Periodical medical examination notice format prescribed for mines, with mandatory manager notification and employment continuity consequence. Specification of the prescribed form of notice for periodical medical examination under the Occupational Safety, Health and Working Conditions (Central) Rules, 2026 requires a manager to notify the person to be examined in the stated format and to forward the notice to the examining authority. The form is intended for use in mines covered by the rules and records the worker's details, the examining authority, place, date and time of examination. Failure, without reasonable cause, to submit to the examination makes the worker ineligible for continuance in employment in the mine from the specified date.