Full Text
REGD. No. D. L.-33004/99
The Gazette of India
CG-DL-E-07062025-263667
EXTRAORDINARY
PART II-Section 3-Sub-section (i)
PUBLISHED BY AUTHORITY
No. 324]
NEW DELHI, WEDNESDAY, JUNE 4, 2025/JYAISTHA 14, 1947
Note: The principal rules were published in the Gazette of India, Extraordinary, Part II, Section 3, Sub-section (i) vide
number G.S.R. 1650 (E), dated the 19th October, 1971 and was last amended vide G.S.R. 228 (E) dated 22th March,
2024.
MINISTRY OF AGRICULTURE AND FARMERS WELFARE
(Department of Agriculture and Farmers Welfare)
NOTIFICAION
New Delhi, the 3rd June, 2025
G.S.R. 367(E). - Whereas the draft rules further to amend the Insecticides Rules, 1971, was published, as
required by section 36 of the Insecticides Act, 1968 (46 of 1968) vide notification of the Government of India in the
Ministry of Agriculture and Farmers Welfare (Department of Agriculture and Farmers Welfare) number G.S.R.507
(E), dated the 20th August, 2024, in the Gazette of India, Extraordinary, Part-II, Section-3, Sub-section (i), dated the
16th August, 2024, inviting objections or suggestions from all persons likely to be affected thereby, before the expiry
of a period of thirty days from the date on which the copies of the Gazette of India in which the said notification was
published were made available to the public;
And whereas, copies of the said notification were made available to the public on 20th August, 2024;
And whereas, objections or suggestions received from the public on the said draft rules have been considered by
the Central Government;
Now, therefore, in exercise of the powers conferred by section 36 of the Insecticides Act, 1968 (46 of 1968), the
Central Government hereby makes the following rules further to amend the Insecticides Rules, 1971, namely :-
1. (1) These rules may be called the Insecticides (Amendment) rules, 2025.
(2) They shall come into force on the date of their publication in the Official Gazette.
2. In the Insecticides Rules, 1971 (hereinafter referred to as the said rules), In rule 10,-
(i) in sub-rule (1B), the words "or renewal of existing license" shall be omitted.
(ii) in sub-rule (1C), for the word "ninety", the word "thirty" shall be substituted.
(iii) in sub-rule (4), in clause (iii), the following proviso shall be inserted, namely:-
"Provided that no such endorsement for any additional insecticide is required in the license to sell, stock or
exhibit for sale of insecticides commonly used for house hold purposes for the control of cockroaches,
mosquitoes, housefly and bed bugs only.";
(iv) in sub-rule (4A), after clause (iv), the following clause shall be inserted, namely:-
"(v) The principal certificate as stated in clauses (i) to (iv) is not applicable for the license to sell, stock or
exhibit for sale of insecticides, commonly used for house hold purposes for the control of cockroaches,
mosquitoes, housefly and bed bugs only.";
3. In rule 18, in sub-rule (1), in clause (u), the following proviso shall be inserted, namely:-
"Provided that the Quick Response (QR) code referred to in clause (i) of sub-rule (1) of rule 19, shall be
placed on retail pack (primary or secondary pack as the case may be) of insecticides commonly used for house
hold purposes (for the control of cockroaches, mosquitoes, housefly and bed bugs only) at suitable place where
on scanning the Quick Response code by scanning equipment like mobile phone or other devices, a web link or
link for opening the Uniform Resource Locator (URL) of the manufacturing company shall appear, which on
pressing or clicking, shall take the user to the entire unique information of leaflet and the Quick Response code
shall contain all the contents of sub-rule (1) of rule 18.";
4. In the said rules, in the "FIRST SCHEDULE",
(i) for the "FORM II, the following Form shall be substituted, namely:-
"FORM II
Application for:
(1) Grant of Licence to Manufacture Insecticides
[See sub-rule (1) of rule 9]
OR
(2) Grant of Licence to sell, stock or exhibit for sale or distribute Insecticides
[See sub-rule (1) of rule 10]
OR
(3) Grant/Renewal of Licence to stock and use of Insecticides Commercial Pest Control Operations
[See sub-rule (3A) of rule 10]
(Submit separate application for different licence)
To
The Licensing Authority,
------------------------
1. Name, address and e-mail address of the applicant:
2. Whether the application is for,-
(a) grant of Licence to manufacture insecticide:
(b) grant of licence to sell or stock or exhibit for sale or distribution of insecticides:
(c) grant or renewal of licence for commercial pest control operations:
3. Address of manufacturing premises (in case of licence to manufacture),-
(i) complete address of premises:
(ii) name of insecticides and its registration number (enclose copy of certificate of registration of the
insecticide duly certified by the applicant):
(iii) validity of certificate of registration (as on certificate of registration):
4. Complete address (including name of the lane, PIN Code, etc.) of the premises, where the insecticide shall
be,-
(a) stored or stocked:
(b) sold or exhibited for sale or issued for use in case of commercial pest control operations:
(c) whether any of the above premises is situated in residential area (undertaking to be submitted):
(d) whether food articles are also stored in any of the above premises (undertaking to be submitted):
5. (a) Qualification of the applicant or the technical personnel under employment of the applicant:
+------------+------------------------+---------------+------------+
| Serial No. | Name and designation | Qualification | Experience |
+------------+------------------------+---------------+------------+
| | | | |
+------------+------------------------+---------------+------------+
(b) Whether fulfill minimum qualification as per the Insecticide Rules, 1971.
6. Training (wherever applicable),-
(a) name of the training/course:
(b) duration of training/course:
(c) certificate awarded, if any (Enclose supporting documents):
7. In case of manufacture, details of facilities,-
for manufacture of the insecticide, including infrastructure and those mentioned in Chapter VIII of the
Insecticides Rules, 1971, and the minimum infrastructure guidelines provided by the Registration
Committee.
(Enclose complete details in a separate sheet duly signed by the applicant):
8. In case of application for commercial pest control operations (Enclose supporting documents),-
(a) address of registered, zonal and branch offices:
(b) address of the premises for which the license is applied for:
(c) whether approval of technical expertise obtained:
(d) if yes, state reference number of approval, its date and validity:
(e) name of restricted insecticides for which approved:
(f) name of the responsible technical person:
(g) whether any quantity of restricted insecticide in possession
as on date of application:
(h) if yes, particulars and respective quantity of each in possession:
(i) details of safety equipment, antidotes and all other essential facilities:
9. In case of licence to sell or stock etc. and for commercial pest control operations, name of the insecticide and
its or their manufacturer or importer which the applicant intends to deal in and status of the principal certificate
in the format give below (Please enclose principle certificate as per format Appended with this rules),-
+------------+--------------------------+------------------------------+--------------------------+---------------------------------------------+
| Serial No. | Particulars of | Name of Manufacturer or | Number of certificate | Detailed principal certificate of |
| | Insecticide | Importer | registration | number or date of issue or validity |
+------------+--------------------------+------------------------------+--------------------------+---------------------------------------------+
| 1 | 2 | 3 | 4 | 5 |
+------------+--------------------------+------------------------------+--------------------------+---------------------------------------------+
10. Full particulars of licence(s),-
if issued in the name of the applicant by any other state in the area of their jurisdiction:
11. In case of renewal, please state licence number and date of grant:
12. Particulars of the application fee paid by the applicant:
13. Any other relevant information:
Signature of the applicant with seal
Declaration
(Strike out which is not applicable)
(a) I............... s/d /o....... do hereby solemnly verify that the information given in the application and the
annexures and statements accompanying it is correct and complete to the best of my knowledge and belief
and that nothing has been concealed. I clearly understand that this license is liable to be cancelled, if any
information, or part thereof, is found to be wrong, fake or false at any stage or any condition of license is
violated.
(b) I declare that we have adequate space and facilities to stock insecticides, so as to maintain their quality on
shelf.
(c) I shall not supply insecticide(s) to any distributor or dealer or person who does not have adequate space and
facilities to stock them so as to maintain their quality on
shelf under every circumstances (for application
for licence to manufacture).
(d) I also declare that I shall not take possession of any stock without satisfying myself with the quality thereof.
(e) I undertake that we shall forthwith inform any change in the responsible technical person.
(f) I undertake that we shall forthwith inform any change in principle certificate to the licensing officer (not
applicable for application for licence to manufacture).
(g) I further declare that I am making this application in my capacity as ............and that I am competent to
make this application and verify it by virtue of...
.., an attested copy of which is enclosed herewith. I
further declare that I shall abide by the conditions laid down in the license and failure to do so shall render
the license liable to cancellation.
Place:
Date:
Signature of the applicant with seal
OR
(4) Grant of License to sell, stock or exhibit for sale insecticides commonly used for household purposes for the
control of cockroaches, mosquitoes, housefly and bed bugs only
[See sub-rule (1) of rule 10]
To
The Licensing Authority,
------------------------
1. Name, address and email of the applicant:
2. Complete address (including name of the lane, PIN Code, etc.) of the premises, where the insecticide shall
be,-
(a) stored or stocked:
(b) sold or exhibited for sale:
3. Full particulars of license, if issued in the name of the applicant by any other state in the area of their
jurisdiction:
4. Particulars of the application fee paid by the applicant:
5. Any other relevant information:
Signature of the applicant with seal
Declaration
(Strike out which is not applicable)
(a) I.............................../d/o do hereby solemnly verify that the information given in the application and the
annexures and statements accompanying it is correct and complete to the best of my knowledge and belief and
that nothing has been concealed. I clearly understand that this license is liable to be cancelled, if any
information, or part thereof, is found to be wrong, fake or false at any stage or any condition of license is
violated.
(b) I declare that we have adequate space and facilities to stock insecticides, so as to maintain their quality on
shelf.
(c) I also declare that I shall not take possession of any stock without satisfying myself with the quality thereof.
(d) I further declare that I am making this application in my capacity as................and that I am competent to
make this application and verify it by virtue of....
.., an attested copy of which is enclosed herewith. I
further declare that I shall abide by the conditions laid down in the license and failure to do so shall render the
license liable to cancellation.
Place.
Date.
Signature of the applicant with seal
APPENDIX
PRINCIPAL CERTIFICATE
(enclose with application wherever applicable)
[See clause (i) of sub-rule (4A) of rule 10]
(On the Letter head of the Manufacturer)
No. .................. Date:
1. We manufacture the following insecticide(s) as per the details given below:-
+------------+-------------------------------------------------------+------------------------+-------------+------------+-------------------------------------+
| Serial No. | Name of the insecticide (Mention trade name, if any, in | Address of the | Licence | Date of | Name and address of the licensing |
| | parenthesis) | manufacturing premises | number | issue | authority |
+------------+-------------------------------------------------------+------------------------+-------------+------------+-------------------------------------+
| (1) | (2) | (3) | (4) | (5) | (6) |
+------------+-------------------------------------------------------+------------------------+-------------+------------+-------------------------------------+
2. We hereby authorise M/s (Name, complete address and e-mail) ..................to sell, stock or exhibit for sale or
distribute following insecticides, manufactured by us, in wholesale or retail in the Taluka/District/State as
detailed below:-
+------------+-------------------------------------------------------+-----------------------------------+------------------------------------------------+-------------------------------------+
| Serial No. | Common name of insecticide (Mention trade name, if any, | Registration number and date of | Manufacturing License number and date of | Name of Taluka and District & State |
| | in parenthesis) | issue and validity | issue, validity if any | |
+------------+-------------------------------------------------------+-----------------------------------+------------------------------------------------+-------------------------------------+
| (1) | (2) | (3) | (4) | (5) |
+------------+-------------------------------------------------------+-----------------------------------+------------------------------------------------+-------------------------------------+
3. The above mentioned dealer shall obtain the above-detailed insecticides
(a) directly from us:
(b) from the following distributor(s):
+------------+--------------------------+-----------------------------------------------------+-------------------------------------+------------------------------------------------+
| Serial No. | Name of distributor | Complete Address, phone No. and email of the | License number and date w.r.t. | Complete address of the premises, where the |
| | | distributor | distribution of above insecticides | distributor is stocking insecticides |
+------------+--------------------------+-----------------------------------------------------+-------------------------------------+------------------------------------------------+
| (1) | (2) | (3) | (4) | (6) |
+------------+--------------------------+-----------------------------------------------------+-------------------------------------+------------------------------------------------+
4. The dealer to whom this principal certificate has been issued shall procure above-detailed insecticides from
the above mentioned distributor. In the event of procuring these insecticides from any other distributor, this
certificate shall become null and void.
Before issuing this certificate, we certify that we have inspected and ensured that the above mentioned
distributor/dealer have adequate space and facilities to stock safely above-detailed insecticides and to maintain
their quality on shelf and have obtained an undertaking to the effect that the insecticide shall be stocked
accordingly to maintain their quality on shelf under every circumstances.
5. This certificate has been issued to enable the distributor or dealer obtain licence to sell, stock or exhibit for
sale or distribute the above-detailed insecticides, including those for stocking and use for commercial pest
control operations, and is valid up to.........................
6. In case of suspension or revocation.................................(date of validity).
Date:
Place:
Signature with company's seal
To,
Name and address of distributor/dealer
Copy for information to:
(i) the licensing officer, ...........................................................................................................
(ii) M/s (the distributor and his address), if the insecticides are to be supplied through distributors)
Signature with company's seal"
(ii) for the "FORM III, the following Form shall be substituted, namely:-
"FORM III
(On the letter of the Licensing Officer)
(1) Licence to Manufacture Insecticides
[See sub-rule (3) of rule 9]
OR
(2) Licence to sell, stock or exhibit for sale or distribute Insecticides
[See sub-rule (4) of rule 10]
OR
(3) Stock and use of Insecticides for Commercial Pest Control Operations
[See sub-rule (3A) of rule 10]
(Separate licence to be issued for manufacture or sale, stock etc. or pest control operations)
1. License Number............................................................................................................................
License to manufacture or sell, stock or exhibit for sale or distribute insecticide or carrying out commercial pest
control operations in the premises situated at ...................................................................................................................
(Complete address along with PIN Code)
is granted to M/s (Name, Complete Address, e-mail etc.) ..............................................................................................
as specified hereunder:-
+------------+--------------------------+----------------------------+---------------------------+--------------------------+
| Serial No. | Particulars of insecticide | Number of Certificate | Date of grant of Licence | Validity of Licence, |
| | | Registration | | wherever applicable |
+------------+--------------------------+----------------------------+---------------------------+--------------------------+
| (1) | (2) | (3) | (4) | (5) |
+------------+--------------------------+----------------------------+---------------------------+--------------------------+
2. The insecticide shall be manufactured or sell, stock or exhibit for sale or distribute insecticide or commercial
pest control operations under the direction and supervision of the following expert staff:-
(a) For manufacture: Name and designation of the expert staff (Insecticide wise, if any); and
(b) For sale or stock or pest control operations: Name and designation of the expert staff.
3. The licence is subject to such conditions as may be specified in the rules for the time being in force under the
Insecticides Act, 1968, as well as the conditions on the certificate of registration and others as stated below.
Signature of the Licensing Officer
Seal
CONDITIONS
1. This licence shall be displayed in the prominent place in the premises for which the licence is being issued and shall
be produced for inspection as and when required by an insecticide Inspector, licensing officer or any other officer
authorised by the Government in this regard.
2. Any change the name of the expert staff, named in the licence, shall forthwith be reported to the licensing officer.
3. The licensee shall scrupulously comply with each and every condition of registration of the insecticide, failing
which the licence is liable to be cancelled.
4. No insecticide shall be sold or exhibited for sale or distributed or issued for use in commercial pest control
operations except in packages approved by the Registration Committee from time to time.
5. If the licensee wants to manufacture or sell, stock or exhibit for sale or distribute/stock and use for commercial pest
control operations, any additional insecticide, he may apply to the licensing officer for addition in the licence for
each such insecticide on payment of the prescribed fee.
6. For pest control operations an application for the renewal of the licence shall be made as laid down in sub-rule (3A)
of rule 10 of the Insecticides Rules, 1971.
7. The licensee shall comply with the provisions of the Insecticides Act, 1968, and the rules made there under for the
time being in force.
8. The licence also authorizes the storage and stocking of insecticide(s) manufactured at the licensed premises, in the
factory premises for sale by way of wholesale dealing by the licensee.
9. The licensee shall maintain the record of 'date expired insecticides' separately in the format as per Appendix A.
10. The licensee shall maintain the record of sale or distribution of insecticides in the format as per Appendix B and
shall submit monthly return to the Licensing Officer.
11. The licensee shall maintain the stock register for technical and formulated products separately as per Appendix C1
and C2, respectively (For manufacturer only).
12. The licensee shall submit the monthly return for technical grade and formulated insecticides separately as per
Appendix D1 and D2, respectively (For manufacturer only).
13. The licensee shall maintain a record of periodical medical examination of persons engaged in connection with
insecticides as per Appendix E.
14. All the registers are to be kept under secured custody by the Licensee and shall be provided for scrutiny any time
to the Insecticide Inspector, Licensing Officer Inspector, Licensing Officer or any other officer authorised by the
Central Government and/or the State Government.
15. Any other condition as specified by the licensing officer.
OR
Signature of the Licensing Officer
(4) License to sell, stock or exhibit for sale Insecticides commonly used for household purposes or the control
of cockroaches, mosquitoes, housefly and bed bugs only.
[See sub-rule (4) of rule 10]
1. License Number.............................................................................................................................
License to sell, stock or exhibit for sale insecticide commonly used for Household purpose only in the premises
situated at .................................................................................................................................................
(Complete address along with PIN Code)
is granted to M/s (Name, Complete Address, e-mail etc.) ...............................................................................................
2. The license is subject to such conditions as may be specified in the rules for the time being in force under the
Insecticides Act, 1968, as well as the conditions on the certificate of registration and others as stated below.
Signature of the Licensing Officer Seal
Appendix A
REGISTER OF DATE EXPIRED PESTICIDES
[See sub-rule (a) of rule 10A]
+----------+---------------------------------------------------+----------+----------------+--------------+-------------------------------------+---------------------------------------+-----------------------------+-----------------------------+----------------+
| Serial No. | Name of insecticide Technical with min purity/ | Batch | Date of | Date of | Name of Manu- | Stocks received from and the quantity | Invoice number and date | Quantity sold (give unit | Quantity | How was the |
| | formulation type and % active ingredient | number | manu-facture | expiry | facture | received (give unit details) | vide which supply received | details) | balance (give | balance |
| | | | | | | | | | unit details) | disposed off? |
+----------+---------------------------------------------------+----------+----------------+--------------+-------------------------------------+---------------------------------------+-----------------------------+-----------------------------+-----------------------------+----------------+
| (1) | (2) | (3) | (4) | (5) | (6) | (7) | (8) | (9) | (10) | (11) |
+----------+---------------------------------------------------+----------+----------------+--------------+-------------------------------------+---------------------------------------+-----------------------------+-----------------------------+-----------------------------+----------------+
Verified with the record and found that the above information is correct.
