The Occupational Safety, Health and Working Conditions (Central) Rules, 2026

Rule Form XXVI Form XXVI

Chapter: Annexures · Forms and Appendices
Text as on: As notified 08 May 2026

FORM- XXVI [See rule 182(1)] APPLICATION FOR COMPOSITION OF OFFENCE

1. Name of applicant :

2. Father's / Spouse name :

3. Address of the applicant :

4. Name of establishment:

5. Particulars of the offence:..... ......................................................................................

..........................................................................................................................................................................................

............................................................................................................................................................................

6. Section of the Code under which the offence is committed :.......................................................................

7. Maximum fine provided for the offence under the Code :............................................................................

8. Whether prosecution against the applicant is pending or not ..............................................................

9. Whether the offence is a first offence or whether the applicant has committed any other offence prior to the offence. If yes, then, full details of such prior

offence

..........................................................................................................................................................................................

.............................................................................................................................................................................

10. Any other information which the applicant desires to provide

..........................................................................................................................................................................................

.............................................................................................................................................................................

Applicant (Name and signature)

Dated:

FORM- XXVI
[See rule 182(1)]
APPLICATION FOR COMPOSITION OF OFFENCE

1. Name of applicant               :

2. Father's / Spouse name    :

3. Address of the applicant     :

4. Name of establishment:

5. Particulars of the offence:..... ......................................................................................

..........................................................................................................................................................................................

............................................................................................................................................................................

6. Section of the Code under which the offence is committed :.......................................................................

7. Maximum fine provided for the offence under the Code :............................................................................

8. Whether prosecution against the applicant is pending or not ..............................................................

9. Whether the offence is a first offence or whether the applicant has committed any other offence prior to the offence. If yes, then, full details of such prior

offence

..........................................................................................................................................................................................

.............................................................................................................................................................................

10. Any other information which the applicant desires to provide

..........................................................................................................................................................................................

.............................................................................................................................................................................

Applicant
(Name and signature)

Dated: