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.

Name and address of the Factory :
Name and address of the Occupier :
Name and address of the Manager :
Registration Number of the Factory :
Group (A,B or C) according to nature of work as mentioned in the enclosed Annexure :
Nature of Industry

Previous Year:	Contest Year:

Average Number of Workers Employed during the year (including contract workers) :
Total Number of Working days during the year :
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) :
Number of Fatal Accidents during the Year :
Number of non-fatal accidents reportable under Factories Act, 1948 causing disability or loss of time for 48 hours or more during the year :
Total Number of man-days lost due due to non-fatal accident
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:

Particulars of longest accident free period during the year (contest year)
Period (Furnish dates) :
Number of days in the period above :
Number of working days in the period above :
Longest accident free period in man-hours including over time :
Safety promotional activities conducted during the year (Contest year) (Furnish Details) :
Particulars of the Postal Order Enclosed: Number Date Amount