Signature of the dealer with date and seal
Place:
Date:
Signature of the Insecticide Inspector (seal)
Appendix B
REGISTER FOR SALE/DISTRIBUTION OF INSECTICIDES (TECHNICAL AND FORMULATION)
(INCLUDING INSECTICIDES USED IN COMMERCIAL PEST CONTROL OPERATIONS)
(Record to be maintained Insecticide wise)
[See sub rule (2) of rule 15]
Particulars of the insecticide:
Registration number:
Month and year:
+----+------------+-------------------+-----------------------+-------------+-------------+---------+-----------------------------------------+-------------------+-----------------+-------------------------------------------------------------------+----------+
| Sl.| Date of | Name of | Name of Supplier | Batch Jumbe | Date of | Date of | Invoice details | Quantity (metric tonnes) | Bill Number (number and address to whom sold/distributed) date and | Remar ks |
| N | recepit | Manu- | or, if any, through | r | expi | e | | Pre | Receiv | Sold/ | Bal | | |
| o. | of the | factur | whom received | | ry | | numbe r, date and quanti ty (Metri C | vio | ed | Distr | a- | | |
| | insectici | | | | | | tonnes ) vide which supply receiv ed | | | i- | nce | | |
| | de | | | | | | | | | bute | | | |
| | | | | | | | | | | d | | quantity sold/distributed | |
+----+------------+-------------------+-----------------------+-------------+-------------+---------+-----------------------------------------+---------+--------+-------+-----+-------------------------------------------------------------------+----------+
| | | | | | | | | | | | | | |
+----+------------+-------------------+-----------------------+-------------+-------------+---------+-----------------------------------------+---------+--------+-------+-----+-------------------------------------------------------------------+----------+
Date:
Signature
Company's seal
Verified with the record and found that the above information is correct.
Signature with date and seal of the Insecticides Inspector
Appendix C1
STOCK REGISTER OF TECHNICAL GRADE INSECTICIDE
(To be maintained Insecticide wise)
[See sub-rule (3) of rule 15]
(Quantity in metric tonnes)
+-------+---------------+-------------------+------------------------+-------------------------+-----------------+-----------------------------+--------------------+-----------------+
| Date | Opening | Quantity | Quantity | Total quantity | Quantity sold | Quantity utilised for | Total quantity | Closing |
| | balance | imported | manufactured | (2+3+4) | | formulation | (6+7) | balance |
+-------+---------------+-------------------+------------------------+-------------------------+-----------------+-----------------------------+--------------------+-----------------+
| (1) | (2) | (3) | (4) | (5) | (6) | (7) | (8) | (9) |
+-------+---------------+-------------------+------------------------+-------------------------+-----------------+-----------------------------+--------------------+-----------------+
Appendix C2
STOCK REGISTER OF FORMULATED INSECTICIDE
(To be maintained Insecticide wise)
[See sub-rule (3) of rule 15]
(Quantity in metric tonnes)
+-------+-------------------------------------------------+--------------------------------+-----------------+------------------------------------------------+------------------------------------------+----------------+---------------------+---------------------+-----------------+-----------------+
| Seri al | Openin g balance of technic al grade pestici de | Technic al grade Insectici de | Total technic al grade | Total technical grade used for formulati ons | Balance of technical grade insectici des | Opening balance of formulati ons | Quantity formulat ed/ imported | Total formulat ed quantity (7+8) | Quanti ty sold | Closi ng balan ce |
| No. | | imported /purchas ed diverted | column (2+3) | | (4+5) | | | | | |
+-------+-------------------------------------------------+--------------------------------+-----------------+------------------------------------------------+------------------------------------------+-----------------------------------+---------------------------------+----------------------------------+-----------------+-----------------+
| (1) | (2) | (3) | (4) | (5) | (6) | (7) | (8) | (9) | (10) | (11) |
+-------+-------------------------------------------------+--------------------------------+-----------------+------------------------------------------------+------------------------------------------+-----------------------------------+---------------------------------+----------------------------------+-----------------+-----------------+
Appendix D1
MONTHLY RETURN/STATEMENT OF TECHNICAL GRADE INSECTICIDES
(MANUFACTURED/IMPORTED)
FOR THE PERIOD................TO................
