establishment
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
____________________________________________________________________________________________________
Nature of building or other construction work: _________________________ Name and address of the Employer
For the month of ________________________________
Sl. No. Name of the Building worker Fathers/ Husbands name Sex 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Remark
s
Name and permanent address of the Establishment
___________________________________________________________________
___________________________________________________________________
________________________________________________________________
FORM XVI
[See Rule 241(1)(a)]
Muster Roll
Name and address/location where the building or other
construction work is carried on/ is to be carried on
_____________________________________
Name and permanent address of the Establishment _______________________________________________
Name and Address of the Employer :_____________________________________________________________
Nameof the building or other construction work.. Wage Period :___________________________________
Basic wages
Dearness
allowances Overtime
Other cash
payments
(nature of
payment to
be indicated) Total
1 2 3 4 5 6 7 8 9 10 11 12 13
Serial No. in
the Register
of Workman Name and Surname of workman
Sl.
No.
Deductions, if any (indicate
nature) Net Amount paid
Signature/Thumb impression of
the worker
FORMXVII
[See Rule 241(1)(a)]
Register of Wages
Name and address/location where the building or other construction work is carried on/
is to be carried on
:_______________________________________________________________________
________________________________________________________________________
_____________________________________________________________________
Amount of Wage earned
Daily rate of wages/
piece rate Units of Work Don
No. of days
worked
Degisnation/Nature of work
done
Initial of
Employer or his
representative
Name and Permanent address of building workers: Name and permanent address of the Employer :
Nature of building or other construction work..
First Installment Last Installment
1 2 3 4 5 6 7 8 9 10 11 12
Name of worker Fathers/ Husband name
Designation/ Nature of
employment
Particulars of
damage or loss
Date of
damage or
loss
Date of recovery
Whether building
worker showed
cause against
deduction
Name of person in whose
presence building workers
explanation was heard
Amount of
deduction
imposed
No. of
installments
FORM XIX
[See Rule 241(1)(b)]
Register for Deductions for Damage or Loss
Name and address/location where the building or other construction work is carried on/ is to be carried on
:______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________
Sl. No.
Name and permanent address of the Establishment :
Name and permanent address of the Employer :
1 2 3 4 5 6 7 8 9 10 11 12
Remarks
whether building
worker showed
cause against fin
Name of person in whose
presence building workers
explanation was heard
Wage
periods and
wages
payable
Amount of
fine imposed
Date on which
fine released
FORM XX
[See Rule 241(1)(b)]
Register of Fines
Name and address/location where the building or other construction work is carried on/ is to be carried on
:______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________
Sl. No. Name of building worker Fathers/Husbands name
Designation/ Nature of
employment
Act/Omission
for which fine
imposed
Date of
Offence
Name and permanent address of the Establishment :
Nature of building or other construction work.. Name and permanent address of the Employer :
1 2 3 4 5 6 7 8 9 10 11
Date and
amount of
each
installment
repaid
Date on
which last
installment
was repaid Remarks
FORM XXI
[See Rule 241(1)(b)]
Register for Advances
Name and address/location where the building or other construction work is carried on/ is to be carried
on
:_______________________________________________________________________________________
_______________________________________________________________________________________
______________________________________
Sl. No. Name of building worker Fathers/Husbands name
Designation/ Nature of
employment
Wage period
and wages
payable
Date and
amount of
advance
given
Purpose(s) for
which advance
given
No. of installments by which
advance to be repaid
Name and permanent address of the Establishment :
1 2 3 4 5 6 7 8 9 10 11 12
Normal rates of
wages Overtime rate of wages
Overtime
earnings
Date on which
overtime
wages paid Remarks Sex
FORM XXII
[See Rule 241(1)(c)]
Register for Overtime
Sl. No. Name of building worker Fathers/Husbands name
Designation/ Nature of
employment
Date on which
overtime
worked
Total hours
of overtime
worked or
production
in case of
piece rated
Name and address/location where the building or other construction work is
carried on/ is to be carried on
:_________________________________________________________________
__________________________________________________________________
__________________________________________
Name and address of Employer
For the week/fort night/month ending ___________________
1. No. of days worked_______________________________________________________________________
2. No. of units worked in case of piece rated workers____________________________________________
3. Rate of daily/monthly wages/ piece rate_____________________________________________________
4. Amount of overtime wages ________________________________________________________________
5. Gross wages payable______________________________________________________________________
6. Deductions, if any, on account of the following:
(a) fines:_____________________________________
(b) damage or loss:____________________________
(c) loans and advances:_________________________
(d) subscription towards provident fund:__________
(e) subscription towards the Building Workers Welfare Fund______________________________________
(f) any other deductions e.g. subscription to co-operative society or account of loans from co-operative
society/housing loan or contribution to any relief fund as per provisions of clause (P) of sub-section-7
of the Payment of Wages Act or for payment of any premium of Life Insurance Corporation.
7. Net amount of wages paid ____________________
Initials of the Employer
or his Representative
Name and Address of the Establishment
where building or other construction work is
carried on
Nature of building or other construction
work
FORM XXIII
[See Rule 241(2)(a)]
Wage Book
Name and permanent address of the
Establishment
Name and location of work :_________________________________________________________
Name and address of the workman :__________________________________________________
__________________________________________________
Age or Date of birth :______________________________________________
Identification marks :_______________________________________________________________
Fathers/Husbands name :__________________________________________________________
Remarks
From To
1 2 3 4 5 8
Signature of the Employer
or his Representative
6 7
Total period for
SL.No.
Nature of
work
done
Rate of
wages
(with
particular
s of units
in case of
piece
If the building worker
was a beneficiary his
registration No., Date
and name of the
Board
FORM XXIV
[See Rule 241(2)(b)]
Service Certificate
Name and permanent address of
the Establishment
Name and address/location where the
building or other construction work is carried
on/ is to be carried on
Reasons/ ground on
which the employee
terminated
1 Full name and full address of the establishment of the building
and other construction work. (Place,post office,district )
2 Name and permanent address of the establishment
3 Name and address of the employer
4 Nature of building and other construction work carried on.
5 Full name of the manager or person responsible for supervisior
and control of the establishment
6 Number of building workers ordinarily employed.
7 Total number of days during the year on which building
workers were employed.
8 Total number of days worked by buildig workers during the
year.
9 Maximum number of building workers employed on any day
during the year.
10 The number of accident that took place during the year as
under :
(a) The total number of accidents.
(b) The number of accidents resulting in disablment of building
workers for less than 48 hours,the number of building workers
involved and the number of man days lost
(c) The number of accident resulting in disablement of building
workers beyond 48 hours, but not resulting in any permanent
pertial or permanent total disablement, the number of building
workers involved and the mumber of man-days lost on
account of such accidents.
(d) The number of accidents resulting in permanent partial or total
disablement of man-days lost account of such accidents.
(e) The number of accidents resulting in deaths of building
workers and the number of resultant deaths.
11 Change, if any, in the management of the establishment,its
location,or any other particulars furnished to the Registering
Officer in the application for Registration indicating also the
dates.
Place: Signature of the Employer
Date :
FORM XXV
[See rule 242]
ANNUAL RETURN OF EMPLOYER TO BE SENT TO THE REGISTERING OFFICER
Year Ending 31 st December ..
Registration Number (To be filled in by office)
1. Name of the worker :
2. Age and Date of Birth :
(Proof to be enclosed)
3. Name of Father / Husband :
4. Details of Dependents (Name, Age and
relationship with the building worker) :
5. Permanent address :
6. Present address :
7. Are you a member of any Trade Union?
If so, state the name of the Union and its Regn. No. :
8. The place of work with location in detail
(Certificate of Employment to be enclosed):
9. Nature of employment and skin :
Place: Signature of the Building Worker
Date:
This is to certify that Sri/Smt / Kum is a building worker as defined
in Section 2 (e) of the Building and Other Construction . Workers (Regulation of Employment
and Conditions of Service) Act, 1996 and he is eligible for Registration as Beneficiary.
Place: Signature of the Authorised
Date : Signatory
Form-XXVII
(See rule 33-A (2)
Application for the Registration of Building Workers
Certificate
Affix Passport size
photograph
Registration Number:
I hereby nominate the persons/person below to receive the Claims due to me under Building and
other construction workers (Regulation of employment and conditions of service) Act.1996 in the
event of my death any amount due to me becomes payable. The nominee(s) are also entitled to
receive any other amount that may become payable under Building and other construction
workers (Regulation of employment and conditions of service) Act, 1996.
Name and Address of
Address of Worker
Name and Relationship of the
Nominee(s) with " the building
worker
Age of the
Nominee(s)
Percentage of Share to be paid to each
nominee
1 2 3
Place: Signature or left-hand thumb-impression
Date: of the Building worker
Certified that the above declaration has been signed/thumb impression has been impressed
by Sri/Smt./Kum.after he/she has read the entries (or) after the
entries have been read over to him/her by me and understood by him/her.
Place: President/Secretary of a Registered Trade
Date: Union/
Labour Department Officer nor below the rank of
an Assistant Labour Officer/
Employer of a Registered
Establishment/
Chief Executive of the Government Organisation
involved in building or other construction activity.
Form-XXVIII
See rule 33-A (5)
Nomination Form
Registration Number:
Date:
1. Name of the worker :
2. Name of Father/Husband :
3. Age :
4. Permanent Address :
5. Details of Dependents (Name, Age and
relationship with the Building worker :
6. Present Address :
7. Occupation :
8. If the member of any Trade Union,
the Registration Number of the Union :
Registration should be renewed before :
Secretary,
Andhra Pradesh BuikHng and Other
Construction Workers Welfare Board
From To Worked as
Name and Address of
the
Employer/Establishm
ent Remarks
Signature of
Employer/Establishm
ent
Form- XXX
See Rule 33-B(i)
Identity Card
Details of Work Done By the Building Worker
(During The Year from 1-4-20 to 31-3-20)
Affix Passport size
photograph
1
2
3
4
Estimated period work :
Date Month Year Month Year
6
7
8
9
10
11
12
13..
14
15
Signature
Designation
Advance-A Deduction at
Source-D Final-F Amount Challan No. and Date
FORM I
[See rule 7]
Date of transfer of cess to the
Board
Amount transferred Challan No.
and date
Date of Appeal, if any
Date of order in Appeal
Amount as per Order in Appeal
Final cost
Date of assessment
Amount assessed
Name of Employer
Date
TO BE FILLED BY ASSESSING OFFICER
Date of completion
Signature of Employer
1st Year
2nd Year
3rd Year
4th Year
Total:
5
Estimated cost of construction Details of payment of cess
Cost Stages
Date of commencement of work
Name of Establishment :
Registration No. under Building
and other Construction Workers
(Regulation of Employment and
Condition of Service) Act, 1996.
Registering Authority
Address :
Name of Work :
No. of Workers employed :
Registration No. under Building and
Other Construction Workers
(Regulation of Employment and
Condition of Service) Act, 1996
Estimated period of work:
Date Month Year Month Year
Advance Cess/Deduction at source
Date of Assessment Order Amount
of Cess Assessed
Reason
Yes/No.
Signature of employer
Name of employer
Date
Date of revision of assessment
Amount of cess after revision
Cess already received
Cess to be recovered
Cess to be refunded, if any
Reference to Board for refund;
Date/number
Signature
Designation
I.Name of Establishment
II.Date of commencement of work
Estimated cost of work (original)
III. Modification to the original estimates
Revised date of completion/date of stoppage
TO BE USED BY ASSESSING OFFICER
FORM II
Actual cost estimates
Actual cost incurred
Whether work is being handed over in any
other person/agency for completion.
If yes. Name/Address of such
Person/agency.
[See rule 9 (1)]
Notice of Stoppage or Reduction of Work
Address: