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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)

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)
  2. Period (Furnish dates) :
  3. Number of days in the period above :
  4. Number of working days in the period above :
  5. Longest accident free period in man-hours including over time :
  6. Safety promotional activities conducted during the year (Contest year) (Furnish Details) :
  7. Particulars of the Postal Order Enclosed: Number Date Amount
Station: Signature of the Station Signature of the Manager Inspector of Factories

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