CHAPTER 330
ACCIDENTS AND OCCUPATIONAL DISEASES (NOTIFICATION) ACT
[SUBSIDIARY LEGISLATION]
INDEX TO SUBSIDIARY LEGISLATION
ORDERS
Accidents and Occupational Diseases (Prescription of Forms of Notice) Order
ORDERS
<FD">THE ACCIDENTS AND OCCUPATIONAL DISEASES (PRESCRIPTION OF FORMS OF NOTICE) ORDER
(Sections 2(1), 3(5) and 5(3))
G.N. No. 296 of 1955
1. This Order may be cited as the Accidents and Occupational Diseases (Prescription of Forms of Notice) Order, 1955.
2. The notice of an accident to any worker required by subsection (1) of section 3 of the Accidents and Occupational Diseases (Notification) Act (hereinafter referred to as the principal Act) to be sent by the employer to the labour officer for the area within which the accident has occurred, shall be in the form, and shall contain the particulars, as set out in Form No. 1 of the Schedule hereto.
3. The notice of a death of a worker required by subsection (5) of section 3 of the principal Act to be sent by the employer to the labour officer for the area in which the worker was employed, shall be in the form, and shall contain the particulars, set out in Form No. 2 of the Schedule hereto.
4. The notice of a case of occupational disease among workers required by subsection (3) of section 5 of the principal Act to be sent by the employer to the labour officer for the area within which the place of employment of such workers is situated, shall be in the form, and shall contain the particulars, set out in Form No. 3 of the Schedule hereto.
SCHEDULE
FORMS
FORM 1
NOTICE OF ACCIDENT TO BE GIVEN BY THE EMPLOYER
MAINLAND TANZANIA
DEPARTMENT OF LABOUR
THE ACCIDENTS AND OCCUPATIONAL DISEASES (NOTIFICATION) ACT
(Section 3(1) of the Act)
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NOTES ON THE USE OF THIS FORM: |
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(i) This form is to be used for giving of injury to a worker by accident. A separate form should be used for each injured person. |
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(ii) Completed forms should always be sent to the Labour Officer for the area in which the accident occurred, and in the case of a mining accident or an accident involving explosives, a completed copy of this form should also be sent to the Inspector of Mines for the area. |
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TO THE LABOUR OFFICER FOR THE ................................................................... AREA |
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TO THE INSPECTOR OF MINES FOR THE ............................................................ AREA |
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(Delete as necessary) |
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EMPLOYER |
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1. Name and postal address ................................................................................... |
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2. Nature of industry or business ............................................................................. |
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3. In case of Mine, state Registered No. of title and name of holder ............................ |
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INJURED OR DECEASED WORKER |
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4. Name (in block letters) ........................................................................................ |
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5. Age ........................... (If not known exactly, give estimate) |
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6. Sex : Male/Female (delete as necessary). |
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7. In the case of a Tanzanian: |
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(a) Tribe ........................................... |
(b) Village ........................................ |
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(c) Village Secretary ......................... |
(d) Ward Secretary ........................... |
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(e) District ........................................ |
(f) Country ....................................... |
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(If other than Mainland Tanzania) |
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8. In fatal case, name and address of next of kin (if known) {mprestriction ids="1,2,3"} |
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ACCIDENT |
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9. Date, time and place of accident. (In case of mining accident state name of mine or works, no. of stope, level, etc., and whether on surface or underground) |
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10. Description of how accident occurred. (If machinery involved give name of machine and part causing accident and state whether machine was moved by mechanical power at time of accident) ................................................................................... |
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11. Occupation of injured person (avoid the term "labourer" where possible): ......................................................................................................................... |
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12. In the case of a mining accident state: |
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(a) Hours of shift worked by injured person before the accident ............................. |
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(b) Rank and name of person who was at the time in charge of the place where |
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(c) Names of witnesses and persons who are able to give material evidence. (Statements may be attached) ..................................................................... |
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INJURY: FATAL/NON-FATAL (delete as necessary). |
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13. IF NON-FATAL has the injured person been disabled for at least three days from working at the work at which he was employed at the time of the accident? (State YES or NO) .................................. |
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14. Particulars of injury (as known to the employer) |
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15. EARNINGS PER MONTH AT THE TIME OF THE ACCIDENT: |
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(a) Rate of wages .............................. |
Sh. ........................................................... |
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(b) Cost of Living Allowances ............. |
Sh. ........................................................... |
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(c) Value of Rations .......................... |
Sh. ........................................................... |
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(d) Value of Housing ......................... |
Sh. ........................................................... |
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(e) Value of Fuel ............................... |
Sh. ........................................................... |
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(f) Overtime payment or other special remuneration for work done, whether by way of bonus or otherwise if of constant character and for work habitually performed ........................................ |
Sh. ........................................................... |
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(g) Total earnings per month .............. |
Sh. ........................................................... |
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................................... 20........ |
............................................................... |
FORM 2
NOTICE OF DEATH OF WORKER TO BE GIVEN BY THE EMPLOYER
MAINLAND TANZANIA
DEPARTMENT OF LABOUR
THE ACCIDENTS AND OCCUPATIONAL DISEASES (NOTIFICATION) ACT
(Section 3(5) of the Act)
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NOTES ON THE USE OF THIS FORM: |
