Schedule 14

Schedule-14
(Relating to Rule 74)

Format of the information of accident caused due to electric current
1. Time and date of accident :-
2. Place, distr ict and zone of accident:-
3. Electric ity supply volta ge and system:-
4. Name of the person killed or injured due to accident (if animal is affected,
mention it) :-
5. Name of the licensee of the area of accident :-
6. Occupation of the person sustaining accident (work relating to electricity
or other work) to be mentioned clearly:-
7. (a) If accident was occurred due to work relating to electricity,
particulars of the same:-
(b) If accident was occurred due to other work, how it occurred,
particulars of the same:-
8. If accident was occurred due to work relating to electriciity, the name and
designation of the person on whose order the victim was working and the
statement of the person giving order:-
9. Detailed description of accident :-
10. Description of the work done after accident:-
11. Details of the measures take or to be taken by the licensee in order to
remove the possibility of such accident in future:-
Licensee’s
Signature:-
Name:-
Designation :-
Date:-