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Annexure - 3

This document provides information on safety procedures for factories involving hazardous processes. It requests details on: 1) The type of hazardous industry and activities involved. 2) Notification of the site, including when it was submitted and if the schedule is new or updated. 3) Appointment of a safety officer, including their name, designation, qualifications, experience, and contact details. 4) Engagement of supervisors, including their qualifications and experience handling hazardous materials.

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Akash Jivani
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219 views1 page

Annexure - 3

This document provides information on safety procedures for factories involving hazardous processes. It requests details on: 1) The type of hazardous industry and activities involved. 2) Notification of the site, including when it was submitted and if the schedule is new or updated. 3) Appointment of a safety officer, including their name, designation, qualifications, experience, and contact details. 4) Engagement of supervisors, including their qualifications and experience handling hazardous materials.

Uploaded by

Akash Jivani
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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Annexure – 3

This annexure is to be filled in case of factory involving hazardous process as per section 2 ( cb ) of the
Factories Act, 1948

1 General
(1) Type of Industry involving hazardous process :
(As per first schedule of Factory Act)
(2) Name of the Hazardous Industrial Activity/ :
Activities
(As per schedule 4 of Rule 67J)
(3) Factory classification in which category?
(MAHI A/B/C)
2 Notification of Site
(1) When site notification is submitted: :
(2) Present schedule-7 is new or updated :
3 Safety officer
• Whether Safety Officer is appointed in the
Factory or Not? If yes
• Name of the Chief Safety Officer
• Designation in Factory
• Qualification
• Experience
• Telephone No.
4 Supervisor
(1) How many supervisors are engaged in the factory for handling hazardous material?
Please specify

Name Qualification Experience


(1)
(2)
(3)

(2) If above supervisors have taken any training of :


Health & safety then please give the details.
5 Factory Medical Officer Details of :
Medical Officer
6 Ambulance Van
(1) Facility of ambulance van is provided in factory?
(2) Give List of Instruments, provided in Ambulance Van
(3) Give List of staff provided for Ambulance Van.

7 Details of Fire Protection


(1) Provision of Fire Trailer Pump is applicable or
Not? If yes
• No of Fire Trailer Pump
• Capacity of the Fire Trailer Pump 600 Ltrs-
1800 Ltrs-
• Is there any provision for fire Hydrant
System? If yes,
• Number of Water Monitor
• Any Provision for Jockey Pump?
• Any Provision for Diesel Operator Fire Pump?

Signature of Occupier
(with rubber stamp)

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