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(523540203) ApplicationForm MFG Sector
(523540203) ApplicationForm MFG Sector
(523540203) ApplicationForm MFG Sector
APPLICATION FORM
(Manufacturing Sector)
GENERAL INSTRUCTIONS
1. Provide specific information related to the question/ item and avoid unnecessary details or
philosophical explanation.
2. Clarity of language and presentation are essential, and care should be taken to avoid
unnecessary technical terminology.
3. Define all abbreviations.
4. Supporting evidence, including annexures, shall include only data and documentation
which most meaningfully and directly provide supporting evidence for statements made in
the application. Photographs, if included, should have captions, clearly stating the specific
features of the attached photograph which is relevant to the item of the application.
5. Missing or irrelevant information and statements made without supporting evidence may
negatively affect quality and scoring.
6. The application preferably should not contain more than 350 pages (including annexures).
All the pages should be serially numbered.
7. One hard copy (duly signed and stamped) and one electronic copy (in the form of CD/DVD)
of the Application form should be submitted in NSC office along with applicable entry fee
before the last date of submission. The hard copy should be well bound and the electronic
copy should be in PDF form.
8. Please read the Rules and Regulations enclosed as Annexure-I and Guidelines for filling
the Application Form enclosed as Annexure-II.
9. Fill - in the Checklist enclosed as Appendix and attach it with the Application.
***
APPLICATION FORM
Notes: a) Before filling up the Application Form, please read the (i) Rules and Regulations for Participation in the
NSCI Safety Awards 2015 (Manufacturing Sector) enclosed as Annexure-I and (ii) Guidelines for
filling Application Form of the NSCI Safety Awards 2015 (Manufacturing) enclosed as Annexure-II.
b) Fill - in the Checklist enclosed as Appendix and attach it with the Application.
GENERAL INFORMATION
1. Information about the Factory
1.1
Name of the Factory: in English
: ..
In Hindi (Devnagiri)
1.2
: ..
: .
..
1.3
1.4
: ..
1.5
Email Id
: ..
1.6
: ..
: ..
: ..
: ..
1.7
Page 1 of 8
Assessment Period
(Three Preceding calendar years)
2014
a)
Regular
b)
c)
Total
2013
2012
Assessment Period
(Three Preceding calendar years)
2014
a)
Regular
b)
c)
Total
2013
2012
Yes:
No:
4.2
4.3
4.4
5.2
Page23of
of88
Page
6. Man-Days Lost
6.1
6.2
6.3
Period
From
b)
To
No. of Days
To
9. Prosecutions and Convictions with regard to Safety, Health and Environment Provisions
9.1 Has there been any Prosecution (launched for accident occurred during the assessment period) / Conviction for
contravention with regard to any Safety & Health provisions under the Factories Act and Rules framed there-under?
Assessment
Period
2014
2013
2012
If yes, please give brief description/particulars in each case.
9.2
Has there been any prosecution/conviction for breach of any provision under the Environment (Protection) Act,
1986 and Rules framed there under or Water (Prevention & Control of Pollution) Act, 1974 or Air (Prevention and
Control of Pollution) Act, 1981?
Assessment
Period
2014
2013
2012
If yes, please give brief description/particulars in each case.
10.3 Briefly describe how the objectives of the HSE Policy are achieved (Companys HSE Goals and the HSE
targets set and achieved at each level / function/department.
10.4 Explain how the policy is made known to the employees of your factory.
11. Review of HSE Performance by Top Management
11.1 Does the top management receive periodic reports from factory on HSE performance? If yes, at what
periodicity: Attach a copy of the last report submitted during the assessment period.
11.2 Explain the action taken by the top management on these reports and its implementation by the factory.
11.3 Is a resume of HSE performance of the factory published in the Annual Report and Sustainability Report of
the Company? If yes, attach a copy of the relevant extract (highlighted) from the last Report published.
11.4 Is your factory certified for OHSMS under the Indian Standard IS: 18001 OR OHSAS 18001? If yes, attach
a copy of the certificate.
11.5 Elucidate, if you have adopted any innovative approach/measure in HSE management practices beyond the
scope of statutory requirements. If so, explain the benefits achieved by virtue of its implementation.
