CO129-505-7 Factory (Accidents) Ordinance- 1927 4-4-1927 - 1-12-1927 — Page 26

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Appendix.

NOTIFICATION OF ACCIDENT.

Name of factory.

Factory (Accidents) Ordinance, 1927.

Address of factory

Kind of work done in factory..

Name of proprietors.

Date of accident..

Name of person injured

Nature of injury

Short description of accident

Date of report

Signature of person making the report.

26 ENT