+--------------------------------+-------------------------------+ |List of Persons Employed in | Particulars of Examination. | | Processes.| | +---+--------+--------+----------+-------+-------+-------+-------+ | | | | First | | | | | | | | | Employed | | | | | | | | | in such | | | | | | |Worker’s| | Process. | Date | Date | Date | Date | | | Name, | +----+-----+-------+-------+-------+-------+ |No.|in full.|Process.|Age.|Date.|Result.|Result.|Result.|Result.| +---+--------+--------+----+-----+-------+-------+-------+-------+ |(1)| (2) | (3) | (4)| (5) | (6) | (7) | (8) | (9) | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | +---+--------+--------+----+-----+-------+-------+-------+-------+ PART II. +----------+------------+---------+---------------------+---------+ | | | | Particulars of any | | | | | | Directions given by | | | | | |the Surgeon. Any Cer-| | | | | | tificate of Suspen- | | | Reference| | | sion or Certificate | | |to Part 1.| |Number of|permitting Resumption|Signature| +-----+----+ Date of | Persons | of Work must be | of | |Page.|Col.|Examination.|Examined.|entered here in full.| Surgeon.| +-----+----+------------+---------+---------------------+---------+ | (1) | (2)| (3) | (4) | (5) | (6) | | | | | | | | | | | | | | | | | | | | | | | | | | | | | +-----+----+------------+---------+---------------------+---------+ In Part I. of the register the surgeon should, at the times of examination, enter the date at the head of one of the columns numbered 6 to 9; and in the space below, opposite the name of each person examined on that date, a brief note (see next page) of the condition found. In Part II. he should again enter, in Column 3, the date of examination, with a statement of the total numbers examined on that occasion (Column 4); and in Column 5 any certificate of suspension from work, or certificate permitting resumption of work, and particulars of any other direction given by him, appending his signature in Column 6.