Schedule 10

TENTH SCHEDULESection 60(1).Notice of Patient Suffering from Industrial Diseases(This notice shall be completed by a registered medical practitioner attending on or called in to visit a patient whom he believes to be suffering from an industrial disease and forwarded to the Chief Inspector of Factories, Ministry of Labour, Havelock Road, Singapore 1).Name of PatientAgeSexRaceNRIC No.Residential AddressPresent OccupationName and Address of EmployerDiagnosisIf patient is deceased, state date of last attendanceName of DoctorLIST OF NOTIFIABLE INDUSTRIAL DISEASES: —Name and Address of Hospital/ClinicANILINE POISONINGANTHRAXARSENICAL POISONINGASBESTOSISTel. No.Doctor’s Ref. No.BERYLLIUM POISONING BYSSINOSISCADMIUM POISONINGCARBON BISULPHIDE POISONINGCHROME ULCERATIONCHRONIC BENZENE POISONINGCOMPRESSED AIR ILLNESSEPITHELIOMATOUS ULCERATION (due to tar, pitch, bitumen, mineral oil or paraffin or any composed product or residue of any such substance)INDUSTRIAL DERMATITISLEAD POISONINGMANGANESE POISONINGMERCURIAL POISONINGMESOTHELIOMANOISE INDUCED DEAFNESSPHOSPHOROUS POISONINGSILICOSISDateSignature of DoctorTOXIC ANAEMIATOXIC JAUNDICE