Rule 55 explained: this guide covers what it means, who it applies to, the step-by-step process, documents required, fees, due dates and penalties in India — so you can stay compliant with confidence and avoid costly mistakes.
Rule 55 requires an ambulance room or dispensary where more than 500 workers are ordinarily employed. It sets the equipment, staffing, qualifications and physical features of the room. "Ambulance room" here means a medical room, not a vehicle.
The employer of every factory, mine and building or other construction work that ordinarily employs more than 500 workers must keep a suitable ambulance room or dispensary, round the clock or during working hours as the case may be, in good order. It must be under a full-time qualified medical practitioner with at least one nurse and one General Duty Assistant-Healthcare or Nursing Assistant, contain the Annexure II equipment (Annexure IV for mines), and have emergency lighting, a communication device and drenching shower points. The employer may also tie up with hospitals for emergency services.
The Code source
Sections 23 and 24 of the Occupational Safety, Health and Working Conditions Code, 2020 (the OSH Code) cover health, working conditions and welfare facilities as prescribed. Section 42 deals with medical officers; see our section 42 explainer. Rule 55 is the facility rule for larger establishments. Compare it with the first aid box rule; see our rule 54 article.
Central Rules apply where the Central Government is the appropriate Government. Where the State Government is the appropriate Government, the State's own OSH rules apply. For help planning an on-site medical facility, see our labour law compliance service.
Who must provide it
Rule 55 names the employer of every factory, mine, and building or other construction work. It does not name beedi and cigar premises, motor transport undertakings, dock work or plantations. The threshold is more than 500 workers ordinarily employed; exactly 500 is not "more than 500". The text does not say whether contract workers count towards the 500. Unlike rule 53 on canteens, rule 55 does not say "including contract labourers", so read it with care and seek advice if your headcount is close to the limit.
The sub-rules at a glance
| Sub-rule | Duty |
|---|---|
| (i) | A suitable ambulance room or dispensary, round the clock or during working hours as the case may be, maintained in good order. The employer may also tie up with hospitals for emergency services |
| (ii) | The ambulance room is a place conveniently located in or near the premises, with adequate space and arrangements to cope with a medical emergency, containing at least the equipment in the illustrative list in Annexure II; the employer may add more |
| (iii) | Mines: at least the equipment in the illustrative list in Annexure IV; the employer may add more |
| (iv) | Under the charge of a full-time qualified medical practitioner appointed directly by the employer, assisted by adequate paramedical staff (at least one nurse and one General Duty Assistant-Healthcare or Nursing Assistant) |
| (v) | The medical practitioner has a qualification in the First or Second Schedule or Part II of the Third Schedule of the Indian Medical Council Act, 1956. Those with Part II qualifications must also meet section 13(3) of that Act, or the National Medical Commission Act, 2019, or hold a Diploma or Degree in Industrial or Occupational Health or Associate Fellow in Industrial Health, or equivalent. The practitioner must acquire a Diploma or Degree in Industrial or Occupational Health, or AFIH, within one year from the date of appointment |
| (vi) | The nurse has a qualification registered under the State Nursing Council, has completed Basic Life Support (BLS) training, and has not less than six months' emergency experience in a multispecialty hospital |
| (vii) | Adequate space for privacy and examination of the patient |
| (viii) | Emergency lighting supply and a suitable communication medium, preferably handheld |
| (ix) | Drenching shower points, as necessary owing to the nature of work, with drainage sloping away from the showers; water supply to the drenching shower secured to ensure continuous supply |
The printed text of sub-rule (v) refers to "sub-rule (iii)" for the medical practitioner and sub-rule (iv) is the one that appoints the practitioner. Read the cross-reference as pointing to sub-rule (iv). The provision on a nurse (vi) similarly refers to sub-rule (iv), which is correct.
What Annexure II lists
Annexure II lists 49 items of equipment. They include a glazed sink with hot and cold water, a table with chairs and a refrigerator, sterilisation arrangements, a patient examination table or couch, kidney tray, thermometers, tetanus toxoid injections, emergency injections (atropine, adrenalin, hydrocortisone, furosemide, local anaesthetics), syringes, suturing materials, surgical instruments, a stethoscope, an oxygen cylinder or concentrator, a blood pressure apparatus, IV fluids and cannulas, an IV stand, a blood glucose monitoring kit, biomedical waste bins, splints, a wheelchair, a scoop stretcher, dressings, a pulse oximeter, a suction unit and resuscitation equipment such as an Automated External Defibrillator and ambu bag. Item 49 lets the qualified medical practitioner add other equipment as specifically needed.
Annexure IV is the mine list. It groups equipment under headings such as advanced medical equipment (portable oxygen, nebuliser, suction, AED, blood pressure monitor, glucometer), sanitation, patient transport, wound care, comfort, splints and medical appliances including an ECG machine. Use the annexure itself for the full list.
Consequences
Rule 55 states no penalty of its own. Contravention is dealt with under the Code's penalty provisions; see our section 94 explainer.
Practical examples
Example 1. A factory has 620 workers. Because that is more than 500, it sets up an ambulance room, appoints a full-time doctor directly, employs one nurse who holds BLS training and six months' emergency experience, and one nursing assistant.
Example 2. A construction company has 520 workers at a large site. It chooses to tie up with a nearby hospital for emergency services, as sub-rule (i) allows, but still keeps the ambulance room in good order. The tie-up is an option stated "also", not a replacement for the room.
Example 3. A doctor is appointed with an MBBS degree and no occupational health qualification. Under sub-rule (v), the doctor must acquire a Diploma or Degree in Industrial or Occupational Health or AFIH within one year of appointment, and the HR file should record the date.
Need help with on-site medical facilities?
Staffing an ambulance room involves qualifications, rosters and equipment lists. Our labour law compliance team can help you check whether your headcount triggers rule 55 and prepare the appointments and equipment register.
Key takeaways
- Rule 55 applies to factories, mines and construction work with more than 500 workers.
- A full-time qualified medical practitioner, a nurse and a nursing assistant are required.
- The doctor must acquire an industrial or occupational health qualification within one year of appointment.
- The room needs Annexure II (or IV for mines) equipment, emergency lighting, a communication device and drenching showers.
- A hospital tie-up for emergencies is permitted in addition.
- State rules apply where the State is the appropriate Government.
Read next
- Rule 54: first aid and medical appliances
- Rule 56: shelter and rest room
- Section 42: medical officers
- Welfare provisions under the Factories Act
Disclaimer: Based on the Occupational Safety, Health and Working Conditions Code, 2020 (as enacted) and, where noted, the Occupational Safety, Health and Working Conditions (Central) Rules, 2026 (G.S.R. 345(E), 8 May 2026), as on 30 September 2026. The Code is in force from 21 November 2025; some provisions may be notified later, and State Governments make their own rules for establishments where the State is the appropriate Government. Verify the current position before acting.