Annexure – 1

Details of the Contractor

1. Name and address of the Contractor / Sub – contractor:

____________________________________________________________________

Registered / Head Office:

____________________________________________________________________
____________________________________________________________________

At:
____________________________________________________________________
____________________________________________________________________

2. Name, address and Phone / Mobile No. of the site-in-charge:

____________________________________________________________________

Registered / Head Office:

____________________________________________________________________
____________________________________________________________________

At:
____________________________________________________________________
____________________________________________________________________

Phone / Mobile No. :

E – mail address :

3. Nature of Work :
____________________________________________________________________
____________________________________________________________________

4. Area / Plant where the work is going on:  P1  P2  P3  P4

5. Work Order Number :

6. Period of Contract : From ____________ to ______________

7. Date of Commencement of work :

8. Provident fund Code No. :

9. GST Number :

10. Detail of Workmen Compensation Policy :

Name of the Insurance Company :

Date of issue :

Period : From ______________ to ______________

 No. of workmen covered :

11. Maximum Nos. of Workmen Proposed : Male :

To be engaged on any day. Female :

Date :

Place : Seal & signature of the

Authorized representative

PRECAUTIONS

 Contractor must ensure that all the activities are being carried out with safety and all
workmen are wearing required PPEs depending on their work.
 Contractor should submit copy of Attendance and Wage Register month wise
Regularly to HR Department as per statutory requirement.
 Contractor should not engage the workmen below age of 18 years.
 Contractor should take maximum precautions to avoid any dispute or IR Problem.
However, if takes place, should be immediately infirmed to the HR Department.
 Contractor should take all safety precautions to avoid accident. However, if take
place, it shall immediately be informed to HR Department.
 Contractor should keep close vigil on the activities carried out by the workmen and in
case of any misconduct(s), in-discipline, it shall immediately be informed to the HR
Department before it gets aggravated into collective grievances.
 Contractor should try to obtain all possible background information about the
workman while deploying at site and will obtain NOC before engaging any new
workman if he has / had been engaged by the other contractor executing work at our
site.
 Contractor having their own set up for Labour Camp should take maximum
precautions to maintain / keep it in hygienic condition to avoid disease and shall
provide all required amenities to avoid IR Problem.
 Contractor should keep liquid fund ready to meet the requirements in case of any
accident, IR Problem or payment dispute.
 Contractor should immediately cancel EPF of the workmen who are LONG
ABSENTEE without any intimation or have left the site at their own or after taking full
and final payment.

DISCIPLINE

 Contractor should observe all disciplines / procedure / rule set by the company and
shall explain to their workmen, such as Safety procedure related to Work /
Assignments, Road etc.
 Contractor should encourage workmen to observe dress code, if they have.
 Contractor should maintain their site office near and clean with display of required
statutory notices under different Labour Laws.
 Contractor should ensure proper use of company provided amenities.
 Contractor should plan / arrange for wage payment to their workmen by 7 th of next
month.
 Contractor should take most care of the disciplines laid down by the company while
working in the company premises.

DOCUMENT SUBMISSION

Contractor required to submit following documents along with application for pass.

 Copy of Work Order

 PAN Card of the Agency or contractor
 Copy of Labour License (In case more than 50 contractual labour)
 Copy of Emoloyees’ Compensation Policy (WC Policy)
 ID card proof and ID card issue register
 Daily manpower report to Security at Main Gate
 Medical Check-up report of all workers
 Police Verification report (within a week of commencement of work)
 Temporary Gate Pass
Date:____________

To,
Security Officer,
Acrysil Limited.

Sub : Temporary Gate Pass

Sir,

I, _____________________________________________________________ proprietor
of M/S. ______________________________________________________ request you
to grant permission for carrying out work of _____________________________
______________________________________________________________________
________________________________________________________________ in your
________________________________________________________ department from
Date: _______________ to ________________.

Details of workers for whom pass is required.