12. HSE Organisation (including Line Managers involvement)
Multi-unit Companies with different factory registration numbers and separated by common boundary and having
certain facilities / service departments (such as HSE, Fire, Utilities depts., etc.) in common should not add the
manpower in these common facilities / service departments fully to each unit, instead they should apportion it to
each unit in proportion to the total number of workers (excluding the workers in the common facilities / service
departments) in the respective units.
12.1 Explain the organisational set-up, assignment of responsibilities at various levels and arrangements for
implementation of the HSE policy. Attach a copy of the Organisation chart.
12.2 Explain the activities
Departments/Sections.
undertaken
by
Line
Managers
to
achieve
HSE
objectives
in
their
12.3 Explain how the Safety & Health performance of individuals and their Departments taken into account while
considering career advancement. Give brief details of the system and attach a copy of the Performance
Appraisal Form, if any.
12.4 How many persons are working full-time in the HSE Department? State their professional qualification (as
prescribed under the Factories Act) in the fields of Safety & Health and experience.
13. Workers Participation in HSE Management & Promotion
13.1 Describe the structure and composition of Safety Committee(s) in your factory. Attach a copy of the order
constituting the Safety Committee (s) during the Assessment Period.
13.2 Give a brief resume covering the following during the assessment:
o number of meetings held
o important issues discussed (up to a maximum of 10)
o Improvements suggested by the Committee and implemented.
13.3 Briefly explain any other activities designed to promote workers participation in HSE management.
(i.e. suggestion scheme, contests, film/video screening, exhibitions, newsletter, poster display, etc.) Give a
brief resume for the assessment period.
13.4 What special campaigns were undertaken in your factory (e.g. National Safety Day/Week, World
Environment Day and Fire Service Week, World Health Day)? Give a brief resume for the assessment
period.
13.5 Has your factory or employees participated in any Local /State /National level competition on HSE (i.e.
Poster, Slogan, Quiz, Essay, Drama, etc.) or any other competition and won prizes?
Give a resume for the assessment period.
Type of
Competition
Organised by
Level of Employees
Participated
Page 4 of 8
Prize(s)
Awarded / won
Year
Total no. of
regular
employees
No. of
regular
employees
covered
under HSE
training
(1)
(2)
(3)
Percentage
of regular
employees
covered
under HSE
training
(%)
(4)
Total manhours
worked by
Regular
employees
(6)
(5)
HSE
Training
manhours
% of HSE
Training manhours over
total manhours worked
by regular
employees
(7)
[(6) / (5) x 100]
2014
2013
2012
14.5 Details about employees deputed for External HSE Training Programmes / Seminars / workshops /
Conferences during the Assessment Period (for regular employees)
Give Year wise Statement as under:
No. of employees
Year
deputed
Title of the
Programme
Organized
by
Duration of the
programme
(1)
(2)
(3)
(4)
(5)
% of participation
over total regular
employees
(6)
2014
2013
2012
14.6
Details of HSE Training Programmes conducted for Contractor / Badli workers during the Assessment
Period.
Give Year wise Statement as under:
Year
Total no. of
Contractor/Badli
workers
(1)
(2)
Percentage
of
No. of
Contractor/
Contractor /
Badli
Badli workers
workers
covered
covered
under HSE
under HSE
training
training
(%)
(4)
[(3) / (2) x 100]
(3)
Total manhours
worked by
Contractor /
Badli
workers
HSE
Training
manhours
(5)
(6)
% of HSE
Training manhours over
total manhours worked
by
Contractor/
Badli workers
(7)
[(6) / (5) x 100]
2014
2013
2012
14.7
Does the management have any policy regarding frequency of HSE training to each and every
employee?
If yes, state the desired frequency of providing training to each & every employee and explain how
you ensure that each & every employee has undergone refresher HSE training at the desired
frequency.
14.8
15.1 List developed and documented standard / safe operating & maintenance procedures in your factory and
briefly explain them (e.g. Start-Up and Shut-Down Procedures, Work Permit System, Preventive
Maintenance Procedures, etc.).
