FormsFollowing Forms & Registers Required to be filed and maintained under The A.P Building & Other Construction Workers (Regulation of Employment and Conditions of Service) Rules,1998Form No.Prescribed Under RuleName of the Register/FormIssued/ Submitted/Maintained By whomWhom to submitRemarksForm ISee rule 23(1)Application for Registration of Establishments Employing Building Workersby Principal EmployerGovt.of A.P,Registering OfficerIn Triplicate along with DD showing Payment of Fees for RegestrationIf 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/-Form IISee rule 24(1)Certificate of RegistrationGovt.of A.P,Registering Officerby Principal EmployerFor any changes occurs in ownership or management or other employer shall intimate to registering officer within 30 daysForm IIISee rule 24(2) and 25(2)Register of EstablishmentGovt.of A.P,Registering OfficerForm - IVSee rule 26(3) and 239(1)Notice of Commencement/Completion of Building or Other Construction Workby Principal EmployerGovt.of A.P,Registering Officerthe 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 IVForm - VSee rule 56 and 74(b),Schedule ICertificate of Initial and Periodical Test and Examination of Winches, Derricks and Their Accessory GearCompetent PersonForm - VISee rule 56 and 74(b)Certificate of Initial and Periodical Test and Examination of Cranes or Hoists and their Accessory GearCompetent PersonForm - VIISee rule 70 and 74(b)Certificate of Initial and Periodical Test and Examination of Loos GearCompetent PersonForm - VIIISee rule 62 and 74(b)Certificate of Test and Examination of Wirerope before being taken into UseCompetent PersonForm - IXSee rule 72 and 74(b)Certificate of Annealing of Loose GearsCompetent PersonForm - XSee rule 69 and 73Certificate of Annual thorough Examination of Loose Gear exemted from AnnealingCompetent PersonForm - XISee rule 223 ('c)Cerificate of Medical Examinationissued by Medical Inspector/CMOAll the building workers employed as driver,Operators of lifting appliance and transport equipment before employing,afetr illness or injuryOnce in every Two years up to age of 40 and Once in a year, thereafterForm - XIISee rule 223(d)Health RegisterInrespect of persons employed in Building and other construction work involving hazardous processesForm - XIIISee rule 230(a)Notice of Poisoning or Occupational Notified Diseasesissued by Employer/CMOForm - XIVSee rule 210(7)Report of Accidents and Dangerous Occurrencesby Principal EmployerForm - XVSee rule 240Register of Building Workers Employed by the Employerby Principal EmployerForm - XVISee rule 241(1)(a)Muster Rollby Principal EmployerForm - XVIISee rule 241(1)(a)Rigister of Wagesby Principal EmployerForm - XVIIISee rule 241(1)(a)Form of Register of Wages-cum-Muster-Rollby Principal EmployerForm - XIXSee rule 241(1)(b)Register of Deductions for Damages or Lossby Principal EmployerForm - XXSee rule 241(1)(b)Register of Finesby Principal EmployerForm - XXISee rule 241(1)(b)Register of Advancesby Principal EmployerForm - XXIISee rule 241(1)(c)Register of Overtimeby Principal EmployerForm - XXIIISee rule 241(2)(a)Wage Bookby Principal EmployerForm - XXIVSee rule 241(2)(b)Service Certificateby Principal EmployerTo Building WorkerForm - XXVSee rule 242Annual Returns of Employer to be sent to the Registering Officerby Principal EmployerGovt.of A.P,Registering OfficerYear Ending 31st December ..Form - XXVISee rule 74(b)Register of Periodical Test - Examination of Lifting Appliance and Gear, ect.Competent PersonForm - XXVIISee rule 33-A(2)Application for the Registration of Building WorkersBy Building WorkerSecretary,APBOCW Welfare BoardAlong 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.With 2 passport size photographs,age proff by School certificate or Doctor's certificate and Fees of rs.50/-Form - XXVIIISee rule 33-A(5)Nomination FormBy Building WorkerSecretary,APBOCW Welfare BoardForm - XXIXSee rule 33-A(6)Register of BeneficiariesSecretary,APBOCW Welfare BoardForm - XXXSee rule 33-B(i)Identity CardSecretary,APBOCW Welfare BoardTo Building WorkerNote :