[See sub-rule (4) of rule 15]
+----------------+----------------------+-------------+---------------+-------------------------------------------------+-----------------------------------------+-------------------------------------------------------------+
| Serial Number | Name of insecticide | Batch | Date of | Details of total Quantity imported/manufactured | Quantity utilised for formulations | Quantity sold (Metric Tonnes) with Name, address and licence|
| | | Number | expiry | (Metric Tonnes) | (Metric Tonnes) | number of purchaser |
+----------------+----------------------+-------------+---------------+-------------------------------------------------+-----------------------------------------+-------------------------------------------------------------+
| (1) | (2) | (3) | (4) | (5) | (6) | (7) |
+----------------+----------------------+-------------+---------------+-------------------------------------------------+-----------------------------------------+-------------------------------------------------------------+
VERIFICATION
I.........................do hereby verify that what is stated above is true to the best of my knowledge and belief based
on information derived from the records. I further declare that I am competent to verify this statement in my capacity
as ............................ (Designation). In case any information is found to be false, I shall be held responsible under
relevant provisions of the Act/Rules.
Signature.........
Name..............
Seal...............
Appendix D2
MONTHLY RETURN/STATEMENT FOR FORMULATED INSECTICIDES (MANUFACTURED/IMPORTED)
FOR THE PERIOD................TO................
[See sub-rule (4) of rule 15]
+----------------+--------------------------+-------------+---------------+----------------------------------------------------------------+------------------------------------------+
| Serial Number | Name of insecticide | Batch | Date of expiry| Details of total Quantity of technical grade insecticide used | Total formulated/imported quantity (Metric|
| | formulation | Number | | for formulation (Metric Tonnes) | Tonnes) |
+----------------+--------------------------+-------------+---------------+----------------------------------------------------------------+------------------------------------------+
| (1) | (2) | (3) | (4) | (5) | (6) |
+----------------+--------------------------+-------------+---------------+----------------------------------------------------------------+------------------------------------------+
VERIFICATION
I.........................do hereby verify that what is stated above is true to the best of my knowledge and belief based
on information derived from the records. I further declare that I am competent to verify this statement in my capacity
as ............................ (Designation). In case any information is found to be false, I shall be held responsible under
relevant provisions of the Act/Rules.
Signature.........
Name..............
Seal...............
Appendix E
REGISTER OF PERSONS ENGAGED IN CONNECTION WITH INSECTICIDES RECORD OF PERIODICAL
MEDICAL EXAMINATION
FOR THE CALENDAR YEAR 20........, QUARTER ENDING.........., 20......
[See rule 37]
Serial number:
I. GENERAL INFORMATION:
Name: Age:
Father's/Husband's name:
Complete address:
Sex: Identification mark:
Date of appointment:
Occupation: ............ (Please specify the nature of duty of the past and of the present)
Details of use Personnel Protective Equipments:
(a) Protective clothing/overalls:
(b) Helmet/hood/hat:
(c) Dust-proof goggles:
(d) Rubber gloves impermeable to liquids:
(e) Respiratory device(s):
(f) Boots:
II. MEDICAL EXAMINATION:
PAST HISTORY
+--------+-----------+---------+-----------------------------+-----------------------------+--------------------+
| Illness| Poisoning | Allergy | Exposure to pesticides | No. of years/days seasons | Remarks, if any |
| | | | (Compound) | and of exposure per year | |
+--------+-----------+---------+-----------------------------+-----------------------------+--------------------+
| (1) | (2) | (3) | (4) | (5) | (6) |
+--------+-----------+---------+-----------------------------+-----------------------------+--------------------+
FAMILY HISTORY:
+----------------+----------------------------+-------------------------+
| Allergy | Psychological disorders | Hemorrhagic disorders |
+----------------+----------------------------+-------------------------+
| (1) | (2) | (3) |
+----------------+----------------------------+-------------------------+
| Marital Status | Nos. of Children-Health | Any other health related|
| | status of children & any | complaint |
| | birth defect, if any | |
+----------------+----------------------------+-------------------------+
| (4) | (5) | (6) |
+----------------+----------------------------+-------------------------+
PERSONAL HISTORY:
+----------------+----------------------------+-------------------------+
| Smoking | Alcohol | Other addiction |
+----------------+----------------------------+-------------------------+
| (1) | (2) | (3) |
+----------------+----------------------------+-------------------------+
| Marital Status | Nos. of Children-Health | Any other health related|
| | status of children & any | complaint |
| | birth defect, if any | |
+----------------+----------------------------+-------------------------+
| (4) | (5) | (6) |
+----------------+----------------------------+-------------------------+
OBSERVATIONS:
Medical
examination
(1)
1. General Examination:
(a) Height;
(b) Weight;
(c) Pulse rate;
(d) Blood pressure;
(e) Respiration: rate, rhythm, type;
(f) Anaemia/Pallor;
(g) Oedema;
(h) Jaundice;
(i) Skin condition;
(j) Temperature;
(k) Fatigability;
(1) Sweating;
(m)Sleep;
(n) Urination.