15.2 Explain how they are implemented.
15.3 Have you prepared Safety/HSE Manual? Is it available in the language spoken by a majority of workers?
To whom its copies have been distributed? Has it been reviewed? If so, when? Attach latest copy of
contents page(s) of English and local language safety manual.
15.4 Explain the Fire Prevention and Protection System in your factory.
16. Hazard Identification and Risk Analysis
16.1 Explain the procedures /techniques used for hazard identification in your factory.
- Give specific examples of areas/operations/processes in which these techniques have been applied.
- Give a brief resume of actions taken on recommendations and consequent improvements achieved.
16.2 Give brief details of the various procedures /techniques used for risk analysis.
17. Reporting/Investigating/Analysis of Accidents, etc.
17.1 Explain the procedure for Reporting, Investigating and Analyzing of Accidents, Dangerous Occurrences and
Near-Miss Incidents. Attach a copy of the Reporting, Investigation and Analysis and Accident/Incidents
during assessment period or format (if no accident / incidents reported).
17.2 How are the findings of Accident Investigations and Analysis utilized?
18. Safety of Contractor and Badli workers
Give a brief description of specific safety measures taken for safety of contractor or Badli workers in the
Assessment Period covering the following points :18.1 Safety Clause in contractors work orders. Attach a copy of the document.
18.2 Supervision of worksite by contractors supervisor and departmental supervisor/engineer.
18.3 Inspection of worksite by factory safety officer.
18.4 Safety meetings with contractors.
18.5 Provision of Personal Protective Equipments to contract workers.
18.6 Any other, please specify.
19-A. Safety in the Use of Hazardous Chemicals
Does your factory produce/ handle/use any hazardous chemicals as defined under the Manufacture, Storage and
Import of Hazardous Chemicals (MSIHC) Rules, 1989?
If yes, give a list of these chemicals, preferably in alphabetical order with their approximate maximum licensed
quantities in tonnes.
19-A1 Are Material Safety Data Sheets (MSDS) on these Chemicals prepared /obtained in the prescribed format
(Schedule 9 under MSIHC Rules/State Factories Rules)? If so, state their locations and availability.
19-A2
Give a summary of the process of disseminating information about these chemicals to the workers
concerned.
19-A3 Explain the system of labelling of the containers for the chemicals.
19-A4
Does your factory come under the First Schedule to the Factories Act, 1948? (i.e. List of Industries
Involving Hazardous Processes) Have you prepared On-Site Emergency Plan? Give a brief description
of the latest on-site emergency plan? Attach copy of contents page(s) of On-Site Emergency Plan.
19-A5 Explain the system for updating and testing of your On-Site Emergency Plan.
Page 6 of 8
19-B
Yes
or No
19-B1 If yes, Give Name and Quantity of the radioactive material (inventory) and explain the measures taken to
prevent exposure of employees during its handling & use.
(Provide radiations characteristics of the material)
19-B2 Explain the procedure established for measuring radiation level and radiation dose.
19-B3 How many persons were subjected to over-exposure of radiations during the Assessment period?
Assessment
period
Regular Employees
No. of persons
engaged in radiation
work
Contract Employees
over-exposure
cases
No. of persons
engaged in radiation
work
over-exposure
cases
2014
2013
2012
20. Occupational Health & Hygiene
20.1 Does your factory handle any chemicals listed under the Second Schedule to the Factories Act?
If yes, name the chemicals and briefly describe the system of monitoring their concentration in the work
environment (frequency, system of recording, follow-up action, etc).
Enclose a copy of minimum one report prepared during each year of the Assessment period.
20.2 Do you have an Ambulance Room (First Aid Post) and/or Occupational Health Centre in your factory?
If yes, briefly explain the services and facilities available in it.
20.3 Give the number of Factory Medical Officer(s) and Para-medical staff/First Aiders in your factory (full time &
part time). Do they have prescribed qualifications as per the Factories Act and Rules?
20.4 What are the decontamination facilities available for the workers in case of any exposure to chemicals?
20.5 Is your factory involved in any hazardous process and/or dangerous manufacturing process or operation?
How many workers are employed in these processes/operations? If yes, give a brief description of the
system of medical examination of your employees (insurance coverage, periodicity, type, etc.)