SchedulesThe A.P Building & Other Construction Workers (Regulation of Employment and Conditions of Service) Rules,1998SchedulesRulesDetailsSchedule ISee Rules 56(a),71(a) and 72Manner of Test and examination before Taking Lifting Appliance, Lifting Gear and Wire Rope into use for the First TimeSchedule IISee Rule 230(a)Notifiable Occupational Diseases in Building and Other Construction WorkSchedule IIISee Rule 231(b)Contents of a First Aid BoxSchedule IVSee Rule 226(c)Articles of Ambulance RoomSchedule VSee Rule 227Contents of Ambulance Van or CarriageSchedule VISee Rule 34Permissible Exposure in case of Continuous NoiseSchedule VIISee Rules 81(iv)and 223(a)(iii)Periodicity of Medical Examination of Building WorkersSchedule VIIISee Rules 209(1) and 209(2)Number of Safety officers,Qualification,Duties.Ect.Schedule IXSee Rule 225Hazardous ProcessSchedule XSee Rule 225(b)Service and facilities to be provided in occupational health centersSchedule XISee Rules 199(2) and 225(c)Qualification of Construction Medical Officer(CMO)Schedule XIISee Rule 152(a)Permissible Levels of Certain Chemical Substance in the Work Environment

SRINIVAS:1)Roof Work2)Steel erection3)Work under and over water4)Demolition5)Work in confined space

Schedule VISCHEDULE VIPermissible Exposure in case of Continuous Noise[See Rule 34]Total time of exposure (continuous or a number of short-term exposures) per day(in hours)Sound pressure level (in dBA)1289069249539721001.510211053/41071/21101/4115

FORM IFORM I[See rules 23 (1)]APPLICATION FOR REGISTRATION OF ESTABLISHMENTS EMPLOYING BUILDING WORKERS1. Name and location of the establishment where Buildingor other construction work is to be carried on2. Postal address of the establishment3. Full name and permanent address of theEstablishment, if any4. Full and address of the Manager or personResponsible for the supervision and controlOf the establishment5. Nature of building or other construction workCarried /is to be carried on in the establishment6. Maximum number of building workersEmployed on any day7. Estimated date of commencement of building or theOther construction work8. Estimated date of completion of the building or otherConstruction work9. Particulars of demand draft, enclosed(Name of the bank, amount, demand draft No. andDate)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 underConstruction Workers (Regulation of Employment and Conditions of Service) Act, 1996, andPrincipal employerSeal and stamp

FORM IVFORM IV[See rules 26 (3) and 239 (1) ]NOTICE OF COMMENCEMENT / COMPLETION OF BUILDING OR OTHER CONSTRUCTION WORK1. (I) Name and address (permanent) of theEstablishment .(ii) Name of the employer and address.2. Name and situation of place where theBuilding and other construction is proposed tobe carried on3. No. and date of certificate of registration4. Name and address of the person in charge of theConstruction work5. Address to which the communications relating toBuilding or other construction work may be sent6. Nature of work involved and the facilities includingPlant or machinery provided7. The arrangement storage of explosives, if any, to beUsed in building or other construction work8. In case the notice is for commencement of work,The approximate duration of workI/We hereby intimate that the construction of building having registration no. dated is likely to commence/has commenced and shall be completed on ..Signature of employerTo:with sealThe Inspector...

FORM XIIIFORM XIII[See Rule -230(a)]Notice of Poisoning and Occupational diseases1.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 OfficerNote: 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 Inspectionof Building and other Construction.

Form- XIVForm- XIV[See Rule 210(7)]Notice of Accidents and Dangerous Occurrences1. 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 occurred7. 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(g) If admitted to Hospital,i. Name of the Hospitalii. Address of the hospitaliii. Phone numberiv. Name of the Doctor8. Mode of transport used:Ambulance Truck Tempo Taxi Private Car9(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 theemployer (Describe about photographs/ video film/ measurements taken etc.)10. Particulars of the person given witness:(a) Name Address Occupation1. .2. .3. .4. .5. .(b) Whether temporary/permanent11. Particulars in case of Fatal-Date Time12. Whether registered with Building and Other Construction Workers Welfare Board13. 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/ SupervisorDate: ______________Designationcc: forwarded for information and follow-up action:123Note: If more than one person is involved, then for each person, information to be filled up in separate forms

FORM XVFORM XV[See Rule 240]Register of Building Workers Employed by the EmployerName 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 and location of work..Sl. No.Name and Surname of workmanAge and SexFathers/ Husbands nameNature of employment/ degisnationPermanent Home address of Workman(Village and Taluka and Distt.)Local AddressDate of Commencement of employmentSignature or Thumb impression of workmanDate of termination of employmentReasons for terminationIf the building worker is/was beneficiary the date of registration as a beneficiary, the registration no. and the name of welfare boardRemarks12345678910111213

FORM XVIFORM XVI[See Rule 241(1)(a)]Muster RollName 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 _____________________________________Nature of building or other construction work: _________________________Name and address of the EmployerFor the month of ________________________________Sl. No.Name of the Building workerFathers/ Husbands nameSex12345678910111213141516171819202122232425262728293031Remarks

FORM XVIIFORM XVII[See Rule 241(1)(a)]Register of WagesName 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 :___________________________________Sl. No.Name and Surname of workmanSerial No. in the Register of WorkmanDegisnation/Nature of work doneNo. of days workedUnits of Work DonDaily rate of wages/ piece rateAmount of Wage earnedDeductions, if any (indicate nature)Net Amount paidSignature/Thumb impression of the workerInitial of Employer or his representativeBasic wagesDearness allowancesOvertimeOther cash payments (nature of payment to be indicated)Total12345678910111213

FORM XIXFORM XIX[See Rule 241(1)(b)]Register for Deductions for Damage or LossName and address/location where the building or other construction work is carried on/ is to be carried on :____________________________________________________________________________________________________________________________________________________________________________________________________________________Name and Permanent address of building workers:Name and permanent address of the Employer :Nature of building or other construction work..Sl. No.Name of workerFathers/ Husband nameDesignation/ Nature of employmentParticulars of damage or lossDate of damage or lossWhether building worker showed cause against deductionName of person in whose presence building workers explanation was heardAmount of deduction imposedNo. of installmentsDate of recoveryFirst InstallmentLast Installment123456789101112

FORM XXFORM XX[See Rule 241(1)(b)]Register of FinesName 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 permanent address of the Employer :Sl. No.Name of building workerFathers/Husbands nameDesignation/ Nature of employmentAct/Omission for which fine imposedDate of Offencewhether building worker showed cause against finName of person in whose presence building workers explanation was heardWage periods and wages payableAmount of fine imposedDate on which fine releasedRemarks123456789101112

FORM XXIFORM XXI[See Rule 241(1)(b)]Register for AdvancesName 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 permanent address of the Employer :Sl. No.Name of building workerFathers/Husbands nameDesignation/ Nature of employmentWage period and wages payableDate and amount of advance givenPurpose(s) for which advance givenNo. of installments by which advance to be repaidDate and amount of each installment repaidDate on which last installment was repaidRemarks1234567891011

FORM XXIIFORM XXII[See Rule 241(1)(c)]Register for OvertimeName 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 :Sl. No.Name of building workerFathers/Husbands nameSexDesignation/ Nature of employmentDate on which overtime workedTotal hours of overtime worked or production in case of piece ratedNormal rates of wagesOvertime rate of wagesOvertime earningsDate on which overtime wages paidRemarks123456789101112

FORM XXIIIFORM XXIII[See Rule 241(2)(a)]Wage BookName and address of EmployerName and permanent address of the EstablishmentName and Address of the Establishment where building or other construction work is carried onNature of building or other construction workFor 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-operativesociety/housing loan or contribution to any relief fund as per provisions of clause (P) of sub-section-7of the Payment of Wages Act or for payment of any premium of Life Insurance Corporation.7. Net amount of wages paid ____________________Initials of the Employeror his Representative

FORM XXIVFORM XXIV[See Rule 241(2)(b)]Service CertificateName and permanent address of the EstablishmentName and address/location where the building or other construction work is carried on/ is to be carried onName and location of work :_________________________________________________________Name and address of the workman :____________________________________________________________________________________________________Age or Date of birth :______________________________________________Identification marks :_______________________________________________________________Fathers/Husbands name :__________________________________________________________SL.No.Total period for which employedNature of work doneRate of wages (with particulars of units in case of piece work)If the building worker was a beneficiary his registration No., Date and name of the BoardReasons/ ground on which the employee terminatedRemarksFromTo12345678Signature of the Employeror his Representative