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(i) This form is to be used for giving notice of the death of a worker from any cause whatever. A separate form should be used for each deceased person. |
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(ii) Where the death was the result of an accident notifiable under section 3 of the Act a Notice of Accident Form No. 1 must be completed in full. In such cases only the words "See Form No. 1 submitted" need be entered at 1 to 8 below. |
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(iii) Completed forms should be sent to the Labour Officer for the area in which the worker was employed. |
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TO THE LABOUR OFFICER FOR THE EMPLOYER .............................................. AREA |
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1. Name and postal address ................................................................................... |
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2. Nature of industry or business ............................................................................. |
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DECEASED WORKER |
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3. Name (in block letters) ........................................................................................ |
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4. Age .................... (If not known exactly, give estimate) |
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5. Sex : Male/Female (delete as necessary). |
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6. In the case of a Tanzania: |
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(a) Tribe ........................................... |
(b) Village ......................................... |
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(c) Village Secretary ......................... |
(d) Ward Secretary ............................ |
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(e) District ....................................... |
(f) Country ....................................... |
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(If other than Mainland Tanzania) |
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7. Name and address of next of kin (if known) ........................................................... |
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8. Circumstances of the death of the worker (if known) ............................................... |
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9. Details of wages and/or deposits due to deceased, and of any property left on employer's premises ........................................................................................... |
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................................... 20........ |
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FORM 3
NOTICE OF OCCUPATIONAL DISEASE TO BE GIVEN BY THE EMPLOYER
MAINLAND TANZANIA
DEPARTMENT OF LABOUR
THE ACCIDENTS AND OCCUPATIONAL DISEASES (NOTIFICATION) ACT
(Section 5(3) of the Act)
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NOTES ON THE USE OF THIS FORM: |
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(i) A separate form should be used for each case of occupational disease among employed persons. |
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(ii) Completed forms should be sent to the Labour Officer for the area within which the place of employment is situated. |
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TO THE LABOUR OFFICER FOR THE EMPLOYER ............................................. AREA |
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1. Name and postal address .................................................................................... |
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2. Nature of industry or business .............................................................................. |
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3. In case of mine, state Registered No. of title and name of holder ............................. |
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PERSON AFFECTED |
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4. Name (in block letters) ........................................................................................ |
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5. Age ................................. (If not known exactly, give estimate) |
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6. Sex : Male/Female (Delete as necessary), |
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7. In the case of a Tanzania: |
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(a) Tribe ........................................... |
(b) Village ......................................... |
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(c) Village Secretary .......................... |
(d) Ward Secretary ............................ |
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(e) District ........................................ |
(f) Country ....................................... |
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(If other than Mainland Tanzania) |
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8. Occupation ........................................................................................................ |
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(Avoid the term "labourer" where possible) |
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9. How long has he/she been so employed? ............................................................. |
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10. How long has he/she been in your employment? .................................................. |
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PARTICULARS OF DISEASE |
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11. Nature of disease ............................................................................................... |
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12. Fatal/Non-fatal (delete as necessary) .................................................................. |
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13. To what hospital or medical practitioner was the patient sent? ................................ |
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14. Date sent .......................................................................................................... |
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15. If a medical practitioner has certified the disease, state his name and address |
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16. MONTHLY EARNINGS |
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(a) Rate of Wages ............................. |
Sh. ........................................................... |
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(b) Cost of Living Allowance ................ |
Sh. ........................................................... |
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(c) Value of Rations ........................... |
Sh. ........................................................... |
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(d) Value of Housing .......................... |
Sh. ........................................................... |
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(e) Value of Fuel ................................ |
Sh. ........................................................... |
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(f) Overtime payment or other special remuneration for work done, whether by way of bonus or otherwise if of constant character and for work habitually performed ................................................. |
Sh. ........................................................... |
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(g) Total earnings per month ............. |
Sh. ........................................................... |
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................................... 20........ |
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{/mprestriction}