Declaration by a person taking up employment in an establishment in which the Employees’ Provident Funds & Family Pension Fund Scheme are in force.
Download ESIC FORM 11 ACCIDENT BOOK EMPLOYEES’ STATE INSURANCE CORPORATION
As per Regulation 66
66. Maintenance of accident book
Every employer shall—
(i) Keep a book readily accessible (hereinafter called ‘the Accident Book’) in [Form 11], in which the appropriate particulars of any accident causing personal injury to an insured person may be entered;
(ii) Preserve every such book when it is completed for a period of five years from the date of the last entry thereon:
PROVIDED that it shall be necessary to enter in the said Accident Book particulars of any employment injury caused by an occupational disease specified in Schedule III to the Workmen’s Compensation Act, 1923:
PROVIDED FURTHER that an employer shall be deemed to have complied with this regulation sufficiently if in any register maintained by him, the appropriate particulars are also shown.