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

P Building & Other Construction Workers (Regula

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
Certificate of Initial and Periodical Test and
See rule 56 and
Form - V Examination of Winches, Derricks and Their
74(b),Schedule I
Accessory Gear
Certificate of Initial and Periodical Test and
Form - VI See rule 56 and 74(b) Examination of Cranes or Hoists and their
Accessory Gear
Certificate of Initial and Periodical Test and
Form - VII See rule 70 and 74(b)
Examination of Loos Gear
Certificate of Test and Examination of
Form - VIII See rule 62 and 74(b)
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
Notice of Poisoning or Occupational Notified
Form - XIII See rule 230(a)
Diseases
Report of Accidents and Dangerous
Form - XIV See rule 210(7)
Occurrences
Register of Building Workers Employed by
Form - XV See rule 240
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
Annual Returns of Employer to be sent to
Form - XXV See rule 242
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 :
The A.P Building & Other Construction Workers (Regulation of Employment and Conditions of Service) Rules,1998
Issued/
Submitted/Maintained By
whom
by Principal Employer
Govt.of A.P,Registering Officer by Principal Employer
Govt.of A.P,Registering Officer
by Principal Employer
Competent Person
Competent Person
Competent Person
Competent Person
Competent Person
Competent Person
issued by Medical
Inspector/CMO
Whom to submit Remarks
In Triplicate along with DD showing
Govt.of A.P,Registering Officer
Payment of Fees for Regestration
For any changes occurs in
ownership or management or other
employer shall intimate to
registering officer within 30 days
the employer shall before 30 days
of commencement and completion
of any building or other
Govt.of A.P,Registering Officer
construction work,submit a written
notice to inspector of area in form
IV
All the building workers
employed as driver,Operators
Once in every Two years up to age
of lifting appliance and
of 40 and Once in a year, thereafter
transport equipment before
employing,afetr illness or injury
 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

Along with Form XXVII together

with the certificate of
employment(containing details of
name,age,father name &
Secretary,APBOCW Welfare
By Building Worker R.address,no. of days worked
Board
during the preceding 12 months)
issued by Registered
Establishment,ALO.Trad Union of
Construction workers.
Secretary,APBOCW Welfare
By Building Worker
Board
Secretary,APBOCW Welfare
Board
Secretary,APBOCW Welfare
To Building Worker
Board
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)
n 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
 SCHEDULE VI
Permissible 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)
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
 FORM I
[See rules 23 (1)]

APPLICATION FOR REGISTRATION OF ESTABLISHMENTS EMPLOYING BUILDING WORKERS

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 IV
[See rules 26 (3) and 239 (1) ]
NOTICE OF COMMENCEMENT / COMPLETION OF BUILDING OR OTHER CONSTRUCTION WORK

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

I/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 employer
To: with seal

The Inspector
………………………….
………………………….
………………………….
 FORM XIII
[See Rule -230(a)]
Notice of Poisoning and Occupational diseases

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.
_____________

____________

_____________
__________________
__________________

___________
__________________

____________
 Form- XIV
*See Rule – 210(7)+
Notice of Accidents and Dangerous Occurrences
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
(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
 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 and location of work………………………………………………..

If the building worker is/was
Signature or Date of beneficiary the date of
Nature of Permanent Home address of Date of Thumb termination registration as a beneficiary, the
employment/ Workman(Village and Taluka and Commencement impression of of Reasons for registration no. and the name of
Sl. No. Name and Surname of workman Age and Sex Father’s/ Husband’s name degisnation Distt.) Local Address of employment workman employment termination welfare board Remarks
1 2 3 4 5 6 7 8 9 10 11 12 13
 FORM XVI
[See Rule 241(1)(a)]

Muster Roll
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
___________________________________________________________________ _____________________________________
________________________________________________________________

Nature of building or other construction work: _________________________ Name and address of the Employer
For the month of ________________________________
Remark
Sl. No. Name of the Building worker Father’s/ Husband’s 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 s
 FORM XVII
[See Rule 241(1)(a)]
Register of Wages
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
:_______________________________________________________________________
________________________________________________________________________
_____________________________________________________________________
Name and Address of the Employer :_____________________________________________________________
Nameof the building or other construction work……………………………………………….. Wage Period :___________________________________

Amount of Wage earned

Other cash
payments
Serial No. in (nature of Initial of
Sl. the Register Degisnation/Nature of work No. of days Daily rate of wages/ Dearness payment to Deductions, if any (indicate Signature/Thumb impression of Employer or his
No. Name and Surname of workman of Workman done worked Units of Work Don piece rate Basic wages allowances Overtime be indicated) Total nature) Net Amount paid the worker representative
1 2 3 4 5 6 7 8 9 10 11 12 13
 FORM XIX
[See Rule 241(1)(b)]
Register for Deductions for Damage or Loss
Name and Permanent address of building workers: Name and permanent address of the Employer :
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………………………………………………..