Form XXVFORM XXV[See rule 242]ANNUAL RETURN OF EMPLOYER TO BE SENT TO THE REGISTERING OFFICERYear Ending 31 st December ..1Full name and full address of the establishment of the building and other construction work. (Place,post office,district )2Name and permanent address of the establishment3Name and address of the employer4Nature of building and other construction work carried on.5Full name of the manager or person responsible for supervisior and control of the establishment6Number of building workers ordinarily employed.7Total number of days during the year on which building workers were employed.8Total number of days worked by buildig workers during the year.9Maximum number of building workers employed on any day during the year.10The 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.11Change, 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 EmployerDate :

Form XXVIIForm-XXVII(See rule 33-A (2)Application for the Registration of Building WorkersRegistration 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 andrelationship 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 WorkerDate:CertificateThis is to certify that Sri/Smt / Kum is a building worker as definedin Section 2 (e) of the Building and Other Construction . Workers (Regulation of Employmentand Conditions of Service) Act, 1996 and he is eligible for Registration as Beneficiary.Place:Signature of the AuthorisedDate :Signatory

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Form-XXVIIIForm-XXVIIISee rule 33-A (5)Nomination FormRegistration Number:I hereby nominate the persons/person below to receive the Claims due to me under Building andother construction workers (Regulation of employment and conditions of service) Act.1996 in theevent of my death any amount due to me becomes payable. The nominee(s) are also entitled toreceive any other amount that may become payable under Building and other constructionworkers (Regulation of employment and conditions of service) Act, 1996.Name and Address of Address of WorkerName and Relationship of the Nominee(s) with " the building workerAge of the Nominee(s)Percentage of Share to be paid to each nominee123Place:Signature or left-hand thumb-impressionDate:of the Building workerCertified that the above declaration has been signed/thumb impression has been impressedby Sri/Smt./Kum.after he/she has read the entries (or) after theentries have been read over to him/her by me and understood by him/her.Place:President/Secretary of a Registered TradeDate:Union/Labour Department Officer nor below the rank ofan Assistant Labour Officer/Employer of a RegisteredEstablishment/Chief Executive of the Government Organisationinvolved in building or other construction activity.

Form- XXXForm- XXXSee Rule 33-B(i)Identity CardRegistration Number:Date:1. Name of the worker :2. Name of Father/Husband :3. Age :4. Permanent Address :5. Details of Dependents (Name, Age andrelationship 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 OtherConstruction Workers Welfare BoardDetails of Work Done By the Building Worker(During The Year from 1-4-20 to 31-3-20)FromToWorked asName and Address of the Employer/EstablishmentRemarksSignature of Employer/Establishment

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Form I BOCW Cess RulesFORM I[See rule 7]1Name of Establishment :Registration No. under Building and other Construction Workers (Regulation of Employment and Condition of Service) Act, 1996. Registering Authority2Address :3Name of Work :4No. of Workers employed :5Date of commencement of workEstimated period work :DateMonthYearMonthYear6Estimated cost of construction Details of payment of cessStagesCostAmount Challan No. and DateAdvance-A Deduction at Source-D Final-F1st Year2nd Year3rd Year4th YearTotal:Signature of EmployerName of EmployerDateTO BE FILLED BY ASSESSING OFFICER7Date of completion8Final cost9Date of assessment10Amount assessed11Date of Appeal, if any12Date of order in Appeal13..Amount as per Order in Appeal14Date of transfer of cess to the Board15Amount transferred Challan No. and dateSignatureDesignation

FormII Bocw CessFORM II[See rule 9 (1)]Notice of Stoppage or Reduction of WorkI.Name of EstablishmentRegistration No. under Building and Other Construction Workers (Regulation of Employment and Condition of Service) Act, 1996Address:II.Date of commencement of workEstimated period of work:DateMonthYearMonth YearEstimated cost of work (original)Advance Cess/Deduction at sourceDate of Assessment Order Amountof Cess AssessedIII. Modification to the original estimatesReasonRevised date of completion/date of stoppageActual cost estimatesActual cost incurredWhether work is being handed over in any other person/agency for completion.Yes/No.If yes. Name/Address of suchPerson/agency.Signature of employerName of employerDateTO BE USED BY ASSESSING OFFICERDate of revision of assessmentAmount of cess after revisionCess already receivedCess to be recoveredCess to be refunded, if anyReference to Board for refund;Date/numberSignatureDesignation