Form 11 (Accident Book) is a statutory document mandated under Regulation 66 of the Employees' State Insurance Corporation (ESIC) framework in India.

 Form 11 (Accident Book) is a statutory document mandated under Regulation 66 of the Employees' State Insurance Corporation (ESIC) framework in India. It serves as an internal workplace register to officially record every on-the-job injury or accident.

Maintaining Form 11 is a key compliance obligation for employers, providing the foundational records required to process subsequent employee insurance and temporary disablement benefits.

Core Structural Fields of Form 11

The register captures exhaustive details about the employee, the nature of the event, and verifying witnesses:

Section	Key Fields Required
Notice Logistics	Serial number, Date of notice, Time of notice
Employee Information	Full name, residential address, sex, age, and unique ESIC Insurance Number
Employment Context	Assigned shift, specific department, and core occupation
Accident Details	Exact date, time, and precise location of the incident
Injury Dynamics	The administrative cause, specific nature of the injury, and an exact description of what the employee was doing at the time of the incident
Signatures & Witnesses	Signature/thumb impression of the person reporting the incident, designation of the person making the entry, and the names, addresses, and occupations of two witnesses

Important Compliance Note: Form 11 vs. Form 12

While Form 11 acts as the employer's internal, comprehensive Accident Book register, it does not substitute for active incident reporting. 

If an accident results in an employee's temporary disablement or unfortunate death, the employer must submit an official Accident Report (Form 12) to the local ESIC branch office or dispensary within 24 hours of the occurrence. Form 12 is submitted via the official ESIC Employer Portal using the structured facts compiled within Form 11.