BLOCK–I             IDENTIFICATION PARTICULARS

1.

Industry Code

6.

Sector Code $

2.

Stratum Code

7.

Reference Date

3.

Size Group Code @

8.

Number of Persons employed on the Reference date

4.

Sl. No. of the Unit

in the Frame

Manual

Non-Manual

Total

a.

Sample List

9.

Name of the Industry

b.

Substitute List

5.

Sl. No. of the Unit in

10.

Name of the Establishment

a.

Sample List

b.

Substitute List

11.

Complete Postal Address

12.

Name and Address of the Employer’s Association of which the Employer is a Member.

13.

Is the Unit covered by any Wage Agreement? If yes, attach a copy.

Sample Sl. No.

BLOCK-II                 EMPLOYMENT

(A)      TIME-RATED WORKERS

Sl.

No.

Occupations

Number of Full Time Manual Workers on Pay Rolls on the Reference Date @

Title

Code

Men

Women

Adole-

scents

Child.

Total

(4-7)

1

2

3

4

5

6

7

8

@  Reference date as shown in column 7 of Block-I

Sample Sl. No.

BLOCK-II                 EMPLOYMENT

(B)      PIECE-RATED WORKERS

Sl.

No.

Occupations

Number of Full Time Manual Workers on Pay Rolls on the Reference Date @

Title

Code

Men

Women

Adole-

scents

Child.

Total

(4-7)

1

2

3

4

5

6

7

8

@  Reference date as shown in column 7 of Block - I

Sample Sl. No.

BLOCK-III           DEARNESS ALLOWANCES

1.

Whether separate DA is paid in the unit? *

2.

If Yes, indicate the number of persons receiving DA according to **

(a)

Consumer Price Index

(e)

Other Methods

(Specify)

(b)

CPI in combination with others

(f)

No. of Persons not getting any DA

(c)

Flat Rate

(g)

Total Number of Persons ***

(d)

Pay Scales/Slabs

3.

If DA (part or whole) is paid according to Consumer Price Index, please give the following information about the index used:

(i)

Labour Bureau Series/State Series $

(ii)

Base Year (ccYY)

(iii)

Centre Name (AICPI/Specify)

(iv)

Mention the rates at which DA is being paid and the number of persons covered by each rate:

Rate of Dearness Allowance

Number of Persons Covered

  * Yes–1, No–2      ** Record the Number of Persons.

*** Record the Total Number of Persons given against (a) to (f).

Sample Sl. No.

BLOCK-IV         PAY ROLL EARNINGS OF SAMPLE WORKERS

Occup-ation Code

Total No. of Workers

Sl. No. of the Sample Worker

Name of the Sample Worker

Sex and Age Code (a)

System of Wage Code (b)

Rate of Basic/ Consolidated Wages & Dearness Allowances

Unit of Time Code (c)

Basic

DA

1

2

3

4

5

6

7

8

9