FormNo.18A (Prescribed under Rule 96) (Vide para 2 of Schedule Under Rule 96) (Notice of dangerous occurrence which does not result in death or Bodily injury). 1. Name and address of the factory 2. Name of the Occupier 3. Name of the Manager 4. Nature of Industry 5. Branch or Department and exact place where the dangerous occurrence took place 6. Date and Hour of occurrence (State exactly what happened) I certify that, to the best of knowledge and belief the above particulars are correct in every respect. Signature of the Occupier /Manager Date of despatch of Report Note.- To be completed in legible handwriting or preferably typewritten. (This space to be completed by Inspector of Factories). District Date of receipt D.O.No. Date of Investigation Causation No. Result of Investigation | 
