Download The Factories & Boilers Organisation's Form-XVIII

Form 18 (see rule 96) RECORD OF EYE EXAMINATION Serial Number Department/ works Name of the worker Sex Age (on last birthday) Occupation Examination of eyesight Signature of ophthalmologist Remarks Nature Date of employment Date Result 1 2 3 4 5 6 7 8 9 10 11 Form 18A Prescribed under rule -99 FORMAT OF APPLICATION TO THE SITE APPRAISAL COMMITTEE 1. Name and address of the applicant 2. Site Ownership Data 2.1 Revenue details of site such as Server No. Plot No. etc 2.2 Whether the site is classified as forest and of so, whether approval of the Central Government under section 5 of the Indian Forests Act, 1927 has been taken. 2.3 whether the proposed site attracts the provisions of section 3(2) (v) of the E.P Act, 1986. If so , the nature of the restrictions. 2.4 Local authority under whose jurisdiction the site is located. 3. Site Plan 3.1 Site plane with clear identification of boundaries and total area proposed to be occupied and showing the following details nearby the proposed site. a) Historical monument, if any, in vicinity. b) Name of neighboring manufacturing units and human habitats educational and training institutions, petrol installations, storage of LPG and other hazardous substance in the vicinity and their distance from the proposed unit. c) Water sources (river streams, canals, dams, water filtration plants, etc.) in the vicinity. d) Nearest Hospitals, Fire-station, civil defence station and police stations and their distances. e) High tension electrical transmission lines, pipe line for water, oil, gas or sewerage; railway lines, Roads, stations, jetties and other similar installations. 3.2 Details of soil conditions and depth at which hard strata obtained. 3.3 Contour map of the area showing nearby hillocks and difference in levels. 3.4 Plot plan of the factory showing the entry and the exit points, roads within, water drains etc. 4. Project Report 4.1 A summery of the salient features of the project. 4.2 Status of the organization ( Govt., Semi-Govt, Public or Private etc.) 4.3 Maximum number of persons likely to be working on the factory. 4.4 Maximum amount of power and water requirements and source of their supply. 4.5 Block diagram of the buildings and installations for the proposed supply. 4.6 Details of housing colony, hospital, school and other structural facilities proposed. 5. Organisation structure of the proposed manufacturing unit/factory 5.1 Organisation diagrams of - Proposed enterprise in general. - Health, Safety and Environment protection departments and their linkage to operation and technical departments. 5.2 Proposed Health and Safety policy. 5.3 Area allocation for treatment of Wastes and Effluent. 5.4 Percentage outlay on safety, health and environment protection measures. 6. Meteorological data relating to the site. 6.1 Average, minimum and maximum of - Temperature - Humidity - Wind velocities, during the previous ten years. 6.2 Seasonal variations of wind direction 6.3 Highest water level reached during the floods in the area recorded so far. 6.4 Lightening and seismic data of the area. 7. Communication links 7.1 Availability of telephone/ telex/ wireless and other communication facilities for outside communication. 8. Manufacturing Process Information 8.1 Process flow diagram 8.2 Brief write-up on process and technology. 8.3 Critical process parameters such as pressure build-up, temperature rise and run-away reactions. 8.4 Other external effects critical to the process having safety implications, such as ingress of moisture or water. 8.5 Highlights of the build-in safety/ pollution control devices or measures/ incorporated in the manufacturing technology. 9. Information of Hazardous Materials 9.1 Raw materials, intermediates, products and by-products and their quantities. Enclose Material Safety Data Sheet (MSDS) in respect of each hazardous substance. 9.2 Main and intermediate storages proposed for raw materials/ intermediates/ products/ by-products (maximum quantities to be stored at any time). 9.3 Transportation methods to be used for materials inflow and outflow, their quantities and likely routes to be followed. 9.4 Safety measures proposed for: - handling of materials. - internal and external transportation; and - disposal (packing & forwarding of finished products) 10.Information on Dispersal/ Disposal of Wastes and pollutants 10.1 Major pollutants (gas, liquid, solid) their characteristics and quantities (average and at peak loads) 10.2 Quality and quantity of solid pollution problems anticipated and the proposed measures to control the same, including treatment and disposal of effluent. 11.Process Hazards Information 11.1 Enclose a copy of the report on environmental impact assessment. 11.2 Enclose a copy of the report on Risk Assessment study. 11.3 Published (open or classified) reports, if any, on accident situations/ occupational health hazards or similar plants elsewhere (within or outside the country). 12.Information of proposed Safety and Occupational Health Measures 12.1 Details of fire fighting facilities and minimum quantity of water, CO2 and or other fire fighting measures needed to meet the emergencies. 12.2 Details of in-house medical facilities proposed 13.Information on Emergency Preparedness 13.1 On site emergency plan 13.2 Proposed arrangements, if any, for mutual aid scheme with the group of neighboring factories. 14.Any other relevant information I certify that the information furnished above is correct to best of my knowledge and nothing of importance has been concealed while furnishing it. Name and signature of applicant