Date of recovery

Whether building
Date of worker showed Name of person in whose Amount of
Designation/ Nature of Particulars of damage or cause against presence building worker’s deduction No. of
Sl. No. Name of worker Father’s/ Husband name employment damage or loss loss deduction explanation was heard imposed installments First Installment Last Installment
1 2 3 4 5 6 7 8 9 10 11 12
 FORM XX
[See Rule 241(1)(b)]
Register of Fines
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
:______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________

Name and permanent address of the Employer :

Wage
Act/Omission whether building Name of person in whose periods and
Designation/ Nature of for which fine Date of worker showed presence building worker’s wages Amount of Date on which
Sl. No. Name of building worker Father’s/Husband’s name employment imposed Offence cause against fin explanation was heard payable fine imposed fine released Remarks
1 2 3 4 5 6 7 8 9 10 11 12
 FORM XXI
[See Rule 241(1)(b)]
Register for Advances
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
:_______________________________________________________________________________________
_______________________________________________________________________________________
______________________________________

Nature of building or other construction work……………………………………………….. Name and permanent address of the Employer :

Date and
Date and amount of Date on
Wage period amount of Purpose(s) for each which last
Designation/ Nature of and wages advance which advance No. of installments by which installment installment
Sl. No. Name of building worker Father’s/Husband’s name employment payable given given advance to be repaid repaid was repaid Remarks
1 2 3 4 5 6 7 8 9 10 11
 FORM XXII
[See Rule 241(1)(c)]
Register for Overtime
Name and address/location where the building or other construction work is Name and permanent address of the Establishment :
carried on/ is to be carried on
:_________________________________________________________________
__________________________________________________________________
__________________________________________

Total hours
of overtime
worked or
Date on which production Date on which
Designation/ Nature of overtime in case of Normal rates of Overtime overtime
Sl. No. Name of building worker Father’s/Husband’s name Sex employment worked piece rated wages Overtime rate of wages earnings wages paid Remarks
1 2 3 4 5 6 7 8 9 10 11 12
 FORM XXIII
[See Rule 241(2)(a)]
Wage Book
Name and address of Employer Name and permanent address of the
Establishment

Name and Address of the Establishment

where building or other construction work is Nature of building or other construction
carried on work

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
 FORM XXIV
[See Rule 241(2)(b)]
Service Certificate

Name and permanent address of Name and address/location where the

the Establishment building or other construction work is carried
on/ is to be carried on

Name and location of work :_________________________________________________________

Name and address of the workman :__________________________________________________

__________________________________________________
Age or Date of birth :______________________________________________

Identification marks :_______________________________________________________________

Father’s/Husband’s name :__________________________________________________________

Total period for Rate of Remarks

wages
(with If the building worker
particular was a beneficiary his
Nature of s of units registration No., Date Reasons/ ground on
work in case of and name of the which the employee
SL.No. From To done piece Board terminated
1 2 3 4 5 6 7 8

Signature of the Employer

or his Representative
 FORM XXV
[See rule 242]

ANNUAL RETURN OF EMPLOYER TO BE SENT TO THE REGISTERING OFFICER

Year Ending 31 st December ………………………………..
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-XXVII
(See rule 33-A (2)
Application for the Registration of Building Workers

Registration Number (To be filled in by office)

Affix Passport size

photograph

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:

Certificate
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-XXVIII
See rule 33-A (5)
Nomination Form

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 Relationship of the

Name and Address of Nominee(s) with " the building Age of the Percentage of Share to be paid to each
Address of Worker worker Nominee(s) 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- XXX
See Rule 33-B(i)
Identity Card

Registration Number:

Date:
Affix Passport size
photograph
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

Details of Work Done By the Building Worker

(During The Year from 1-4-20 to 31-3-20)

Name and Address of

the Signature of
Employer/Establishm Employer/Establishm
From To Worked as ent Remarks ent
 FORM I
[See rule 7]

Registration No. under Building

and other Construction Workers’
(Regulation of Employment and
Condition of Service) Act, 1996.
1 Name of Establishment : Registering Authority

2 Address :

3 Name of Work :

4 No. of Workers employed :

Date of commencement of work Estimated period work :

5 Date Month Year Month Year

6 Estimated cost of construction Details of payment of cess

Advance-A Deduction at
Stages Cost Amount Challan No. and Date Source-D Final-F
1st Year
2nd Year
3rd Year
4th Year
Total:

Signature of Employer
Name of Employer
Date
TO BE FILLED BY ASSESSING OFFICER
7 Date of completion
8 Final cost
9 Date of assessment
10 Amount assessed
11 Date of Appeal, if any
12 Date of order in Appeal
13.. Amount as per Order in Appeal
Date of transfer of cess to the
14 Board
Amount transferred Challan No.
15 and date
Signature
Designation
 FORM II
[See rule 9 (1)]
Notice of Stoppage or Reduction of Work

Registration No. under Building and

Other Construction Workers’
(Regulation of Employment and
I.Name of Establishment Condition of Service) Act, 1996
Address:

II.Date of commencement of work Estimated period of work:

Date Month Year Month Year
Estimated cost of work (original) Advance Cess/Deduction at source
Date of Assessment Order Amount
of Cess Assessed

III. Modification to the original estimates Reason

Revised date of completion/date of stoppage

Actual cost estimates
Actual cost incurred

Whether work is being handed over in any

other person/agency for completion. Yes/No.
If yes. Name/Address of such
Person/agency.
Signature of employer
Name of employer
Date
TO BE USED BY ASSESSING OFFICER
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