GOVERNMENT OF PONDICHERRY Labour and Employment Department 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, Pondicherry -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 7. Average Number of Workers Employed during the year (including contract workers) : 8. Total Number of Working days during the year : 9. 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) : 10. Number of Fatal Accidents during the Year : 11. Number of non-fatal accidents reportable under Factories Act, 1948 causing disability or loss of time for 48 hours or more during the year : 12. Total Number of man-days lost due due to non-fatal accident 13. Number of dangerous occurrences as defined under the Pondicherry Factories Rules, 1964 (Give a brief description of each occurrence particularly covering cause, damage, loss and impact outside the factory) : FROM TO 14. Particulars of longest accident free period during the year (contest year) (a) Period (Furnish dates) : (b) Number of days in the period of (a) above : (c) Number of working days in the period (a) above : (d) Longest accident free period in man-hours including over time : 15. Safety promotional activities conducted during the year (Contest year) (Furnish Details) : 16. Particulars of the Postal Order Enclosed: Number Date Amount Station: Signature of the Station: Signature of the Manager Inspector of Date: Date: Factories
