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Accident Report-Form 12 (ESI) - The Employees’ State Insurance Act, 1948

When you send these forms, the receiver will get an email form filling instructions, checklist,all relevant forms attached, list of desired documents and Government proofs.

Who should use this?
Employer has to use this form to report the accident.

Which are the forms & what is their purpose?
Form 12 (Regulation 68). Employer has to report the accident to the nearest ESI Branch Office in prescribe time limit.

Documents to be submitted along with the forms
1) Witness statement ( 2 nos)

Note: Submit immediately if the injury is serious i.e. it is likely to cause a death or permanent disablement or loss of a member; In other case within 24 hours from the notice of the accident.

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