No Name of Worker Age Type of Work Remarks

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15

_____________ _____________ ___________ __________

Contractor Sign. Dept. Head Sign. HR Dept. Sign. Security Sign
 Daily Manpower Report

Temporary Gate Pass no.: _____________ Date : ___________

Contractor Name :_______________________________________________________

No Name of Worker Age Type of Work Remarks

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17

_____________ ____________________
Contractor Sign. Entry by Security Officer

Contractor Contact no. : ____________________

Manpower Summary

Sr. Particulars No of Workmen

1 Skilled
2 Semi-skilled
3 Unskilled
Total
 Accident Handling Procedure

In order to streamline the existing system of handling accident cases and make the
system more affective, the following actions are proposed to be taken

1. As soon as the accident is noticed or information of accident is received, immediately

following representatives to rush to the spot and put the injured person in any
available Vehicle and send him to nearest Occupational Health Center for First Aid
treatment . As per the Doctor advice, the injured person may be referred / shifted to
the Govt. or Private Hospital at Bhavnagar looking to the emergency.

(Action : Contractor representative / Area In charge / Site In-charge / Engineers /

Security / HR / Safety Personnel).

2. It is to be ensured that the injured person should be accompanied with representative

of area in – charge, contractor’s representative and 3 to 5 nos. of willing co – workers
right from the place of accident till hospitalization and remain there for further orders.

(Action : Contractor / Area In- charge)

Immediately send the information regarding accident by any means of

communication – according to the communication chart shown in the annexure – I
attached herewith.

3. It is to be ensured that X-ray / Scanning and suitable treatment is provided to the

workman and entire expenses of treatment, medicine and other miscellaneous
expenses will be borne by the contractors. The contractor will keep informed the
condition of the patient or any further development to HR / security Department. In
case of Death (on the spot or at hospital) only a qualified doctor can make
declaration of death.

4. In case of death / serious bodily injuries, the co-workers demand for photography. In
such cases Security Personnel at the spot will arrange for photography and barricade
the place of accident for legal inquiry. In case of above nature of accident prompt,
proper and tactful action is required to be taken by keeping the co-worker / relative
into confidence and prompt them to take lead of the mob. It would play an important
role in pacifying the situation.

(Action : Contractor / Site In- charge / Security / HR Personnel )

5. If the injured person dies on the way or in hospital, the contractor has to take full
responsibility for cremation or sending the dead body to the native place of deceased
accompanied by his friends / relative / contractor representatives as the case may
be. In such cases transfer certificate from the police and death certificate from
hospital (Medical Officer) mist be obtained. Dead body shall not be brought back
to site under any circumstances. The information regarding shifting of the body
and details of workers accompanied with the body shall be sent to Security Control
Room.

(Action : Contractor)
6. Some money is to be sent along with Co- workers / family members for body
crimination. A Condolence massage to the family members of the deceased for sad
demise may also be sent to is native place through the relative / co- workers.

(Action: Contractor)

7. In case of the fatal accident, due attention is to be paid by contractor to obtain

following reports immediately to complete the statutory formalities for the payment of
compensation. They should also submit a copy of the same to HR Department for
follow up action :

i. Police FIR report / Panchnama

ii. Postmortem Report
iii. Copy of Insurance (WC) Policy
iv. Death Certificate
v. Details of next of kin / legal heirs
vi. A copy of relevant page of Muster Roll / Wage Register
vii. Age proof – School Leaving Certificate / Gram Panchayat Record
viii.Passport size Photographs of legal heirs attested by local authority to avoid
duplicity of Claimant.
ix. Bank Accounts details of the Legal heirs.

(Action: Contractor / Site In- charge)

8. On receipt of the above, HR Department will ensure statutory compliance and follow
up with the contractor (in case of fatal accident).

i. Depositing Compensation
ii. Disbursement of Compensation
iii. All other help, if required.

(Action: Contractor / HR Department)

9. It is also to be ensured that the contractor has made arrangements for

accommodation, food, Transport and provide all other assistance etc. to legal heirs /
next of kin along with family members of the deceased who have come from their
native place to collect the amount of compensation HR Department may be
contacted for any help, if required.

(Action: Contractor / Site In – charge / HR Department)