21. Major Accident Hazard (MAH) Installations
Is your factory covered under the definition of Major Accident Hazard installation as per the MSIHC Rules-1989?
If yes, please answer the following:21.1 Explain in brief, major accident hazards identified and the steps taken for their prevention.
21.2 Give a brief resume of your factorys involvement in preparation of Off-Site Emergency Plan.
21.3 Explain the steps taken by your factory to inform the persons outside the site who are likely to be in an area
which may be affected by a major accident on your site.
21.4 Is your MAH Installation covered under Rule 10 of the MSIHC Rules, 1989? If yes, give a summary of the
Safety Report as submitted to the Enforcing Authority highlighting the risk management measures taken.
22. Occupational Safety & Health Audit System
22.1 a) Give brief description of Internal OSH Audit System (i.e. Team, Frequency, Methodology, Submission of
Reports, etc).
b) Give a brief description of action taken on the reports and consequent improvements achieved.
22.2 a) Have External OSH Audits been conducted during the Assessment Period?
Give details. (Organisation, Team, Frequency, Methodology etc)
b) Give a brief description of action taken on the reports and consequent improvements achieved.
Page 7 of 8
If yes,
Certified that the above information has been verified and found correct
Workers Representative on the Safety Committee
Signature
Signature
Name
Name
Designation
: ...
Designation :
Page 8 of 8
Appendix
Description
1.
1.3
2.1
2.2
4.
4.2
4.3
4.4
10.1
11.1
11.3
11.4
12.1
12.3
13.1
14.4
14.5
15.3
17.1
Checked By
Applicant
NSC
18.1
19 A
24.6
25.4
Application No.:
(To be filled by NSC)
Page 1 of 1
Annexure I
1.
OBJECTIVE
To recognize industrial undertakings (Manufacturing Sector) for their consistent and meritorious Occupational
Safety and Health (OSH) performance and implementing effective OSH Management Systems, practices and
procedures and to encourage their further commitment to OSH.
2.
DEFINITIONS
The Rules may be called as the NSCI Safety Awards Rules
(a) Assessment Period means the three Consecutive Calendar Years 2012, 2013 and 2014
(b) Awards Committee means the Committee constituted by the Board for scrutinising and evaluating the
Applications for the Awards
(c) Award Year means the Calendar Year for which the Applications are invited i.e. Calendar Year 2015
(d) Board means the Board of Governors of the Council
(e) Chairman means the Chairman of the Council
(f) Council means the National Safety Council of India
(g) Director General means the Director General of the Council
3.
ELIGIBILITY
(a) The Scheme is open to the industries in the manufacturing sector registered as factories under the Factories
Act, 1948 and have commenced the manufacturing activity before the assessment period. The Members of
the Council who are in arrears of membership subscription will be eligible to participate in the Scheme only if
the arrears are cleared before the last date for submission of Applications.
(b) An individual undertaking will be disqualified, if it has been convicted for any contravention with regard to any
health and safety provision under the Factories Act or the Rules framed there under as well as the
Environment (Protection) Act, the Water (Prevention & Control of Pollution) Act, 1974 and the Air (Prevention
and Control of Pollution) Act, 1981 and the Rules framed there-under during the previous year of the Award
Year.
(c) Any organisation in which an accident occurs, in which multiple fatalities / injuries or major damage to
property or the environment either during the assessment period or subsequent period till the Awards
Function is held, that organisation will be disqualified for getting any Safety Award.
Page 1 of 2
4.
AWARDS GROUP
The industrial undertakings (Manufacturing Sectors) are grouped in five groups for the Award purpose as follows:
Group
A
NIC Code*
19
Main Activity
Manufacturing Coke and Refined Petroleum products.
20,21
35
23,24,25,27,28,29 and 30
10,11,12,13,14,15,16,17,18,
Other industries not covered above e.g. Manufacture of food products and
22,26,31,32,36
andfor
38NIC Code)beverages, textiles, tobacco products, paper & paper products etc.
