APPLICATION FOR THE SITE APPRAISAL COMMITTEE
1. Name and Address of the applicant:
2. Site Ownership Data:
2.1 Revenue details of the site such as Survey
No. Plot No:
2.2 Whether the proposed site attracts the
provisions of section 3 of Environment
Protection Act, 1986, if so the nature of the
restriction: and
2.3 Local authority under whose jurisdiction the
site is located.
3. Site Plan:
3.1 Site Plan with clear identification of
boundaries and total area proposed to be
occupied and showing details near by the
proposed site-
(a) Name of adjoining manufacturing Units and
human habitats, educational and training
institutions, petrol installation, storage
liquefied Petroleum Gas and other hazardous
substances, if any, with in one kilometer
from the proposed site.
(b) Water sources (rivers, streams, canals, dams,
and water filtration plants) in the vicinity.
(c) Nearest hospitals, Fire stations, Civil
Defence Stations and Police Station and their
distances.
(d) Details of high tension electrical
transmission lines, pipe lines for oil, gas or
sewerage, if any passing through the site, and
(e) Location of railway stations, railway lines,
scheduled road bypass, if any, near the site.
3.2 Plot Plan of the factory, showing the entry
and exit points, roads.
4. Project Report
4.1 A summary of the salient features of Project
4.2 Maximum number of persons likely to be
working in the factory.
4.3 Maximum amount of power and water
requirements and source of their supply.
4.4 Block diagrams of the building and
installations, in the proposed site and
4.5 Details of housing colony, hospital, school
and other infrastructural facilities proposed.
5 Organisation structure of the proposed
manufacturing unit/factory:
5.1 Person responsible for protection of safety,
health and environment.
5.2 Proposed health and safety policy of the
proposed enterprise.
6 Meteorological data relating to the site
6.1 Average, minimum and maximum of
Temperature
Humidity
Wind velocities during the previous 10 years
6.2 Seasonal variations of wind direction
6.3 Highest water level reached during the floods
in the area recorded so far
6.4 Lightening and seismic data of the area
7 Communication Links
7.1 Availability of telephone/telex/wireless and
other communication facilities for outside
communication
7.2 Internal communication facilities proposed
8 Manufacturing Process Information:
8.1 Process flow diagrams.
8.2 Briefs write up on process and technology.
8.3 Critical Process parameters such as pressure
build-up, temperature rise and run-away
reaction.
8.4 Other external effects critical to the process
having safety implications such as ingress of
moisture or Water, contact with
incompatible substances, sudden power
failure: and
8.5 High lights of the built-in-safety/pollution
control devices or measures in-corporated in
the manufacturing technology.
9 Information of Hazardous Materials:
9.1 Raw materials, intermediates, products and
bye-products and their quantities, (enclosed
Material Safety Data Sheet in respect of each
hazardous substance).
9.2 Main and intermediate storages proposed for
raw material/intermediates/products/Bye
products (maximum quantities to be stored at
any time).
9.3 Transportation methods to be used for
materials in flow and out flow, their
quantities to be stored at any time; and
9.4 Safety measures proposed for:
9.5 Handling of materials
9.6 Internal and external transportation and
disposal (packing and forwarding of finished
products).
10 Information on Dispersal/Disposal of wastes
and pollutants:
10.1 Major Pollutants (gas, liquids, solid) their
characteristics and quantities (average and at
peak loads).
10.2 Quality and quantity of solid wastes
generated, methods of their treatment and
disposal.
10.3 Air, Water and Soil Pollution problems
anticipated and the proposed measures to
control the same, including treatment and
disposal of effluents.
11 Process Hazards Information:
11.1 Enclose a copy of the report on
environmental impact assessment.
11.2 Enclose a copy of the report on Risk
Assessment Study; and
11.3 Published (open or classified) reports if any,
on accident situation/occupational health
hazards of similar plants (within or outside
the country).
12 Information of proposed Safety and
Occupational Health Measure;
12.1 Details of fire fighting facilities and
minimum quantity of waste carbon dioxide
and other fire fighting measures needed to
meet the emergencies; and
12.2 Details of in-house medical facilities
proposed
13 Information on emergency preparedness:
13.1 On Site Emergency Plan: and
13.2 Proposed arrangements, if any for mutual aid
scheme with the group of neighbouring
factories.
14 Any other relevant information
I certify that the information furnished above is correct to the best of my knowledge and nothing has been
concealed while furnishing it.
Date: Signature
Designation