2. Gastro Intestinal:
(a) Nausea;
(b) Vomiting;
(c) Appetite;
(d) Taste;
(e) Pain in abdomen;
(f) Bowel movement;
(g) Liver;
(h) Spleen.
3. Cardio-respiratory:
(a) Nasal discharge;
(b)Wheeze;
(c) Cough;
(d) Expectoration;
(e) Tightness of chest;
(f) Dyspnoea;
(g) Palpitation;
(h) Heart;
(i) Cyanosis;
(j) Tachycardia or Bradycardia.
4. Neuro-muscular:
(a) Headache;
(b) Dizziness;
(c) Irritability;
(d) Twitching;
(e) Tremors;
(f) Convulsions;
(g) Paresthesia;
(h) Hallucinations;
(i) Unconsciousness;
(j) Superficial reflexes;
(k) Deep reflexes;
(1) Coordination.
Pre-
employment
examination
(2)
End of 1st
quarter i.e.
after 3
(3)
After 2nd quarter
after 6 months
(4)
After 3 quarter
after 9 months
(5)
End of Remarks
year
(6) (7)
5. Eye:
(a) Pupil;
(b) Lacrimation;
(c) Double vision;
(d) Blurred vision.
6. Psychological:
(a) Temperament;
(b) Judgment;
(c) Nervousness.
7. Kidney:
Kidney Condition
8. Investigation:
(a) Complete Haemogram: (Hb, TRBC, TLC, DLC, Platelet, Reticulacytes count, ESR)
(b) Liver Function Tests: (Serum Bilirubin, SAP, SGOT, SGPT, Cholesterol, Total Protein and serum albumin)
(c) Kidney Function Tests: (Blood urea, Serum creatinine)
(d) Blood Sugar, HbA1C
(e) *Serum cholinesterase
(f)** Blood residue estimation (In case of Organochlorine once in a year)
(g) Urine-routine & microscopic
(h) X-ray chest (PA View): Once every year
(i) Ultrasound whole abdomen: Once every year
*Serum cholinesterase level should be measured at six monthly intervals in case of organophosphorus/carbamatic
group of insecticides.
**In organochlorine group of insecticides the blood residue estimation should be done once a year. General remarks
of the doctor in the light of the above examination.
III. DIAGNOSIS:
IV. ADVICE GIVEN TO:
1. The employee;
2. The employer;
Signature of the Doctor with date and seal
V. ACKNOWLEDGMENT TO BE GIVEN BY
1. The employee:
2. The employer:
3. The Licensing Officer:
VI. ACTION TAKEN BY THE EMPLOYER ON DOCTOR'S ADVICE:
VII. CERTIFICATE BY THE DOCTOR:
Certified that M/s. ................................................ have completed the action as per my doctor's advice as
given above and consequently the patient has shown improvement or recovered from the ailment.
Signature of the Doctor with date and seal
[F. No. 13035/08/2023-PP-I]
MUKTANAND AGRAWAL, Jt. Secy. (Plant Protection)
Uploaded by Dte. of Printing at Government of India Press, Ring Road, Mayapuri, New Delhi-110064
and Published by the Controller of Publications, Delhi-110054.
GORAKHA NATH YADAVA