(Refer
Annexure-III
Based on the NIC code of the Company, its application would be considered for the Awards in respective
group as mentioned in above table.
5.
Gr.
C
Gr.
D
Gr.
E
No. of
Awards
Minimum
Score
Prize
st
95%
Golden Trophy
and Certificate
nd
SHRESHTHA SURAKSHA
PURASKAR
(for Outstanding Performance)
10
85%
Silver
Trophy
and Certificate
rd
SURAKSHA PURASKAR
(for Very Good Performance)
15
80%
Bronze Trophy
and Certificate
th
PRASHANSA PATRA
(for Good Performance)
75%
Certificate
1
Award
2
Award
3
Award
4
Award
If no applicant comes within the minimum of score of points prescribed against the respective four levels of
Awards (see Rule # 5), the Awards Committee may decide not to give the prescribed number of the Awards in
different levels as mentioned above. Further, the Committee may, if deemed necessary, increase the number of
Awards in the lower level, in case there are no eligible winners in the higher level. However, the aggregate
maximum number of Awards for the first three levels will not exceed 30.
6.
ASSESSMENT PROCESS
(a) The information furnished in the Applications will be assessed and points awarded.
(b) Based on the above assessment, Awards Committee would invite selected Organisations to make
presentations by a team consisting of minimum three senior members of whom at least one each should be
from the Production and Safety Departments.
(c) Visit will be made to selected organisations for further assessment
(d) Final list of Award wining organizations will be prepared on the basis of above three stages of assessment.
7.
AWARDS COMMITTEE
(a) Constitution
The Awards Committee will be constituted by the Board for the assessment.
(b) Decision of the Awards Committee
The decision of the Awards Committee shall be final.
***
Page 2 of 2
Annexure II
Guidelines For Filling Application Form of the
NSCI SAFETY AWARDS 2015
(Manufacturing Sector)
1.
The duly filled in Application should be sent along with a Crossed Demand Draft for Rs. 17,000/- (Rupees
Seventeen Thousand only) in case of NSC Corporate Members and Rs. 20,000/- (Rupees Twenty
Thousand Only) in case of Non-Member drawn in favour of the "NATIONAL SAFETY COUNCIL", payable at
Mumbai/Navi Mumbai. The Entry fee is NON-REFUNDABLE.
2.
The Application duly completed in all respects should be submitted in a sealed cover superscribed
NSCI Safety Awards - 2015 (Manufacturing Sector) to the Director General, National Safety Council,
st
Plot No. 98-A, Sector 15, Institutional Area, CBD Belapur, Navi Mumbai - 400 614 by 31 May, 2015.
3.
Each Application should be accompanied by the duly signed checklist attached along with the Application
Form as Appendix.
4.
The industrial undertakings (Manufacturing Sectors) are grouped in five groups for the Award purpose as
follows:
Group
A
NIC Code*
19
Main Activity
Manufacturing Coke and Refined Petroleum products.
20,21
35
23,24,25,27,28,29 and 30
10,11,12,13,14,15,16,17,18,
22,26,31,32,36 and 38
Multi-unit Companies with different factory registration numbers and separated by common boundary and
having certain facilities / service departments (such as HSE, Fire, Utilities depts., etc.) in common should not
add the manpower in these common facilities / service departments fully to each unit, instead they should
apportion it to each unit in proportion to the total number of workers (excluding the workers in the common
facilities / service departments) in the respective units.
6.
Attach separate sheets wherever required as Annexures with the same Item no.
7.
The information given in the Application should be verified for their correctness and got approved by the
Safety Committee set up as per the provisions under the Factories Act. If there is no Safety Committee, the
verification should be done by any other joint Management - Workers Committee. The Application should be
signed by both the Representatives of the Management and Workers after verification.
8.
Applications incomplete in any respect or not accompanied by the Checklist in Appendix and
necessary information are liable to be rejected.
***
Page 1 of 1
Annexure III
NIC Code
Industry
10
11
Manufacture of beverages
12
13
Manufacture of textiles
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Manufacture of furniture
32
Other manufacturing
35
36
38
Page 1 of 1