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FACTORY INSPECTORATE - APPLICATION FOR SAFETY AWARD

OFFICE OF THE CHIEF INSPECTOR OF FACTORIES AND BOILERS

APPLICATION FOR SAFETY AWARD -

(Contest Year)  

  1. The application in this proforma giving the particulars specified below should be filled and accompanied by a separate crossed postal order endorsed to the Member-Secretary Safety Awards Committee for the value of Rs.500/- (Rupees Five Hundred Only) should be sent direct to the Member-Secretary Safety Awards Committee, Office of the Chief Inspector of Factories and Boilers, Vazhudavur Road, Gandhi Nagar, Puducherry - 605 009, on or before the 30th April of the current year.  

     

    1. Name and address of the Factory :

    2. Name and address of the Occupier :

    3. Name and address of the Manager :

    4. Registration Number of the Factory :

    5. Group (A,B or C) according to nature of work as mentioned in the enclosed Annexure :

    6. Nature of Industry

     Previous Year : 

     

    Contest Year :

     

     

     

    1. Average Number of Workers Employed during the year (including contract workers) :

    2. Total Number of Working days during the year :

    3. Total Man-hours worked during the year (This should be the total man-hours including overtime actually worked inside the factory during the calendar year by the workers as defined in the Factories Act, 1948) :

    4. Number of Fatal Accidents during the Year :

    5. Number of non-fatal accidents reportable under Factories Act, 1948 causing disability or loss of time for 48 hours or more during the year :

    6. Total Number of man-days lost due due to non-fatal accident

    7. Number of dangerous occurrences as defined under the Puducherry
      Factories Rules, 1964 (Give a brief description of each occurrence particularly
      covering cause, damage, loss and impact outside the factory) :

     FROM :

     

    TO :

     

     

     

    1. Particulars of longest accident free period during the year (contest year)

      1. Period (Furnish dates) :

      1. Number of days in the period of

      1. above :

      1. Number of working days in the period

      1. above :

      1. Longest accident free period in man-hours including over time :

    1. Safety promotional activities conducted during the year (Contest year) (Furnish Details) :

    2. Particulars of the Postal Order Enclosed:
      Number Date Amount

Station: Signature of the Station:

Signature of the Manager
Inspector of Factories

Date: Date:

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